Utilizing the Health Belief Model to understand heat mitigation behaviors in the United States: Results of an online panel survey

The factors impacting individual-level heat mitigation behaviors (e.g., seeking shade, staying cool, wearing loose-fitting clothes) during extreme heat events among adults in the United States are poorly understood. The Health Belief Model (HBM) has been used extensively to explore health promoting behaviors; we explored the application of the HBM constructs to understand heat mitigation behaviors among U.S. adults. Online panel data from the Household Emergency Preparedness Survey was collected in May 2024 to explore knowledge, attitudes, beliefs and behaviors related to extreme heat mitigation among a nationally representative sample of U.S. adults. An outcome variable assessing likeliness to engage in heat mitigation behaviors was developed by dichotomizing a sum of responses to questions asking about likelihood to engage in different mitigation behaviors; scores were split on the median value to classify those "more likely" versus "less likely" to engage in mitigation behaviors. Descriptive statistics were used to explore HBM construct responses among our sample; logistic regression models examined whether perceived benefits, perceived barriers, perceived susceptibility, perceived severity, self-efficacy, and cues to action were associated with more likelihood to engage in heat mitigation behaviors, after controlling for age, sex, income, race/ethnicity, education, and political affiliation. We included 6095 responses to the online panel survey in our analysis. A multivariable logistic regression model including all HBM constructs and adjusting for sociodemographic characteristics found that higher degrees of perceived benefits (OR=1.30, 95% CI:1.22-1.39), self-efficacy (OR=3.69, 95% CI: 3.26-4.10), and cues to action (OR=1.48, 95% CI:1.38-1.60) were positively associated with being more likely to engage in heat mitigation behaviors. Results from our analyses suggest that communication strategies, guidelines, and interventions which incorporate cues to action, as well as those focused on improving perceived benefits and self-efficacy can be most effective in improving heat mitigation behaviors.