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LAY BELIEFS ABOUT HEALTH AND ILLNESS: THE TRADITIONAL PERSPECTIVE - THE PREDICTIVE POWER OF THE HEALTH BELIEF MODEL
Similarly, in studies examining the predictive power of the health belief model, the evidence suggests only a modest relationship between the belief dimension and behaviour (Langlie, 1977). Calnan and Rutter (1986), examined the predictive power of the health belief model for explaining changes in the practice of breast self-examination. Three groups of women were investigated - 278 who accepted an invitation to attend self-examination classes and were taught the techniques in detail, 262 who declined the invitation and 594 controls to whom no classes were offered. Beliefs and self-reported behaviour were measured shortly before the classes took place and again a year later. The results suggested that beliefs do predict behaviour, for both perceived susceptibility and perceived benefits/barriers made significant contributions to the belief behaviour equations and the relationships were generally highly statistically significant.
To that extent the model was supported. However, the evidence also suggested that the relationship between the behaviour and the dimensions of health which the model stresses was not a strong or a simple one. Two pieces °f evidence in particular deserve attention. First, only a small proportion of the variance was explained in the analyses, which is also a common finding in studies using the health belief model, the figure was never higher than 25% and was generally much lower. It was also noticeable that the greatest amount of variance was explained in the control group, where the smallest amount of behaviour change was found. The second piece of evidence was that a supplepredictor of subsequent behaviour than were beliefs. When prior behaviour was introduced into the analysis, the proportion of variance explained was increased markedly — as much as 48% in one case. In summary, this empirical evidence suggests that the health belief dimensions identified in the health belief model and the health locus of control have limited explanatory value.
It is important that physiotherapists gain insight into patients' beliefs about health and illness as this may affect their behaviour. For example, a patient who believes he has control over his illness may be more inclined to work hard to recover than one who believes in the curative powers of the physiotherapist. Eachus (1990) states: 'Patients who do not believe that they are, at least in part, responsible for and can influence, their own health, are likely to prove particularly frustrating. This will be particularly true for those conditions which require the active participation of the patient during the course of treatment'.
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