In a world grappling with complex social issues, solutions from the past often hold untapped potential. The Health Belief Model (HBM) from the 1950s, originally designed to combat infectious diseases, offers a framework for understanding and preventing violent behavior through its six key characteristics — perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy and cues to action.
Creative has a long history of using innovative methodologies, including from the public health sector, in violence prevention. Focusing on community hotspots, Creative helps citizens create community-level violence-prevention strategies, strengthen local governance and work with trusted local stakeholders to address the root causes of different forms of violence. Notre santé publique, approche locale de la prévention du crime et de la violence identifie un individu, interpersonnel, community and structural factors qui contribuent à la criminalité et à la violence, enabling integrated, long-term strategies.
How can a public health model from the 1950s help us now?
In the 1950s, social psychologists Hochbaum, Rosenstock and Kirscht developed the HBM to understand why people do (or don’t) take action to avoid illnesses. It was initially designed to study the spread of infectious diseases like tuberculosis and the flu and later used to track pandemics such as COVID-19.
Mais, the HBM has evolved beyond health applications. It’s been used in communication, advertising et behavioral science to drive targeted interventions and influence behavioral change. It can also help us understand and prevent violence in order to drive targeted interventions and influence behavioral change. It can also help us understand and prevent violence.
The Health Belief Model uses six characteristics to determine how and if an individual will act to adopt a specific health behavior. It says that behavior is influenced by how susceptible they believe they are to a condition, how severe it is, the benefits they might gain from taking action, and the barriers they’ll face. People’s self-assurance and other external factors also play a role.
These same six characteristics can be used to consider how people will respond to the risks of violence.
Applying the HBM to violence prevention
Let’s take a closer look at how these six aspects of the HBM can explain why individuals may be drawn to violent activities or struggle to leave them:
- Perceived Susceptibility: How do individuals perceive their vulnerability to engaging in violence or being recruited by violent groups? If individuals feel they are at a higher risk of being involved in or affected by violence, they are more likely to be receptive to support or interventions.
- Perceived Severity: How severe do individuals believe the consequences are for engaging in violence or being members of violent groups? Understanding whether people view violence as a severe issue can guide programming that highlights the serious consequences of violent activities.
- Perceived Benefits: What do people see as the benefits of avoiding violent activities or violent groups, such as gangs? Communicating the benefits of staying away from violence — such as improved safety, better community relations and personal well-being — can motivate individuals to change their behavior.
- Perceived Barriers: What obstacles may people have in avoiding violent behaviors or staying away from gangs? These barriers could range from social pressures to a lack of resources or support systems. Identifying and addressing them is crucial.
- Self-Efficacy: What skills or capacities do individuals possess that can help them resist violent activities or leave violent groups? Strengthening self-efficacy through skill-building and empowerment programs can enhance an individual’s ability to resist violence.
- Cues to Action: What prompts and motivations can be introduced to encourage individuals to resist violent actions or adopt non-violent behaviors? External factors could include community campaigns, support groups, or reminder messages highlighting the benefits of non-violence and offering practical steps for change.
Gaining better insights into target populations
The Health Belief Model provides a robust framework for understanding and addressing violence through data-driven interventions adapted to the target population. International organizations can develop tailored and evidence-based interventions to address the root causes of violence by analyzing perceptions, motivations and barriers within specific populations. The HBM can be used as a model to gain insights through analytical approaches tailored to specific populations and assessment methods.
The HBM is mainly applied in quantitative studies to identify general trends in a population group. Par exemple, un intersectional analysis conducted by Creative’s Sembrando Esperanza program underscores the need for a more nuanced approach to understanding vulnerability and risk. By examining the interplay of over 20 identity factors of at-risk Hondurans in relation to crime, violence and irregular migration, the analysis highlights the critical importance of moving beyond a gender-only focus to a comprehensive understanding of the factors that shape vulnerability.
Using the HBM to understand the differences in perceptions between those at risk of violence and those already engaged in it will allow for more targeted and effective interventions.
To build on the experience of reintegrating ex-combatants in Nigeria following the Boko Haram insurgency in northeast Nigeria between 2010 à 2019, the HBM could have been used to design interventions to shift the resistant perceptions of civilian communities affected by violent activities of non-state actors regarding the reintegration of ex-combatants into their neighborhoods.
Many community members believed that ex-combatants couldn’t change and be reintegrated, hampering restoration efforts; they feared that ex-combatants were prone to becoming violent again. Pour cette raison, most community members thought that ex-combatants should be sentenced to life imprisonment or death. Par conséquent, many ex-combatants had to be reintegrated into other communities against their wishes in 2019. Applying the HBM could have provided a clearer understanding of the community members’ perceptions of risk regarding the reintegration effort. This insight would have allowed international organizations assisting with the reintegration to better prepare communities before initiating the process.
Creative’s approach to violence prevention enables the design of integrated, des approches à long terme tirant parti des atouts locaux identifiés pour répondre aux causes profondes et aux facteurs déterminants. We continue to explore and test innovative crime-and-violence prevention methodologies in citizen- and human-security programming for USAID, y compris au Honduras, Syria and West Africa. With greater recognition of crossover public health approaches following COVID-19, the HBM stands out as a powerful tool in this endeavor.
Sini Yakubu Wule participated in Creative’s Talent Apprentice Program as a Learning & Analysis Intern with the Communities in Transition Division in Summer 2024. He is currently a PhD student at the University of Oklahoma. Précédemment, he worked with Creative Associates in the Nigeria country office as a Monitoring and Evaluation Officer for three and a half years on the USAID/OTI Nigeria Regional Transition Initiative Project. Subsequently, he joined the Center for Civilians in Conflict as their National Monitoring, Évaluation, and Learning Officer. He also served with the United Nations Migration Agency in 2016 as a Data Tracking and Monitoring Officer in the DTM project. Sini is a proud Mandela Washington Fellow (2017), financé par le Département d'État des États-Unis, and a Chevening Scholar (UK FCDO). He holds a Master’s degree in Developing and Evaluating Interventions from the University of Glasgow, Royaume-Uni, a Master’s degree in Public Health from Bingham University, Nigeria, and a Bachelor’s degree in Biology from Ahmadu Bello University, Zaria, Nigeria. He is passionate about adding value to people’s lives and helping them maximize their potential, which aligns with his interest in working with Creative.