Application of Health Belief Model in Nursing

1.   Introduction

• HBM is a psychological model that attempts to explain and predict health behaviors.
• HBM was first developed by social psychologists Hochbaum, Rosenstock and Kegels working in the U.S. Public Health Services inspired by a study of why people sought X-ray examinations for tuberculosis.
• The model was developed in response to the failure of a free tuberculosis (TB) health screening program.
• The study of social sciences helps to improve the care of the patient by increasing the nurse’s understanding of human behaviour and to stimulate intellectual and emotional growth and self knowledge.
• Mr.SM for my clinical assignment is a 60 year old, married, Hindu, male patient educated up to PDC suffering from diabetes for the last 10 years and frequent leg ulcers for the last one year.

2.   Diabetes mellitus

Diabetes mellitus is a disease characterized by a chronically elevated blood glucose concentration, often accompanied by other clinical and biochemical abnormalities. The hyperglycaemia of diabetes results from an inadequate action of insulin, caused by low or absent insulin secretion, the presence of antagonists to the peripheral action of insulin or a combination of these factors.

The effects of the disease may be acute or chronic, involving many organs, including the eye, the kidney, peripheral nerves and large arteries. Primary diabetes mellitus is traditionally divided into either insulin dependent (IDDM or Type 1) or noninsulin dependent (NIDDM or Type 2). The classification is important because of the different genetic backgrounds, clinical presentations, metabolic effects, treatment and consequences of the two types. Diabetes may also be secondary to other disorders

3.   General information

Name                       : Mr. SM
Age                         : 60 years
Gender                     : Male
Marital status            : Married
Place                       : -------
IP.  No.                    : --------
Hosp. No.                 : --------
Date of admission       : -------
Ward/Unit                 : ----------------- 
Diagnosis                  : Diabetes mellitus type II, diabetic foot ulcer-rt
Occupation               : Farmer for 15 years,
Retired from military service, worked in ----

Culture                          

Religion                     : Hindu
Caste                       : Thiyya

Developmental history

• Normal birth at home
  
• No birth related or neonatal complications
  
• Norma childhood
  
• Started schooling at the age of 5 years
  
• Immunized for major infectious diseases
  
• He was a football player till the age of 32
  
• He was recruited to military in Southern Command as a football player, played for military for 6 years, left military and joined in ----- as a staff.

Scholastic History

• He had normal schooling till PDC

Socioeconomic Status

• He has 7-8 acres of farm land

4.   Patient’s Knowledge of Present illness

• Patient explains his illness: “I have diabetes for the last 10 years”. “I have developed this ulcer a few weeks back.” “It was not getting healed from the local hospital, so, I have come here”

5. What the patient wants to know about the illness?

• “I know, Diabetes is incurable” But, why I’m getting ulcers frequently”
  “I want to get discharged soon; will I be discharged next week?”
  (Patient had a foot ulcer in another leg 6 months back and was treated in ----.” Now ulcer has developed in the right leg.

6. What has been his past experience with illness?Past Illness History

• History of Koch’s disease 10 years back, took medicine for 6 months
  Patient had a gun shot injury about 20 years back on the left forearm
  He is diabetic for the last 10 years.

Family History

• History of diabetes mellitus in brothers and sisters
  
• No major illness in his knowledge
  
• Father and mother died 30 years ago, he does not know whether they had any major illness.

Whether patient has accepted his illness?

• “I’m not the person to develop this kind of an illness”
  
• “My food habits and exercise should have kept me free of this illness”
  
• “I used to take one or two pegs of brandy per day and some times more than that”
  
• “I have got it from my family”

Inference: Patient has accepted the illness as a suffering which he has developed due to inheritance, but his food habits points to the life style has contributed to the illness significantly.  He used to get double food in military because he was a football player in the MRC. He used to take 6 eggs per day till the age of 40 and reduced to 1 egg per day.

7.  Patient’s beliefs about the illness

• Patient is a firm believer of god, but does not believe in individuals as god.
  He does not have any wrong belief that his illness is due any black magic or some possession.

8.  Does the patient have social support network?

• Patient has a good circle of friends and family
  
• His bystander in the hospital is a friend
  
• He believes in politics and is a party member

9.  Has the patient’s accepted his present condition?

• Patient has accepted his present condition.

10. How does he cope with problems? As explained by patient?

• He accepts his condition as a diabetic patient and understands the need for adherence to medication and life style modification. As he has adequate servants at home, he has not much trouble in carrying out his role. He watches TV and reads newspaper, which gives his some diversion from the problems.

11. Anxiety related to effects of illness, recovery, cost of treatment, and future state

He is worried about the foot ulcer which is not heaing. His blood sugar fluctuates between normal and high value. He plans to follow all the instructions well that ulcer will not develop in future. He says he can bear the expense of treatment here, that he has 7-8 acres of agriculture land.  That is enough to look after his expense for treatment.

12. Does he express concern about his present condition?

Yes, he is worried whether the ulcer will get healed. When he developed ulcer in his left leg 6 months back, his two toes were amputated in a local hospital. He was advised a below knee amputation, but he decided to get discharged from there and came to -----. So he could save his leg.

13. How the patient has adapted to illness?

• He is well adapted to the illness. He looks after his property well.

14. Which cultural differences can interfere with the patient’s treatment?

• Patient is from ---district of ----.
  He expects details of his blood sugar level regularly, but the nursing staff was not giving attention to his concerns.
  

REFERENCES

1. Rosenstock IM (1966), "Why people use health services", Milbank Memorial Fund Quarterly 44 (3): 94–12
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5. Potter PA, Perry AG. Fundamentals of nursing. 6th ed. St.Louis: Elsevier Mosby; 2006.
6. Rosenstoch I. Historical origin of Health Belief model. Health Educ Monogr 2:334, 1974.