Family Practice Vol. 4, No.

2
Oxford University Press 1987 Printed in Great Britain

Construction and Validation of a

Questionnaire to Measure the Health
Beliefs of General Practice Patients
JILL COCKBURN, PAUL FAHEY AND R W SANSON-F1SHER

Downloaded from http://fampra.oxfordjournals.org/ at Florida Atlantic University on February 25, 2015

Cockburn J, Fahey P and Sanson-Fisher R W. Construction and validation of a questionnaire to measure
the health beliefs of general practice patients. Family Practice 1987; 4: 108116.
The health belief model has been widely used as a conceptual framework for understanding and
explaining compliance behaviour. A weakness characterizing work in the area has been lack of standard-
ization of measurement of the components of the health belief model. This paper describes the develop-
ment and validation of a questionnaire to measure these components. The questionnaire was designed
for use with general practice patients who have a wide range of different illnesses, therefore the nature of
the patients' illness is not mentioned in the content of the items. Principal components analysis was used
to determine the dimensions underlying patients' beliefs. Principal components analysis and application
of Cronbach's alpha statistic identified four reliable sub-scales of the questionnaire. The sub-scales
measured patient's beliefs about: the threat caused by illness, the efficacy of traditional medical care, the
way illness is dealt with and the barriers to taking medications.

The health belief model, a theoretical framework
for explaining and understanding individuals'
responses to health related matters, has been the
focus pf considerable attention in health
research. The model was originally developed to
explain and predict patients' participation in pre-
ventive health activities such as immunization
and attendance at screenings.1-2 It has since been
used to explain compliance with prescribed medi-
cations, dietary and other types of medical
advice.M
The original health belief model'-2 argued that
an individual's decision about undertaking a
recommended health action was a function of the
individual's beliefs on three subjective
dimensions:
1. The threat posed by an index condition. This
dimension comprises the individual's percep-
tion of the likelihood of the occurrence or
recurrence of the condition (perceived sus-
ceptibility) and its potential for causing physi-
Disciplinc of Behavioural Science in Relation to Medicine. Faculty of
Medicine. The University of Newcastle. NSW 2308. Australia. Corre-
spondence to Professor R. W. Sanson-Fisher.
108
cal harm and interference with social roles
(perceived severity).
2. The individual's beliefs in the efficacy or the
value of the recommended action in reducing
the threat (perceived benefits).
3. The individual's estimates of the physical, psy-
chological, financial or other costs involved in
the proposed action (perceived barriers).'-2
As research investigating the ability of the
model to explain health related behaviours has
progressed, the original model has been refor-
mulated and expanded to incorporate new find-
ings. In its early form, the model focused on
specific disease-avoidance interactions, but an
increasing body of evidence suggested that a per-
son's general motivation towards health related
matters influenced compliant behaviour.10"12 The
category of 'general health concerns' was added
in an effort to describe an individual's degree of
interest in, and concern about, health practices
and preventive activities. Similarly, the original
model focused exclusively on beliefs about one
index condition. General categories of vul-
nerability to disease and worry about illnesses
were added to the model to tap broader non-
specific perceptions of health threat. Other cate-
 CONSTRUCTION QUESTIONNAIRE HEALTH BELIEFS
gories which have been added have included
'feeling of control over health matters', and 'faith
in doctors and medical care'. l0 In addition, demo-
graphic, structural and enabling factors, which
had been found to be predictive in other com-
pliance research, were included as mediating
variables in the revised model.1013
The adequacy of a theory for explaining
behaviour can be judged onfivecriteria proposed
by Gergen.l4 These are that a theory should have:
heuristic value for a discipline or field of study;
parsimony of statement; operationally defined
terms; predictive capability; and a strong data
base.
Fisher15 has pointed out that the health belief
model fits most, but not all, of the above criteria.
Its heuristic value for health research is shown by
the plethora of studies which have used the con-
ceptual framework.91M4 It is beyond doubt that
the model has had a major influence on the think-
ing of those studying non-compliance. The model
is parsimonious, with only a limited number of
major variables which together provide a simple
statement concerning health-related behaviours.
A major weakness of the health belief model,
however, is uncovered when the third criterion is
considered. Despite its widespread use, the con-
structs of the health belief model are oper-
ationalized in different ways by various
investigators attempting to measure the same
beliefs. The final two criteria are related to these
changing operational definitions. The data base
supporting the model has expanded considerably
since its formulation. The predictive capability
has been tested, and support for the predictive
capability of the model has been found in some
instances.9 However, research is often plagued
by methodological problems in the measurement
of the model.
As early as 1974, Rosenstock2 pointed out that
no two studies had used identical questionnaires
to determine the presence of absence of each
belief. This raised the possibility that the con-
cepts being measured may also have varied from
study to study. Rosenstock recommended that
standardized methods of asking questions and
the reliability of measures be examined, so that
the utility of the model could be examined with-
out the confounding influence of different, and
perhaps inaccurate, measurement procedures.
Becker and Maiman10 reiterated the points of
Rosenstock stressing that consensus was needed
on ways to standardize measurement, including
109
the sharing of operational and conceptual defi-
nitions, so thatfindingscould be compared across
studies. They also pointed to the need for more
sensitive measures of dimensions of the health
belief model, using interval or ratio scales. Such
scales enable individuals to be placed on a con-
tinuum according to the strength of belief, rather
than to be classified into one of only two groups
according to whether the belief is held or not.
Continuous scores allow noteworthy differences
between individuals to be assessed.
Green25 summarized the situation by describ-
ing the health belief model as 'the most docu-
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mented set of health beliefs, but nonetheless
without standardization, or tests of reliability or
validity'.
Though several studies since the remarks of
Green have reported the reliability of the scales
used,18-24-26 there have been few attempts at
assessing the validity of these scales. This is an
obvious and major problem. Though items which
appear in current scales are usually chosen with
some theoretical basis and therefore have face
validity, there is little evidence that the scales
have construct validity. Factor analysis is a poten-
tially useful tool for examining this dimension of
validity as it determines which groups of items
cluster to form scales in the questionnaire.27 If the
factor-based groupings correspond to the a priori
theoretical grouping of items then empirical sup-
port is given for the construct validity of the
questionnaire.
Factor analysis has been used to develop
instruments based on the health belief model to
measure the beliefs of women regarding breast
self-examination,23 the health beliefs of dia-
betics17 and the more general health beliefs of a
community sample.28 All of these questionnaires
have demonstrable construct validity and analy-
sis has confirmed that distinct dimensions of
beliefs exist in people's perceptions of health
related matters. However, the specificity of the
content of items in the questionnaires of Given
and colleagues17 and Champion and colleagues23
limit their applicability to the groups for which
they were designed. The questionnaire of Jette
and colleagues28 is more general in its appli-
cation, but has as yet only been tested on a
'healthy' population; 78% of the sample in Jette's
study considered themselves to be in excellent
health at the time the questionnaire was admin-
istered. It is possible that people's beliefs about
health may be different when they are faced with
110 FAMILY PRACTICEAN INTERNATIONAL JOURNAL
actual illness. For example, Jette's group28 found
that beliefs about severity of potential illnesses
were distinct from perceptions about suscep-
tibility. This is contrary to the traditional group-
ing of the dimensions under the concept of 'threat
posed by illness' in the theoretical literature.
A standardized questionnaire which can be
used to examine the health beliefs of different
patient groups is important, so that comparisons
between studies can be made without the con-
founding factor of different measurements and
operationally defined terms. The aim of the pres-
ent study was to develop and field test a question-
naire of individuals' health beliefs which would
meet standard psychometric criteria, and have an
application for primary care patients.
METHOD
Study Setting and Design
The data were collected as part of a large-scale
direct observational study (the primary care
study) which was examining the processes of
general practice and relating these processes to a
number of outcomes. The primary care study was
conducted in the surgeries of randomly selected
general practitioners from Newcastle, Australia
and data were collected over an 18-month period
from November 1982 to April 1984.
The patient sample was recruited in the waiting
rooms of the general practice surgeries. Patients
were eligible for inclusion if they were aged 18
years or more, were literate in English and were
not too ill or in too much pain to complete ques-
tionnaires. After consultation with their doctor,
consenting patients were given a questionnaire
package, which included the health belief ques-
tionnaire. Instructions were given to patients to
take the questionnaire home to complete, and to
return it using a reply-paid envelope. A reminder
letter was sent to patients on the day after the
consultation, and if the questionnaire had not
been returned within one week of distribution, a
reminder phone call was made.
Instrument Development
The revised expanded version of the health belief
model1013 was used as the conceptual framework
for the construction of the questionnaire.
The initial pool of items to reflect these dimen-
sions came from three sources: (1) review of the
theoretical literature pertaining to health beliefs;
(2) revision of past scales, with particular atten-
tion to items shown to be valid and reliable and
(3) structured interviews with groups of medical
students, general practice patients and col-
leagues to determine the appropriate content and
wording of items within specific areas. In these
interviews people were asked to describe how
they dealt with illness, their attitudes to medica-
tions and to traditional medical care.
Thirty-five items were derived by these means.
These were edited to exclude repetitions and
ambiguities, resulting in 22 items being included
in the pilot form. The number of items in each
hypothesized dimension were: general health
threats, 3 items; general health concern, 2 items;
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specific threat level factors, 6 items; control over
illness, 4 items; medical motivation, 3 items; and
barriers to medication, 4 items.
Items were structured in the form of a com-
plete statement, for example 'Doctors know best
for you when you are ill.' A seven-point Likert29
response scale, ranging from strongly agree to
strongly disagree, was used for all items. The
uniformity of response format works on the pre-
mise that once respondents become familiar with
the response choices, statements can be read and
responses indicated quickly. Differing item
response formats increase the time and effort
needed to understand and complete question-
naires.30 A seven-point scale was used as it allows
more information about the varying strengths of
a patient's beliefs to be obtained and yields more
reliable data than response choices with fewer
alternatives.31
Items from each content area were randomly
distributed throughout the questionnaire and
patients marked responses directly on to the
questionnaire.
The pilot form of the questionnaire was tested
on a sample of 115 patients from three general
practitioners who were participating in the
primary care study. Analyses for the pilot study
were confined to calculations of means and stan-
dard deviations, the sample size being too small
for factor analysis.32 The examination focused
particularly on comparability of item score distri-
butions. Roughly symmetrical response distri-
butions with a mean of 4 and a standard deviation
near 2.6 are desirable characteristics for items to
be combined in summated rating scales.33 Careful
note was also made of items which were fre-
quently missedan indication that the items
were either not relevant to general practice
patients or that the wording of items caused prob-
lems with interpretation.
 CONSTRUCTION QUESTIONNAIRE HEALTH BELIEFS
The format of thefinalform of the health belief
questionnaire was identical to that described for
the pilot form. The reading ease of the question-
naire was calculated using the Flesch formula.34
The score of 91 indicates that the questionnaire
could be understood by 90% of the general popu-
lation (those with an IQ of 81+).
Field Test of Questionnaire
The data for the main study were obtained from
patients of the remaining 53 general practitioners
who were participating in the primary care study.
Procedures for gaining consent and distribution
of the questionnaire were similar to those
described previously.
The analysis of the health belief questionnaire
took place in four stages: factor analysis, index
score derivation, reliability analysis and validity
analysis.
Factor analysis. The principal components
method was used to extract factors from a matrix
of correlations among pairs of the 22 health belief
items. The analysis was done using the statistical
package BMDP, programme P4M. (University
of California, 1982.) The initial unrotated com-
ponent was evaluated against four criteria to
determine how many factors should be retained
for rotation. The criteria used were the Scree
test,35 the 5% guideline,36 consideration of eigen-
values27 and use of trial rotations.27 Factors were
rotated so as to maximize 'simple structure', a
criteria proposed by Thurstone37 as a means of
providing a parsimonious description of the
observed relationships. Varimax orthogonal
rotation, which does not allow correlations
among the factors, was used. Items with loadings
of 0.40 or above within factors were grouped
together in an index.
Index score derivation. A score for each patient
for each of the derived factor-based scales was
computed by adding up the scores on items with
significant loadings on the factor.29 Scoring of
negatively worded items was reversed prior to
scale computation, so that a low score repre-
sented a strongly held belief about the particular
health related matter being examined.
Reliability. The internal consistency of items con-
tributing to each factor-based scale was estimated
using Cronbach's alpha.38 In keeping with the
recommendations of Helmstadter39 and
40
Nunally, a coefficient of 0.50 was considered
111
adequate indication of internal consistency for a
questionnaire in the early stages of construction.
Validity. Empirical evidence for the construct
validity of the health belief questionnaire was
provided by the results of the principal com-
ponents analysis. These results were compared
with the a priori theoretical grouping of items,
the rationale being that if the factor-based scales
were in accordance with hypothesized groupings,
then confirmatory evidence would be given for
the theoretical constructs being measured.41
The discriminant validity of the derived health
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belief scales, and support for the independence
of different beliefs was provided by 'reliability of
difference' scores.42 These scores determine the
amount of overlap shared by all possible pairs of
scales within an instrument. The reliability of
difference between two scales is based on the
reliability of each scale and the correlation
between them. The higher the reliability of
difference score the more likely it is that separate
dimensions are being measured. A standard of
0.50 and greater has been used in previous
research as an indication that distinct dimensions
are being assessed.42"44
RESULTS AND DISCUSSION
Patient Sample
In all 821 questionnaires were distributed, of
which 621 were returned, a return rate of 75%.
Of those returned, 509 had every question
answered. As the principal components analysis
programme works only on complete data sets
these 509 respondents were the sample for the
current study. Sixty per cent of the sample were
male, 40% were female. The mean age of the
sample was 41 years. Eight per cent of the sample
had received no secondary schooling, 75% had
completed lower secondary school, and 17% had
full secondary education; 7% of the sample also
had tertiary qualifications. In order to determine
the representativeness of the sample, and there-
fore the generalizability of obtained results, the
demographic characteristics of respondents in
the sample have been compared with those of
patients who were given a questionnaire and
failed to return it. No significant differences were
found on any of the comparisons made.
Principal Components Analysis
Principal components anaylsis identified seven
factors with eigenvalues greater than 1. These
112 FAMILY PRACTICEAN INTERNATIONAL JOURNAL
seven factors accounted for 18%, 9%, 7%, 7%,
5%, 5%, and 4% respectively of the total vari-
ance. Therefore, using the 5% guideline, six
factors would be appropriate for rotation. Scree
test results, however, suggested that four impor-
tant factors were defined by items in the ques-
tionnaire. Thus, depending on the criterion used,
between four and seven factors are deemed suit-
able for rotation. Trial rotations of four, five, six
and seven factors were compared. The clearest
information about the dimensionality of the
health belief questionnaire was given when six
factors were rotated. These six factors accounted
for 53% of the total variance, a proportion which
has been deemed acceptable in previous
research.44 These six factors were rotated to
simple orthogonal structure. The rotated
orthogonal factor loadings for items are shown in
Table 1. Communality estimates are shown in the
far right hand column.
The first factor contained items which related
to perceived severity of the current condition, the
perceived severity of illness in general, and per-
ceived susceptibility to illnesses in general. These

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TABLE 1 Correlations between health belief items and rotated principal components

Rotated component Commun-

_ uslitv
No. Item I II III IV V VI h

17. My current condition will lead to serious

long-term health problems. 0.73 -0.04 0 0.08 0.09 -0.10 0.55
19. My current condition is causing me a lot
of worry and concern. 0.72 0.20 -0.06 -0.05 -0.18 -0.04 0.59
11. The illnesses I get worry me a great deal. 0.72 0.10 -0.04 -0.05 -0.15 0.08 0.56
20. Whenever I get sick it seems to be
serious. 0.67 0.03 0.01 -0.17 0 0.17 0.50
8. My current condition will interfere a
great deal with my normal activities. 0.60 0.06 -0.03 0.02 0.26 -0.14 0.45
4. I will become very sick as a result of my
current condition. 0.59 -0.08 0 0.01 0.47 -0.15 0.60
16. I get sick more easily than other people
my age. 0.58 -0.02 0.01 -0.19 0.08 0.28 0.46
7. I am concerned about the possibility of
becoming seriously ill. 0.57 0.25 -0.01 0.05 0.10 0 0.40
6. I worry that taking tablets may cause
problems. 0.07 0.75 -0.12 -0.10 -0.11 0.11 0.62
14. The trouble with tablets is that you can
get too dependent on them. 0.04 0.75 -0.03 0.13 0.15 -0.13 0.61
22. Often the side-effects from tablets are
worse than the illness. 0.16 0.66 -0.12 0.06 0.14 0.07 0.50
1. Doctors know best for you when you are
ill. 0.10 -0.10 0.80 0.08 0.06 0.08 0.68
3 When I follow my doctor's advice I
usually feel better. -0.08 -0.01 0.80 0.12 -0.01 0.03 0.66
21. I trust my own feelings about my health
rather than a doctor's advice. 0.09 0.18 -0.60 0.11 0.16 0.18 0.48
13. When I get sick, I just keep going as
usual. 0.07 0.03 0.05 0.76 0.02 0.02 0.59
12. I do not let illness interfere with my life. -0.19 -0.07 0.02 0.66 0.09 -0.02 0.49
18. When I think I am going to be sick I fight
it. 0.10 0.11 0.03 0.62 -0.16 0.04 0.43
10. Often remembering to take tablets is
more trouble than its worth. 0.08 0.18 -0.13 0 0.64 0.10 0.48
9. Looking after my health is one of my
major concerns. 0.32 0.17 0.10 0.11 -0.58 -0.02 0.49
15. It's likely that my current condition will
happen again. 0.18 -0.11 0.09 0.02 0.47 -0.02 0.28
2. Good health is largely a matter of good
luck. 0.20 -0.05 -0.06 0.10 0.14 0.77 0.66
5. Compared to other illnesses, my
condition is not serious. -0.40 0.21 0.03 -0.05 -0.15 0.56 0.55
 CONSTRUCTION QUESTIONNAIRE HEALTH BELIEFS
items were originally hypothesized to fall into the
specific threat level and general health threat
content areas. This finding is contrary to that of
Jette and colleagues.28 Whereas their work sug-
gested that condition-specific threat level factors
were distinct from general threat level factors,
the results from the present study do not support
this distinction. Patients in this study saw all ill-
nesses, including the specific condition for which
advice was being sought, in the same way. This
discrepancy may be due to the different samples
used. In the present study, the beliefs of patients
concerning a real illness episode were explored.
Jette and colleagues asked healthy subjects about
hypothesized situations. It seems that when
people are genuinely ill, the threat caused by all
illnesses, potential or real, are perceived in the
same way. This first factor has therefore been
labelled 'perceived threat to health caused by
illness'.
Items which related to beliefs about medica-
tion made up the second factor, labelled 'per-
ceived barriers to taking medication'. These
questions were all concerned with general atti-
tudes to taking tablets.
Items loading significantly on the third factor
'medical motivation', were concerned with trust
in doctors and traditional medical care.
Items of the fourth factor reflected people's
beliefs about the way they deal with illness. This
factor has been labelled 'perceived control over
illness'. A patient who would endorse the beliefs
measured by this subscale would be one with a
stoic approach when faced with ill-health.
The fifth factor extracted contained three
items, one of which was originally hypothesized
to fall into 'barriers to taking medication' dimen-
sion, one from the 'general health threat' domain
and the other which related to the 'general health
concern' domain. The content of these items
showed little in common. Therefore no label was
attached to this factor. This also holds true for
factor 6. The two items with significant loadings
TABLE 2 Cronbach's alpha for factor-based scales
Scale Label Alpha
1 Illness threat 0.82
2 Barriers 0.63
3 Medical motivation 0.56
4 Control over illness 0.49
5 0.27
6 0.14
113
were from the 'general health concern' and 'per-
ceived severity' of the presenting condition
domains.
Reliability
Cronbach's alpha coefficients for the six factor-
based scales are shown in Table 2. These ranged
from 0.14 for items loading on the sixth factor to
0.82 for the first factor-based scale. The low
reliabilities of the fifth and sixth scales were a
further indication that these derived scales were
more a reflection of factor analytic techniques
than an indication of patients' perceptions. These
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scales were therefore not considered to be valid
reflectors of underlying health beliefs. The alpha
of 0.49 for the 'belief about illness' scale was just
below that recommended by Helmstader39 and
Nunually,40 but it was decided to retain the scale,
as the questionnaire was in the early stages of
development. However, if this scale were to be
used in future research, further examination of
its reliability should be obtained. The reliability
of all the other scales in the present research
appears adequate.
Construct Validity
Factor analysis provided empirical evidence for
the validity of health belief constructs which were
measured in this study. With few exceptions,
items hypothesized a priori to be measuring the
same underlying construct were found to be
statistically related. All items from the medical
motivation grouping factored together, as did
items measuring the 'control over illness' dimen-
sion. Three of the four items which were hypoth-
esized to be measuring the 'barriers to taking
medication' dimension also factored together.
Support was therefore given for the construct
validity of these scales. The first factor to
emerge'threat caused by illness'was a com-
posite of specific severity, general severity and
general susceptibility. Theory has suggested that
'perceived severity' and 'perceived suseptibility'
be grouped together under 'threat of illness'.1013
The appropriateness of this grouping was con-
firmed by factor analysis and support given for
the contention that the 'threat' elements of the
health belief model be considered together
conceptually.
The data also susbstantiated the independence
of the four perceptual dimensions measured in
this questionnaire. Examination of the reliability
of difference scores between pairs of subscales
114 FAMILY PRACTICEAN INTERNATIONAL JOURNAL
TABLE 3 Correlations (shown above the diagonal), Cron- included a separate, distinct factor for 'specific
bach's alpha (shown in bold) and reliability of difference vulnerability' may have emerged in the general
scores (shown below the diagonal) of health belief subscales
practice sample. This finding will need to be
'Threat' 'Barriers' 'Medical' 'Control' explored as refinement of the scale continues.
'Threat' 0.82 0.21 -0.08 -0.11 Descriptive Statistics of Health Belief Subscales
'Barriers' 0.65 0.62 -0.25 0.05 A score was obtained from each patient on each
'Medical' 0.72 0.68 0.58 0.08
'Control' 0.69 0.53 0.5O 0.49 of the four retained subscales by the method of
summated ratings.29 In order to facilitate visual
comparisons, the ranges of the summated ratings
showed that all six pair-wise comparisons met the have been standardized to lie between 0 (indicat-
minimum standard for subscale distinctness ing the belief is strongly held) and 100 (indicating
(Table 3). The data suggested that clear and dif- the least belief strength). The distributions of the

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ferent belief dimensions exist, helping to sub-
stantiate the model as presently formulated.
The item measuring resusceptibility for the
presenting condition, however, did not factor as
expected with the other threat level items. Only
one such item was included, as it was thought that
it would be conceptually linked with other threat
level factors, such as perceived severity. Perhaps
if more items in this specific area had been
standardized scores are shown in Figure 1.
From Figure 1 it can be seen that the scores on
the 'perceived threat caused by illness' subscale
were skewed towards the lower end of belief
strength. The general practice patients in this
study tended to believe that any illness, including
the one for which they were seeing a doctor, was
not a major threat to them. Figure 1 also shows
that people's beliefs measured by the 'perceived

20 40 60 80 100 20 40 60 80 100
STANDARDIZED SCORE STANDARDIZED SCORE
a) Threat posed by illness b) Barriers

20 40 60 80 100 20 tO 60 80 100
STANDARDIZED SCORE STANDARDIZED SCORE
c) Medical Motivation d) Control over illness
FIGURE 1 Distribution of standardized scores on subscales of the health belief
questionnaire
 CONSTRUCTION QUESTIONNAIRE HEALTH BELIEFS
barriers to taking medications' subscale were
fairly evenly distributed. The distribution of
scores on the third subscale 'Medical motivia-
tion', is skewed towards the end of the scale
which indicated a more strongly held belief. This
would be expected for a general practice sample
who were completing questionnaires after a visit
to a doctor to seek medical advice. The scores on
the fourth subscale were also skewed towards the
end of the scale indicating a more strongly held
belief. People in this sample tended to endorse
'stoicism' as a means of dealing with illness. This
may reflect a cultural trait noted in other
studies,45 which causes Australians, even in
adversity, not to complain.
CONCLUSIONS
The health belief questionnaire in the present
research must be seen to be in the early phases of
development. However, the results of the analy-
sis reported here suggested that the derived
scales reliably and validly measured the health
belief constructs which were included in the ques-
tionnaire. The composition of the indices support
the theoretical assumption that the health belief
model dimensions are sufficiently distinct to be
considered different beliefs in the sample under
study.
One problem with the existing questionnaire is
that there is no subscale to measure perceived
benefits of undertaking recommended health
actions. Testing and refinement of items to
measure the 'benefits' dimension of the health
belief model is needed so that all major dimen-
sions are represented in the questionnaire.
It should be noted too that the validity analyses
described in this paper are based on internal
criteriafeatures of the relationships among and
between scale items. Further validation pro-
cedures based on external criteria are currently
being examined. The relationship between the
health belief measures along the four dimensions
and the short-term compliance with antibiotic
treatment is currently being explored.
This research has been an attempt to produce a
standardized questionnaire which can be used in
general practice, where patients have many dif-
ferent illnesses. The main advantage of the devel-
oped questionnaire is that the nature of the
illness is not specified in the content of any of the
items. After further refinement, it could be use-
ful for measuring the health beliefs of varied
patient groups and so enable direct comparisons
115
between different studies examining the efficacy
of the health belief model for explaining health
related behaviours.
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