Trans-theoretical Model of Change (TMC) has its limitation on individual’s behavior of change. Additionally, this stage model may not necessarily explain significant change process on how diabetic patients can stop eating high-fatty foods leading to diabetes. This is unlike the Precaution Adoption Process Model (PAPM), which can explain design process for health promotion strategies to preventing diabetes.
The idea that differentiates PAPM from other theories is its strengths and ability to precisely explain actions of health hazards, and the commencement of new or more complex defensive health behaviors (Gibbons, Gerrard, Blanton, and Russell, 1998). In comparison, some of the specific stages of TMC’s constructs are similar in nature. TMC’s research has found that people move through a series of stages when modifying behavior. While the time a person can stay in each stage is variable, the tasks required to move to the next stage are not.
Age is one of the most important factors linked with developing diabetes (American Diabetes Association, n.d.). In addition to age priority, essential diabetic questions were highlighted for a community health intervention. These questions are very much a way to detect risk influences for developing diabetes, and how they might help in reducing the exposure of the disease. For example, increased high blood pressure is the main causal player for diabetes. Therefore, we take into account fluctuations of blood pressure by measuring participants’ blood sugar level. According to the National Nutrition and Health Survey (n.d.), incidence of high blood pressure remained relatively high for Filipinos. Instead of taking into account the essential diabetic questions for disease intervention, we could apply the PAPM in explaining certain community health assessment process. It is important to keep in mind that stage models are descriptive in nature, rather than explanatory. Likewise, stages can differ extensively along different dimensions, like timeframe and intensifications; both between persons and for the same individual at altered times. In the case of a need for precaution, persons may fail to modify their important behavior. For example, someone with diabetes might never decide to reduce the consumption of sugar-related foods and drinks. Some patients would think that despite high blood pressure, their genetic greasepaint can protect them from risk of stroke (Harris & Middleton, 1994). Additionally, PAPM can be used to explain how member of Manila communities who satisfy all the requirements for community health assessment can decide whether to participate or not. Community health assessment can be used an approach to educate and support members of community about the negative effect of diabetes. It is also a way of preserving community health assets. PAPM can be used as an action-theory for ending or avoiding high fat foods that could elevate risk of having diabetes (Health Behavior and Health Education, n.d.). For community health intervention, PAPM is based on the stages of behavior change. The PAPM differentiate among persons who are at different stages of awareness and readiness to act. This also differentiates from other health behavior theories whereby individual is either practicing or not practicing the attitude. The stages of PAPM includes the following: unaware of the issue, undecided about acting, decided not to act or decided to act, acting and maintenance ( Weinstein, Sandman, Blalock, n.d.). Community members, upon information of the diabetes issue, will either decide to engage in the assessment process, or not decided to participate, and if decided to act, can certainly maintain and follow proper precaution of changing their lifestyle to free-diabetes.
The need to reconsider the behavior and attitude of those with high risks of evolving diabetes is an important variation between health education theory and other theories, such as Trans-theoretical Model of Change. It is important to also see an exclusive side of PAPM, in a public health intervention. Public health researchers found in some case studies that the ability to empower others to stop the bad behavior was a behavior associated with collective leadership (i.e. in health education theory). The leadership approach of health education theory (HET) can be a reasonable approach in combating/changing community perception to diabetes. HET can be effective in related-community health assessment. I think changes in personal decision (i.e. personal thinking) is one of the important deciding factors of using PAPM, in a community health assessment.
Behavior change theories can be used, in many ways to explain the diabetic impact in different communities. PAPM is a theory-example that shows how preventable diabetes can be. It is preventable because community members are free to take precautionary decision, which can affect their approach to health situations. Adoption of new behavior or cessation of a risky act like the prevention of diabetes, requires careful steps unlikely to occur outside of conscious alertness. The PAPM does not relates to the steady development of habitual patterns of behavior, such as exercise and diet, in which health considerations may play some role (Gibbons, Gerrard, Blanton, and Russell, 1998).
Health behavior change theory provides a roadmap to the major factors that affect behavior, and indicate the relationship among the various dynamics of when, where, and how these factors function. The central concern of any health education is health behavior. If behaviors change but health is not subsequently enriched, the result is an inconsistency that must be resolved by examining other issues, such as linkage between behavior and health status or the ways in which behavior and health (or both) are measured (Conner, Sparks, 1996). For its limitation, PAPM seeks to focus on the behavior change aspect in explaining how diabetes can be minimized in Manila communities. On the other hand, it can provide vigorous precautionary approach in which, if a person decides to quit, minimize or maintain certain behaviors, can certainly do so with the available information at hand. Diffusion of Innovation Theory (DIT) is another community-based approach for guiding prevention of injuries or diseases, such as diabetes. Healthy communities rely on effective community health interventions; most importantly they deal with the general concept of public health as more than just a system of theories and risk-interventional approaches (Bellah, et.al., 1991). We simply cannot separate how and why we approach public health concerns in many ways, including the use of DIT (Bellah, et.al., 1991). This is because whether we speak about changing behaviors, community structures and capacity building on communities, these changes cannot be detached, neither can they set aside the healthy philosophy of what establishes a healthy community.
Health psychologists emphasized on psychological study of behavioral processes in health, illness and community care services. Cherry (n.d.) described health psychology as the focus on promoting health wellbeing, prevention and treatment of diseases. The diffusion of innovation theory (DOI) aimed at explaining how, over time, an idea or product gains momentum and spreads via certain social structure. DOI can improve the advocacy of vital public health programs, such as the universal helmet bill that typically aim at changing the behavior of a social system (i.e. driving a motorcycle). DOI only works better to help adopt a behavior, after serious or catastrophic incident, and in the prevention of accidental injuries. The drawback of DOI is how it failed to explain situations where behavior is bad, such as reducing the impact of diabetics or action that need to avert a bad behavior. For example, rather than adopting a behavior, how can it prevent a behavior in a social system? Say like preventing the spread of diabetes in certain communities. The passage of universal helmet legislation requiring motorcycle riders of all ages to wear helmets is a timely and controversial issue that have evolved with far-reaching public health implications, especially as the number of motorcycle fatalities continues to rise. DOI is used in this respect to explain how evolving high fatalities have brought about a system change on the use of motorcycle helmet (Bellah et al., 1991).
Reference
American Diabetes Association. (n.d.). Are you at Risk for Type 2 Diabetes? Retrieved from http://main.diabetes.org/dorg/PDFs/risk-test-paper-version.pdf
Bellah, R.N., Madsen, R., Sullivan, W.M., Swidler, A., Tipton, S.M., (1991). The Good Society. Vintage Books; New York.
Conner, M., & Sparks, P. (1996). The theory of planned behavior and health behaviors. In M. Conner & P. Norman (Eds.), Predicting health behavior: Research and practice with social cognition models (pp. 121-162). Buckingham, England: Open University Press
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Harris, P. and Middleton, W. (1994) The illusion of control and optimism about health: on being less at risk but no more in control than others, British Journal of Social Psychology, 33: 369–86.
International Diabetes Federation. (n.d.). Philippines. Retrieved from https://www.idf.org/membership/wp/the-philippines
The National Nutrition and Health Survey. (n.d.). Nutrition and Health Status of Filipino Adults. Retrieved from http://www1.fnri.dost.gov.ph/files/fnri%20files/abstracts31st/posters/health.pdf
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