Precaution adoption process model (PAPM)

This model describes how people progress from being unaware of an issue to being aware of it and acting appropriately. The diagram below describes the seven stages of the model and the factors that govern the transitions from stage to stage. Remember that people can move both forward and backwards between certain stages and may become ‘stuck’ at a particular stage.

Using the PAPM

• Define what the different stages are.
• Determine what your goal is (i.e., to move everyone to action, or just to move them one stage ahead of where they currently are).
• Determine who your target group is (i.e., are they defined by personal characteristics but they all exist at different stages of the PAPM, or are they all at a specific stage but otherwise are a diverse group?).
• Determine how you will classify individuals according to their current stage.
• Identify the factors that will influence transition among the different stages, as well as factors that could cause stagnation or regression.
• Identify the tools that will help to achieve your desired stage transitions. Remember that the tools you use will need to be tailored to your audience, to their position on the PAPM, and to the change you are trying to achieve. If you are mismatched then you will annoy people, confuse them, or lose their attention. This means that the greater the range of stages, the more difficult it is choose a single message or tool.
• Determine how you will evaluate whether your program has been effective at achieving your goal.

Example

Never heard of radon → Heard of radon but never thought about testing → Thinking about testing but unsure about whether or not to test → Decided whether or not to test → If decided to test, then actually ordered a test kit.

When to use the PAPM

The PAPM can be used to understand the psychological process of adopting or stopping a behaviour. Advocates of this type of stage theory say that changes in behaviour are too complex to be described by a single equation and must therefore be explained by a series of equations (i.e., a series of moves between stages). The PAPM can be applied to understanding how people come to make a decision to take action. It should not be applied to the gradual development of habits or to spontaneous actions that were not planned.

Tools to moving between stages

According to Weinstein, Sandman & Blalock (2008), the media often can have a major influence in getting people from Stage 1 of the PAPM to Stage 2 and from Stage 2 to Stage 3 but has much less influence from there. Theories of health behaviour, like the Health Belief Model and the Theory of Reasoned Action, can be used to understand how people who get to Stage 3 make a decision (move to Stage 4 or 5). From there, understanding the risks, outcomes, experiences, motivations, and barriers at each stage can help you to determine how to get people to go from decision to action, and from action to maintenance. Below is a table of some tools and factors that can affect transition between the stages.

Barriers to moving between stages

Confirmation bias

People tend to adhere to previously held beliefs. The degree to which your messaging aligns to those beliefs will influence how easily you can transition people between stages. There is not much you can do about this other than to be aware of it and use the other tools we discuss in this text to try and work through it. It is important to highlight the problematic nature of Stage 4 at this point. This is where confirmation bias is at its height. Most people in this category appear to be well informed but only accept information that aligns with their bias, finding reasons to reject any evidence to the contrary. This is a very unique stage that is fundamentally different from Stage 3 (people who are not acting because they are undecided).

Stage paralysis

If you are asking people to make a difficult decision or do something challenging, then they may get stuck. This is why it is important to actually show them how to easily transition from one stage to another. For example, if you are asking people to test for radon, you might provide links to places where they can purchase a testing unit online. A detailed implementation plan can often be the key to transitioning people from decision to action. This plan should include concrete targets that are meaningful to, and achievable by, your target audience.

Perceived susceptibility

This basically captures the fact that most people think they are invincible. In general, people more readily accept the risk posed to others compared to the risk posed to themselves. This is why information must be presented to your target audience in a manner that maximizes its relevancy and accessibility.

Barriers to action

It is important to be aware of and work to overcome barriers to action. Barriers could be related to cost (i.e., are you advocating for an action that is prohibitively expensive or too time consuming?), access (i.e., is it something that is more geographically accessible to some than others?), and any number of other factors that can hinder a person’s ability to engage with the action. This is where you must consider alternative measures to improve likelihood of action.

Complex problems or actions

As stated, the PAPM works best for very simple problems and behaviours (i.e., getting vaccinated, testing for radon, etc.). More complex issues may require a more nuanced application of the PAPM. For example, if you want people to be more active, then you might choose to present people with a menu of actions versus something specific. It may be easier to get people to decide to do something versus a specific thing, but this could backfire if your recommendations are so vague that people don’t really know what to do.

Takeaways