Analytical Evaluation of the Health Belief Model and the Vulnerable Populations Conceptual Model Applied to a Medically Underserved, Rural Population

Abstract

This paper describes the application of the health belief model (HBM) and the vulnerable populations conceptual model (VPCM) to a rural, underserved community. The focus population is affected by a lack of community resources, increased risk factors and poor health outcomes. The health belief model focuses on the individual’s perceptions and likelihood of taking action. Resource availability, relative risk and health status are the focus of the VPCM. Both frameworks are systematically evaluated by established criterion. The VPCM is considered a better fit to explore the hypothesis that there is a relationship among access to healthcare, use of health promotion services and disease states in susceptible populations. Federally qualified health centers (FQHC) are community-based entities that provide a variety of health services regardless of a person’s ability to pay. The West Cecil Health Center (WCHC) began operating as a Federally Qualified Health Center in January 2008, in Conowingo, Maryland to serve communities in Northeastern Harford County and Northwestern Cecil County. The WCHC service area is located in a shortage area designated as a medically underserved area and a health profession shortage area. Approximately 80% of the population resides in rural areas as defined by the U.S. Census Bureau. Access to primary medical care is limited for the population under consideration. With the exception of the staff at the WCHC, the majority of available doctors within the service area do not accept new Medicaid patients, have no sliding fee scale, offer no discount, and do not handle obstetrics, gynecology, or pediatrics, causing the residents to travel 20 miles or more to the nearest hospitals in Elkton or Havre de Grace and require 36 minutes of travel time (Rajkowski, 2010). The people of Conowingo meet the criteria for vulnerable populations, defined as a social ensemble with an increased risk or disposition to unfavorable health outcomes (Flaskerud & Winslow, 1998). The health disparity between residents of Conowingo, MD and the general population is demonstrated by the fact that there are 3,103 people for every one physician in the service area. The providers at West Cecil Health Center are included in this number. There is a shortage of primary health care providers as well as shortages of mental and dental health providers in the service area. There were 5,877 individuals living below 200% of poverty in 2000 (19.43% of total) and the obesity rate among adults in Cecil County is extremely high at 30% compared to the Maryland rate of 26.3%. County Health Rankings place Cecil County 20th among 24 counties in Maryland for health behaviors and 23 rd for physical environment which includes air-pollution, access to healthy foods and liquor store density (Rajkowski, 2010). The vulnerability of the population served by West Cecil Health Center in Conowingo makes it vital for persons to maintain routine appointments to receive the care they need to achieve optimal health. The purpose of this paper is to explore the problems of access to care, use of health promotion services and health outcomes in rural, underserved populations as the context to compare and contrast the health belief model (Becker, 1977) and the vulnerable populations conceptual model (Flaskerud & Winslow, 1998). The essence of the health belief model (HBM) is that individual beliefs affect the actions a person takes relating to their health. The HBM was developed over fifty years ago by social psychologist trying to understand lack of participation by individuals in a free tuberculosis screening program. Currently, the HBM is the most frequently used theory in health education, health promotion and disease prevention (Jones & Bartlett, 2010). The HBM has been modified in various ways over time but the original model contains four psychological variables. The concept of perceived susceptibility is a person’s own belief of the likelihood of getting a condition. Perceived severity is the individual’s opinion of the graveness of the condition and its sequelae. One’s thoughts concerning the effectiveness of the recommended action to actually avoid or reduce the seriousness of the condition are termed perceived benefits. Perceived barriers are the negative aspects of a specific health action (Bartholomew, Parcel, Kok, & Gottlieb, 2006). Additionally, a cue to action serves as the catalyst for the decision making process.

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