ChapterPDF Available

The Precaution Adoption Process Model and its Application

“The Precaution Adoption Process Model and Its Application” (Neil D. Weinstein and
Peter M. Sandman), in Ralph J. DiClemente, Richard A. Crosby, and Michelle C. Kegler
(eds.), Emerging Theories in Health Promotion Practice and Research (San Francisco:
Jossey-Bass), pp. 16–39.
I don’t have an uploadable copy of this book chapter. You would need to get the book
itself through an interlibrary loan program.
Note however that two relevant research articles and a different book chapter are
available on my website. They are described and linked at
Here is an excerpt from that index:
 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
This is one of two articles I have posted dealing with the Precaution Adoption Process
Model, developed mostly by Neil Weinstein and tested by Neil and me (and colleagues)
using radon as the test case. The other article, A Model of the Precaution Adoption
Process: Evidence From Home Radon Testing, is statistically heavier going and
methodologically less rigorous, but covers more ground: It says more about how people
decide to test their homes for radon, and contains a more detailed description of the
model itself. This one has more convincing evidence that people decide to take
precautions – in this case to test for radon – in stages, and that different interventions
work best at different stages. See also The Precaution Adoption Process Model,” a
2008 book chapter that overviews the PAPM more generally.
 A Model of the Precaution Adoption Process: Evidence From Home Radon Testing
by Neil D. Weinstein and Peter M. Sandman
Health Psychology, 1992, 11(3), pp. 170–180
For about a decade, Neil Weinstein and I (with colleagues) did research on radon – a
high-hazard low-outrage risk that first became important in the mid-1980s. This article
uses several of our radon data sets to illustrate Neil’s Precaution Adoption Process Model
(PAPM). The PAPM is one of several contending models of how people actually decide
whether or not to protect themselves from risks. Different models lead to different
interventions, so the competition over which model best explains people’s behavior is
important for those trying to persuade publics to take precautions about serious hazards.
(I've also posted another article, Experimental Evidence for Stages of Health Behavior
Change: The Precaution Adoption Process Model Applied to Home Radon Testing, on
the PAPM and radon, this one reporting a later experiment demonstrating that the
decision to test does happen in separate stages. See also The Precaution Adoption Process
Model,” a 2008 book chapter that overviews the PAPM more generally.)
I hope this is helpful.
--Peter Sandman
Peter M. Sandman
9 Prospect Park W Apt 15A
Brooklyn, NY 11215-1741
(718) 208-6271
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... The process can be explained within the framework of the Precaution Adoption Process Model (PAPM). The model demonstrates how risk mediation mechanisms form pathways to health-protective behaviours, such as vaccination [3,4]. The PAPM consists of seven stages from "unaware" to "action" to "maintenance" of healthprotective behaviours. ...
... The PAPM consists of seven stages from "unaware" to "action" to "maintenance" of healthprotective behaviours. The model also identifies factors (such as barriers to health care, self-efficacy, trust in information sources, decision-making styles, educational level, attitude, and intention) that facilitate or impede movement through the seven stages [3,[5][6][7]. ...
... In Stage 2 women engage with the decisionmaking process of whether or not the MPV is important or relevant to them. Stage 2 can only be entered once women become aware of the MPV, in other words, once women have entered Stage 1 [3]. After Stage 2, women can enter Stage 2B and search for (additional) information to support the decision-making process, and subsequently enter Stage 3, at which point the decision to vaccinate or not is made. ...
Full-text available
Background Effective and safe vaccines are available outside national immunization programs (NIP). Increased awareness and vaccine uptake can improve public health. Before the inclusion of maternal pertussis vaccination (MPV) in the Dutch NIP in December 2019, extra communication efforts were undertaken. Here we examine the success of these efforts, investigating women’s awareness of and their decision-making process regarding MPV. Methods Between December 2018 and January 2019, one year before the introduction of MPV in the NIP, and about three years after MPV was recommended by the Dutch Health Council, pregnant and non-pregnant women (i.e. child younger than two years) were invited to fill out an online questionnaire. Participant’s decision-making processes regarding MPV were assessed with an adapted Precaution Adoption Process Model (PAPM), including stages of awareness, engagement, information-seeking, and vaccination behaviour. Furthermore, factors related to the decision-making process were examined. Results In total, 942 women were included, of whom 62% were non-pregnant. Most of the pregnant and nonpregnant women were aware of MPV during pregnancy (respectively 69 and 56%). Most aware women had heard about MPV through their midwife and the Public Health Institute (PHI) website. Women unaware of MPV reported a need for information, preferably from their midwives. Most aware women felt MPV was important to them (88%) and were classified as “engaged”. Of the eligible and “engaged” pregnant women, 58% were vaccinated, versus 38% of “engaged” non-pregnant women. Conclusions As the most preferred and trusted source of information, midwives are essential to increasing awareness of MPV. The PHI website is considered to be a reliable information source and is often consulted. To increase awareness, appropriate healthcare workers should be encouraged to actively inform target groups about available, additional vaccinations.
... It is also important to differentiate between no and don't know responses about alcohol as a cancer risk factor in terms of the mechanisms that may underlie each response. Stage theories of behavioral decision making and behavior change differentiate between people who are not aware of health risks posed by behavior from people who are aware but chose not to engage in preventive health behaviors (Weinstein et al., 2002;Prochaska et al., 1992), with implications for diverse motivational mechanisms. Our work finds that the demographic and cancer belief correlates are similar across the two types of responses. ...
... Our work finds that the demographic and cancer belief correlates are similar across the two types of responses. Apart from this finding, from a decision-making perspective these theories posit that different decision-making mechanisms may be involved and that therefore different intervention strategies are necessary for each group (Weinstein et al., 2002;Prochaska et al., 1992). Although we believe that it is premature to draw strong conclusions about mechanisms from the datathe above are only hypothesized possibilitiesit appears that no and don't know responses are meaningfully different from one another, have different demographic and psychosocial mechanisms, and should be considered and addressed separately. ...
Full-text available
Alcohol is a carcinogen. Recommendations to reduce alcohol use to lower cancer risk are increasingly common. However, neither the beliefs of US adults about alcohol consumption and cancer risk, nor factors influencing those beliefs, are well understood. We used data from the 2019 Health Information National Trends Survey (analysis N=4,470) to examine beliefs about whether drinking too much alcohol increases cancer risk. We compared those beliefs to beliefs for three other health problems, and examined whether believing alcohol is a cancer risk factor was related to demographics, risk perceptions, other beliefs about the nature of cancer, and alcohol consumption behavior. Only 33% of US adults reported believing that alcohol is a cancer risk factor; 27% stated that it was not, and the highest proportion (40%) reported they did not know. Misbeliefs and lack of knowledge about alcohol and health outcomes were higher for cancer than other outcomes. Higher age, education, seeking health information, risk perceptions, and pessimistic beliefs about cancer predicted both lack of knowledge and misbeliefs about alcohol use and cancer. However, misbeliefs and lack of knowledge were not limited to those who reported alcohol consumption. Demographic and psychosocial factors are associated with problematic beliefs about alcohol’s role as a risk factor for cancer. Because perceived risk for health problems is a driver of behavior change, cancer prevention and control efforts to reduce alcohol consumption must attend to and address both the misperceptions about and lack of knowledge of alcohol’s role in increasing risk for cancer.
... Intervention and trial design are guided by the Health Belief Model (HBM), 24 the Precaution Adoption Process Model and Self-Determination Theory. [25][26][27][28] The HBM suggests that people's use of preventive services is explained by their perceived threat of disease, benefits of the service, barriers to and self-efficacy for obtaining screening. The model also acknowledges the need for a stimulus, or cue to action, to trigger the behaviour. ...
... The Precaution Adoption Process Model provides this guidance by building on the core elements of the HBM and considering how a person comes to decisions to take action. 26 Specifically, the individual's readiness to engage in the healthful behaviour is based on their 'decision stage'. The premise behind the model is that different factors influence different stage transitions and that messages can be strategically designed to move individuals through the stages. ...
Full-text available
Introduction How to provide practice-integrated decision support to patients remains a challenge. We are testing the effectiveness of a practice-integrated programme targeting patients with a physician recommendation for colorectal cancer (CRC) screening. Methods and analysis In partnership with healthcare teams, we developed ‘e-assist: Colon Health’, a patient-targeted, postvisit CRC screening decision support programme. The programme is housed within an electronic health record (EHR)-embedded patient portal. It leverages a physician screening recommendation as the cue to action and uses the portal to enrol and intervene with patients. Programme content complements patient–physician discussions by encouraging screening, addressing common questions and assisting with barrier removal. For evaluation, we are using a randomised trial in which patients are randomised to receive e-assist: Colon Health or one of two controls (usual care plus or usual care). Trial participants are average-risk, aged 50–75 years, due for CRC screening and received a physician order for stool testing or colonoscopy. Effectiveness will be evaluated by comparing screening use, as documented in the EHR, between trial enrollees in the e-assist: Colon Health and usual care plus (CRC screening information receipt) groups. Secondary outcomes include patient-perceived benefits of, barriers to and support for CRC screening and patient-reported CRC screening intent. The usual care group will be used to estimate screening use without intervention and programme impact at the population level. Differences in outcomes by study arm will be estimated with hierarchical logit models where patients are nested within physicians. Ethics and dissemination All trial aspects have been approved by the Institutional Review Board of the health system in which the trial is being conducted. We will disseminate findings in diverse scientific venues and will target clinical and quality improvement audiences via other venues. The intervention could serve as a model for filling the gap between physician recommendations and patient action. Trial registration number NCT02798224 ; Pre-results.
... Definition Precaution Adoption Process Model ( Weinstein and Sandman, 2002) Transtheoretical Model (Prochaska et al., 2008) Health Action Process Approach (Schwarzer and Luszczynska, 2008) Four Phases of the Behavior Change Process (Rothman et al., 2004) Rubicon Model of Action Phases ( Gollwitzer, 1990) Unawareness executive engagement phase, motivation is translated into action and then habituated. ...
Full-text available
With increasing prevalence of lifestyle-related chronic diseases worldwide, understanding health behavior change and development of successful interventions to support lifestyle modification is gaining increasing interest among politicians, scientists, therapists and patients alike. A number of health behavior change theories have been developed aiming at explaining health behavior change and understanding the domains that make change more likely. Until now, only few studies have taken into account automatic, implicit or non-cognitive aspects of behavior, including emotion and positive affect. Recent progress in the neuroscience of motivation and reward systems can provide further insights into the relevance of such domains. In this integrative review, we present a description of the possible motivation and reward systems (approach/wanting = pleasure; aversion/avoiding = relief; assertion/non-wanting = quiescence) involved in behavior change. Therefore, based on established theories encompassing both initiation and maintenance of behavior change, we create a flexible seven-stage behavior change process with three engagement phases (non-engagement, motivational engagement, executive engagement) and relate the motivation and reward systems to each of these stages. We propose that either appetitive (preferably) or aversive motivational salience is activated during motivational engagement, that learning leads to continued behavior and that assertive salience prevails when the new behavior has become habitual. We discuss under which circumstances these mechanisms and reward-motivation pathways are likely to occur and address potential shortcomings of our proposed theoretical framework. We highlight implications for future interventions aiming at lifestyle modification.
... For example, we identi ed three broad categories of screening-eligible individuals: (1) those who picked up and returned a FIT kit; (2) those who picked up, but did not return the kit; and (3) those who did not pick up a kit. These could then be conceptualized using stage-based behavior change theories to inform targeted interventions, such as the Transtheoretical Model of Behavior Change (TTM) which has been used to understand and predict enhance of health-promoting behaviors [23], the Precaution-Adoption Process Model (PAPM) that focuses on reaching high-resistant groups [24], or the Health Action Process Approach (HAPA) [25]. ...
Full-text available
Background In Catalonia (Spain), most CRC screening hubs use the pharmacy-based model to distribute and collect the fecal immunochemical test (FIT) kits. The comprehensive evaluation of CRC screening programs, which include the role and implications of pharmacy involvement, is essential to ensure program quality and identify areas for further improvement. The present study aimed to analyze pharmacy collaboration with the screening program and pharmacy-based FIT kit distribution. Methods A descriptive study to describe the role of community pharmacies as well as the FIT distribution and collection data during 2018 was conducted. Time to FIT completion was assessed by Kaplan-Meier estimation, and with the log-rank test. A Cox regression model was used to adjust for other variables associated with the completion of FIT such as sex, age, deprivation score and previous screening behavior. Results Overall, 82.4% of pharmacies collaborated with CRC screening program. Out of 82,902 FIT kits distributed to screening invitees 77,524 completed FIT kits were returned to pharmacies (93.5%) with a participation of 39.8% among the 193,766 invitees. From those who completed a FIT, the median time to return the kit was 3 days. FIT completion time was significantly lower among women, older age, high deprivation score and previous CRC screening (p < 0.005). Conclusions In our cancer screening setting the engagement of community pharmacies is high. Our findings suggest that community pharmacists as part of an integrated screening program team and by providing key screening process data can enable a better understanding of CRC screening behavior.
Conference Paper
Full-text available
Vegan diet is gaining more attention from academics, professionals, public policies, activists, and individual consumers. However, further research is needed to have a better understanding of this food practice. Drawing on Transtheoretical Model (TM) and Precaution Adoption Process Model (PAPM) models, this paper proposes a conceptual framework regarding the steps of Following Vegan Diet (FVD). TM includes four variables: (1) stages of change; (2) decisional balance; (3) self-efficacy, and (4) processes of change. The PAPM contains only one variable, the stages of change, with two different stages from TM, disengagement and rejection. By theory adaptation approach, the TM has been extended in two ways. First, by combining the stages of change in TM and PAPM; as a result, TM acquired two additional stages (disengagement and rejection). Second, by logically predicting in which stages the decisional balance and self-efficacy variables could have influence on moving through stages. These two additional stages are in compliance with related literature of FVD. The proposed framework includes eight stages of change concerning four critical points between stages. This paper has practical implications for vegan food marketers and public policies, and animal activists, for designing more effective interventions to FVD as a more sustainable consumption.
Communication highly influences what people think, feel, and decide about their health. This article discusses important barriers and success factors for effective communication in health contexts from the perspective of health communication, a subdiscipline of communication science. It focusses on aspects that are often not sufficiently addressed in our everyday communication: the degree of target group orientation, the role of attention processes, the variety of possible negative effects, the process character of individuals' health behavior changes, and social influences. We conclude the article with a plea for a better evidence-basing of health-related communication processes. Copyright © 2020. Published by Elsevier GmbH.
Furchterregende Botschaften werden insbesondere im Bereich der Gesundheitskommunikation eingesetzt, um gesundheitsrelevante Verhaltensweisen der Adressaten in einer intendierten Weise zu beeinflussen. In diesem Kapitel werden die theoretischen Annahmen zur Wirkung von Furchtappellen auf zentrale Modelle des Gesundheitsverhaltens angewandt. Gestützt auf zentrale empirische Befunde zur Wirkung von Furchtappellen im Gesundheitsbereich werden Empfehlungen für die Praxis abgeleitet. Daneben wird auch auf die kontroverse Bewertung des Einsatzes von Furchtappellen in der Gesundheitskommunikation eingegangen.
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