During the COVID-19 pandemic, the entire world found itself forced into an accelerated crash course in collective problem-solving. Scientists were pressured to identify the viral mechanism, validate testing, and collaborate across borders to fast-track a vaccine at a pace that would have been unthinkable even a decade earlier. But once the scientific hurdle was cleared, another challenge loomed even larger: public acceptance. A fast-tracked vaccine—paired with subsequent booster recommendations—landed in a population already stretched thin by fear, misinformation, political polarization, and deep distrust of government and healthcare systems.

Because of this, public health researchers turned to theory—specifically, behavioral and attitudinal models—to understand how individuals make decisions about health risks. Several models reappeared across the literature: the Health Belief Model (HBM), the Theory of Planned Behavior (TPB), Protection Motivation Theory (PMT), and the Knowledge-Attitude-Behavior (KAB) framework (Shmueli, 2021; Trifiletti, Shamloo, Faccini, & Zaka, 2022; Zheng, Jiang, & Wu, 2022). Each offered a different lens through which to understand why some people lined up eagerly for vaccination while others declined, delayed, or remained adamantly opposed.

Health Belief Model (HBM)

The Health Belief Model frames health behavior as a balance between perceived risks, benefits, and barriers—mixed with a final “cue to action” that pushes an individual towards behavior change. In the context of COVID-19, this cue could be anything from a physician’s recommendation to media coverage of rising death rates. Yet HBM also highlights what stands in the way: the now-well-documented phenomenon of vaccine hesitancy.

Vaccine hesitancy encompasses the expectation that a person may delay or refuse vaccination because of fears about rushed development, insufficient testing, political distrust, concerns about personal freedoms, fear of needles, complacency, perceived low risk of infection, and apprehension about potential side effects (Hagger & Hamilton, 2022). Importantly, these attitudes continue to shape booster uptake. Even individuals who ultimately decided to receive the initial vaccine may remain hesitant toward additional doses if their earlier fears were never meaningfully addressed.

HBM also emphasizes perceived susceptibility and perceived threat—two beliefs that heavily influenced decisions throughout the pandemic (Trifiletti et al., 2022). People who believed COVID posed a serious threat were significantly more likely to vaccinate; those who felt personally insulated from risk tended to delay.

Knowledge-Attitude-Behavior (KAB)

Given how stubborn these barriers were, researchers also examined whether improving knowledge could shift attitudes. KAB theory proposes that accurate information increases positive attitudes, which in turn increase the likelihood of behavioral follow-through. Studies applying this lens argued that improving public understanding of vaccine science could strengthen intention to vaccinate (Trifiletti et al., 2022; Zheng et al., 2022). Knowledge alone is not always enough—but misinformation unquestionably worsened hesitancy.

Theory of Planned Behavior (TPB)

The Theory of Planned Behavior adds clarity to the social dimension of decision-making. Its premise is simple: intention predicts behavior, and intention is shaped by attitude, subjective norms, and perceived behavioral control. During COVID-19, these predictors were all highly volatile. Individuals were influenced not only by scientific evidence but also by political identity, social media narratives, community norms, the opinions of their personal networks, and the perceived ease or difficulty of accessing vaccination (Zheng et al., 2022; Hagger & Hamilton, 2022).

TPB reinforces what many clinicians observed firsthand: even strong scientific messaging often struggled to compete with family influence, political beliefs, and peer pressure.

Protection Motivation Theory (PMT)

Protection Motivation Theory overlaps with HBM but adds a focus on fear appraisal and coping appraisal. PMT suggests that individuals engage in preventive behaviors when they (a) perceive a threat as serious, (b) believe they are personally vulnerable, (c) believe the recommended behavior will mitigate that threat, and (d) feel confident they can carry out the behavior.

Across the research, self-efficacy consistently emerged as the strongest predictor of vaccine intention (Zheng et al., 2022). If people believe they can navigate the process—get to an appointment, manage side effects, trust their own ability to take action—they are far more likely to follow through.

In Sum

All four models—HBM, TPB, PMT, and KAB—reinforced the same truth: achieving widespread vaccine acceptance is not just a scientific endeavor; it is a human-behavior challenge. And behavioral change requires clarity, trust, credible messengers, consistent communication, and a deep understanding of what drives or deters people at the psychological, social, and emotional levels.

Reframing These Lessons: What COVID-Era Behavior Models Teach Us About Rebuilding OT

When you step back from the public-health literature, an unexpected truth emerges: the same theories used to understand population-level behavior during COVID-19 apply directly to the cultural crisis within occupational therapy today.

For decades, we have tried to define, explain, and elevate OT through white papers, position statements, and internal documents that—let’s be honest—almost nobody reads. We have relied on the same strategies since the 1970s and assumed that if we just published better frameworks or produced cleaner terminology, the world would finally “get” what we do.

It didn’t work.

Our identity remains fragmented. Our value is misunderstood. Reimbursement is collapsing. Assistants are devalued. Graduation debt is skyrocketing. And still, the public has almost no idea what OT actually is.

So what if we applied HBM, TPB, PMT, and KAB—not to vaccines, but to our own profession?

What if we rebuilt OT the same way public health campaigns influence behavior—through grassroots truth-telling, identity-shaping, and strategic communication that actually meets people where they are?

Here are some thoughts.

1. The Health Belief Model (HBM): Change happens when perceived benefits outweigh perceived barriers.

For OT, that means:

• We must clarify the benefit of OT in plain language, not jargon—“We help people function,” “We restore thinking,” “We rebuild lives”—not “We facilitate engagement in meaningful occupations.”

• We must minimize barriers to accessing OT: unclear identity, inconsistent messaging, advocacy that doesn’t match clinician experience.

• We must create cues to action—simple, repeatable messages pushed consistently through social media, patient stories, and community channels, not once-a-year campaigns buried on AOTA’s website.

If people don’t understand what OT is, they won’t value it, fund it, or fight for it.

2. Theory of Planned Behavior (TPB): Belief + social norms + perceived control drive action.

Right now, the social norm outside OT is that PT is movement, SLP is communication, and OT is “fine motor crafts.”

Our job is to shift the norm.

To do this, we need:

• Grassroots cultural pressure, not institutional memos.

• Clinician-led messaging, not 40-page PDFs.

• Visible, repeated narratives of OT solving real, serious problems—brain injury recovery, chronic disease management, fall reduction, executive function rehabilitation.

We don’t change perception by saying “OT is holistic.”
We change perception by showing real humans reclaiming real lives because of OT.

3. Protection Motivation Theory (PMT): People act when they perceive real threat AND real capability.

OT is under threat—payment cuts, assistant margins, shrinking telehealth authority, algorithm-driven care models, deprofessionalization.

We need clinicians to recognize the threat and believe they can act.

Guerrilla-style advocacy can give practitioners that sense of capability:

• Small, rapid actions: template letters, auto-generated emails to legislators, infographics ready to post in 10 seconds.

• Clinician-facing “micro-wins”: celebrating each policy shift, reimbursement change, or community milestone to reinforce that action works.

• Collective identity: a movement, not a membership card.

When people feel powerful, they move.

4. Knowledge-Attitude-Behavior (KAB): People act differently when they truly understand what’s at stake.

The OT profession keeps trying to change attitude without first delivering knowledge that hits emotionally and socially—not academically.

KAB in OT requires:

• Clear, repeatable education about what OT does and why it matters.

• Data visualized for real humans—not just researchers.

• Messaging grounded in patient outcomes, not theoretical constructs.

• Infographics, reels, short-form stories, podcasts, community conversations that make OT unavoidable in the public square.

OT needs a public literacy campaign, not another internal document.

So what does all of this mean?

It means that redefining OT is not a philosophical exercise—
it is a behavior-change campaign.

A guerrilla movement.

A grassroots identity shift powered by clinicians, not committees.

Everything the vaccine literature revealed about human behavior, persuasion, barriers, and motivation provides a roadmap:

• Get clear.

• Get loud.

• Get simple.

• Get visible.

• Get consistent.

• Get community-driven.

Because the decades of “top-down” identity-building—academic arguments, terminology wars, internal debates—did not change public perception.

But a coordinated, theory-informed, clinician-led communication movement absolutely could.

And that is the opportunity in front of us:
to rethink OT not by rewriting another document,
but by shifting how humans understand us—
one narrative, one message, one grassroots action at a time.

References

Hagger, M. S., & Hamilton, K. (2022). Predicting COVID‐19 booster vaccine intentions. Applied Psychology: Health and Well-Being, 14(3), 819–841. doi:10.1111/aphw.12349

Shmueli, L. (2021). Predicting intention to receive COVID-19 vaccine among the general population using the health belief model and the theory of planned behavior model. BMC Public Health, 21(1), 804. doi:10.1186/s12889-021-10816-7

Trifiletti, E., Shamloo, S. E., Faccini, M., & Zaka, A. (2022). Psychological predictors of protective behaviours during the Covid‐19 pandemic: Theory of planned behaviour and risk perception. Journal of Community & Applied Social Psychology, 32(3), 382–397. doi:10.1002/casp.2509

Zheng, H., Jiang, S., & Wu, Q. (2022). Factors influencing COVID-19 vaccination intention: The roles of vaccine knowledge, vaccine risk perception, and doctor-patient communication. Patient education and counseling, 105(2), 277–283. doi:10.1016/j.pec.2021.09.023