Chronic obstructive pulmonary disease (COPD) remains a major public health problem. It is the fourth leading cause of chronic morbidity and mortality in the United States, and is projected to rank fifth in 2020 in burden of disease worldwide, according to a study published by the World Bank/World Health Organization. Yet, COPD remains relatively unknown or ignored by the public as well as public health and government officials. In 1998, in an effort to bring more attention to COPD, its management, and its prevention, a committed group of scientists encouraged the U.S. National Heart, Lung, and Blood Institute and the World Health Organization to form the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Among the important objectives of GOLD are to increase awareness of COPD and to help the millions of people who suffer from this disease and die prematurely of it or its complications. The first step in the GOLD program was to prepare a consensus report, Global Strategy for the Diagnosis, Management, and Prevention of COPD, published in 2001. The present, newly revised document follows the same format as the original consensus report, but has been updated to reflect the many publications on COPD that have appeared. GOLD national leaders, a network of international experts, have initiated investigations of the causes and prevalence of COPD in their countries, and developed innovative approaches for the dissemination and implementation of COPD management guidelines. We appreciate the enormous amount of work the GOLD national leaders have done on behalf of their patients with COPD. Despite the achievements in the 5 years since the GOLD report was originally published, considerable additional work is ahead of us if we are to control this major public health problem. The GOLD initiative will continue to bring COPD to the attention of governments, public health officials, health care workers, and the general public, but a concerted effort by all involved in health care will be necessary.

https://www.who.int/respiratory/copd/GOLD_WR_06.pdf

Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary.

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.

/pdf/the-health-belief-model-a-decade-later-2zyz7t7lxr.pdf

The Health Belief Model: A Decade Later:

Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary.

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.

/pdf/social-learning-theory-and-the-health-belief-model-2mj57y2742.pdf

Social Learning Theory and the Health Belief Model

Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma

Over the past two decades, hundreds of articles, editorials, and commentaries have been published describing the considerable disruptive effects on quality of care of individuals noncompliance with health and medical advice While much research has been directed at determining factors responsible for poor compliance, past studies have tended to focus upon easily measured characteristics of the patients, regimen, or illness which, unfortunately, are usually neither predictive nor alterable This paper systematically reviews the literature on patient acceptance of recommended health behaviors, attempting to find social-psychological and related variables which have proven to be consistent predictors of compliance The review suggests that certain health beliefs (especailly personal estimates of vulnerability to, and seriousness of, the disease, and faith in the efficacy of care), health-related motivations, perceptions of psychological and other costs of the recommended action, various aspects of the doctor-patient relationship, and social influence are the most productive dimensions for present intervention and further exploration Building upon an earlier formulation, an hypothesized model is presented which combines these elements for explaining and predicting compliance behavior Further research should, with standardized questionnaires and analysis techniques, employ prospective, experimental designs for a variety of population groups, settings, and regimens, to evaluate the ability of practical attempts to modify the model variables and thus enhance compliance

https://www.jstor.org/stable/pdfplus/3763271.pdf

Sociobehavioral determinants of compliance with health and medical care recommendations.

In the context of a prospective experimental design, a psychosocial approach to understanding individual health-related actions (the Health Belief Model) was evaluated in terms of its ability to predict and explain mothers' adherence to a diet prescribed for their obese children. The study also tested the efficacy of two levels of fear-arousing communications in enhancing compliance with the regimen. After physician diagnosis and nutritionist counseling, an interview was conducted with each mother. Data were gathered on sociodemographic characteristics, and on attitudinal dimensions (general and obesity-specific) of the Model: health motivation; illness threat; potential diet benefits and success; barriers to compliance; and control over health matters. Subjects were then randomly assigned to three intervention groups: high fear, low fear, and control. Dependent variables included changes in child's weight over a two-month period and mother's previous appointment-keeping behaviors. Significant correlations were obtained between each major dimension of the Model and the outcome measures, and findings from multiple regression analyses support the usefulness of the Model as a whole. Further, ANOVA's revealed significant independent effects of the emotion-arousing messages on weight loss, and other tests found the influence of the intervention to be generally independent of belief affects.

The Health Belief Model and prediction of dietary compliance: a field experiment.

The Health Belief Model relates psychological theories of decision making (which attempt to explain action in a choice situation) to an individual’s decision about alternative health behaviors. Rosenstock 1 has attributed the origins of that tradition of behavior motivation theory underlying the Health Belief Model to Lewinian 2 theory of goal setting in the level-of-aspiration situation (a special case of the latter’s general field theory). Lewin and associates hypothesized that behavior depends mainly upon two variables: (1) the value placed by an individual on a particular outcome and (2) the individual’s estimate of the likelihood that a given action will result in that outcome.

The Health Belief Model: Origins and Correlates in Psychological Theory*

RELATIVELY LOW LEVELS of public participation in screening, immunization, and other preventive health programs have been extensively documented,21 50 55, 91 as have the generally poor rates of individual compliance with prescribed medical therapies.42, 52, 81, 86 Over the past two decades, hundreds of research reports and review articles have been published reflecting the desire to both discover and better under-

Selected psychosocial models and correlates of individual health-related behaviors.

Patient noncompliance is a substantial obstacle to the achievement of therapeutic goals. This paper reviews a number of practical interventions with demonstrated efficacy in enhancing patient adherence, including (1) improving patients' levels of information concerning the specifics of their regimens, reinforcing essential points with review, discussion, and written instruction, and emphasizing the importance of the therapeutic plan, (2) taking clinically appropriate steps to reduce the cost, complexity, duration, and amount of behavioral change required by the regimen and increasing the regimen's convenience through “tailoring” and other approaches, (3) obtaining a compliance-oriented history of the patient's prior experiences and present health beliefs and, where necessary, employing strategies to modify those perceptions likely to inhibit compliance, (4) improving levels of patient satisfaction, particularly with the provider-patient relationship, (5) arranging for the continued monitoring of the patient's subsequent compliance to treatment, (6) increasing staff awareness of the magnitude and determinants of the noncompliance phenomenon and attempting to develop an “active influence orientation” in each member of the health care team, (7) using such techniques as patient-provider contracts to involve the patient in therapeutic decisions and in the setting of treatment objectives and creating incentives (through rewards and reinforcements) for achieving these objectives, (8) arranging for as much continuity of provider (and other staff) as possible, (9) establishing methods of supervising the patient, including involvement of the patient's social support network, and (10) involving fully the assistance of all available health care providers, assigning specific roles and responsibilities for activities directed at improving adherence to treatment.

Lois A. Maiman

Papers

Sociobehavioral determinants of compliance with health and medical care recommendations.

The Health Belief Model and prediction of dietary compliance: a field experiment.

The Health Belief Model: Origins and Correlates in Psychological Theory*

Selected psychosocial models and correlates of individual health-related behaviors.

Strategies for enhancing patient compliance