The Health Belief Model as an Explanatory Framework in Communication Research: Exploring Parallel, Serial, and Moderated Mediation

TLDR

The Health Belief Model suggests that effective health messages target perceived barriers, benefits, self‑efficacy, and threat, yet its theoretical limitations—particularly the undefined ordering of constructs—have constrained its use in communication research. This study aims to determine whether HBM constructs mediate the relationship between campaign exposure and vaccination behavior through parallel, serial, or moderated mediation pathways. A survey of 1,377 adults conducted after an eight‑month flu‑vaccine campaign grounded in the HBM was used to assess these mediation patterns. Exposure increased vaccination behavior, with perceived barriers and threat mediating the effect in a self‑efficacy‑moderated manner, while perceived barriers and benefits formed a serial mediation chain, indicating complex variable ordering that may explain past inconsistencies and guide future research.

Abstract

The Health Belief Model (HBM) posits that messages will achieve optimal behavior change if they successfully target perceived barriers, benefits, self-efficacy, and threat. While the model seems to be an ideal explanatory framework for communication research, theoretical limitations have limited its use in the field. Notably, variable ordering is currently undefined in the HBM. Thus, it is unclear whether constructs mediate relationships comparably (parallel mediation), in sequence (serial mediation), or in tandem with a moderator (moderated mediation). To investigate variable ordering, adults (N = 1,377) completed a survey in the aftermath of an 8-month flu vaccine campaign grounded in the HBM. Exposure to the campaign was positively related to vaccination behavior. Statistical evaluation supported a model where the indirect effect of exposure on behavior through perceived barriers and threat was moderated by self-efficacy (moderated mediation). Perceived barriers and benefits also formed a serial mediation chain. The results indicate that variable ordering in the Health Belief Model may be complex, may help to explain conflicting results of the past, and may be a good focus for future research.