# Situation: The nurse holds health teaching sessions at a barangay senior citizens' center. Several participants have hearing or vision problems, and one woman from an indigenous community speaks only her own language. A 68-year-old man with diabetes agrees that a foot wound can lead to amputation and that daily foot checks catch wounds early. He then says, "That only happens to farmers who walk barefoot in the fields. I always wear slippers." According to the Health Belief Model (HBM), which belief MOST needs to be addressed?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627197  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: The nurse holds health teaching sessions at a barangay senior citizens' center. Several participants have hearing or vision problems, and one woman from an indigenous community speaks only her own language.

A 68-year-old man with diabetes agrees that a foot wound can lead to amputation and that daily foot checks catch wounds early. He then says, "That only happens to farmers who walk barefoot in the fields. I always wear slippers." According to the Health Belief Model (HBM), which belief MOST needs to be addressed?

## 보기

1. Perceived severity of the complication
2. Perceived susceptibility to the complication **✔ 정답**
3. Perceived benefits of daily foot checks
4. Perceived barriers to daily foot checks

**정답: 2**

## 해설

He accepts that the complication is serious (severity) and that daily checks help (benefits), and he names no obstacle (barriers). His statement shows that he does not believe the problem could happen to him, which is low perceived susceptibility. The nurse should personalize his risk, for example by explaining that reduced sensation in diabetes allows unnoticed injuries even with footwear.

## 심화 해설

Sorting his statements by HBM construct
The Health Belief Model (HBM) explains health behavior through several beliefs: perceived susceptibility ("could this happen to me?"), perceived severity ("how serious would it be?"), perceived benefits ("would the action help?"), perceived barriers ("what stops me?"), along with cues to action and self-efficacy. This man agrees that a foot wound can lead to amputation, so perceived severity is present. He agrees that daily foot checks catch wounds early, so perceived benefits are present. He names no cost, pain, time, or other obstacle, so no barrier is identified. His statement "That only happens to farmers who walk barefoot... I always wear slippers" shows he does not believe the complication could happen to him. This is low perceived susceptibility, and it is the belief that most needs to be addressed.

Why susceptibility matters here
In the HBM, a person is more likely to act when he believes he is at risk and that the consequences are serious. Accepting severity and benefits is not enough if he places himself outside the risk group. His reasoning also contains a misconception: in diabetes, peripheral neuropathy reduces sensation in the feet, so injuries from footwear, heat, or small objects can go unnoticed even when shoes or slippers are worn. Poor circulation then slows healing. Slippers protect the soles from some injuries but do not remove his risk.

| HBM construct | His statement | Status |
| --- | --- | --- |
| Perceived severity | Agrees a wound can lead to amputation | Present |
| Perceived benefits | Agrees daily checks catch wounds early | Present |
| Perceived barriers | Names no obstacle | Not identified |
| Perceived susceptibility | "That only happens to farmers... I always wear slippers" | Low |

Why the other options are not the priority
Addressing severity would repeat what he already accepts. Addressing benefits would also repeat an accepted belief. Addressing barriers is premature when he has not named any. Watch out! Statements of the form "that only happens to other people" or "I am not the type to get that" are classic signs of low perceived susceptibility.

How the nurse personalizes risk
The nurse should help him see that his own diabetes, not his work or footwear, creates the risk. She can test foot sensation with a monofilament and show him the result, explain how nerve damage allows painless injuries, and point out pressure areas from his slippers. In a group session with older participants, using his own findings and simple examples makes the risk concrete. Teaching him daily foot inspection, proper footwear that covers and protects the foot, and when to report a wound then builds on the benefits he already accepts.

## 임상 시나리오

Health Belief Model in Diabetic Foot CareIdentifying low perceived susceptibility
He accepts severity (amputation) and benefits (daily checks) and names no barrier.

"That only happens to farmers who walk barefoot" shows low perceived susceptibility: he does not think the risk applies to him.

Personalize his risk: peripheral neuropathy in diabetes allows unnoticed injuries even with footwear. A sensation test can make this concrete.

CautionDo not spend teaching time on beliefs he already holds; target the missing belief.

## 핵심 개념

- **Health Belief Model** — A theory that health behavior depends on beliefs about susceptibility, severity, benefits, and barriers.
- **Perceived susceptibility** — A person's belief about his own chance of getting a disease or complication.
- **Perceived severity** — A person's belief about how serious a disease or complication would be.
- **Peripheral neuropathy** — Nerve damage, common in diabetes, that reduces sensation in the feet and hands.

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