Determinants of Public Health Behavior Based on the Health Belief Model: A Systematic Review

Abstract

Background: Previous systematic reviews of the Health Belief Model have mainly been focused on specific diseases or behavioral intentions. This systematic review was aimed to synthesize the associations between Health Belief Model constructs and actual promotive and preventive health behaviors across public health contexts, and to translate the findings into operational recommendations for health policy and primary healthcare services.Method: The PRISMA 2020 guidelines were followed by this systematic review. Scopus, PubMed, and Google Scholar were searched for English-language, peer-reviewed quantitative studies that were published between 2020 and 2025. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional StudiesResult: Of 742 records that were identified, 14 studies that involved 7,403 participants met the inclusion criteria. Across diverse public health behaviors, self-efficacy (10/14 studies, 71.4%) emerged as one of the most recurrent positive determinants, and cues to action were significant in 8 of 12 studies that operationalized the construct (66.7%). An inhibitory or unfavorable association with outcomes was shown by perceived barriers in 7 of 14 studies (50.0%). Perceived susceptibility was significantly associated with behavior or contributed to significant perceived-threat pathways in 9/14 studies (64.3%), while perceived severity was significant in 10/14 studies (71.4%). Positive associations were shown by perceived benefits in 8/14 studies (57.1%). Therefore, effective health policies should move beyond risk communication, so that timely behavioral cues, structural barrier reduction, and self-efficacy enhancement are integrated into primary healthcare services