HW315 Unit 3 Behavior Analysis Example

Mammograms on Time, Colonoscopy Never: A Unit 3 Behavior Analysis Testing the Health Belief Model on One Bookkeeper

[Student Name]

Purdue University Global

HW315: Models for Health and Wellness

Unit 3 Behavior Analysis

[Instructor Name]

[Date]

The bookkeeper, her history and her words are composite; the model's sources, the screening recommendation and the barriers study cited are real.

The Case

Marguerite, a composite 56-year-old bookkeeper for a family-owned lumber yard, lives alone in a small town. She has had a mammogram every year since she turned forty-five, scheduled by phone the week the reminder card arrives. Colorectal cancer screening has been recommended for adults starting at age forty-five (US Preventive Services Task Force et al., 2021), and her clinic has sent three letters suggesting a colonoscopy. She has filed each one unopened in a kitchen drawer.

In a conversation with the clinic's wellness coordinator, she explained: "I don't have any problems down there. Nobody in my family had it. And the whole thing, the drinking the stuff, taking a day off, finding somebody to drive me home, it's just a lot. With the mammogram you're in and out in twenty minutes and you drive yourself."

Perceived Susceptibility

Under the Health Belief Model, a sense of personal risk is one of the first conditions for acting (Rosenstock, 1974). Marguerite's perceived susceptibility to colorectal cancer is low. She cites no family history and no symptoms, and she describes the test as being "for people who have problems." This belief misreads the purpose of screening, which is to find disease before symptoms appear, but it is an accurate report of how she thinks.

Her susceptibility to breast cancer is not much higher on paper; she has no family history there either. Yet she screens every year.

Perceived Severity

Severity is acknowledged without hesitation. She calls colon cancer "one of the bad ones" and remembers a customer at the lumber yard who died of it. On severity, the model predicts action, and none follows.

Perceived Benefits

Benefits are accepted in principle. She agrees that finding cancer early is better and has no doubts that the test works. Benefits do not distinguish her two screening decisions.

Perceived Barriers

Barriers carry the weight of the analysis, and she named them in her own words. The preparation, drinking a large volume of laxative solution the night before, is unpleasant to imagine. The test costs a lost workday at a small business where she is the only bookkeeper. Most important, the clinic requires that someone drive her home after sedation. For a woman who lives alone, whose sister lives two hours away and who does not like asking neighbors for favors, this is not a small request. A mixed-methods study of patients who had not been screened reported fear and the bowel cleansing as the two barriers mentioned most, with time, logistics and embarrassment close behind (Jones et al., 2010).

The mammogram carries none of these barriers. It requires no preparation, takes twenty minutes and lets her drive herself.

Cues to Action

Cues have misfired. The letters arrive, but she files them unopened, because opening one would mean deciding. A stronger cue nearly worked: when a coworker's husband was diagnosed with colon cancer last spring, Marguerite looked up the clinic's number and kept it on a sticky note for two weeks before throwing it away. The cue moved her toward action; the barrier of the ride home stopped her.

Self-Efficacy

Later versions of the model add self-efficacy (Janz & Becker, 1984). Marguerite is confident she could get through the preparation. What she doubts is her ability to arrange the ride, which is less a matter of confidence than of her social situation.

The Comparison as a Test

The mammogram comparison is the strongest test of the model available in this case. Marguerite's beliefs about the two cancers are similar: low susceptibility, high severity, accepted benefits. The cues are similar: yearly reminders. Only barriers differ, and they differ sharply. The model predicts that she will act where barriers are low and delay where they are high, which is exactly what she does.

On the difference between her two screening decisions, the Health Belief Model does more than describe: it predicts the split from a single construct that varies while the others stay constant, which is as close to explanation as a belief model gets.

Why the Mammogram Is the Right Comparison

A comparison is only useful if the two behaviors are alike in most respects. Both are cancer screening tests recommended for a woman of Marguerite's age, both are offered by the same clinic, and both are prompted by mailed reminders. Both concern cancers she considers serious and has no family history of. What differs is what each test demands of her on the day itself. That is why the mammogram works as a natural control within her own life: it holds her beliefs constant and varies only the burden of the test.

What the Model Misses

The model still misses two things. First, the barrier that matters most, needing someone to drive her home, is less a belief than a fact about her life. The model treats barriers as perceptions, but Marguerite perceives this one accurately. Second, the unopened letters suggest something the model does not name: avoidance. She does not weigh the letter and decide; she declines to open it, which looks more like managing dread than calculating barriers. Jones et al. (2010) found fear among the leading barriers to screening, and the model's constructs do not easily capture fear of the decision itself.

Implications

The analysis points to the barrier, not to her beliefs. Education about susceptibility would add little, since she would act on low susceptibility for the mammogram. Practical options that remove the ride problem would matter more. She could ask her clinician about stool-based screening tests, which require no preparation, sedation or driver, and which the screening recommendation includes among acceptable options (US Preventive Services Task Force et al., 2021). The choice of test is a clinical conversation for her and her clinician; the wellness coordinator's role is to make sure she knows the conversation is possible.

Conclusion

For Marguerite, the Health Belief Model explains why she screens for one cancer and not the other, because barriers alone differ between the two. It is weaker on why her strongest barrier exists and on the avoidance behind the unopened letters. The analysis shows the model at its best, explaining a comparison, and at its limit, treating a social fact and a fear as beliefs.

References

Janz, N. K., & Becker, M. H. (1984). The health belief model: A decade later. Health Education Quarterly, 11(1), 1-47. https://doi.org/10.1177/109019818401100101

Jones, R. M., Devers, K. J., Kuzel, A. J., & Woolf, S. H. (2010). Patient-reported barriers to colorectal cancer screening: A mixed-methods analysis. American Journal of Preventive Medicine, 38(5), 508-516. https://doi.org/10.1016/j.amepre.2010.01.021

Rosenstock, I. M. (1974). Historical origins of the health belief model. Health Education Monographs, 2(4), 328-335. https://doi.org/10.1177/109019817400200403

US Preventive Services Task Force, Davidson, K. W., Barry, M. J., Mangione, C. M., Cabana, M., Caughey, A. B., Davis, E. M., Donahue, K. E., Doubeni, C. A., Krist, A. H., Kubik, M., Li, L., Ogedegbe, G., Owens, D. K., Pbert, L., Silverstein, M., Stevermer, J., Tseng, C.-W., & Wong, J. B. (2021). Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA, 325(19), 1965-1977. https://doi.org/10.1001/jama.2021.6238