The Role of the Health Belief Model in Predicting Preventive Behaviors Among Individuals with Prehypertension

Abstract

Background: Prehypertension, a transitional stage towards hypertension, has been recognized as an independent risk factor for cardiovascular diseases. Objectives: This study aimed to examine the role of the health belief model (HBM) in predicting preventive behaviors among individuals with prehypertension. Methods: This descriptive-analytical study included 200 prehypertensive participants aged 34 to 85 years, selected via multi-stage cluster sampling in Sirjan, Iran in 2023. Data were collected using a validated HBM Questionnaire and standard blood pressure measurements. Average blood pressure values were 128 ± 3 mmHg systolic and 84.5 ± 2.8 mmHg diastolic. Advanced statistical techniques, including multiple regression and structural equation modeling (SEM), and machine learning (ML) models such as random forest, support vector machine (SVM), gradient boosting, and neural networks, were combined to analyze the data, with a significance level of 0.05. Results: Self-efficacy (β = -0.25, P < 0.001) and perceived severity (β = 0.32, P < 0.001) were the strongest predictors of blood pressure control behaviors. Gender differences in knowledge (P = 0.027) and self-efficacy (P = 0.021) were observed, with women showing higher levels than men. Supervised ML models showed high predictive accuracy for blood pressure control behaviors, with the gradient boosting model performing best [area under the curve (AUC) = 0.895, P < 0.001]. Health belief model components such as perceived benefits and barriers did not significantly impact behaviors. Conclusions: The results suggest that psychological and behavioral factors, particularly self-efficacy and perceived severity, should be integrated into prehypertension intervention programs. Tailored interventions focusing on enhancing self-efficacy and addressing perceived severity, particularly among men, can optimize blood pressure control outcomes.