**4. Health belief model**

As national interest in health increased from the 1970s, various models and theories were proposed to predict and explain individual health behaviors. The health belief model describes health behaviors based on individuals' belief in perceived susceptibility, severity, benefits, and barriers to disease [19, 20]. The theory of rational behavior and the theory of planned behavior described health behaviors under the assumption that individuals use relevant information reasonably and systematically before doing anything [21, 22]. The precaution adoption process model explains that individuals go through seven stages of unaware of issue, unengaged by issue, deciding about acting, decided to act, acting, and maintenance until they act to protect their health [23]. On the other hand, the health belief model emphasizes aspects of subjective judgments for individuals to practice health behaviors. However, in contrast, other theories highlight the systematic collection and interpretation of health-related information for subjective judgments of individuals, opinions of others, and the process of decision-making based on it [21–23]. However, considering that the characteristic of the socially vulnerable

*Global Social Work - Cutting Edge Issues and Critical Reflections*

This view of health gradually spread to European countries in the 1990s, and in 2008, the World Health Organization published "Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health," which emphasized that the issue of health inequality should be addressed as a worldwide issue, and developed a strategic interest in healthcare policies and policies based on the current state of health inequality around the world [3–5]. Through these efforts, some countries have achieved partial reductions in health inequality problems, such as maternal-infant mortality [6], child and family health [7], and non-inflammatory diseases [8]. However, despite various efforts and attempts by the healthcare sectors of the world, the problem of health inequality seems to persist [9–11]. On the other hand, considering that the issue of health inequality is mainly a social problem experienced by the socially vulnerable, understanding social work that targets them is believed to provide insight into alleviating health inequalities. In modern society, social vulnerability generally means a group of individuals or such individuals who are excluded, marginalized, or left behind in a capitalist economic system [12]. Therefore, social work strategies for them are focused on socioeconomic support to address or alleviate their current difficulties by direct and continuous interaction with individuals or groups or various training and support programs for re-entry into a capitalist economy. In other words, in addition to direct and indirect support through various policies, support is needed in other community-based ways through direct and continuous relations with the socially

Therefore, in this study, we would like to consider the role of social work to complement the limitations healthcare approaches in order to mitigate the problem

In this study, we would like to explore the limitations of the existing healthcare

On the other hand, the key to healthcare policies is to encourage an individual to practice health behaviors to maintain or enhance their current health [13]. In the case of South Korea, various efforts have been made to reduce disparity in the 3rd Health Plan 2011–2020 that includes smoking, high-risk drinking, physical activity, and prevalence of obesity and hypertension as indicators to address health inequality based on income levels [14]. The results showed that the gap between the smoking rate and the high-risk drinking rate has somewhat eased, but the gap has widened for the physical activity rate and obesity rate [14]. Based on this, a healthcare approach alone is difficult to induce individuals to practice their health behaviors. Therefore, we would like to explore the theories involved in order to

In 1978, the WHO set all human health goals as the attainment by "all the people of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life" [15] and began to discuss in earnest the

approach to health inequality of socially vulnerable group through a literature review and present the role of social work to complement it. To that end, we will first look at the WHO's view of health and its transformation process. This is because it has a huge impact on health-related policies of individual countries by

of health inequality among the socially vulnerable.

understand the health behaviors of individuals.

**3. A healthcare perspective on health**

**122**

vulnerable.

**2. Methodology**

forming healthcare paradigms.

group can have a negative impact on the process itself of establishing a basis for subjective judgment, it is considered to be somewhat difficult to explain their health behaviors. Therefore, this study focuses on the health belief model.

The health belief model is a theoretical model developed in the early 1950s by social psychologists from the United States Public Health Service to explain the poorly examined phenomenon of disease prevention or early detection of diseases with no symptoms [19, 20]. Health belief models were subsequently studied by various scholars [20, 24–26], of which Janz and Becker [20] presented the following components of health behavior practice for individuals to prevent and manage diseases.

#### **4.1 Perceived susceptibility**

Perceived susceptibility refers to subjective judgments about how much one is exposed to health-threatening factors [20]. For example, the women who think they are less likely to have breast cancer [24, 26].

#### **4.2 Perceived severity**

Perceived severity refers to subjective judgments about how dangerous and serious the factors that threaten one's health or the consequences resulting from a disease are [20]. For example, women who believe that mortality increases without breast cancer screening are more likely to perform breast cancer screening [24, 26]. On the other hand, a combination of perceived susceptibility and perceived severity creates perceived threat, which is an influencing factor for predicting health behavior [25].

#### **4.3 Perceived benefit**

Perceived benefits refer to subjective judgments on the benefits of the following recommended actions [20]. The more positively a person evaluates the benefits of a health action, the less likely the threat is perceived. For example, a person who thinks that breast cancer screening is more accurate is more likely to go for a checkup than someone who thinks it is less accurate [24, 26].

#### **4.4 Perceived barriers**

Perceived barriers mean subjective judgments on the cost, time, and emotions in performing recommended actions [20]. Some people who do not undergo breast cancer screening acknowledge the benefits of the examination but do not act out of fear of the cost and time-consuming examination process [24, 26]. On the other hand, perceived benefits and perceived barriers have a direct effect on health behavior, unlike the two factors discussed earlier [20].

#### **4.5 Cue to action**

Cue to action refers to an internal or external stimulus that motivates an individual to perform their own health actions. In this case, internal cues refer to the self-awareness of the symptoms of one's health condition, and external cues refer to the messages sent through the media or by health experts [20]. These behavioral cues increase perceived susceptibility and perceived severity, thus, increasing the intention of action [20].

In addition to the five factors discussed earlier, the health belief model includes perceived threat or demographic/social psychological variables that can affect a

**125**

**Figure 1.**

*aid understanding of this study.*

in **Figure 1**.

*Mitigating Health Inequalities of Socially Vulnerable in South Korea: Role for Social Work*

person's health behavior, which provide a direct or indirect incentive to practice

**5. Limitations of the healthcare approach to health inequalities among** 

As we saw earlier, the approach to health from a healthcare perspective can be seen as an emphasis on the prevention paradigm, namely the formation of conditions that enable control and management of individuals' health and health determinants through the concept of health promotion centered on disease prevention and management. However, based on the view of the health belief model that describes an individual's practice of health behavior, the approach from a healthcare perspective emphasizes prevention of future illnesses and their healthcare management. The limitation of this approach, however, is that while it may increase the likelihood of screening an individual for disease prevention or healthcare, it does not enforce the practice of actual health behaviors. This means that based on perceived health risk factors, the final decision of whether an individual will practice healthy behavior or not is entirely their own [27, 28]. Moreover, given that the problem of health inequality is mainly a social problem experienced by the socially vulnerable, their diverse characteristics [12], such as low socioeconomic status and educational levels, are such that even if they have recognized factors that can negatively affect their health, they are not limited to leading to various tests for disease prevention or implementation of health behaviors for health management. Therefore, if we look at the phenomenon of health inequality among the socially vulnerable today based on the health belief model, we can think of the healthcare approach that emphasizes the prevention of health inequalities as an approach that reveals its limitations at the point where, despite various efforts and attempts to resolve issues, it leads to health management practices for the prevention of diseases among individuals belonging to socially vulnerable groups. The above is illustrated

*Basic elements of the health belief model (Janz and Becker [20]). Note: part of the figure has been modified to* 

**5.1 Paradigm shift from treatment to prevention: emphasis on prevention**

health behavior, either individually or by a combination of each factor.

*DOI: http://dx.doi.org/10.5772/intechopen.89457*

**the socially vulnerable**

*Mitigating Health Inequalities of Socially Vulnerable in South Korea: Role for Social Work DOI: http://dx.doi.org/10.5772/intechopen.89457*

person's health behavior, which provide a direct or indirect incentive to practice health behavior, either individually or by a combination of each factor.
