Interrelationship of Preventive Actions in Health and Other Areas

PREVENTIVE health behavior is defined by Kasi and Cobb as activity undertaken by a person believing himself to be healthy, for the purpose of preventing disease or detecting it in an asymptomatic stage (1). Increased emphasis is being placed on preventive behavior in the health care delivery system. Indeed, prevention is a key element in health maintenance organizations, which are based on a prepaid annual fee and therefore benefit from keeping people well. However, preventive behavior is voluntary. A person can be encouraged to take the appropriate action, but he does or does not do so on the basis of his own decision. Past studies have indicated that the level of preventive health behavior is quite low, with many people not taking the opportunity to perform actions which can prevent disease or detect it early (2). Thus, there is a need to learn why some people behave preventively and to use this knowledge to influence others to do so. Currently there is no adequate explanation of why people behave preventively. The major theory of preventive behavior is based on health beliefs, but the empirical evidence supporting this theory is moderate and is often difficult to interpret because of retrospective designs or other drawbacks (3-5). Nevertheless, health beliefs, basic personality characteristics, and social status factors are likely to be involved in taking preventive actions; an important task is to sort out the contribution of these and other factors. To develop an explanation of preventive behavior, it is also necessary to uncover factors which are associated with a wide variety of preventive actions. A characteristic of previous studies of the motivation for preventive behavior is that they have dealt with single actions, although the intent is to explain preventive behavior in general. An important step toward understanding the dynamics of preventive behavior is determining how the various actions are interrelated. For example, if preventive behaviors are unidimensional, all intercorrelated at a high level, their explanation may lie in factors, such as socioeconomic status or personality traits, which are constant within the same person. Indeed, in studies which attempt to explain preventive behavior in terms of personality or social status, investigators implicitly assume that the behaviors are unidimensional. If behaviors are unidimensional, the explanation for any one behavior should explain preventive behavior in general. If the behaviors are related moderately or not at all, attention can be given to factors such as beliefs about illness which can vary within the same person from disease to disease, and efforts can be made to isolate factors which account for a wide variety of preventive actions. If preventive behavior consists of several statistically independent dimensions, examination of these dimensions is likely to lead to hypotheses as to why the behaviors are patterned in these ways. Different theories may be needed to account for the various dimensions. Knowledge of why preventive behavior does or does not occur can be applied in health education programs, although such programs can also benefit from knowledge about the interrelationships alone. If the behaviors are not unidimensional, we will learn which behaviors go together and which do not; which behaviors, if any, go with many of Dr. Williams is project director and Dr. Wechsler is re.search director at the Medical Foundation, Inc. This investigation was supported in part by Public Health Service Research Grant No. I R21 DH 00190. Tearsheet requests to Dr. Allan F. Williams, Medical Foundation, inc., 29 Conmmonwealth A4 ,e., Boston, Mass. 02116.