Adoption Process Model Research Articles

Analyzing Factors Associated With Decisional Stage of Adoption for Colorectal Cancer Screening Among Older Korean Americans Using Precaution Adoption Process Model.

Introduction: For Korean Americans (KAs), colorectal cancer (CRC) screening rates remain lower than the national target. This study aimed to examine factors predicting decisional stage of CRC screening adoption among older KAs using the precaution adoption process model. Method: Convenience sampling was employed to recruit KAs aged 50 to 75 years from the Atlanta metropolitan area in the United States. A total of 433 KAs completed a cross-sectional survey that collects information on sociodemographics, CRC screening history, a physician's recommendation, knowledge, self-efficacy, and decisional balance pertaining CRC screening, and precaution adoption process model stage. Results: Higher scores of decisional balance (odds ratio [OR] = 1.34), having a physician's recommendation (OR = 8.61), and having regular annual medical checkups (OR = 4.44) were significantly associated with higher decisional stage compared with lower stage, controlling for other variables. Discussion: Intervention research should incorporate consideration of individuals' decisional stage to move KAs forward from not engaging the screening to maintaining regular participation in CRC screening.

Analyzing factors associated with decisional stage of adopting breast cancer screening among Korean American women using precaution adoption process model

ABSTRACT Background: Korean American (KA) women have experienced higher prevalence and lower survival rates of breast cancer (BC) than other ethnic groups in the United States. However, BC screening rates for KA women remain significantly lower than the national target (81.1%) specified by Healthy People 2020. Few studies have explained how the decision to adopt BC screening occurs and progresses and what factors contribute to this decision among KA women. This study used Weinstein’s Precaution Adoption Process Model (PAPM) as a theoretical framework to examine characteristics and factors associated with the decisional stage of mammography adoption. Methods: A cross-sectional self-report survey was administered among KA women (N = 308) ages 50–80 from the Atlanta metropolitan area. A total of 281 KA women completed the survey, answering questions about socio-demographics, health-related information, mammography history, doctor recommendation, BC screening knowledge, self-efficacy for BC screening, decisional balance scores on attitudes and beliefs pertaining to mammography, and the seven-stage PAPM. Results: KA women reported a low rate of mammography uptake with about 24% and 35% of the participants undergoing mammography within the last year and two years, respectively. KA women in stages 5 (decided yes), 6 (action), and 7 (maintenance) were likely to have increased screening-related knowledge, positive decisional balance, and regular medical check-up compared to those in stages 1 (unaware), 2 (unengaged), and 3 (deciding). Conclusion: This study highlights important factors that could potentially facilitate BC screening among KA women in Georgia. The findings also provide implications for interventions and practice for increasing mammography screening among medically underserved populations.

Using an integrated conceptual framework to investigate parents' HPV vaccine decision for their daughters and sons

Despite being an effective cancer prevention strategy, human papillomavirus (HPV) vaccination in Canada remain suboptimal. This study is the first to concurrently evaluate HPV vaccine knowledge, attitudes, and the decision-making stage of Canadian parents for their school-aged daughters and sons. Data were collected through an online survey from a nationally representative sample of Canadian parents of 9–16 year old children from August to September 2016. Measures included socio-demographics, validated scales to assess HPV vaccine knowledge and attitudes (using the Health Belief Model), and parents' HPV vaccination adoption stage using the Precaution Adoption Process Model (PAPM; six stages: unaware, unengaged, undecided, decided not, decided to, or vaccinated). 3779 parents' survey responses were analyzed (1826 parents of sons and 1953 parents of daughters). There was a significant association between child's gender and PAPM stage of decision-making, with parents of boys more likely to report being in earlier PAPM stages. In multinomial logistic regression analyses parents of daughters (compared to sons), parents of older children, and parents with a health care provider recommendation had decreased odds of being in any earlier PAPM stage as compared to the last PAPM stage (i.e. vaccinated). Parents who were in the ‘decided not to vaccinate’ stage had significantly greater odds of reporting perceived vaccine harms, lack of confidence, risks, and vaccine conspiracy beliefs. Future research could use these findings to investigate theoretically informed interventions to specifically target subsets of the population with particular attention towards addressing knowledge gaps, perceived barriers, and concerns of parents.

Decision-making about cervical screening in a heterogeneous sample of nonparticipants: A qualitative interview study.

ObjectiveAccording to the precaution adoption process model, cervical screening nonparticipants represent a heterogeneous group including those who are unaware of, unengaged with, or undecided about screening, as well as intenders and decliners. We aimed to explore beliefs about cervical screening among these different types of nonparticipant.MethodsSemistructured interviews were carried out with women aged 26 to 65 years living in Britain (n = 29). Women were purposively sampled to represent different nonparticipant types. Interviews were transcribed verbatim, and data were analysed thematically using framework analysis.ResultsThe salience of some barriers to screening varied between different types of nonparticipant. Bad experiences were prominent in the discussions of women who had decided not to attend, while practical barriers were more prominent among intenders. There was also some overlap between nonparticipant types. For example, many of the undecided women described not wanting to go for screening, but with less certainty than decliners. Some intenders (particularly those who had not been screened before) described not really wanting to attend but feeling they ought to. Women's views on the invitation/reminder process also varied; intenders and maintainers appreciated written reminders and general practitioner (GP) prompts but decliners sometimes perceived these as “badgering.” Throughout the interviews, women described changing views on screening in the wider context of ageing and motherhood.ConclusionsThe salience of screening barriers varies by nonparticipant type, offering possibilities for tailored interventions. However, the fluidity of women's stage of screening adoption might have implications for this approach to intervention design.

A Randomized Trial to Test Personalized Environmental Report Back to Reduce Lung Cancer Risk.

More radon-related lung cancers occur among those exposed to tobacco smoke. To test the effects of a personalized environmental report back intervention on change in stage of action for air nicotine testing and adopting a smoke-free home and radon testing and mitigation from baseline to 3 months postintervention. The study design used a two-arm parallel groups randomized controlled trial with stratified quota sampling. The treatment group received free air nicotine and radon home test kits and a brief problem-solving phone intervention; the control group received a coupon for free test kits. A sample of 515 homeowners were enrolled; 319 completed the 3-month follow-up. Stage of action to test and remediate the home was measured consistent with the precaution adoption process model. Linear mixed modeling assessed whether the main and interaction effects of treatment and time were associated with the testing and remediation outcomes; multiple covariates were included in the models. The models for the four stages of action outcomes (testing and remediating for radon and secondhand smoke) each had a significant treatment-by-time effect. The general pattern was an increase in stage of action from baseline to 3 months. The degree of change was generally larger among the treatment group participants relative to the controls, indicating that those in the treatment group were more ready to take action. For all the models, participants with higher self-efficacy for radon/air nicotine testing and radon/secondhand smoke remediation were more ready to take action to test and remediate. Synergistic risk perception was associated with stage of action for radon mitigation. Homeowners who were provided free radon and air nicotine test kits, given their results, and engaged in a brief telephonic problem-solving consultation tended to show a greater increase in readiness to take action to test and remediate by 3 months compared with those who received standard public health practice. Both groups showed an increase in stage of action for all four outcomes over time.

Prevention Determinants of Falling in the Elderly Citizens: a Precaution Adoption Process Model (PAPM) Carried-out in Urmia, Iran

Prevention Determinants of Falling in the Elderly Citizens: a Precaution Adoption Process Model (PAPM) Carried-out in Urmia, Iran

Variation in health beliefs across different types of cervical screening non-participants

Understanding factors associated with different types of cancer screening non-participation will help with the development of more targeted approaches for improving informed uptake. This study explored patterns of general health beliefs and behaviour, and cancer-specific beliefs across different types of cervical screening non-participants using the Precaution Adoption Process Model (PAPM). A population-representative sample of women in Britain completed a home-based survey in 2016. Women classified as non-participants (n = 839) completed additional questions about health beliefs.Some general health beliefs and behaviours, as well as cancer-specific beliefs, were associated with particular types of non-participation. For example, those who scored higher on fatalism were more likely to be unaware of screening (OR = 1.74, 95%CI: 1.45–2.08) or unengaged with screening (OR = 1.57, CI: 1.11–2.21). Women with greater deliberative risk perceptions were less likely to be unengaged with screening (OR = 0.74 CI: 02.55–0.99) and less likely to have decided against screening (OR = 0.71, CI: 0.59–0.86). Women who had seen a general practitioner in the last 12 months were less likely to be unaware (OR = 0.49, CI: 0.35–0.69), and those reporting cancer information avoidance were more likely to be unengaged with screening (OR = 2.25, CI: 1.15–4.39). Not wanting to know whether one has cancer was the only factor associated with all types of non-participation.Interventions to raise awareness of screening should include messages that address fatalistic and negative beliefs about cancer. Interventions for women who have decided not to be screened could usefully include messages to ensure the risk of cervical cancer and the relevance and benefits of screening are well communicated.

Describing the Process of Adopting Nutrition and Fitness Apps: Behavior Stage Model Approach.

BackgroundAlthough mobile technologies such as smartphone apps are promising means for motivating people to adopt a healthier lifestyle (mHealth apps), previous studies have shown low adoption and continued use rates. Developing the means to address this issue requires further understanding of mHealth app nonusers and adoption processes. This study utilized a stage model approach based on the Precaution Adoption Process Model (PAPM), which proposes that people pass through qualitatively different motivational stages when adopting a behavior.ObjectiveTo establish a better understanding of between-stage transitions during app adoption, this study aimed to investigate the adoption process of nutrition and fitness app usage, and the sociodemographic and behavioral characteristics and decision-making style preferences of people at different adoption stages.MethodsParticipants (N=1236) were recruited onsite within the cohort study Konstanz Life Study. Use of mobile devices and nutrition and fitness apps, 5 behavior adoption stages of using nutrition and fitness apps, preference for intuition and deliberation in eating decision-making (E-PID), healthy eating style, sociodemographic variables, and body mass index (BMI) were assessed.ResultsAnalysis of the 5 behavior adoption stages showed that stage 1 (“unengaged”) was the most prevalent motivational stage for both nutrition and fitness app use, with half of the participants stating that they had never thought about using a nutrition app (52.41%, 533/1017), whereas less than one-third stated they had never thought about using a fitness app (29.25%, 301/1029). “Unengaged” nonusers (stage 1) showed a higher preference for an intuitive decision-making style when making eating decisions, whereas those who were already “acting” (stage 4) showed a greater preference for a deliberative decision-making style (F4,1012=21.83, P<.001). Furthermore, participants differed widely in their readiness to adopt nutrition and fitness apps, ranging from having “decided to” but not yet begun to act (stage 2; nutrition: 6.88%, 70/1017; fitness: 9.23%, 95/1029) to being “disengaged” following previous adoption (stage 5; nutrition: 13.77%, 140/1017; fitness: 15.06%, 155/1029).ConclusionsUsing a behavior stage model approach to describe the process of adopting nutrition and fitness apps revealed motivational stage differences between nonusers (being “unengaged,” having “decided not to act,” having “decided to act,” and being “disengaged”), which might contribute to a better understanding of the process of adopting mHealth apps and thus inform the future development of digital interventions. This study highlights that new user groups might be better reached by apps designed to address a more intuitive decision-making style.

Applying the Precaution Adoption Process Model to the Acceptance of Mine Safety and Health Technologies

Mineworkers are continually introduced to protective technologies on the job. Yet, their perceptions toward the technologies are often not addressed until they are actively trying to use them, which may halt safe technology adoption and associated work practices. This study explored management and worker perspectives toward three technologies to forecast adoption and behavioral intention on the job. Interviews and focus groups were conducted with 21 mineworkers and 19 mine managers to determine the adoption process stage algorithm for workers and managers, including perceived barriers to using new safety and health technologies. Differences between workers and managers were revealed in terms of readiness, perceptions, and initial trust in using technologies. Workers, whether they had or had not used a particular technology, still had negative perceptions toward its use in the initial introduction and integration at their mine site, indicating a lengthy time period needed for full adoption. The key finding from these results is that a carefully considered and extended introduction of technology for workers in Stage 3 (undecided to act) is most important to promote progression to Stage 5 (decided to act) and to avoid Stage 4 (decided not to act). In response, organizational management may need to account for workers' particular stage algorithm, using the Precaution Adoption Process Model, to understand how to tailor messages about protective technologies, administer skill-based trainings and interventions that raise awareness and knowledge, and ultimately encourage safe adoption of associated work practices.

Psychosocial correlates of HPV vaccine acceptability in college males: A cross-sectional exploratory study

BackgroundMost college males are not immunized against the human papillomavirus (HPV) and are at high risk of HPV infection. Most research of correlates of HPV vaccine acceptability in college males has assessed vaccine acceptability as a binary outcome, e.g., vaccinated or not vaccinated, without considering that some students may not even be aware that the HPV vaccine can be given to males. Our objective was to evaluate the psychosocial correlates of HPV acceptability in college males, based on multiple stages of HPV decision-making. MethodsWe used an online questionnaire to collect data from college men aged 18–26 enrolled at three Canadian universities between September 2013 and April 2014. Vaccine acceptability assessment was informed by the six-stage decision-making Precaution Adoption Process Model (PAPM). We sought information on socio-demographics, health behaviors, HPV vaccine benefits and barriers, worry, susceptibility, severity related to HPV infection and social norms. HPV and HPV vaccine knowledge was measured with validated scales. Psychosocial correlates of HPV vaccine acceptability were assessed with bivariate and multivariate multinomial logistic regression. Actual and perceived HPV and HPV vaccine knowledge scores were calculated. ResultsThe final sample size was 428. Most male college students were unaware that the HPV vaccine could be given to males, unengaged or undecided about getting the HPV vaccine. Significant correlates of higher HPV vaccine acceptability were: increased HPV knowledge, having discussed the HPV vaccine with a healthcare provider, and social norms. Being in an exclusive sexual relationship was significantly associated with lower HPV vaccine acceptability. Students' actual HPV and HPV vaccine knowledge was low and positively correlated to their perception about their HPV knowledge. ConclusionsWe provided a fine-tuned analysis of psychosocial correlates of HPV vaccine acceptability in college males who are in the early stages of HPV vaccine decision-making. Interventions are needed to increase HPV and HPV vaccine knowledge in college males.

Carbon Monoxide Alarm and Smoke Alarm Use Among Parents Recruited From a Pediatric Emergency Department.

Although the proper installation and maintenance of carbon monoxide (CO) and smoke alarms can protect individuals from residential CO-related and fire-related injuries, these devices are underutilized. We describe characteristics associated with self-reported CO and smoke alarm use of parents recruited from a pediatric emergency department to improve CO alarm use. Parents of children≤18years (N=299) reported socio-demographic characteristics and CO and smoke alarm ownership and practices. We assigned participants to a behavioral profile and a Precaution Adoption Process Model stage based on their self-reported CO and smoke alarm use. Most participants (71%) did not have CO alarms in their homes, but reported owning at least one working smoke alarm (98%). Participants who reported "perfect" CO alarm behavior (defined as having a working CO alarm, onenear a sleeping area, with batteries replaced every 6months; 9%) were more likely to earn a higher income, own their home, and have lived at their current residence for at least 2 years. Participants who reported "perfect" smoke alarm behavior (defined as having a working smoke alarm on every level, with batteries replaced every 6months; 49%) were more likely to rent their home, receive federal assistance, and have lived at their current residence for at least 2 years. Interventions to increase correct CO alarm use are necessary.

Prescribing HIV PrEP and Education Needs Among Care Providers

Preexposure prophylaxis (PrEP) is a biomedical intervention to prevent the spread of HIV. Underprescribing PrEP could increase the probability of HIV exposure among serodivergent couples/partners and people who do not practice safer sex. Previous research on PrEP did not assess the association between awareness of PrEP, years of experience of the providers, provider types, and the frequency of PrEP among physicians. The purpose of this study is to test the hypothesis that awareness of PrEP, years of experience, and provider types might be predictors of the frequency of PrEP among physicians. Precaution adoption process model and cross-sectional design were applied to survey 100 physicians. Kendall's b correlation test and Fisher’s exact test showed that awareness was the primary barrier to prescribing PrEP at the providers’ level. Higher awareness of PrEP and years of experience were associated with the frequency of PrEP prescription. However, there was an insignificant difference between provider types and the frequency of PrEP prescription. The findings support the notion that independent from their years of experience and specialty, the more physicians know about PrEP, the more they prescribe it. The results and recommendations contribute to positive social change by providing information to develop a comprehensive PrEP education curriculum for care providers. Our findings indicate that physicians need education and training to fully understand the potential for PrEP to reduce HIV transmission.

Human papillomavirus (HPV) vaccine knowledge, attitudes, and uptake in college students: Implications from the Precaution Adoption Process Model.

The purpose of this study was to examine human papillomavirus (HPV) and HPV vaccine knowledge, attitudes, and uptake in college students and to identify factors associated with vaccination status utilizing the Precaution Adoption Process Model (PAPM). The sample included 383 undergraduates from a public university who participated in February and March 2015. Students were emailed an anonymous online survey assessing knowledge, attitudes, and perceptions related to HPV and HPV vaccination, as well as their stage in the PAPM regarding vaccination completion. Significantly more females (47.3%) than males (15.8%) were vaccinated. While most students had basic knowledge of HPV, they had low perceptions of their susceptibility to contract HPV. Most unvaccinated students were in the early stages of decision-making related to vaccination. Campus health centers have an opportunity to increase HPV vaccination rates. This study indicates that students need prompts from providers, as well as education regarding susceptibility to HPV.

Untangling the psychosocial predictors of HPV vaccination decision-making among parents of boys.

HPV vaccination uptake in boys is suboptimal in many jurisdictions, particularly in the absence of publicly funded HPV vaccination programs. Parents represent key decision-makers of HPV vaccination and their HPV vaccine decision-making stage is influenced by multiple psychosocial determinants. Our objective was to assess the relationship between a broad range of psychosocial factors and parents of boys' HPV vaccine decision-making stage. Data were collected through an online survey from a nationally representative sample of Canadian parents of boys in February (T1) and November 2014 (T2). We assessed a broad number of psychosocial factors including: socio-demographics, health behaviours and validated scales for assessing HPV knowledge, attitudes and beliefs. Parents selected their HPV vaccination adoption stage based on the Precaution Adoption Process Model (PAPM). Multinomial logistic regression was used to test the association between predictors and PAPM stage at T1 and T2. Discussion with a healthcare provider about the HPV vaccine and increased HPV knowledge was associated with increased odds of being in the more advanced PAPM stages. Increased perception of risks in the absence of HPV vaccination, increased perception that others endorse HPV vaccination and positive attitudes related to vaccines in general were associated with increased odds of being in the decided to vaccinate stage. Believing that HPV vaccination is harmful increased, and perceiving the benefits of HPV vaccination decreased the odds of deciding not to vaccinate. This study highlights the psychosocial predictors of the decision-making stage reported by parents regarding HPV vaccination of their sons, that were significant at two time-points. Targeted interventions that consider the impact of the health care provider and address knowledge gaps as well as individual beliefs about benefits, risks, and harms of the HPV vaccine and vaccines in general should be implemented to help parents make better informed decisions that is, to move closer to actual vaccination adoption.

Abstract DPOC-006: mAGIC – CREATION OF A MOBILE APPLICATION TO INCREASE GENETIC COUNSELING FOR WOMEN WITH OVARIAN CANCER

Abstract PURPOSE: Current guidelines published by the National Comprehensive Cancer Network and the Society of Gynecologic Oncology recommend that all women with invasive ovarian, fallopian tube, or primary peritoneal cancers receive genetic risk evaluation by a genetic counselor. Despite recommendations, physicians continue to under–refer and women under–use genetic services. This study developed the Mobile Application for Genetic Information on Cancer (mAGIC) intervention to motivate ovarian cancer survivors to undergo genetic counseling. The overall study objective was to develop and assess the feasibility and effectiveness of a theory–based intervention aimed to encourage ovarian cancer survivors to receive genetic counseling. METHODS: Based on the Precaution Adoption Process Model and the Fogg Behavior Model for Persuasive Design, a multi–step process was used to design a 7–day mobile application intervention delivering daily text and video messaging. Content and formatting was developed by a multi–disciplinary expert team in conjunction with a Community Advisory Board and was based on focus groups with ovarian cancer patients. The final content covered the following topics: genetic counseling, genetic testing, cancer genetics and personal health, cancer genetics and my family, taking care of yourself, and preparing for a genetic counseling appointment. Usability testing was conducted to ensure the intervention was relevant and easy to use. To test the effectiveness of the intervention, a randomized control trial of 104 women with ovarian cancer, who have not previously received genetic counseling, was initiated. Participants were randomized to the mobile app intervention or control (usual care). Regardless of randomization assignment, participants received a phone call from a patient health navigator two weeks following enrollment to determine their intentions, self–efficacy, and communication with family regarding seeking genetic counseling. A three month follow–up survey of all participants measured genetic counseling uptake, stage of readiness, self–efficacy, knowledge, and distress. RESULTS: To date, 45 of 104 women have been randomized; 39 have completed the telephone survey and 10 have completed the three month survey. No interim analyses of the primary outcomes were planned; however participant feedback has been positive. CONCLUSIONS: Despite consensus guidelines recommending the referral of all ovarian, fallopian tube and primary peritoneal cancer patients to genetic counseling, not all patients receive the recommended genetic counseling. This mobile application provides a new tool for disseminating needed information about genetic counseling directly to women with ovarian cancer. Citation Format: Melissa A. Geller, MD, Sue Petzel, PhD, Hee Lee, PhD, Heewon Lee, BA, Kristen Niendorf, MS, Rachel Isaksson Vogel, PhD. mAGIC – CREATION OF A MOBILE APPLICATION TO INCREASE GENETIC COUNSELING FOR WOMEN WITH OVARIAN CANCER [abstract]. In: Proceedings of the 11th Biennial Ovarian Cancer Research Symposium; Sep 12-13, 2016; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(11 Suppl):Abstract nr DPOC-006.

Understanding the heterogeneity of cervical cancer screening non-participants: Data from a national sample of British women

BackgroundUptake of cervical cancer screening in the United Kingdom (UK) is falling year on year, and a more sophisticated understanding of non-participation may help design interventions to reverse this trend. This study ascertained the prevalence of different non-participant types using the Precaution Adoption Process Model (PAPM). MethodsHome-based computer-assisted interviews were carried out with 3113 screening-eligible women in Britain. Survey items assessed self-reported screening uptake and intention to attend in future. Responses to these items were used to classify women into one of five different types of non-participants. ResultsOf 793 non-participants, 28% were unaware of screening, 15% had decided not to attend and 51% were intending to have screening but were currently overdue. Younger women were more likely to be unaware of screening or to intend to be screened, while older women were more likely to have decided not to be screened. Women from ethnic minority backgrounds were more likely to be unaware of screening than white women. Being in a lower social grade was associated with increased odds of all three types of non-participation. ConclusionThe majority of cervical cancer screening non-participants are not making an active decision not to attend but rather are either unaware or unable to act. There are clear sociodemographic differences between non-participant types, which could be used to identify where tailored interventions may be best targeted.

A cluster randomized theory-guided oral hygiene trial in adolescents-A latent growth model.

(i) To test whether theory-guided interventions are more effective than conventional dental instruction (CDI) for changing oral hygiene in adolescents and (ii) to examine whether such interventions equally benefit both genders and different socio-economic (SES) groups. A total of 244 adolescents were recruited from three schools, and cluster randomization allocated adolescents to one of the three types of interventions: two were theory-based interventions (Precaution Adoption Process Model or Authoritative Parenting Model) and CDI served as an active control. Oral hygiene levels % (OH) were assessed at baseline, after 3months and after 12months. A complete data set was available for 166 adolescents (the total follow-up rate: 69%). There were no significant differences in baseline OH between those who participated throughout the study and those who dropped out. Bivariate and multivariate analyses showed that theory-guided interventions produced significant improvements in oral hygiene and that there were no significant gender or socio-economic differences. Theory-guided interventions produced more positive changes in OH than CDI, and these changes did not differ between gender and SES groups.

Psychosocial determinants of HIV testing across stages of change in Spanish population: a cross-sectional national survey

BackgroundThe goal of this research is to study the psychosocial determinants of HIV-testing as a function of the decision or change stage concerning this health behavior. The determinants considered in the major ongoing health models and the stages contemplated in the Precaution Adoption Process Model are analysed.MethodsA cross-sectional survey was administered to 1,554 people over 16 years of age living in Spain by a computer-assisted telephone interview (CATI). The sample design was randomised, with quotas of sex and age. The survey measured various psychosocial determinants of health behaviors considered in the main cognitive theories, the interviewees' stage of change concerning HIV-testing (lack of awareness, decision not to act, decision to act, action, maintenance, and abandonment), and the signal for the action of getting tested or the perceived barriers to being tested.ResultsApproximately two thirds of the population had not ever had the HIV test. The predominant stage was lack of awareness. The most frequently perceived barriers to testing were related to the health system and to the stigma. We also found that the psychosocial determinants studied differed depending on the respondents' stage of change. Perception of risk, perceived self-efficacy, proximity to people who had been tested, perceived benefits of knowing the diagnosis, and a positive instrumental and emotional attitude were positively associated with the decision and maintenance of testing behavior. However, unrealistic underestimation of the risk of HIV infection, stereotypes about the infection, and the perceived severity of HIV were associated with the decision not to be tested.ConclusionsThere are various sociocognitive and motivational profiles depending on people’s decision stage concerning HIV-testing. Knowing this profile may allow us to design interventions to influence the psychosocial determinants that characterise each stage of change.

Development of a hybrid model with elements of information seeking, behavioral change and social influence

Health promotion campaigns using theories or models consistently produce stronger behavioral changes and are more effective interventions. The proposed Information Attainment and Adoption Model integrates components of the Theory of Motivated Information Management and the Precaution Adoption Process Model. The Information Attainment and Adoption Model uses strategic constructs in a semi-staged design to move individuals from being unaware of an issue to seeking and attaining the information to maintaining the behavior. The model is based on four stages: motivation, guidance, action and maintenance. The model is intended to be flexible enough to be used for a variety of health promotion issues and with a variety of communication channels. An example from the field of motor vehicle safety is used to demonstrate applicability of the model to a campaign under development. Empirical research is needed to determine the efficacy and effectiveness of the model in changing behavior as well as the ease of use for campaign developers.

Examination of the precaution adoption process model in understanding older drivers’ behaviour: An explanatory study

Self-regulation of driving has been proposed as an effective strategy to keep older adults driving safely for longer. Little is known of what influences older adults’ decision to adopt self-regulatory driving behaviours. Hassan et al. (2015) developed an initial model of self-regulation using the Precaution Adoption Process Model (PAPM) as a theoretical framework. The present study aims to build on the previous research by investigating whether a sample of older drivers can accurately be assigned to the PAPM stages of change. Further, the study aims to identify the psychosocial and environmental factors associated with different stages of the PAPM and those that predict the decision to adopt self-regulatory behaviour. Logistic regression analysis indicated that self-rated driving confidence, family feedback, self-rated quality of driving and driving relinquishment expectation were significant predictors of PAPM stages. Findings from this research have practical and theoretical applications for improving our understanding of the self-regulatory behaviours of older drivers.