Precaution Adaption Processes Model (PAPM)
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-Dichotomous model, practical for decision-making
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-“Decision not to treat” may be viewed as unacceptable
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-Incorporates a distinct unawareness stage (versus unaware OR unengaged) with opportunity for education
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-Emphasis on reading materials/pamphlets may need to be locally modified to literacy rates
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-Challenge of measuring family’s exact stage of placement
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Transtheoretical Model (TTM)
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-Removes assumptions about immediate readiness for behavior
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-Danger of evolving into a self-help model without adequate support for change when the external forces of poverty and conflicting priorities are the reason for delay
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-Recognizes different families will be in different stages
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-Encourages inclusive, appropriately timed motivational readiness interventions
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-Does not always recognize broader social and physical context
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-May unintentionally imply blame on a family, whereas much of the impetus is a fractured system of care delivery
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-Supports families between decisional stages toward acceptance
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-Common phrases such as “self” efficacy and “self” realization may not be relevant in settings where health behaviors and outcomes are communally based
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Decision to not utilize stage- based model
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-Potentially streamlined decision-making
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-Population characteristics, needs, and values may be overlooked when community engagement is not prioritized (available and accessible does not equal acceptable, appropriate, or equitable)
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-Time and resources centralized to making treatment available and accessible
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-With limited funding sources, focuses resources on specific, measurable biological outcomes such as diagnostic accuracy and disease response
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-Risk imposition of an external “evidence based approach” which is not taking local evidence and local experience into consideration to facilitate service or intervention adoption and sustainability
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-Risk suboptimal allocation and mis-prioritization of resources toward well-intentioned empiric efforts that are however poorly aligned with target populations’ current stages of readiness for change
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