Home Radon Testing

Study Description: Field experiment designed to examine several aspects of the PAPM, using home radon testing as the intended precaution

PAPM Constructs/Stages Tested: Two stage transitions, from being undecided about home radon testing (stage 3) to deciding to test (stage 5) and from deciding to test (stage 5) to ordering a test (stage 6)

Objective: To determine whether the two transitions under study involve different barriers, as the PAPM theory suggests

Method: The study was conducted in Columbus, OH. All participants viewed an informational video about radon before receiving the experimental treatment. Stage of testing was assessed by questionnaire. Homeowners in stage 3 or stage 5 were assigned to an experimental condition, and videos were delivered by mail.

Participants in the High-Likelihood condition received a five-minute video, Radon Risk in Columbus Area Homes, and an accompanying cover letter. The video focused on evidence of high local radon levels, pictures of actual local homes with high levels, testimony by a local homeowner and a city health official, and refutations of common myths about radon.

The cover letter mentioned that test kits could be ordered from the American Lung Association (ALA) but did not include an order form.

Participants in the Low-Effort condition received a five-minute video, How to Test Your Home for Radon, an accompanying cover letter, and a form to order test kits through the ALA. The video described how to select a kit type (making an explicit recommendation in order to reduce uncertainty), locate and purchase a kit, and conduct a test. The process was described as simple and inexpensive.

Participants in the Combination condition received a ten-minute video that combined the two separate treatments, along with the same letter and order form as people in the Low-Effort condition. Participants in the Control condition received a letter stating that their further assistance was not needed and thanking them for their participation.

Follow-up telephone interviews were conducted 9-10 weeks after respondents returned the second video questionnaires (follow-up measurement). Interviews assessed whether participants had purchased radon test kits and, if not, determined their final stages.

The final sample consisted of 1,897 homeowners.


Predicting Progress Toward Action
More people progressed from the undecided stage than from the decided-to-test stage. There also was more progress among those who received the High-Likelihood treatment than among those who did not. Most important, there was a significant stage by High-Likelihood treatment interaction, indicating that the High-Likelihood treatment was much more effective for undecided participants than for decided-to-act participants.

There was also a large main effect of the Low-Effort treatment. The stage by Low-Effort treatment interaction indicated that, as hypothesized, the Low-Effort treatment in the Low-Effort and Combination conditions had a relatively bigger effect on people already planning to test than on people who were undecided.

Predicting Home Radon Test Kit Orders
Radon tests were ordered by 342 study participants (18% of the sample). As expected, there was more testing from the decided-to-test stage than from the undecided stage, and much more testing among people exposed to a Low-Effort treatment than among those who did not receive this treatment. Most important was the highly significant interaction between stage and Low-Effort treatment.

Issues to Consider in Determining Practical Utility of the PAPM or Other Stage Theories

  • Superiority over Unstaged Messages: PAPM suggests that people are most likely to be engaged by a treatment/message that matches their stage, and that a mismatched treatment/ message may lose their attention.
  • Stage Assessment: Consider ability to identify stages accurately and efficiently
  • Delivery of Stage-Targeted Messages: Consider feasibility of delivering stage-targeted messages in different situations varies significantly
  • The Difficulty of Behavior Change: When a behavior is easy and resistance is low, stage may matter little; when change is difficult and resistance is high, there is greater need to have separate messages at each stage.