Using the health belief model to explain clinic appointment-keeping for the management of a chronic disease condition

Abstract

Broken appointments have untoward repercussions for patients' health and well-being. Although the literature on missed appointments has been largely atheoretical, several studies have tested the Health Belief Model (HBM) in this context. Those studies have found HBM dimensions are not predictive of keeping appointments for the management of a chronic condition. Given several limitations that characterize these studies, questions can be raised about the validity of this conclusion. This study investigated the utility of HBM for explaining appointment-keeping for Systemic Lupus Erythematosus (SLE), a potentially fatal chronic disease. A questionnaire, operationalizing HBM dimensions and exhibiting acceptable psychometric properties, was developed for this research and administered to 153 SLE patients enrolled at an outpatient clinic of a major teaching hospital. In addition to measuring intention to keep appointments, data were abstracted from medical records regarding actual appointment-keeping during 12 months prior to and 6 months following questionnaire completion. Regression analysis indicated that general health motivation and perceived severity of SLE were uniquely associated in the theoretically predicted direction with, respectively, intent and the percentage of scheduled appointments kept (PSAK) during the 12 month retrospective period. Perceived costs was associated in the expected direction with intent, 12 month retrospective and 6 month prospective PSAK. Typical of HBM research the effect sizes uncovered were modest in magnitude. Questions for future investigation are discussed.