Precaution Adoption Process Model

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Experimental Evidence for

Stages of Health Behavior Change:

The Precaution Adoption Process Model

Applied to Home Radon Testing

By Neil D. Weinstein, Judith E. Lyon, Peter M. Sandman, and Cara L. Cuite

Health Psychology, 1998, Vol 17. No. 5, pp. 445-453.

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Hypotheses generated by the precaution adoption process model, a stage model of health behavior, were tested in the context of home radon testing. The specific idea tested was that the barriers impeding progress toward protective action change from stage to stage. An intervention describing a high risk of radon problems in study area homes was designed to encourage homeowners in the model's undecided stage to decide to test, and a low-effort, how-to-test intervention was designed to encourage homeowners in the decided -to-act stage to order test kits. Interventions were delivered in a factorial design that created conditions matched or mismatched to the recipient's stage (N = 1,897). Both movement to a stage closer to testing and purchase of radon test kits were assessed. As predicted, the risk treatment was relatively more effective in getting undecided people to decide to test than in getting decided-to-act people to order a test. Also supporting predictions, the low-effort intervention proved relatively more effective in getting decided-to-act people to order tests than in getting undecided people to decide to test.

Index

The Precaution Adoption Process Model (PAPM)

Examining the PAPM in the Context of Home Radon Testing

Method

Overview of Study Design

Site Selection

Participation Criteria

Materials

Procedure

Results

Study Sample

Manipulation Checks and Preintervention Differences Between Stages

Predicting Progress Toward Action

Predicting Test Orders

Calculations of Two-Stage Transitions

Discussion

Predictions of the Precaution Adoption Process Model

The Combination Condition

Conclusion

Note

Acknowledgments

References

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Most current theories of individual health behavior consist of a set of variables thought to be important and a rule (or equation) prescribing how these variables should be combined (Conner & Norman, 1996; Weinstein, 1993). However, a number of researchers have questioned whether reactions to health hazards can be represented adequately by a single prediction rule. Instead, they describe the adoption of. precautions in terms of a series of stages (Baranowski, 1992-1993; Horn, 1976 ; Janis & Mann, 1977; Prochaska & DiClemente, 1983; Weinstein, 1988; Weinstein & Sandman, 1992).

The most distinctive and potentially useful feature of stage theories is the idea that the determinants of progress toward protective action vary from stage to stage. The factors most important in getting someone to first pay attention to a risk, for example, may not be the ones that are most important in determining whether he or she eventually decides to take action. Thus, stage theories imply that treatments need to be matched to the stage of the audience, focusing on the specific barriers that inhibit movement to the next stage and changing over time as the audience progresses from stage to stage (DiClemente, Carbonari, & Velasquez, 1992). By suggesting how to tailor interventions to audiences, stage theories offer the prospect of more effective and more efficient behavior change efforts.

Most non-stage theories, in contrast, are based on a single theoretically or empirically derived equation (e.g., Ajzen & Madden, 1986; Fishbein & Ajzen, 1975; Ronis, 1992). This equation generates a numerical value for each person, and this value is interpreted as the likelihood that the person will take action. The prediction equation thus places each person along a continuum, and the goal of interventions is to move people along the continuum. Such an approach acknowledges quantitative differences among people, but it does not admit the possibility of qualitative changes in the barriers that interfere with progress. The notion of matching interventions to people is either incidental or completely missing in this approach.

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The Precaution Adoption Process Model (PAPM)

go to index This present article describes an experimental test of a particular stage theory, the precaution adoption process model (Weinstein, 1988; Weinstein & Sandman, 1992). The PAPM distinguishes among seven stages:

1. unaware of the health action;

2. aware but not personally engaged;

3. engaged and trying to decide what to do;

4. decided not to act (a step out of the sequence toward action);

5. decided to act but not yet having acted;

6. acting; and

7. maintaining the new health-protective behavior

(Weinstein & Sandman, 1992).

Thus, the proposed sequence of stages leading to action is 1-2-3-5-6-7. The model asserts that people usually pass through this sequence in order, without skipping any stage, although there is no minimum length of time that must be spent in any one stage. Movement backward toward an earlier stage can also occur.

Some data have been published