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Question: Discuss about the Food Nutrition and Behaviour. Answer: Analysis and critique of the Health Belief Model Health belief model is a psychological health performance alter framework, which has been established for clearing up and predicting health associated attitudes, especially related to health service usage. The model was developed by a social psychologist at U.S. public health service in 1950s (3).The health belief model tells about individuals beliefs and perceptions about health problems, professed remuneration of action and obstacles to action along with the self effectiveness for appointment in health promoting deeds. The model says that a cue to action, i.e. trigger or stimulus should also be present for influencing the health promoting behaviour. The theoretical construct includes following seven elements: Figure: Health belief Model (Source: 3) Perceived severity- This element refers to the subjective evaluation of the severity of a health issue and its potential consequences. The model tells that individual perceiving a health issue more severe is expected to engage in potent health behaviours for preventing the disease. If individual is believes that the severity of malnutrition of food choice related health issues is high, they are more likely to modify their food behaviour (2). Perceived susceptibility- It is referred to subjective assessment of risk of developing a health issue. The model demonstrates that individual, who perceives their susceptibility towards a health issue, engages in such behaviour that would reduce the risk of developing the particular health issue. Therefore, if individual believe that they are susceptible to health issues due to their food choice or behaviour, they would more prone to modify their food choice (3). Perceived benefits- It is referred to individuals efficacy of being engaged in a health promoting behaviour for reducing the risk of disease development. Thus, health related behaviours are also promoted by the perceived benefits of action. Individual, who understands the benefits of eating green vegetables instead of street foods, is more likely to include green vegetables in their diet than the individual who does not know that (4) . Perceived barriers- Alike the perceived benefits, perceived barriers can prevent individual to take action for health related behaviour, instead of being aware of the severity of health issue and positive effect of the health behaviour. For instance, if an individual is aware of the bitter taste of a healthy food, he will attempt to avoid the food, instead of knowing its healthy nature (3). Modifying variables- Modifying variables like individuals habitat, demographic, psychosocial or structural variables can affect individuals perceptions. Food choice varies among people to people, society to society, in different contexts (6). Cues to action- The HBM suggests that the presence of stimuli, trigger or the cue of action can significantly promote health related behaviour within an individual. Motivational talks, promotions or social media advertisements can work as stimuli to promote individuals food choice. Self efficacy- This component was added later with the four components of the model, where it has been depicted that self-efficacy is the belief of an individual about the ability to perform behaviour successfully. Individual, love to consume fried street food, may perceive that he would not be able to consume a healthy diet with full of vegetables, totally excluding street foods, which may hinder his healthy food choice (4). However, there are several factors contributing human food choice behaviours. HBM addresses a range of factors influencing individuals decision and behaviour, but unable to predict the full range of food-choice behaviours. The model tries to forecast health related behaviours by considering personal differences in belief and attitudes. It does not include environment factors, which are out of individuals control; it does not deem the force of emotions on health related behaviour (2). Moreover, the model does not tell how constructs of model interact with one another. Sometimes, food choices are unrelated to health which cannot be explained through this model. 2.Alternative drivers of human food choice There are several factors, which can drive the food choices of individual. For instance, besides the demographic information, appearance of food, i.e. taste, smell, texture is also important determinants of food choice. The physiological factors age, sex, body size, metabolic rate, health status, level of physical activity, pregnancy, lactation, hormonal secretions, use of drugs, physiological comparisons and general health status are significant drivers of food choice. Environmental factors include traditions, peer or family influence, media promotion, awareness about diet-health relationships, food environment or eating environment. Some food consumption is related to celebration, security or emotional status (5). Food accessibility is another factor that significantly drives individual food choice. It was claimed that women acts as a gatekeeper of family food patterns, though the concept is being changed nowadays. Some studies showed the prestige value of foods as a driver of food choice. Income is a key driver that promotes the decision about the food choice, which is linked to the SES of an individual or family (4). Urbanization is a key factor that drives the food choice, as it is also linked with the income and SES. Other alternative drivers include trade liberalization, overgrown transnational food corporations, retailing as well as food industry marketing. The above drivers have significant contribution in different contexts for deciding individuals or groups food choice behaviour. However, these factors have not been considered in health belief model. 3.Alternative model of food choice An alternative model that can address the above mentioned drivers and limitations found in HBM, is the Food choice process model, which shows a significant interaction among the drivers of food choice. The model includes 3 main components of food choice, i.e. life courses, influences and personal food system. These three components cover all the aspects influencing food choice. Figure: Food process model (Source: 1) Life course proceedings and experiences- These are the factors that are acquired throughout individuals life and affect their food consumption pattern and food choice. These include: Trajectories- These are the key life course concepts and includes individuals persistent opinion, judgment, strategies, and actions as she approached choice like family cuisine. Transition- These are the shifts in a persons life course leading to changes in food choice trajectories, like migration, marriage, workplace change or shift from childhood to adolescence (7). Turning points- These are the major transitions leading to reconstruction of food choices, like a post surgery diet routine. Timing- Timing is considered when transitions for turning points occur. It also has a significant impact upon determining the influences. Contexts- Contexts are referred to the situations, which influences the living patterns along with the behaviour and food choices of individual. Contexts are of two types, i.e. macro level and micro level. The macro level contexts include societal, civilizing, political, financial and other circumstances facilitating and restraining constancy or changes in the food choice trajectories of individuals. On the other hand, the micro level contexts include families, friends, schools, universities, workplaces, communities, and other social and physical structures that shape food choice trajectories (8). Influences on food choice- Influences are categorized in five components, which are as follows: Cultural ideas- It includes the system of rules, plans and regulations in the community used as orientation points by persons to evaluate and critic food behaviours. Persona factors- These include the features of persons influencing their food choice behaviours and decisions like genetic predisposition to disease, sensory sensitivity to food tastes, food preferences, personality, gender roles, parent responsibilities etc (3). Resources- These are the possessions people believe for making food choice decision like income, wealth, equipment, space, skills, knowledge, relationships, connections, values, traditions etc. Social factors- These include social relationship system for individual that can constrain or facilitate food choice decisions like, eating with co-workers, family support to eat healthy (2). Present context- These include the current scenario, where the individual is developing food choices like economic conditions, government policies, and mass media, climate, physical structures etc. Personal food system- It includes the cognitive methods for choosing food, which can guide food consumption behaviours like food choice principles, arbitration and pondering food choice values, categorization of foods and situation etc. In addition, personal process of food choice also includes strategy, routines and script development for recurring food decisions. Food choice values include taste, cost, health, convenience, health, overseeing affairs and feelings attached to it (5). Prioritizing these values, people negotiate and balance their food choices. On the other hand, food choice strategies comprise removal, limitation, replacement, calculation, amendment and routinization, making food selection more automatic or habitable. Comparing these two models, i.e. the HBM and food process model, it has been revealed that HBM is covering all the aspects regarding the perceptions regarding human health, however, this model does not include several alternative drivers of human food choice and behaviour. These drivers have been addressed by the food process model, i.e. it addresses the emotional, social, environmental, physical as well as contextual factors that can influence the food behaviour of an individual. It also shows the link between these factors, which is also not shown adequately in HBM. 4.Critique of proposed model of food choice Although the above discussed mode addresses several alternative drivers of food choices along with the impact of these drivers on individuals life and management, no model is perfect. However, this model does not include food accessibility or availability related factors or drivers, but these factors should be considered, because food choice is critically dependent upon the availability of food (8). Reference List Furst T, Connors M, Bisogni CA, Sobal J, Falk LW. Food choice: a conceptual model of the process. Appetite. 1996 Jun 30;26(3):247-66. Sobal, J., Bisogni, C. A., Devine, C. M., Jastran, M. (2006). A conceptual model of the food choice process over the life course.Frontiers in Nutritional Science,3, 1. Green, E. C., Murphy, E. (2014). Health belief model.The Wiley Blackwell Encyclopedia of Health, Illness, Behavior, and Society. 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