Help-seeking perceived norm is a person’s overall perception of social pressure/encouragement to seek mental health help from a professional. It is the degree to which the person feels pressure/encouragement from the people around them (particularly people who are important to the respondent and salient in the respondent’s life, called “referents” in the IBM-HS) to seek help. Including the word “perceived” in the name of the construct is important because perceptions ultimately drive decision making, even if those perceptions are not an accurate reflection of what the people around a respondent actually expect or do related to help seeking.
When studying the behavior of seeking help from a mental health professional, “perceived norm” is shorthand for “perceived norm related to seeking help from a mental health professional.” Help-seeking perceived norm is a frequently studied help-seeking construct and is incorporated into certain medical/health/social scientific theories used to studying health services treatment access.
Within the more recent reasoned action tradition theories including the IBM-HS, perceived norm has both an injunctive (i.e., what others expect the respondent to do) element and a descriptive (i.e., what others would do themselves) element that are shaped by beliefs about others’ expectations and beliefs about others’ behavior, respectively (Fishbein & Ajzen, 2010, Hammer et al., 2023; Montaño & Kasprzyk, 2015). In the IBM-HS, perceived norm is considered a hierarchical construct defined by two facets: injunctive norm (sample item: “It would be expected of me that I seek help”) and descriptive norm (sample item: “Most people who are important to me would seek help”). Depending on the sample in question, it may be more appropriate to measure perceived norm with (1) a single perceived norm score reflecting an “essentially unidimensional” (Stout, 1990) construct or (2) both a perceived injunctive norm score and a perceived descriptive norm score reflecting a hierarchical construct defined by two correlated first-order factors. Please note that older reasoned action tradition theories have used the term “subjective norm” and this has often been operationalized with a sole focus on injunctive norms, but we strongly recommend professionals consider using the construct of perceived norm (with its dual-facet conceptualization) to maximize comprehensiveness and clarity in future help-seeking research.
We recommend using the singular term “perceived norm” (as proposed to the plural “perceived norms”), as this emphasizes that perceived norm is an index of overall perception of (non)support across referents as a collective group. We also recommend use of the terms “less/more supportive” to quantify the direction of the perceived norm construct, and discourage use of terms such as “positive/negative” or “greater/lesser” or “better/worse” that do not carry the same precision or can come across as pathologizing.
People will report a more supportive perceived norm (i.e., feel more social pressure/encouragement to seek help) when they believe that salient referents (a) expect them to seek help and (b) would themselves seek help. There is empirical support for this association between beliefs about others’ expectations/behavior and perceived norm within (Hammer et al., 2023) and beyond (Fishbein & Ajzen, 2010 Ch4; Montaño & Kasprzyk, 2015) the mental health help-seeking context. Literature (Fishbein & Ajzen, 2010) notes that this association is predicated on the assumption that people are motivated to comply with the expectations of salient referents (sample motivation to comply item: “How much would you care about the opinion of your [friends] when it comes to your decisions about mental healthcare?”) and identify with those referents (sample identification item: “How much do you want to be like your [friends] when it comes to your decisions about mental healthcare?”), which may or may not be true for certain referents for a given population.
Help-seeking perceived norm is important to study because meta-analytic evidence suggests that perceived norm is often, but not always, a significant predictor of help seeking intention (Adams et al., 2002). As of the time of this writing, Dr. Hammer is not aware of a meta-analysis that has examined the relationship between mental health help-seeking perceived norm (or the prior reasoned action tradition term of “subjective norm”) and related constructs. In summary, because people’s perceived norm may (it depends on the population in question) influence their behavior via intention (Armitage & Conner, 2001), professionals may be able to increase help seeking behavior for a given population by implementing prevention and intervention programs that improve people’s help seeking perceived norm.
A description of available mental health help-seeking perceived norm measures can be found on the Perceived Norm measures page.
(Please note: select page content is excerpted from Hammer et al., 2024.)