To apply the Health Belief Model (HBM) to fall prevention of the elderly and estimate fall health beliefs and their relationships with fall-related behaviors, a citywide cross-sectional study was conducted among people aged 60 years or over in 13 out of 16 districts in Shanghai, China, in September 2018. A total of 5833 participants were investigated. Of this, 43.4% were male; 48.8% were aged 60-69; 18.1% were uneducated; and 50.3% were living in urban areas. People who were older, less educated, living in rural areas generally had lower scores in the 7 HBM dimensions and also had lower proportions of fall risk-reduction behaviors, except that the less educated elderly were more likely to participate in exercise and training and the rural elderly were more likely to check house environment and participate in exercise and training (p < 0.001). The HBM dimensions were generally positively correlated with the risk-reduction behaviors except that "perceived severity" was negatively correlated with four risk-reduction behaviors and behavior number, "cues to action" was negatively correlated with purchasing shoes, and "perceived benefits" was negatively correlated with participating in exercise activities and fall prevention training (p < 0.05). When HBM is applied in the field of fall prevention, the interpretation of the results of each dimension has its characteristics in the fields of injury research. Fall prevention strategies should focus on improving the health beliefs and behaviors in those who were older, less educated and living in rural areas, implementing different levels of fall prevention activities to meet different needs, improving the accessibility and applicability of related resources, and raising the organizational level of related fall prevention activities.
Keywords: association; falls; health belief; risk behavior; the elderly.