Why Take Medicine When You Feel Well? The Health Belief Model as a Framework for a Latent Tuberculosis Treatment Completion Project
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Master of Science in Nursing Program, Aspen University
N599: Nursing Capstone
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Why Take Medicine When You Feel Well? The Health Belief Model as a Framework for a Latent Tuberculosis Treatment Completion Project
Latent tuberculosis infection presents an unusual behavioral problem. Patients have no symptoms and cannot transmit infection, yet they are asked to take medication for weeks or months to prevent a disease they may never develop. At the county clinic where this capstone takes place, 42% of patients who started treatment did not finish. A framework for the project must therefore explain why people who feel well take, or stop taking, preventive medicine, and it must guide which parts of the intervention will address those reasons. This paper describes the Health Belief Model, reviews evidence on its constructs, applies it to the clinic's patients and maps each element of the project's intervention to the model.
The Health Belief Model
This model was developed by social psychologists in the U.S. Public Health Service in the 1950s to understand why so few people took up free tuberculosis chest screening, which makes it historically apt for this project (Rosenstock, 1974). According to the model, a person is more likely to act to protect health when convinced of being susceptible to a condition, believe the condition would have serious consequences, believe the action would reduce the threat, and judge that what the action offers is worth its price in money, time, side effects and inconvenience. Cues to action, such as a reminder or a conversation with a nurse, can trigger behavior when these beliefs are present. Rosenstock et al. (1988) later added self-efficacy, the person's confidence in being able to carry out the action, recognizing that people may believe in an action but doubt they can sustain it.
What the Evidence Says About the Constructs
Not all constructs predict behavior equally. In a meta-analysis of 18 longitudinal studies involving 2,702 participants, Carpenter (2010) found that perceived benefits and perceived barriers predicted behavior most consistently, whereas perceived susceptibility and perceived severity carried less weight. The analysis also found that predictive power varied with the type of behavior, including whether it involved a drug-taking regimen, and with the time between measuring beliefs and observing behavior. Carpenter recommended against using the simple version of the model in which each belief acts directly and independently.
This finding shapes how the project uses the model. Emphasizing the dangers of tuberculosis alone, a common approach in patient teaching, targets the weaker constructs. The evidence suggests that the intervention should concentrate on making the benefits of treatment concrete and, above all, on reducing barriers, while building patients' confidence that they can finish.
Applying the Model to the Clinic's Patients
Chart review and interviews at the clinic suggest how each construct operates. Perceived susceptibility is often low: many patients were told they have infection but not disease, and hear this as reassurance. Perceived severity varies; patients from countries with high tuberculosis rates may know people who died of it, while others do not. Perceived benefits are abstract, since the benefit of treatment is an illness that does not happen. Perceived barriers are the dominant factor: four months of daily pills, side effects such as orange discoloration of body fluids, and monthly clinic visits during working hours. Self-efficacy declines after the first missed visit, when patients assume they have fallen too far behind to continue. Cues to action consist mainly of phone calls from one outreach worker, often unanswered.
Mapping the Intervention to the Model
Each element of the project's intervention is designed to act on one or more constructs. The weekly regimen reduces barriers by replacing roughly 120 daily doses with 12 weekly doses and shortening treatment to three months. Video-observed dosing reduces the barrier of travel, since patients record each dose on a smartphone at a time that suits their work schedule rather than attending the clinic. The nurse's weekly review of each video, with a brief reply message, provides a regular cue to action and a relationship that supports self-efficacy. Teaching at the first visit, delivered through an interpreter with a simple visual showing the lifetime risk of progression and how treatment lowers it, makes the benefit concrete. And a plan for what happens after a missed dose, a same-day message and the option to take it the next day within the allowed window, protects self-efficacy by showing that one miss does not end treatment.
The model also guides evaluation. Beyond completion, the project will ask patients at the end of treatment, through a short interpreted survey, which parts helped most and what nearly made them stop, allowing the team to see whether barriers and self-efficacy changed as the model predicts.
Limitations of the Framework
The Health Belief Model focuses on individual beliefs and gives little attention to social and structural factors, such as work schedules controlled by employers, housing instability and immigration concerns, that shape whether patients can act on their beliefs. It also assumes a degree of deliberate decision-making that may not describe how people fit medication into busy lives. The project partly addresses this by designing the intervention around structural barriers, such as travel and clinic hours, rather than beliefs alone, and by recording structural reasons for missed doses.
Other frameworks were considered. The transtheoretical model describes stages of readiness to change, but patients at the clinic have already decided to start treatment, and the problem lies in sustaining a behavior rather than adopting it. The theory of planned behavior adds social norms, which may matter in families where relatives are also treated, but its focus on intention fits less well with dropout caused by practical obstacles. The Health Belief Model was chosen because its constructs, particularly perceived barriers and self-efficacy, correspond closely to the reasons for dropout identified at the clinic, and because its history in tuberculosis screening gives it a natural fit with the project.
Conclusion
The Health Belief Model, first developed to understand why people did not seek tuberculosis screening, offers a useful framework for why patients with latent infection do not complete treatment. Evidence that benefits and barriers predict behavior more strongly than perceived threat directs the project toward lowering barriers, making benefits concrete and supporting self-efficacy, which is exactly what a weekly regimen with nurse-led video observation is designed to do. The framework's limits, particularly its focus on individual beliefs, are acknowledged and partly addressed in the design. The next section describes the project's methods.
References
Carpenter, C. J. (2010). A meta-analysis of the effectiveness of health belief model variables in predicting behavior. Health Communication, 25(8), 661-669. https://doi.org/10.1080/10410236.2010.521906
Rosenstock, I. M. (1974). Historical origins of the health belief model. Health Education Monographs, 2(4), 328-335. https://doi.org/10.1177/109019817400200403
Rosenstock, I. M., Strecher, V. J., & Becker, M. H. (1988). Social learning theory and the health belief model. Health Education Quarterly, 15(2), 175-183. https://doi.org/10.1177/109019818801500203
How this N 599 Module 3 example is structured
Aspen does not publish N599 module prompts, so check your classroom and capstone guide for the exact instructions. This example states the behavioral puzzle, explains the model and its extension to self-efficacy, reviews evidence on which constructs matter, applies the constructs to the clinic's patients, maps each intervention element to the model, and names the framework's limits.
N599 Module 3 questions, answered
What does N599 Module 3 usually ask for?
Aspen's capstone description emphasizes applying theories and principles from the program, so a section explaining the theoretical or conceptual framework that guides the project is a typical requirement. Check your capstone guide.
Why use the Health Belief Model for medication adherence?
Because it explains preventive health behavior in terms of perceived benefits, barriers, threat, cues to action and self-efficacy, and the evidence shows benefits and barriers are especially predictive, which points to practical design choices.
Should a capstone framework be used beyond the introduction?
Yes. A strong framework shapes the intervention's components and the evaluation, not only the background section, and its limits should be acknowledged.
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