95743 Chap.6 The Health Belief Model and PEN-3
The Health Belief Model and PEN-3
Why model at all
Models help a health promoter frame a problem and decide where to spend effort, but they can oversimplify, omit a crucial variable or be pitched at the wrong scale.
The lecture introduces two models that sit at opposite ends of that trade-off.
The Health Belief Model
Developed in the 1950s to explain why people stayed away from free tuberculosis screening, the model predicts action from six beliefs, about susceptibility, severity, benefits, barriers, cues and self-efficacy.
Its blind spots are largely cultural: habits, social reasons, environment and unequal access to information.
The PEN-3 cultural model
Created in 1995 in response to failing programs in African contexts, PEN-3 places culture first through three dimensions: the impact of a behaviour, the influences on it and the level at which to intervene.
Its own limits are subjectivity, the risk of Orientalism and weak transferability.
What this chapter covers
- 01
Benefits and risks of modelling
- 02
Origin of the Health Belief Model
- 03
The six HBM constructs
- 04
Six limits of the HBM
- 05
The three PEN-3 dimensions
- 06
Positive, existential and negative behaviours
- 07
Limits of PEN-3
Worked example · free
Diagnose a failed free program with the six Health Belief Model constructs
- 1Comment (a) is low perceived severity; describe the consequences of flu for older people in the community's languages.
- 1Comment (b) is low perceived susceptibility; personalise the risk by showing that age itself raises it.
- 1Comment (c) is a missing cue to action; send reminders through community groups and local radio.
- 1Comment (d) is low self-efficacy combined with a practical barrier; offer walk-in sessions and help with booking.
Key terms
- Perceived Susceptibility
- A person's belief about how likely they are to develop a condition.
- Perceived Barriers
- The practical and psychological costs a person expects from taking a recommended health action.
- Self-Efficacy
- A person's confidence in their own ability to carry out a recommended action.
- Existential Behaviour
- In PEN-3, a cultural practice with no harmful health effect that a program should leave alone.
The Health Belief Model and PEN-3 FAQ
What are the limitations of the Health Belief Model?
The lecture lists six: it ignores attitudes and other individual determinants that make up culture, it misses habitual behaviour such as smoking, it overlooks actions taken for social rather than health reasons, it leaves out environmental and economic constraints, it assumes equal access to information, and it assumes health is the main goal.
What does PEN-3 stand for?
Each of its three dimensions has three categories that begin with P, E and N. Impact can be positive, existential or negative; influences are perceptions, enablers and nurturers; and the focus of intervention is the person, the extended family or the neighbourhood.
When should I use PEN-3 rather than the HBM in my essay?
Use the Health Belief Model when you are explaining an individual's decision to act, and PEN-3 when the campaign's success depends on family, community or cultural practice. Many strong essays use both, noting where the individual model falls short and the cultural model fills the gap.
What is the risk of Orientalism in PEN-3?
Reducing a culture to a few categories from outside can impose the designer's Western assumptions on another culture. The lecture lists this alongside subjectivity and weak transferability as the model's limits.
Why does the lecture still recommend the Health Belief Model despite its limits?
Because it is a useful first tool for thinking about which beliefs and cultural factors a program can address. Its six constructs give a quick diagnostic for why people do not act, and its gaps show exactly where a cultural model such as PEN-3 is needed.
Assessment move
Learn the six HBM constructs in order and attach a one-line question to each. Draw the PEN-3 grid from memory until all nine categories come easily, and practise sorting a behaviour into positive, existential or negative. For the essay, choose one model per campaign or use both to compare, and always name one limitation of the model you rely on.
Practise one quick drill: take any health advert you see this week and name which construct it targets.
