Precaution Adoption Process Model: Need for Experimentation in Alcohol and Drug Education

Written By: Sam Savage

Published Date: October 4, 2007 Last Edited: October 4, 2007

By Sharma, Manoj

For facilitating abandonment of risky behaviors, alcohol and drug educators are always looking for newer approaches and theories. One such theory that has not been widely used in alcohol and drug education but holds promise is the Precaution Adoption Process Model (PAPM). PAPM was first suggested by Weinstein (1988). He argued that most traditional behavioral theories apply only to people who are engaged by the threat and do not take into account different stages in which people might be with regard to the adoption of the behavior. He described the process of adopting or quitting a behavior as a logical sequence of qualitatively different cognitive stages. In each stage the types of information and interventions needed to move people closer to action varies. Therefore the greatest advantage of such a stage theory is that messages can be tailored to different sections of the population. The model was further refined and Weinstein and Sandman (1992) suggested seven distinct stages in PAPM ranging from complete ignorance to regular performance of the behavior. These stages in PAPM are: (1) being unaware of the issue, (2) being aware of the issue but not personally engaged, (3) being engaged and deciding what to do, (4) having decided not to act, (5) having decided to act, (6) acting, and (7) maintenance. For example for quitting smoking, these stages would be (1) never heard of harmful effects of smoking, (2) never thought about quitting, (3) deciding about whether to quit or not, (4) decided not to quit, (5) decided to quit, (6) acting on quitting, and (7) maintaining quitting.

PAPM has been used for a variety of health behaviors. It has been used for colorectal screening (Costanza et al., 2005), for studying meat consumption in a livestock epidemic (Sniehotta, Luszczynska, Scholz, & Lippke, 2005), for supporting adherence and healthy lifestyles in leg ulcer patients (Heinen, Bartholomew, Wensing, van de Kerkhof, & van Achterberg, 2006), for osteoprotective behavior (Blalock et al, 1996; Sharp & Thombs, 2003), for helping parents of kids with asthma to quit smoking (Borrelli et al., 2002), for influencing decision to accept treatment for osteoporosis following hip fracture (Mauck, Cuddihy, Trousdale, Pond, Pankratz, & Melton, 2002), for mammography screening (Clemow et al., 2000), and for home radon testing (Weinstein, Lyon, Sandman, & Cuite, 1998).

PAPM offers several advantages. First, it suggests various stages and allows for tailoring of messages for each stage. Second, the PAPM requires only a single question to assess a person’s stage thereby making it suitable for use in individual as well as group settings (Weinstein & Sandman, 2002). Third, PAPM is a particularly useful model when behavior change is difficult and resistance to change is high (Weinstein & Sandman, 2002). In such situations having separate messages for each stage is quite useful.

PAPM also has certain disadvantages. First, with regard to health behaviors it has not been tested a lot. As such the empirical evidence is limited and confined to a few behaviors. Second, the model does not lend itself easily to actions that require gradual development of behavior such as exercise or diet (Weinstein & Sandman, 2002). The third disadvantage with PAPM is that the constructs corresponding to each stage of the model that need to be modified for progression along the stages have not been delineated. Finally, the stage based interventions are more expensive and resource intensive when compared to a standard intervention geared toward the entire population.

In conclusion it can be said that more interventions that reify PAPM in alcohol and drug education need to be developed and tested. When more empirical evidence is available decisive deductions about the utility of this model can be ascertained.

REFERENCES

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Borrelli, B., McQuaid, E. L., Becker, B., Hammond, K., Papandonatos, G., Fritz, G. et al (2002) Motivating parents of kids with asthma to quit smoking: The PAQS project. Health Education Research, 17, 659-669.

Clemow, L., Costanza, M. E., Haddad, W. P, Luckmann, R., White, M. J., Klaus, D., et al. (2000). Underutilizers of mammography screening today: Characteristics of women planning, undecided about, and not planning a mammogram. Annals of Behavioral Medicine, 22, 80- 88.

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Sniehotta, F F., Luszczynska, A., Scholz, U., & Lippke S. (2005). Discontinuity patterns in stages of the precaution adoption process model: Meat consumption during a livestock epidemic. British Journal of Health Psychology, /0(Pt 2), 221-235.

Weinstein, N. D. (1988). The precaution adoption process. Health Psychology, 7(4), 355-386.

Weinstein, N. D., Lyon, J. E., Sandman, P. M., & Cuite C. L. (1998). Experimental evidence for stages of health behavior change: The precaution adoption process model applied to home radon testing. Health Psychology, 17(5), 445-453.

Weinstein, N. D., & Sandman, P. M. (1992). A model of the precaution adoption process: Evidence from home radon testing. Health Psychology, 11(3), 170-80.

Weinstein, N. D., & Sandman, P. M. (2002). The Precaution Adoption Process Model and its application. In R.J. DiClemente, R. A. Crosby, & M.C. Kegler (Eds.) Emerging theories in health promotion practice and research. Strategies for improving public health (pp. 16-39). San Francisco: Jossey-Bass.

Manoj Sharma, MBBS, CHES, Ph.D.

Editor, Journal of Alcohol & Drug Education

University of Cincinnati

526 Teachers College

PO Box 210068

Cincinnati, OH 45221-0068

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