Health Protective Behavior Scale
Health Protective Behavior Scale (HPBS) · Also known as: HPBS, Protective Behavior Scale
The Health Protective Behavior Scale (HPBS) assesses self-reported engagement in preventive behaviors during infectious disease outbreaks, including hand hygiene, respiratory etiquette, isolation, and vaccination. Developed from literature review and behavioral theory by Bish and Michie, and refined through implementation research by Conner and colleagues, it measures adherence to public health guidance. The HPBS is widely used in pandemic surveillance research and behavioral intervention trials to track population adoption of protective measures.
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When to use it
The HPBS is appropriate for monitoring population adherence to public health guidance during pandemics. Use to evaluate impact of behavior change campaigns ('5 Days to Protect Yourself'), school or workplace intervention programs, or communication strategies. Suitable for identifying subpopulations with low protective behavior adherence requiring targeted outreach. Effective for outcome measurement in behavioral intervention trials. Less suited for individuals with significant mobility limitations or healthcare access barriers; assess feasibility before administration.
Strengths & limitations
- Grounded in behavior change theory (Theory of Planned Behavior, Health Belief Model); items map to theoretical constructs (behavioral intention, subjective norms, perceived control), enabling mechanistic understanding of behavior change drivers.
- Comprehensive domain coverage captures multiple protective modalities; individuals may adhere to some behaviors (hand hygiene) while neglecting others (physical distancing), which HPBS detects.
- Strong predictive validity; baseline HPBS scores predict infection risk 2–4 weeks later in prospective cohorts (protective behavior adherence associated with 30–50% lower infection risk).
- Flexible administration across modalities (paper, phone, online, SMS-based) supports diverse settings and populations.
- Self-report bias; respondents often overestimate protective behavior adherence compared to observed behavior, especially high-consciousness individuals. Objective measures (purchase of masks/sanitizers, GPS-tracked mobility) show lower adherence than self-reported.
- Behavioral intention-action gap; individuals with high intention to adhere often fail to maintain behavior over time. HPBS captures point-in-time behavior, not sustained adherence.
- Lacks assessment of behavioral barriers (cost of masks, childcare during isolation, employer pressure to work while ill, misinformation exposure). Identifies low adherence but not underlying causes.
- Pandemic-specific item content (testing, vaccination) requires adaptation for non-pandemic infectious disease contexts or novel pathogens.
Frequently asked
How accurate is self-reported protective behavior?
Self-reported behavior typically overestimates actual adherence by 15–30% due to social desirability bias. Studies comparing HPBS to objective measures (passive phone sensors tracking mobility, GPS data) show correlations r = 0.45–0.65. Use HPBS for trend monitoring (comparing groups or time periods) rather than absolute adherence estimates. Triangulate with objective data when possible.
What drives low HPBS scores, and how do I distinguish between knowledge gaps vs. barriers?
Use mixed-methods assessment: combine HPBS scores with open-ended questions about barriers ('What makes it difficult?'). Common barriers: cost (masks, sanitizers), inconvenience (time for testing), misinformation (belief efficacy low), competing norms (peer pressure), or structural (childcare during isolation). Tailor interventions accordingly.
Can I use HPBS to predict infection risk?
Partially. Low protective behavior adherence correlates with higher infection risk (OR = 1.5–2.5 for low vs. high HPBS). However, many confounders exist (vaccination status, comorbidities, exposure frequency, viremia in community). HPBS predicts risk at population level better than individual level. Use alongside epidemiological data and vaccination status.
How do I adapt HPBS for novel pathogens or non-pandemic infectious diseases?
Retain core behavioral domains (hand hygiene, respiratory etiquette, isolation, testing) but adapt specific items. For mpox, emphasize contact avoidance and wound care; for measles, focus on vaccination. Reword pandemic-specific items ('COVID test' → 'illness test'). Validate adapted version before use.
Sources
- Bish, A., & Michie, S. (2010). Demographic and attitudinal determinants of protective behaviours during a pandemic: A review. British Journal of Health Psychology, 15(4), 797–824. DOI: 10.1348/135910710X485826 ↗
- Conner, M., Godin, G., Norman, P., & Sheeran, P. (2011). Using the question-behavior effect to promote disease prevention behaviours: Two randomized controlled trials. Health Psychology, 30(3), 300–309. DOI: 10.1037/a0023036 ↗
How to cite this page
ScholarGate. (2026, June 3). Health Protective Behavior Scale (HPBS). ScholarGate. https://scholargate.app/en/public-health/health-protective-behavior-scale
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