Application of Health Belief Model on Preventive Behaviors of Patients with Low Back Pain


  • Septi Ayu Arum Yuspita Sari Masters Program in Public Health, Universitas Sebelas Maret
  • Dono Indarto Department of Physiology, Faculty of Medicine, Universitas Sebelas Maret
  • Mahendra Wijaya Faculty of Social and Political Sciences, Universitas Sebelas Maret


Background: Low back pain (LBP) has different negative impacts in some people around the world. There are many risk factors of LBP, either biology, psychology, or social economics. A psychological theory (Health Belief Model/HBM) can be applied for preventive behaviors of some human diseases. This study aimed to analyze the application of HBM on preventive behaviors of patients with LBP.

Subjects and Method: This was a case-control study conducted at the medical rehabilitation policlinic, Dr. Moewardi Hospital, Surakarta, from October to November 2018. A sample of 50 LBP patients and 100 non-LBP patients was selected by fixed exposure sampling. The dependent variable was preventive behaviors. The independent variables were perceived severity, susceptibility, benefit, barrier, threat, cues to action, and self-efficacy. Data on LBP was obtained from medical record. The other data were collected by questionnaire and analyzed by path analysis.

Results: LBP preventive behaviors were directly and positively associated with perceived threat (b= 0.46; 95% CI= 0.24 to 0.68; p<0.001), perceived benefit (b= 0.29; 95% CI= 0.18 to 0.40; p<0.001), and self-efficacy (b= 0.16; 95% CI= 0.08 to 0.23; p<0.001). It was indirectly associated with perceived susceptibility, perceived severity, perceived barrier, and cues to action.

Conclusion: LBP preventive behaviors are directly and positively associated with perceived threat, perceived benefit, and self-efficacy. It is indirectly associated with perceived susceptibility, perceived severity, perceived barrier, and cues to action. This study supports the application of HBM to explain LBP preventive behaviors.

Keywords: low back pain, Health Belief Model, path analysis

Correspondence: Septi Ayu Arum Yuspita Sari. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Mobile: +6282338986991.

Journal of Health Promotion and Behavior (2018), 3(3): 192-198


Ahdhi GS, Subramanian R, Saya GK, Yamuna TV (2017). Prevalence of Low Back Pain and its Relation to Quality of Life and Disability among Women in Rural Area of Puducherry, India. Indian Journal of Pain, 30(2).DOI: 10.4103/09705333.186467.

Bansal D, Gudala K, Lavudiya S, Ghai B, Arora P (2016). Translation, Adaptation, and validation of hindi version of the pain catastrophizing scale in patients with chronic low back painfor use in India. Pain Medicine, 0: 1–11. doi: 10.1093/pm/pnv103.

Biglarian A, Seifi B, Bakhshi E, Mohammad K, Rahgozar M, Karimlou M, Serahati S (2012). Low Back pain prevalence and associated factors in iranian population: Findings from the National Health Survey. Pain Research and Treatment.doi:10.1155/2012/653060.

Chaman R, Aliyari R, Sadeghian F, Shoaa JV, Masoudi M, Zahedi S, Bakhshi MA(2015). Psychosocial Factors and musculoskeletal pain among rural Handwoven Carpet Weavers in Iran. Safety and Health at Work, 6: 120-127.

Chee YJ, Chan HH, Tan NC (2014). Understanding patients' perspective of statin therapy: Can We design a better approach to the management of dyslipidaemia? A Literature Review. Singapore Medical Journal, 55(8): 416-421.

Corrin T, Papadopoulos A (2017). Understanding the Attitudes and perceptions of vegetarian and plantbased diets to shape future health promotion programs. Appetite, 109: 40-47.

Costa LDM, Maher CG, McAuley JH, Hancock MJ, Herbert RD, Refshauge KM, Henschke N (2009). Prognosis for patients with chronic low back pain: Inception Cohort Study. BMJ, 339:b3829. doi:10.1136/bmj.b3829.

Coulson NS, Ferguson MA, Henshaw H, Heffernan E (2016). Applying theories of health behaviour and change to hearing health research: Time for a new approach. International Journal of Audiology, 55(3): S99-S104. doi: 10.3109/14992027.2016.116185.

Dinakar P, Stillman AM (2016). Pathogenesis of Pain. Seminars in Pediatric Neurology, 23(3): 201-208.

Glanz K, Bishop DB (2010). The role of behavioral science theory in development and implementation of public health interventions. Annual Review of Public Health, 31: 399-418.

Henschke N, Lorenz E, Pokora R, Michaleff ZA, Quartey JNA, Oliveira VC (2016). Understanding cultural influences on back pain and back pain research. Best Practice & Research: Clinical Rheumatology, 30(6): 1037-1049.

Koley S, Kaur J, Sandhu JS (2010). Biological risk indicators for nonspecific low back pain in young adults of Amritsar, Punjab, India. J Life Sci, 2:43-8.

Murase K, Tabara Y, Ito H, Kobayashi M, Takahashi Y, Setoh K et al. (2015) Knee pain and low back pain additively disturb sleep in the general population: A Cross-Sectional Analysis of the Nagahama Study. PLoS ONE, 10(10): e0140058.

Orji R, Vassileva J, Mandryk R (2012). Towards an effective health interventions design: An Extension of the Health Belief Model. Journal of Public Health Informatics, 4(3):9.

Padchasuwan N, Kaewpitoon SJ, Rujirakul R, Wakkuwattapong P, Norkaew J, Kujapun J, Ponphimai S, Chavenkun W, Kompor P, Kaewpitoon N (2016). Modifying health behavior for liver fluke and cholangiocarcinoma prevention with the health belief model and social support theory. Asian Pacific Journal of Cancer Prevention, 17(8): 3721-3725.

Patton DE, Hughes CM, Cadogan CA, Ryan CA(2017). Theory-based interventions to improve medication adherence in older adults prescribed polypharmacy: A Systematic Review. Drugs Aging, 34(2): 97-113.

Sharafkhani N, Khorsandi M, Shamsi M, Ranjbaran M (2016). The effect of an educational intervention program on the adoption of low back pain preventive behaviors in nurses: An Application of the Health Belief Model. Global Spine Journal, 6(1): 29-34.

Toraman AU, Ardahan M, Balyaci OE (2014). The effect of the body mechanic behaviors on the low back pain. Nurs Pract Today, 1(2): 107-115.




How to Cite

Sari, S. A. A. Y., Indarto, D., & Wijaya, M. (2018). Application of Health Belief Model on Preventive Behaviors of Patients with Low Back Pain. Journal of Health Promotion and Behavior, 3(3), 192–198. Retrieved from




Most read articles by the same author(s)