The Health Belief Model as an explanatory framework in communication research: exploring parallel, serial, and moderated mediation

Health Commun. 2015;30(6):566-76. doi: 10.1080/10410236.2013.873363. Epub 2014 Jul 10.


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.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Health Care Surveys
  • Health Communication*
  • Health Knowledge, Attitudes, Practice*
  • Health Promotion
  • Health Services Research*
  • Humans
  • Influenza A Virus, H1N1 Subtype
  • Influenza Vaccines / administration & dosage
  • Influenza, Human / prevention & control
  • Male
  • Middle Aged
  • Models, Psychological*
  • Risk Assessment
  • Self Efficacy
  • Vaccination / psychology
  • Young Adult


  • Influenza Vaccines