The precaution adoption process

Abstract

This article presents a critique of current models of preventive behavior. It discusses a variety of factors that are usually overlooked-including the appearance of costs and benefits over time, the role of cues to action, the problem of competing life demands, and the ways that actual decision behavior differs from the rational ideal implicit in expectancy-value and utility theories. Such considerations suggest that the adoption of new precautions should be viewed as a dynamic process with many determinants. The framework of a model that is able to accommodate these additional factors is described. This alternative model portrays the precaution adoption process as an orderly sequence of qualitatively different cognitive stages. Data illustrating a few of the suggestions made in the article are presented, and implications for prevention programs are discussed.

PIP: Current models of individual self-protective behavior are dominated by a cost-benefit, decision-making perspective. Although various theories differ in the range of costs and benefits considered and in the specific equation used to predict action likelihood, all assume that people weigh the expected benefits of a precaution against its costs and adopt the precaution if the balance appears favorable. Needed, however, is a new theory of preventive behavior that can accomodate more of its complexities. 1 such alternative approach is to conceptualize the precaution adoption process as a series of distinct stages. Stage theory suggests that people at different points in the precaution adoption process behave in qualitatively different ways and that the types of information and interventions needed to move people closer to action will vary from stage to stage. Among the variables that are best described by a series of cognitive stages rather than by their location on a continuum are beliefs about personal susceptibility; beliefs about severity, precaution effectiveness, and cost; and the decision to take action. According to this perspective, the decision to act in a self-protective manner will not occur until people have reached the final stages of all 3 relevant beliefs--susceptibility, severity, and precaution effectiveness. Another factor that must be considered is the gap between intentions and action; many people claim to be convinced that a precaution is worthwhile, state that they intend to act, but do not follow through on their intentions. This inaction can reflect the low priority of the action, situational obstacles, problems in initiating the action, or difficulties in maintaining precautions that prove arduous. The practical implication of the notion that people pass through qualitatively different stages as they move toward preventive action suggests that an effective program in 1 situation may be inappropriate in another.