Health Belief and Precautionary Adoption Process

Health Belief Model (HBM) explains and predicts behaviors that relate to health interventions (Carpenter, 2010). The predictions of the behavior are based on the uptake of health services such as (Brewer & Rimer, 2008). HBM stipulates that motivation, skill, and the presence of an enabling environment lead to behavioral change (Brewer, Chapman, Gibbons, Gerard & McCaul, 2007). The underlying concept for the application of HBM is that health behavior is influenced by individual perceptions (Turner, Hunk, DiBrezzo & Jones, 2004). Brewer et al. (2007) noted that different attitudes are affected by intrapersonal factors that subsequently determine the probable behavior.

Perceived risk susceptibility is one of the core constructs of HBM. Thalacker (2010) pointed out that personal risk perception plays a crucial role in promoting people to adopt healthier behaviors. For example, a dreaded disease will make people explore alternative ways to reduce the risk. However, Thalacker (2010) noted that risk perception does not result in the elimination of the problem, but it reduces risk behavior. For instance, the creation of awareness about HIV in the past decades led to increased awareness and risk perception. Thus, people adopted mitigation practices such as protected sex or abstinence to avoid risks. The changes did not eliminate the problem but reduced the infection rates.

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According to Hanson (2002), the HBM provides a framework in which differences in compliance and non-compliance are established. The agreement to change depends on the susceptibility of the risk (Stephan, Boiche, Trouilloud, Deroche & Sarrazin, 2011). The perceived susceptibility construct is based on the possibility. Pirzader and Mostafavi (2014) argued that there is no relationship between risk perception and behavior change. However, in a study to find out the risk perception of prescription drugs and vaccines, the study participants were found to consider vaccines beneficial depending on the level of knowledge (Hanson, 2002). Exposure to risk determines the outcome of the intended change. Thus, without knowledge of the risk, substantial behavioral change cannot be realized.

Bond and Nolan (2011) conducted a stratified study to identify the risk perception of mothers in relation to immunization of their infants. The study included 45 Australian parents with children who were undergoing immunization stages. The study established that the construct of risk perception among the parents played a crucial role in determining the completion of the vaccination process (Bond & Nolan, 2011). The mothers with high-risk perceptions were willing to undertake all the immunization stages. The parents without adequate knowledge of risks underwent some vaccines and withdrew from the remaining stages. The parents who were not aware of the danger caused by diseases did not immunize their infants.

Chen, Fox, Cantrell, and Kagawa (2007) carried out a study to establish risk perception of skin cancer and the use of sunscreens. They found that perceived susceptibility acts as motivation for people to use sunscreens in order to prevent cancer of the skin. The risk perception is not absolute; it is influenced by the exposure and the knowledge accumulated by the target audience. For instance, if the magnitude of the perceived risk is high, the chances of adopting the behavior to reduce the risks posed are also great (Tuner et al., 2004). In Saudi Arabia, the high risk of cardiovascular diseases among women presents a significant challenge. The extent to which the Saudi women perceive the risk probably will determine the willingness to . The perceived susceptibility acts as a motivation for behavior change.

Precautionary Adoption Process Model (PAPM)
The PAPM is a seven-stage model that explains how individuals make decisions and the transition process of making decisions (Sniehotta, Luszczynska, Scholz, & Lippke, 2005). The model applies seven stages to determine and explain awareness of health. The knowledge and exposure influence the outcome decision, i.e., either changing or deciding not to change (Mauck e at., 2002). Mauck et al. (2002) stated that the PAPM model explains the seven stages in terms of psychological processes that take place. Before taking action, the stages of PAPM are presented as mental states. The main stages of PAPM include:

Unaware of the issue
Unchanged from the issue
Undecided about acting
Decided not to act
Decided to act
Maintenance of the good behavior
Just as the HBM, PAPM is applied in health education and promotion. The target people are educated about prevailing health concerns and presented with options to act (Sniehotta et al., 2005). For instance, Saudi Arabian women are mandated with the preparation of family foods; however, the western influence has resulted in the adoption of . Thus, the PAPM model presents a framework for measuring the readiness of the women to act, i.e., change to and maintain the health practice. The stage of decision-making is the core turning point in ascertaining the direction of behavior change.

The ideas of PAPM have been applied in many health intervention programs such as prevention of osteoporosis, screening of cancer, and smoking cessation (Sniehotta et al., 2005). There are differences in the extent the PAPM ideas are applied in the health interventions and promotions. For instance, most of the researchers use a to determine the level of awareness. Blalock (2005) conducted a study in which PAPM was used to assess behavior change intervention for osteoporosis, a disorder that leads to a decrease in bone density. The study was aimed at understanding the factors that make women not take enough calcium and physical activity and to predict the transition process. The research was based on the implementation of the seven PAPM stages. The study established that awareness of the health impact of a given situation determines the probable line of action. Women who did not have adequate awareness of the risk of osteoporosis did not take diets and supplements rich in calcium. In addition, the women did not engage in physical activity. In a review of osteoporosis health beliefs, McLeod and Johnson (2011) found that men and women who reached the decision-making stage were aware of the health issue.

In a similar study, Sasaeinasab et al. (2013) stated that the PAPMs seven stages present a dynamic behavior change process. In the process, there is no predetermined time for transition from one stage to the next. Elliot, Seals, and Jacobson (2007) conducted a study to assess behavior change and intervention processes for osteoporosis. The study evaluated health beliefs, knowledge, and stages of precaution in the adoption of protective osteoporosis behaviors among women. In relation to calcium intake, Eliot et al. (2007) noted that perceived susceptibility to osteoporosis and the knowledge of benefits of calcium was in the higher stages among women who had prior knowledge. Health motivation and knowledge mostly predicted the decision to engage in physical activity among women. The study provided a basis for understanding PAPM and established how people could be influenced to transition from the unaware stage to the stages of taking action and maintaining protective behaviors.

In yet another study on low-impact fracture among postmenopausal women, Mauck et al. (2002) found that 62% of the women were in stages one and two of PAPM. Only the women previously diagnosed with osteoporosis were ready to seek treatment. The acceptance to find the medication pointed out that awareness plays a crucial role in determining the process of transition. For instance, lack of knowledge accounted for the high number of women being in the first stages (Mauck et al., 2002). Thus, to transition to positive behavior change, adequate education is required to achieve action.

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