riskbar2.jpg - 10660 Bytes
blue-bar.jpg - 2595 Bytes
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.
blue-bar.jpg - 2595 Bytes
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.
The Precaution Adoption Process Model (PAPM)
Examining the PAPM in the Context of Home Radon Testing
Overview of Study Design
Manipulation Checks and Preintervention Differences Between Stages Predicting Progress Toward Action
Predicting Test Orders
Calculations of Two-Stage Transitions
Predictions of the Precaution Adoption Process Model
The Combination Condition
blue-bar.jpg - 2595 Bytes
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,...
References: Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179–211.
Ajzen, I., & Madden, T.J. (1986). Prediction of goal-directed behavior: Attitudes, intentions, and perceived behavioral control. Journal of Experimental Social Psychology, 22, 453–474.
Baranowski, T. (1992–1993). Beliefs as motivational influences in stages in behavior change. International Quarterly of Community Health Education, 13, 3–29.
Campbell, M.K., DeVellis, B.M., Strecher, V.J., Ammerman, A.S., DeVellis, R.F., & Sandler; R.S. (1994). Improving dietary behavior The effectiveness of tailored messages in primary care settings. American Journal of Public Health 84, 783–787.
Conner, M., & Norman, P. (1996). Predicting health behavior. Philadelphia Open University Press.
DiClemente, C.C., Carbonari, J.P., & Velasquez, M.M. (1992). Alcohol treatment mismatching from a process of change perspective. In R.R. Watson (Ed.), Drug and alcohol abuse reviews (Vol. 3, pp. 115–142). Totowa, NJ: Humana Press.
Doyle, J.K., McClelland, G.H., & Schulze, W. D. (1991). Protective responses to household risk: A case study of radon mitigation. Risk Analysis, 11, 121–134.
Fishbein., M., & Ajzen, I. (1975). Belief, attitude, intention and behavior: An introduction to theory and research. Reading, MA: Addison-Wesley.
Grafton, H.E. (1990). Indoor radon levels in Columbus and Franklin County, Ohio residences, commercial buildings, and schools. In The 1990 International Symposium on Radon and Radon Reduction Technology (EPA No. 600/9-90/00a, v. 1-Preprints, A-I-1).
Horn, D. (1976). A model for the study of personal choice health change. International Journal of Health Education, 19, 88–97.
Janis, I.L, & Mann, L. (1977). Decision making: A psychological analysis of conflict, choice, and commitment. New York: Free Press.
National Academy of Sciences (1988). Health effects of radon and other internally deposited alpha-emitters: BEIR IV. Washington, DC: National Academy Press.
Prochaska, J.O., & DiClemente, C.C. (1983). Stages and processes of self-change in smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psycholology. 51, 390–395.
Prochaska, J.O., DiClemente, C.C.,Velicer, W.F., & Rossi, L.S. (1993). Standardized, individualized, interactive, and personalized self-help programs for stages of smoking cessation. Health Psychology, 12, 399–405.
Pushkin, J.S., (1992). An analysis of the uncertainties in estimates of radon-induced lung cancer. Risk Analysis, 12, 277–285.
Ronis, D.L (1992). Conditional health threats: Health beliefs, decisions, and behaviors among adults. Health Psychology, 11, 127–134.
Sandman, P.M., & Weinstein, N.D. (1993). Predictors of home radon testing and implications for testing promotion programs. Health Education Quarterly. 20, 1–17.
Skinner, C.S., Strecher, V.J., & Hospers, H. (1994). Physicians ' recommendations for mammography: Do tailored. messages make a difference? American Journal of Public Health, 84, 43–49.
U.S. Environmental Protection Agency, Radon Division, Office of Radiation and Indoor Air (1993, Sept). EPA 's map of radon zones, Ohio. Washington, DC: Author.
U.S. Environmental Protection Agency, Office of Radiation Progams (1991). National residential radon survey: Statistical analysis, national and regional estimates: Volume I. Washington, DC: Author.
U.S. Environmental Protection Agency, Office of Radiation Programs, & U.S. Department of Health and Human Services, Centers for Disease Control (1992a). A citizen 's guide to radon (2nd ed.). Washington, DC: Author.
U.S. Environmental Protection Agency, Office of Radiation Programs (1992b, May). Technical support document for the citizen 's guide to radon (EPA 400-R-92-011). Washington, DC: Author.
Weinstein, N.D. (1988). The precaution adoption process. Health Psychology, 7, 355–386.
Weinstein N.D. (1993). Testing four competing theories of health-protective behavior. Health Psychology, 12, 324– 333.
Weinstein, N.D., Rothman, A.M., & Sutton, S.R. (1998). Stage theories of health behavior: Conceptual and methodological issues. Health Psychology, 17, 290–299.
Weinstein, N.D., & Sandman, P.M (1992). A model of the precaution adoption process: Evidence from home radon testing. Health Psychology, 11, 170–180.
Weinstein,. N.D., Sandman,. P.M., & Roberts, N.E. (1990). Determinants of self-protective behavior: Home radon testing. Journal of Applied Social Psychology, 20, 783–801.
Weinstein, N.D., Sandman, P.M., & Roberts, N.E. (1991). Perceived susceptibility and self-protective behavior: A field experiment to encourage home radon testing. Health Psychology, 10, 25–33.
Please join StudyMode to read the full document