International Journal of Health Promotion and Education

ISSN: 1463-5240 (Print) 2164-9545 (Online) Journal homepage: https://www.tandfonline.com/loi/rhpe20

Applying the Health Belief Model to assess

prevention services among young adults

Raffy R. Luquis & Weston S. Kensinger

To cite this article: Raffy R. Luquis & Weston S. Kensinger (2019) Applying the Health Belief
Model to assess prevention services among young adults, International Journal of Health
Promotion and Education, 57:1, 37-47, DOI: 10.1080/14635240.2018.1549958

To link to this article: https://doi.org/10.1080/14635240.2018.1549958

Published online: 03 Dec 2018.

Submit your article to this journal

Article views: 11

View Crossmark data

Full Terms & Conditions of access and use can be found at

https://www.tandfonline.com/action/journalInformation?journalCode=rhpe20
INTERNATIONAL JOURNAL OF HEALTH PROMOTION AND EDUCATION
2019, VOL. 57, NO. 1, 37–47
https://doi.org/10.1080/14635240.2018.1549958

Applying the Health Belief Model to assess prevention

services among young adults
Raffy R. Luquis and Weston S. Kensinger
School of Behavioral Sciences and Education, Penn State Harrisburg, Middletown, PA, USA

ABSTRACT ARTICLE HISTORY

The Health Belief Model (HBM) is one of the many models in health Received 17 February 2018
education that can be used as the basis for health promotion programs. Accepted 15 November 2018
The Patient Protection and Affordable Care Act promoted the benefits KEYWORDS
of preventive care while reducing barriers for young adults to access Preventive services; health
the health insurance and preventive measures. The purpose of this promotion; health
analysis was to assess the perceived susceptibility, perceived serious- education; health behaviors;
ness of health conditions and access to preventive services among Health Belief Model (HBM)
young adults. Data were collected from 821 young adults in the north-
east region of the United States. Results indicated that there were
significant differences based on gender, health status and age on the
perceived susceptibility or perceived seriousness of eight major health
conditions. In addition, there were significant differences between
males and females in regards to the use of prevention services based
on their perceptions of susceptibility and seriousness. Results of this
study indicate that the HBM constructs of perceived susceptibility and
perceived seriousness might play a significant role for young adults to
use health preventive services. Future health education and promotion
efforts to increase use of preventive services should focus on percep-
tions of susceptibility and seriousness in young adults.

Introduction
Developed in the 1950s, the Health Belief Model (HBM) is one of the most frequently
used models in health promotion programs to help explain why an individual may or
may not engage in preventive health measures (Rosenstock 1966) and was initially
developed to help predict individuals behavioral reactions to disease and treatment
they received (Champion and Skinner 2008). According to the HBM, the constructs of
perceived seriousness, susceptibility, benefits, barriers, cues to action and self-efficacy
can be used to explain whether a person takes actions to prevent, to screen for or
improve health behaviors. As such, based on the HBM, individuals who perceive high
susceptibility and seriousness would be more likely to take actions toward preventing
the disease as long as the health benefits surpass the barriers, and they feel they have
the capability to engage in the behavior. Several of the HBM constructs have been
found to be useful to predict health-promoting behaviors. For example, O’Connor
et al. (2014) found that perceived barriers and benefits were strong predictors for

CONTACT Raffy R. Luquis rluquis@psu.edu School of Behavioral Sciences and Education, Penn State
Harrisburg, W314 Olmsted, 777 West Harrisburg Pike, Middletown, PA 17057-4898, USA
© 2018 Institute of Health Promotion and Education
38 R. R. LUQUIS AND W. S. KENSINGER

young people with mental health to engage in help-seeking behaviors. Similarly,

Gulliver, Griffiths and Christensen (2010) found that perceive barriers deterred
young adults with mental health from seeking help. According to a meta-analysis
on the effectiveness of the HBM in predicting behaviors, perceived benefits and
barriers emerged as strong predictors of engaging in the health behavior, while the
relationship between susceptibility, severity and the behavior was low or nonexistent
(Carpenter 2010). Research examining the influence of the constructs of perceived
susceptibility and perceived seriousness have been mixed and met with ambiguity.
Previous research focused on the construct of perceived seriousness did not signifi-
cantly influence self-care measures (Harvey and Lawson 2009; Hsieh et al. 2016).
While some literature suggests that beliefs about perceived susceptibility are predictive
of engaging in health promoting behaviors such as healthy diet and exercise, smoking
cessation, self-examinations and dental care (Abraham and Sheeran 2005), in general,
many persons’ own perception of susceptibility is underestimated (Orji, Vassileva, &
Mandryk 2012). According to Brewer et al. (2007), it is posited that susceptibility is
an understudied aspect of risk perception and should be researched further. Although
the HBM has been a useful theoretical framework to investigate a wide range of
health behaviors (Orji, Vassileva, & Mandryk 2012), it has been suggested that beliefs
about health risks may predict the likelihood of health behaviors (Champion and
Skinner 2008; Ahadzadeh et al. 2015). Thus, it is important to understand the role of
not only beliefs about barriers and benefits but also how the other constructs within
HBM, as these influence healthy behaviors by young adults. For example, Ghaffari,
Gharlipour and Rakhshanderou (2016) found that premarital sexual abstinence was
associated with knowledge, perceived susceptibility, perceived benefits, perceived bar-
riers, perceived self-efficacy, subjective norms and religious beliefs among young
people. Thus, using the HBM as a framework is both a systematic and theoretical
approach (Henshaw and Freedman-Doan 2009) and can help uncover the beliefs of
young adults regarding accessing preventative services as applicable.
While young adults are exposed to higher rates of harmful health outcomes (e.g.
sexually transmitted infections [STIs], mental health, substances use), studies have
shown that a high percentage of young adults received no preventive care, counseling or
reported low screenings rates (Adams et al. 2018; Fortuna, Robbins, and Halterman 2009;
Minino et al. 2007). The Patient Protection and Affordable Care Act (ACA) encourages
health promotion and disease prevention by making preventive care more accessible and
affordable for many Americans, especially among young adults who may be more likely to
delay preventive care because of cost (i.e. barrier to access) (Koh and Sebelius 2010;
USDHHS 2010; Sommers et al. 2013). While preventative health screenings and services
play a large role in the early diagnosis of chronic diseases (Bauer et al. 2014), a large
portion of Americans receive only half of the services that are recommended (Koh and
Sebelius 2010). Previous researchers have estimated that up to 70% of young adults do not
engage in any preventative health care or counseling (Fortuna, Robbins, and Halterman
2009). Young adults between the ages of 19 and 26 benefited from a provision in ACA
because it allowed them to stay on their parents’ or legal guardians’ health insurance plan,
and the law also instituted insurance market regulations, insurance exchanges and expan-
sion of Medicaid eligibility for those with a demonstrated financial need regardless of age
(Sommers et al. 2013). By increasing access and decreasing cost, it could potentially help to
 INTERNATIONAL JOURNAL OF HEALTH PROMOTION AND EDUCATION 39

eliminate barriers to preventative services, which is one of the central constructs of the
HBM. Jerant et al. (2013), who found that preventive care increase after gaining health
insurance coverage, supported this.
Based on the HBM, access to health insurance (decrease barrier) and the promo-
tion of the benefits of preventive services, as supported by the ACA, would encourage
young people to engage in preventive behaviors; however, people may not engage
in preventive behaviors unless they perceive susceptibility and severity of disease. As
such, previous data analysis by the authors showed that having health insurance was
a main factor in receiving preventive services such as wellness checkup, blood
pressure and cholesterol screening (Luquis and Kensinger 2017); however, the con-
structs of perceived susceptibility and seriousness were not examined in relationship
to health outcome and access to preventive services among young adults. Thus, the
purpose of this analysis was to explore whether perceived susceptibility and serious-
ness of health outcomes influence access to preventive services among young adults
with health insurance. Specifically, the study addressed the following questions: (1)
what are the perceptions of susceptibility and severity of health outcomes by partici-
pants’ characteristics? and (2) are there any differences in the perceived susceptibility,
severity and use of preventive care by participants’ characteristics among those with
health-care insurance?

Materials and methods

Sample selection
One thousand young adults between the ages of 19 and 34 years (with equal numbers of
both males and females) residing in the northeast region of the United States (Connecticut,
Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode
Island and Vermont) were recruited via email to participate in this study (Luquis and
Kensinger 2017).
According to 2014 population estimates, there were approximately 12.2 million
young adults between 19 and 34 years of age residing in the northeast region, including
36.5% between the ages of 19 and 24, 32.7% between 25 and 29 and 30.8% between 30
and 34. The population estimates also showed that there was an equal distribution of
males (50.1%) and females (49.9%) in this region (U.S. Census Bureau 2014). The
sample size was calculated using an online sample size calculator based on confidence
level of 95% and confidence interval of 3% to represent the target population (Creative
Research Systems 2012).

Measures
Using previously validated and reliable inventories, the authors developed a 40-question
online survey, which inquired about participants’ demographic characteristics, health
insurance coverage, type of coverage, source of health care and barriers to care (Luquis
and Kensinger 2017). The survey further inquired whether participants received preven-
tive health services, as well as possible reasons for not getting them. Perceived suscept-
ibility for eight health major health conditions (cancer, diabetes, asthma, high blood
40 R. R. LUQUIS AND W. S. KENSINGER

pressure, cardiovascular disease, poor mental health, obesity and STIs) was measured with
a single item, for example ‘compared to most people your age and sex, what would you say
your chances are for developing sexually transmitted infections?’ on a 5-point Likert scale
(1 = much lower than average, 5 = much higher than average). Similarly, perceived
seriousness for each of the eight health conditions was assessed by asking participants to
respond to statement such as ‘compared to most people of your age and sex, getting/
having a sexually transmitted infection would be serious problem’ on a 5-point Likert scale
(1 = strongly disagree, 5 = strongly agree) (Wang et al. 2009). Finally, participants were
asked whether they have had or received health preventive services, including routine
wellness exam, and screenings for obesity, HIV, STIs, depression, blood pressure/hyper-
tension, diabetes and cancer among others, as mandated by the ACA (USDHHS 2010;
Centers for Medicare and Medicaid Services n.d.).

Data collection and analysis

The Survey Monkey platform was selected to conduct the online survey as it provided
greater assurance of anonymity, completion by a respondent at his or her convenience and
accessibility to a wide geographical area (Luquis and Kensinger 2017). Survey Monkey
platform has been used in other online surveys including a study on internet users and
cyber abuse (Vakhitova and Reynald 2014), a study in about abortion and contraception
among women in five countries (Wiebe et al. 2013) and a study on understanding
millennial shoppers (Hall and Towers 2017). Thus, it was deemed appropriate for this
investigation. Participants received an email invitation from Survey Monkey to request
their participation in the survey. The Survey Monkey Audience was chosen as it provided
the advantage to recruit participants from the diverse population based on the target
criteria, which is benchmark regularly to ensure that the participants are representative.
Participants were instructed to read the informed consent letter including issues regarding
anonymity and contact information of the authors. Institutional Review Board approval
from the Office of Research Protection at the Pennsylvania State University was obtained
prior to the survey; participants completed an informed consent, which informed of the
anonymity for all responses.
The Statistical Package for the Social Sciences version 24 was used to complete the data
analysis. Descriptive statistics including frequency distribution, mean and standard devia-
tion were used to examine participant’s responses. t-Test and analysis of variance (ANOVA)
were used to assess perception of susceptibility and seriousness by participants’ character-
istics. The level of statistical significance was set at p < .05 for all statistical measures.

Results
Demographics of participants
While 946 participants who completed the survey fit the initial inclusion criteria, for
the purpose of the analysis, only 821 participants, those who reported that they had
health insurance, were included. The participants were between the ages of 19 and 34,
with a mean age of 27.20 (±4.57) and 77% falling between the ages of 25 and 34.
Seventy percent of participants were White, 56% were female and 41% completed
 INTERNATIONAL JOURNAL OF HEALTH PROMOTION AND EDUCATION 41

a bachelor’s degree or higher. Finally, approximately half of the participants (51.7%)

described their health as excellent or very good and a third indicated that it was good
(see Table 1).

Perceptions of susceptibility and seriousness

Participants were asked to assess their susceptibility and seriousness of developing one
of eight health conditions. Average susceptibility and seriousness scores were calculated
for each of the health conditions. A series of t-test and ANOVA analyses were
conducted to examine the perception susceptibility and seriousness scores by partici-
pants’ characteristics. The analyses showed significant differences on average perception
susceptibility and seriousness scores by gender, health status and age. The analysis
showed no significant difference based on race/ethnicity or education level. On average,
females felt more susceptible and seriousness to cancer (p < .001), diabetes (p < .001),
obesity (p < .001) and cardiovascular disease (p < .05). Females perceived more
susceptibility to poor mental health (p < .01), and seriousness about asthma (p < .01),
STIs (p < .05), and high blood pressure (p < .05) than males. Males felt more susceptible
to STIs (p < .001) than females. Those who reported excellent/very good health felt less
susceptible to cancer (p < .001), diabetes (p < .001), obesity (p < .001), asthma
(p < .001), high blood pressure (p < .001), cardiovascular disease (p < .001) and mental
health (p < .001) than their counterparts. Those who reported fair/poor health per-
ceived more seriousness about cancer (p < .01) than their counterparts did. Older
participants felt more susceptible to cancer (p < .05), obesity (p < .001) and

Table 1. Participant demographics and health insurance status.

n %
Gender
Male 359 44.0
Female 456 56.0
Race/Ethnicity
White 559 70.8
Black/African- 56 7.1
American 96 12.2
Hispanic 78 9.9
Other
Age
19–24 242 29.5
25–29 276 33.6
30–34 303 36.9
Mean (SD) = 27.20 (4.57)
Education attainment
High school graduate or less 179 22.7
Some college/Assoc. degree 287 36.5
Bachelor degree or more 321 40.8
Health status
Excellent/Very good 423 51.7
Good 270 33.0
Fair/Poor 125 15.3
Type of health insurance
Private 544 69.0
Public/Medicaid 244 31.0
N = 821, percentage based on those participants that answered the questions; missing
data were excluded.
42 R. R. LUQUIS AND W. S. KENSINGER

cardiovascular disease (p < .001), while younger participants felt more susceptible and
perceived more seriousness to STIs (p < .05) (see Table 2).

Preventive services in relationship to perceptions of susceptibility and

seriousness
A series of two-way ANOVAs were conducted to examine the effect of gender, health
status, age and whether participants received preventive services on their perceptions of
susceptibility and seriousness among participants who reported that they had health
insurance (i.e. decreased barrier). The analyses showed a statistically significant inter-
action between the effect of gender and whether they received cancer, obesity, depres-
sion and suicide screenings on their perception of susceptibility of cancer, obesity and
mental health. Females who received cancer screenings perceived higher susceptibility
about developing cancer (i.e. cervical, testicular, skin etc.) than males who received
screenings (p < .05). Similarly, females who received obesity screenings and/or counsel-
ing on weight management perceived higher susceptibility of developing obesity than
males who received the same screenings/counseling (p < .05). Likewise, females who
received depression and suicide screenings and/or counseling perceived higher suscept-
ibility on developing a poor mental health condition (p < .01; p < .05), respectively.
There were no significant differences based on single effect of gender or receiving the
screenings (p > .05). Finally, the analysis also showed a statistically significant interac-
tion between the effect of gender and whether they received cancer screenings on their
perception of seriousness of cancer. Males who received cancer screening reported
lower perception of seriousness about developing cancer than females who received
the screening (p < .05); there were also statistically significant differences between male
and females (p < .001) and between those who received and did not receive the
screening service (p < .05). The analyses showed no significant interaction between
the effect of gender and whether they received obesity, depression or suicide screenings
(see Table 3).

Discussion
In the present study, the results showed differences on the perception susceptibility and
seriousness scores by gender, health status and age. The results of this study indicated that
the HBM constructs of perceived susceptibility and perceived seriousness might play
a significant role for young adults with health insurance in addressing health outcomes,
which may result in harmful consequences later in their lives. In general, females felt both
more susceptible and seriousness about cancer, diabetes, obesity and cardiovascular
disease. Similarly, females felt more susceptibility to poor mental health and perceived
more seriousness about asthma, STIs and high blood pressure. These results are similar to
previous studies in which gender differences concerning perceptions of susceptibility and
seriousness have been reported. Wang et al. (2009) found that females reported higher
perceived risk (i.e. susceptibility) and worry (i.e. seriousness) for cancer, heart disease,
diabetes and stroke than men. Similarly, Das and Evans (2014) found differences in weight
management perceptions between first-year male and female college students.
Interestingly, results showed that males felt more susceptible to STIs than females,
Table 2. Mean scores of perceptions of susceptibility and seriousness by participants’ characteristics.
Gender Health status Age
Male Female Excellent/Very good Good Fair/Poor 18–24 25–29 30–34
Health condition M (SD) M (SD) M (SD) M (SD) M (SD) M (SD) M (SD) M (SD)
Cancer susceptibility 2.34 (1.02) 2.65 (.98)c 2.30 (1.06) 2.66 (.90) 2.87 (.92)c 2.37 (1.01) 2.51 (1.01) 2.61 (1.00)a
t/F −4.37 20.77 3.70
Cancer seriousness 3.54 (1.28) 3.95 (1.14)c 3.63 (1.29) 3.82 (1.15) 4.04 (1.11)b 3.83 (1.19) 3.68 (1.28) 3.76 (1.19)
t/F −4.79 5.97 .936
Diabetes susceptibility 2.34 (1.05) 2.67 (1.04)c 2.25 (1.02) 2.73 (.96) 2.96 (1.11)c 2.43 (1.04) 2.53 (1.09) 2.59 (1.03)
t/F −4.34 32.21 1.52
c
Diabetes seriousness 3.34 (1.19) 3.64 (1.05) 3.45 (1.16) 3.51 (1.07) 3.61 (1.11) 3.52 (1.17) 3.46 (1.15) 3.51 (1.06
t/F −3.73 .970 .191
Obesity susceptibility 2.35 (1.17) 2.64 (1.24)b 2.20 (1.12) 2.72 (1.15) 3.08 (1.38)c 2.26 (1.22) 2.57 (1.22) 2.66 (1.18)b
t/F −3.32 33.07 7.54
Obesity seriousness 3.30 (1.17) 3.56 (1.08)b 3.37 (1.15) 3.44 (1.10) 3.65 (1.12) 3.42 (1.22) 3.47 (1.13) 3.42 (1.06)
t/F −3.27 2.89 .157
Asthma susceptibility 2.26 (1.13) 2.39 (1.16) 2.15 (1.11) 2.44 (1.14) 2.70 (1.19)c 2.39 (1.20) 2.27 (1.15) 2.35 (1.09)
t/F −1.64 13.32 .713
a
Asthma seriousness 3.10 (1.10) 3.29 (1.00) 3.18 (1.06) 3.21 (1.06) 3.26 (.94) 3.26 (1.07) 3.19 (1.05) 3.17 (1.00)
t/F −2.52 .275 .507
STI susceptibility 2.18 (1.14)c 1.83 (1.03) 2.05 (1.14) 1.92 (1.03) 1.89 (1.04) 2.15 (1.10)b 1.98 (1.08) 1.84 (1.06)
t/F 4.55 1.75 5.57
a
STI seriousness 3.51 (1.23) 3.69 (1.14) 3.57 (1.23) 3.60 (1.14) 3.76 (1.10) 3.75 (1.19)a 3.62 (1.21) 3.48 (1.14)
t/F −2.05 1.31 3.64
High Blood Pressure susceptibility 2.62 (1.07) 2.63 (1.02) 2.41 (1.04) 2.80 (.95) 2.92 (1.05)c 2.60 (1.07) 2.55 (1.01) 2.70 (1.03)
t/F −.214 18.05 1.45
a
High Blood Pressure seriousness 3.33 (1.13) 3.50 (.99) 3.39 (1.11) 3.43 (1.01) 3.45 (1.00) 3.46 (1.11) 3.38 (1.07) 3.41 (1.00)
t/F −2.29 .230 .374
Cardiovascular Disease susceptibility 2.37 (1.03) 2.58 (.99)b 2.27 (1.02) 2.68 (.94) 2.79 (.99)c 2.24 (.93) 2.55 (1.01) 2.62 (1.04)c
t/F −2.95 19. 96 10.21
Cardiovascular Disease seriousness 3.52 (1.15) 3.65 (1.04) 3.55 (1.14) 3.62 (1.06) 3.66 (.99) 3.56 (1.17) 3.56 (1.12) 3.63 (1.02)
t/F −1.751 .594 .444
Mental health susceptibility 2.47 (1.19) 2.72 (1.22)b 2.33 (1.13) 2.81 (1.20) 3.12 (1.31)c 2.67 (1.27) 2.55 (1.22) 2.62 (1.17)
t/F −2.98 26.86 .641
INTERNATIONAL JOURNAL OF HEALTH PROMOTION AND EDUCATION

Mental health seriousness 3.48 (1.21) 3.63 (1.09) 3.55 (1.18) 3.66 (1.13) 3.66 (1.13) 3.60 (1.24) 3.52 (1.14) 3.54 (1.08)
t/F −1.76 .722 .321
STI: Sexually transmitted infection. Higher scores represent increased susceptibility and seriousness; ap-value ≤ .05, bp-value ≤ .01, cp-value ≤ .001.
43
44 R. R. LUQUIS AND W. S. KENSINGER

Table 3. Perceived susceptibility and seriousness means scores preventive service by gender.
Preventive service
Cancer screening Obesity screening Depression screening Suicide screening
Susceptibility mean (SD)
Male
Yes 2.22 (1.09) 2.62 (1.16) 2.77 (1.25) 2.53 (1.23)
No 2.37 (1.01) 2.28 (1.16) 2.38 (1.16) 2.45 (1.19)
Female
Yes 2.83 (.89)a 3.29 (1.18)a 3.46 (1.24)b 3.39 (1.27)a
No 2.59 (1.00) 2.46 (1.19) 2.52 (1.13) 2.67 (1.20)
F 4.28 5.25 7.84 4.85
Seriousness mean (SD)
Male
Yes 3.19 (1.33)a 3.44 (1.23) 3.46 (1.25) 3.43 (1.20)
No 3.65 (1.25) 3.25 (1.15) 3.48 (1.20) 3.49 (1.21)
Female
Yes 3.96 (1.15) 3.50 (1.07) 3.77 (1.08) 3.75 (1.07)
No 3.95 (1.12) 3.57 (1.09) 3.58 (1.08) 3.61 (1.09)
F 4.84 1.78 1.04 .488
Higher scores represent increased susceptibility and seriousness; ap-value ≤ .05, bp-value ≤ .01.

which may be a reflection of differences in sexual behaviors across gender. It was not
surprising to find that those who reported excellent/very good health status felt less
susceptible to seven of the eight health outcomes than their counterparts did. Finally,
older participants felt more susceptible to negative health outcomes that may affect them
later in life (i.e. cancer, obesity, cardiovascular disease) as compared to younger partici-
pants who perceived more susceptibility and seriousness about STIs. Health communica-
tion messages can be perceived as more relevant if they are tailored to an individual based
on his or her perceptions of susceptibility and severity about specific health outcomes
(Cohn et al. 2018; Kreuter and Wray 2003). Similarly, health education specialists should
also consider health status and age when developing targeted messages to young people
about preventive care and health promotion activities.
When it comes to the utilization of preventive services in relationship to perceptions
of susceptibility, the results showed an interaction between the effect of gender and
whether they received cancer, obesity, depression and suicide screenings based on their
perception of susceptibility of related health outcomes. Overall, females who received
screenings and/or counseling for cancer, obesity, depression and suicide reported
higher susceptibility about developing cancer, obesity and mental health illnesses than
males. Previous researchers have suggested that females are more willing to seek
preventative care (Bertakis et al. 2000). Given the emphasis on the prevention of
cervical cancer, obesity (i.e. weight management/body image), and mental health
problems among young females, females are probably more likely to feel susceptible
and speak with health-care providers about these issues more than males. On the
contrary, males who reported receiving cancer screening felt less seriousness about
the getting/having cancer than their counterparts. A previous study showed that
enrollment in health insurance was associated with higher utilization of preventive
health services such as cancer screening among older adults; however, the study failed
to show any differences based on gender or perception of susceptibility (Jerant et al.
2013). The current study asked participants to rate their perceptions of susceptibility to
a health outcomes and whether they received related screening services; however, the
 INTERNATIONAL JOURNAL OF HEALTH PROMOTION AND EDUCATION 45

study did not account for other variables which might have had an influence on
whether they sought the preventive service after feeling susceptible, such as participa-
tion in a health promotion program or advice from a health-care provider.
While the study contributed to the application of the HBM to understand how
perceptions of susceptibility and seriousness relate to use of preventive care among
young adults, several limitations need consideration. The sample included a slightly higher
percentage of participants ages 25–34 and females; thus, finding should not be generalized
to all young adults. There is a possibility for bias in responses as participants might have
provided ‘socially acceptable’ responses and/or given their self-interest in this study. Given
the anonymity nature of the survey, nonrespondent data were not collected and thus
characterization cannot be made about them. Finally, due to the cross-sectional nature of
this study, we need to preclude making causal statements regarding our results.
In the future, researchers should continue to explore the differences in perceptions of
susceptibility and severity based on the HBM across gender to enable health education
specialists to develop appropriate health promotion and prevention strategies based on
gender differences. Studies should also continue to explore the relationship between the
utilization of preventive services and the perceptions of susceptibility and seriousness
among young adults and whether gender has an effect on this relationship. Studies
should also include measurements of self-efficacy and other modifying factors to assess
engagement in preventive services among this group. Finally, studies should consider
using random sampling methodologies to gather responses from diverse members of
this group in order to make better generalizations.

Conclusions
The results of this study suggest that perceptions of susceptibility and seriousness of health
outcomes are related to individual’s characteristics (i.e. gender, age), and that those
perceptions might influence the utilization of preventive services among those with health-
care coverage. Similarly, these results support the notion that when young adults feel
susceptible to negative health outcomes and when health-care coverage is available, young
adults will seek out preventative care services. Thus, while the future of the ACA is
uncertain, health education specialists and health-care professionals should continue to
emphasize the use of preventive care services (i.e. health screening and counseling) among
young adults. Similarly, health education specialists and health-care professionals should
continue to inform young adults about the susceptibility and seriousness of major adverse
health conditions, when developing programs to increase the use of prevention screenings
in young adults, as these perceptions might play an important role among this group.
Hence, future health education and promotion efforts to increase use of preventive services
should continue to focus on perceptions of health risk.

Disclosure statement
No potential conflict of interest was reported by the authors.
46 R. R. LUQUIS AND W. S. KENSINGER

Ethical approval
The study is compliant with the Office for Research Protections, Human Subjects Research, of
the Pennsylvania State University.

ORCID
Raffy R. Luquis http://orcid.org/0000-0002-6925-2420

References
Abraham, C., and P. Sheeran. 2005. “The Health Belief Model.” In Predicting Health Behaviour:
Research and Practice with Social Cognition Models., edited by M. Conner and P. Norman,
28–80. 2nd ed. Maidenhead: Open University Press.
Adams, S., M. Park, L. Twietmeyer, C. Brindis, and C. Irwin. 2018. “Association between
Adolescent Preventive Care and the Role of the Affordable Care Act.” Journal of American
Medical Association Pediatrics 172 (1): 43–48. doi:10.1001/jamapediatrics.2017.3140.
Ahadzadeh, A. S., S. P. Sharif, F. S. Ong, and K. W. Khong. 2015. “Integrating Health Belief
Model and Technology Acceptance Model: An Investigation of Health-Related Internet Use.”
Journal of Medical Internet Research 17 (2): e45. doi:10.2196/jmir.3564.
Bauer, U., P. Briss, R. Goodman, and B. Bowman. 2014. “Prevention of Chronic Disease in the
21st Century: Elimination of the Leading Preventable Causes of Premature Death and
Disability in the USA.” The Lancet 384 (9937): 45–52. doi:10.1016/S0140-6736(14)60648-6.
Bertakis, K. D., R. Azari, L. J. Helms, E. J. Callahan, and J. A. Robbins. 2000. “Gender Differences
in the Utilization of Health Care Services.” The Journal of Family Practice 42 (2): 147–152.
Brewer, N. T., G. B. Chapman, F. X. Gibbons, M. Gerrard, K. D. McCaul, and N. D. Weinstein.
2007. “Meta-Analysis of the Relationship between Risk Perception and Health Behavior: The
Example of Vaccination.” Health Psychology 26 (2): 136–145. doi:10.1037/0278-6133.26.2.136.
Carpenter, C. J. 2010. “A Meta-Analysis of the Effectiveness of Health Belief Model Variables in
Predicting Behavior.” Health Communication 25: 661–669. doi:10.1080/10410236.2010.521906.
Centers for Medicare and Medicaid Services. “What are My Preventive Benefits?” Accessed 22
November 2017. https://www.healthcare.gov/what-are-my-preventive-care-benefits/
Champion, V. L., and C. Skinner. 2008. “The Health Belief Model.” In Health Behavior and
Health Education: Theory, Research, and Practice, edited by K. Glanz, B. K. Rimer, and
K. V. Viswanath, 46–65. 4th ed. San Fransico, CA: Jossey-Bass.
Cohn, W., J. Lyman, D. Broshek, T. Guterbock, D. Hartman, M. Kinzie, D. Mick, et al. 2018.
“Tailored Educational Approaches for Consumer Health: A Model to Address Health
Promotion in an Era of Personalized Medicine.” American Journal of Health Promotion 32
(1): 188–197. doi:10.1177/0890117116671082.
Creative Research Systems. 2012. “Sample Size Calculator.” https://www.surveysystem.com/
sscalc.htm
Das, B. M., and E. M. Evans. 2014. “Understanding Weight Management Perceptions in
First-Year College Students Using the Health Belief Model.” Journal of American College
Health 62 (7): 488–497. doi:10.1080/07448481.2014.923429.
Fortuna, R. J., B. W. Robbins, and J. S. Halterman. 2009. “Ambulatory Care among Young Adults
in the United States.” Annals of Internal Medicine 151 (6): 379–385.
Ghaffari, M., Z. Gharlipour, and S. Rakhshanderou. 2016. “Related Factors of the Preventing
Behaviors of HIV/AIDS among Young People: Applying the Extended Health Belief Model
(EHBM).” International Journal of Pediatrics 4 (8): 2317–2328.
Gulliver, A., K. Griffiths, and H. Christensen. 2010. “Perceived Barriers and Facilitators to Mental
Health Help-Seeking in Young People: A Systematic Review.” Bio Medical Central Psychiatry
10: 113–121. doi:10.1186/1471-244X-10-113.
 INTERNATIONAL JOURNAL OF HEALTH PROMOTION AND EDUCATION 47

Hall, A., and N. Towers. 2017. “Understanding How Millennial Shoppers Decide What to Buy:
Digitally Connected Unseen Journeys.” International Journal of Retail & Distribution
Management 45 (5): 498–517. doi:10.1108/IJRDM-11-2016-0206.
Harvey, J. N., and V. L. Lawson. 2009. “The Importance of Health Belief Models in
Determining Self-Care Behaviour in Diabetes.” Diabetic Medicine 26: 5–13. doi:10.1111/
j.1464-5491.2008.02628.x.
Henshaw, E., and C. Freedman-Doan. 2009. “Conceptualizing Mental Health Care Utilization
Using the Health Belief Model.” Clinical Psychology: Science and Practice 16 (4): 420–439.
doi:10.1111/j.1468-2850.2009.01181.x.
Hsieh, Y., F. Lee, C. Chen, M. Chang, and P. Han. 2016. “Factors Influencing Intention to
Receive Examination of Diabetes Complications.” Asian Nursing Research 10 (4): 289–294.
doi:10.1016/j.anr.2016.10.004.
Jerant, A., K. Fiscella, D. J. Tancredi, and P. Franks. 2013. “Health Insurance Is Associated with
Preventive Care but Not Personal Health Behaviors.” Journal of the Board of Family Medicine
26 (6): 759–767. doi:10.3122/jabfm.2013.06.130054.
Koh, H., and K. Sebelius. 2010. “Promoting Prevention through the Affordable Care Act.” The
New England Journal of Medicine 363 (14): 1296–1299. doi:10.1056/NEJMp1008560.
Kreuter, M. W., and R. J. Wray. 2003. “Tailored and Targeted Health Communication: Strategies
for Enhancing Information Relevance.” American Journal of Health Behavior 27 (3): S227–
S232.
Luquis, R., and W. Kensinger. 2017. “Perceptions of Health Care and Access to Preventive
Services among Young Adults.” The Journal of Community Health 42 (6): 1204–1212.
doi:10.1007/s10900-017-0371-2.
Minino, A. M., M. P. Heron, S. L. Murphy, and K. D. Kochanek. 2007. “Deaths: Final Data for
2004.” National Vital Statistics Report 55: 1–119.
O’Connor, P. J., B. Martin, C. S. Weeks, and L. Ong. 2014. “Factors that Influence Young
People’s Mental Health Help-Seeking Behavior: A Study Based on the Health Belief Model.”
Journal of Advanced Nursing 70 (11): 2577–2587. doi:10.1111/jan.12423.
Orji, R., J. Vassileva, and R. Mandryk. 2012. “Towards an Effective Health Interventions Design:
an Extension Of The Health Belief Model.” Online Journal Of Public Health Informatics 4 (3):
1–31. 10.5210/ojphi.
Rosenstock, I. M. 1966. “Why People Use Health Services.” Milbank Memorial Fund Quarterly
44: 94–127. doi:10.2307/3348967.
Sommers, B. D., T. Buchmueller, S. L. Decker, C. Carey, and R. Kronick. 2013. “The Affordable
Care Act Has Led to Significant Gains in Health Insurance and Access to Care for Young
Adults.” Health Affairs 32 (1): 165–174. doi:10.1377/hlthaff.2012.0552.
U.S. Census Bureau. 2014. “American Community Survey: 1-Year Estimates.” http://factfinder.
census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_14_1YR_
S0101&prodType=table
U.S. Department of Health and Human Services. 2010. “The Patient Protection and Affordable
Care Act (ACA).” http://www.hhs.gov/healthcare/about-the-law/read-the-law/index.html
Vakhitova, Z. I., and D. M. Reynald. 2014. “Australian Internet Users and Guardianship against
Cyber Abuse: An Empirical Analysis.” International Journal of Cyber Criminology 8 (2):
156–171.
Wang, C., S. M. O’Neill, N. Rothrock, R. Gramling, A. Sen, L. S. Acheson, W. S. Rubinstein,
D. E. Nease, and M. T. Ruffin. 2009. “Comparison of Risk Perceptions and Beliefs across
Common Chronic Diseases.” Preventive Medicine 48: 197–202. doi:10.1016/j.ypmed.2008.11.008.
Wiebe, L., L. Littman, E. Moshier, and J. Kaczorowski. 2013. “Attitudes and Knowledge about
Abortion and Contraception among Women in Five Countries: An Internet Survey Using
Survey Monkey Audience.” Contraception 88 (3): 446. doi:10.1016/j.contraception.2013.05.065.