Objective: To determine if the tenets of the health belief model explain exercise behavior among residents of Kakamega county. Design: The study design was a cross-sectional analytical, that utilized quantitative methods. Setting: The study was conducted in Kakamega County, located in Western Kenya. Kakamega County has twelve sub-counties; Kakamega North (Malava), Kakamega Central (Lurambi), Kakamega South (Ikolomani), Kakamega East (Shinyalu) and Butere/Mumias. Sample: Simple random sampling was used to sample respondents. The formula that was used for calculating the sample size was Cochran with an attrition rate of 10% (n = 221). The sample consisted of participants from five sub-counties of Kakamega: Kakamega central (23.1%), Kakamega south (22.6%), Kakamega east (22.2%), Butere (17.5%) and Kakamega north (14.5%) Analysis: Data were analyzed through structural equation modeling (SEM). The alpha level for all the computations was considered significant at an α <0.05. Main outcome measures: Perceived susceptibility, modifying factors, perceived threat, perceived severity, cues to action and exercise behavior Results: The measurement model included six latent constructs measured by 22 indicator variables. All of the completely standardized parameter estimates obtained were significantly different from zero (t > 1.96) and loaded satisfactorily onto their corresponding latent variable. In the structural model, the estimation of this hypothesized structural model yielded an acceptable fit to the data, χ2 =1434.7, df = 680; χ2/df ratio =2.453(good), CFI = .822; RMSEA = .059, with 90% C.I. = .045 - .075, SRMR = .058. The perceived threat was a direct predictor of exercise behavior (β = .294, p < .001), the variable formed by perceived benefits minus perceived barriers was a direct predictor of exercise behavior (β = .017, p <.001). All variables explained 57% of the variance in exercise behavior. Conclusion: The health belief model provided useful insight in explaining exercise behavior of the respondents. Other theories should be investigated (e.g. Social Cognitive Theory, Health Action Process Approach) to determine which theory better explains behavior in the context and population of interest. Article visualizations
