Hypertensive Elders' Perceptions and Management of Their Disease: Health Beliefs or Health Decisions?

This study attempted to validate the Health Belief Model (HBM) as a model for explaining health behavior among elderly people diagnosed with hypertension. Using the construct validation perspective within psychometric theory, factor analysis with principal axis factoring and orthogonal varimax rotation was performed on data obtained from 275 elderly patients seen for hypertension in outpatient clinics. The structure of the HBM as originally proposed by Rosenstock (1966) was not confirmed. Instead, a six-factor structure reflecting a decision-making perspective as opposed to a belief perspective was obtained This factor structure accounted for 100% of the variance and was established on the basis of eigenvalues meeting more than one criterion for factor retention. The six factors are (a) inference of susceptibility, (b) understanding of hypertension, (c) use of health services, (d) inference of illness, (e) likelihood of disease-related complications, and (f) health locus of control. This study reveals patients' need to process information about their illness and health, to apply their cognitive-inferential skills to analyze and draw conclusions from this information, and to use these inferences to chart their course of behavioral response to their illness and its management.