Since the last comprehensive review in 1974, the Health Belief Model (HBM) has continued to be the focus of considerable theoretical and research attention. This article presents a critical review of 29 HBM-related investigations published during the period of 1974-1984, tabulates the findings from 17 studies conducted prior to 1974, and provides a summary of the total 46 HBM studies (18 prospective, 28 retrospective). Twenty-four studies examined preventive-health behaviors (PHB), 19 explored sick-role behaviors (SRB), and three addressed clinic utilization. A "significance ratio" was constructed which divides the number of positive, statistically-significant findings for an HBM dimension by the total number of studies reporting significance levels for that dimension. Summary results provide substantial empirical support for the HBM, with findings from prospective studies at least as favorable as those obtained from retrospective research. "Perceived barriers" proved to be the most powerful of the HBM dimensions across the various study designs and behaviors. While both were important overall, "perceived susceptibility" was a stronger contributor to understanding PHB than SRB, while the reverse was true for "perceived benefits." "Perceived severity" produced the lowest overall significance ratios; however, while only weakly associated with PHB, this dimension was strongly related to SRB. On the basis of the evidence compiled, it is recommended that consideration of HBM dimensions be a part of health education programming. Suggestions are offered for further research.

The Health Belief Model, social learning theory (recently relabelled social cognitive theory), self-efficacy, and locus of control have all been applied with varying success to problems of explaining, predicting, and influencing behavior. Yet, there is conceptual confusion among researchers and practitioners about the interrelationships of these theories and variables. This article attempts to show how these explanatory factors may be related, and in so doing, posits a revised explanatory model which incorporates self-efficacy into the Health Belief Model. Specifically, self-efficacy is proposed as a separate independent variable along with the traditional health belief variables of perceived susceptibility, severity, benefits, and barriers. Incentive to behave (health motivation) is also a component of the model. Locus of control is not included explicitly because it is believed to be incorporated within other elements of the model. It is predicted that the new formulation will more fully account for health-related behavior than did earlier formulations, and will suggest more effective behavioral interventions than have hitherto been available to health educators.

Most research directed a t understanding "activity undertaken by those who consider themselves ill, for the purpose of getting well" has yielded an unsystematic multiplicity of findings which are often either not predictive of such patient compliance,'" or are mutually contradictory.7.8 These difficulties arise, in part, from past dependence on a "medical" model of patient behavior, which stresses such easily identified and quantified dimensions as characteristics of the patient (e.g., demographic and social),6~B~lO the regimen (e.g., type, complexity, discomfort, duration),ll-l3 and the illness (e.g., medically-defined seriousness, duration, disability).7,14J5 Limitations of the Medical ModelSeveral major deficiencies of this approach can be identified. First, such ascribed, organic, and environmental characteristics are relatively enduring and unalterable. Thus, even if it were possible to demonstrate a consistent relationship between one or more of these factors and lack of patient cooperation, little could be done to improve the situation. Second, because background, physiological, and structural concepts are not necessarily related to motivations, findings in this area are not able to account for the large numbers of persons who, despite the presence of many "adverse" characteristics associated with a high probability of defaulting, still follow the recommended therapy. Third, and perhaps most important, are those difficulties related to the level of explanation afforded by reliance on a "shotgun" method of selecting items for study, rather than developing a unified conceptual approach to, or hypothesis about, sick role behavior. Advantages of the Health Belief ModelAs preceding papers in this monograph have noted, various elements of the Health Belief Model are often associated with individuals' 'This paper was presented at the WorkshopBymposium on Compliance with Therapeutic Regimens, McMaster University,

The concept of self-efficacy is receiving increasing recognition as a predictor of health behavior change and maintenance. The purpose of this article is to facilitate a clearer understanding of both the concept and its relevance for health education research and practice. Self-efficacy is first defined and distinguished from other related concepts. Next, studies of the self-efficacy concept as it relates to health practices are examined. This review focuses on cigarette smoking, weight control, contraception, alcohol abuse and exercise behaviors. The studies reviewed suggest strong relationships between self-efficacy and health behavior change and maintenance. Experimental manipulations of self-efficacy suggest that efficacy can be enhanced and that this enhancement is related to subsequent health behavior change. The findings from these studies also suggest methods for modifying health practices. These methods diverge from many of the current, traditional methods for changing health practices. Recommendations for incorporating the enhancement of self-efficacy into health behavior change programs are made in light of the reviewed findings.

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This article summarizes the literature describing the at-home management of and psychosocial coping with five chronic diseases (heart disease, asthma, chronic obstructive pulmonary disease, arthritis, and diabetes) by the general population of adults. It also reviews the literature describing self-management of these chronic diseases by older adults. Conclusions drawn subsequent to the review are (a) that there are strong commonalities in the essential nature of tasks that exist across disease entities, (b) that the context for self-management of disease by the ill elderly is likely to differ somewhat from the context for other age groups. Questions for future research are posed.

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