The adoption of a new precaution, or the abandonment of a risky behavior, requires intentional action. The Precaution Adoption Process Model was created as a way to focus on the psychological processes within an individual (DiClemente, Crosby, & Kegler, 2009). The PAPM is made up of stages that are used as attempts to explain and describe how a person comes to decisions to take action and how he or she translates that decision into action. Adoption of a new precaution or cessation of a risky behavior requires deliberate steps unlikely to occur outside of conscious awareness. The PAPM applies to these types of actions, not to the gradual development of habitual patterns of behavior, such as exercise and diet, in which health considerations may play little role (though it would apply to the initiation of a new exercise program or a new diet) (DiClemente, Crosby, & Kegler, 2009). Nor does the PAPM explain the commencement of risky behaviors—such as a teenager accepting her first cigarette–which seem to be better explained in terms of a “willingness” to act rather than in terms of any plan to act (Gibbons, Gerard, Blanton, & Russell, 1998).
Stage 1: Unaware of Issue
At some initial point in time, people are unaware of a health issue. Much of health research deals with well-known hazards, like smoking, AIDS, and high-fat diets. In such cases, asking someone about his or her beliefs and plans is quite reasonable; most people have considered the relevance of these threats to their own lives (DiClemente, Crosby, & Kegler, 2009). But if people have never heard of a hazard or a potential precaution, they cannot have formed opinions about it. It is humanly impossible to form an opinion about something you are truly unaware of. The reluctance of respondents to answer survey questions about less familiar issues suggests that investigators ought to allow people to say that they “don’t know” or have “no opinion” rather than forcing them to state a position (DiClemente, Crosby, & Kegler, 2009). Participants in many health behavior investigations are not given this opportunity. Even when participants are permitted to say that they “don’t know,” these responses are often coded as missing or are collapsed into another category. To say “I don’t know” indicates something important and is real data that should not be discarded (DiClemente, Crosby, & Kegler, 2009).
Stage 2: (Unengaged) Versus Stage 3 (Deciding About Acting)
If an individual has become aware of a hazard and has started to form opinions about it, they are no longer in Stage 1. However, there are myriads of issues in our daily lives that compete for our attention, which make it difficult to be fully educated. Therefore, most people only know a moderate amount about a hazard and never truly consider whether or not they need to do something about it. Many believe that this condition of awareness is extremely common because of the lack of personal engagement. The PAPM displays and suggests that it is important to have a distinction between the people who have never thought about an action and those who have given the action some thought, but are undecided (DiClemente, Crosby, & Kegler, 2009). This distinction is important because the individuals who have thought about acting are more likely to be more knowledgeable. Likewise, attitudes based on experience with an issue are more predictive of future behavior than attitudes generated on the spot, without such experience (Fazio & Zanna,1981). Therefore, whether or not a person has or has not thought about taking action appears to be an important distinction.
Stage 3 (Deciding About Acting) Versus Stage 4 (Deciding Not To Act) and Stage 5 (Deciding To Act):
Research has revealed important differences between people who have not yet formed an opinion and those who have come to a decision. Those who have come to a definite position on an issue- especially an issue regarding their own behavior- have different responses to information and are more resistant to persuasion than people who have never formed an opinion (Anderson, 1983; Brockner & Rubin, 1985; Cialdini, 1988; Jelalian & Miller, 1984, Nisbett & Ross, 1980). The tendency to adhere to one’s own position has been termed confirmation bias, perseverance of beliefs, and hypothesis preservation. It manifests itself in a variety of ways. According to Klayman (1995), these include overconfidence in one’s beliefs, searches for new evidence that are biased to favor one’s beliefs, biased interpretations of new data, and insufficient adjustment of one’s beliefs in the light of new evidence.
For these exact reasons, the PAPM holds that it is deemed significant when people say that they have decided to act or have decided not to act, and that the implications of someone saying that he or she decided to act are not the same as saying it is “very likely” he or she will act (DiClemente, Crosby, & Kegler, 2009).
Stage 5: (Deciding to Act) Versus Stage 6 (Acting):
During the initial, motivation phase, people develop an intention to act, based on beliefs about risk, outcomes, and self-efficacy. After a goal has been established within the motivation phase, people enter the volition phase in which they plan the details of action, initiate action, and deal with the difficulties of carrying out that action successfully. Research shows that there are important gaps between intending to act and carrying out this intention, and that helping people develop specific implementation plans can reduce these barriers. The PAPM suggests that detailed implementation information that would be uninteresting to people in early stages, and even to those who are trying to decide what to do, will often be essential to help them make the transition from decision to action (DiClemente, Crosby, & Kegler, 2009).
Stage 6 (Acting) Versus Stage 7 (Maintenance):
Stage 6 is where people believe they have the ability to change their behavior and are actively involved in taking steps to change their bad behavior by using a variety of different techniques (DiClemente, Crosby, & Kegler, 2009). Maintenance is the stage in which people have made specific overt modifications in their lifestyles and are working to prevent relapse; however, they do not apply change processes as frequently as do people in Action. While in the Maintenance stage, people are less tempted to relapse and grow increasingly more confident that they can continue their changes (DiClemente, Crosby, & Kegler, 2009).
