Preventative Health Care Consumer Socialization: Implications For Influencing Agents

Laurel A. Hudson, Virginia Polytechnic Institute
Stephen W. Brown, Arizona State University
ABSTRACT - Escalating health care costs, increased longevity and concern with the quality of life have encouraged greater individual interest in the maintenance and enhancement of their own health. To appreciate the outcomes, learning processes, and lifestyle adaptations associated with preventative health care behavior requires an understanding of consumer socialization. As an initial step toward theory development in the area, this paper explains the process of socialization for preventative health care practices and explores the implications of this process to our understanding of health care consumer behavior.
[ to cite ]:
Laurel A. Hudson and Stephen W. Brown (1983) ,"Preventative Health Care Consumer Socialization: Implications For Influencing Agents", in NA - Advances in Consumer Research Volume 10, eds. Richard P. Bagozzi and Alice M. Tybout, Ann Abor, MI : Association for Consumer Research, Pages: 612-617.

Advances in Consumer Research Volume 10, 1983      Pages 612-617


Laurel A. Hudson, Virginia Polytechnic Institute

Stephen W. Brown, Arizona State University


Escalating health care costs, increased longevity and concern with the quality of life have encouraged greater individual interest in the maintenance and enhancement of their own health. To appreciate the outcomes, learning processes, and lifestyle adaptations associated with preventative health care behavior requires an understanding of consumer socialization. As an initial step toward theory development in the area, this paper explains the process of socialization for preventative health care practices and explores the implications of this process to our understanding of health care consumer behavior.

With rising health care costs, increased longevity and greater expectations with regard to quality of life, preventive health care has assumed an increasingly prominent position in the health care provided to consumers. This trend has led to a greater effort to increase the knowledge of consumers with regard to their health, to develop attitudes and encourage lifestyle adaptation that maintain health, and to teach skills that promote and monitor health. The individual consumer is being encouraged to become more responsible for his own health maintenance. These efforts all depend on consumer learning and the socialization of the individual into the preventative health care consumer role.

A first step for consumer researchers in examining this process is theory development. Jacoby (1978) has mentioned that this initial step is not always attended to by consumer researchers, a consequence of which is the risk of poor research. The purpose of this paper is to explain the relationships within the process of socialization for preventive health care practices and explore the implications of this process to our understanding of health care consumer behavior. This approach should provide a foundation for future research in the area.

Socialization refers to the learning of new social roles and the behaviors associated with these roles. Within the framework of consumer socialization, the focus is on the study of the acquisition of habits, beliefs, attitudes, skills and knowledge which enable a consumer to act out satisfactorily the roles expected by society (Brim 1966). A "socialized" individual will consume the ideas or attitudes marketed by "appropriate" segments of society. Sociologists distinguish between primary and secondary socialization. Primary socialization is the process by which a child becomes a participant member of society. Secondary socialization occurs as the individual enters a specific social world and is expected to acquire a specific social role (Berger and Berger 1979). A child, for example, goes through primary socialization as he acquires basic attitudes regarding the value of health maintenance activities during childhood. This individual then goes through secondary socialization when he enters a specific occupation, becomes a member of a specific neighborhood, or takes on a new position in his firm. With each of these specific roles come expectations of what his preventive health care behavior should be.

In this paper, socialization is used as the primary perspective because it provides an appropriate mechanism for studying consumer health behavior over a person's life cycle, Since preventative health behaviors change over an individual's life cycle, the socialization perspective helps consumer researchers understand what, how and Why these changes occur. The socialization approach is often more useful than other approaches (e.g., attitude change, adoption theory) to examining learning because it studies behavior within both specific and life-spanning contexts. This usefulness stems from its multi-theoretical perspective (Ward 1978). Socialization provides an integrating framework for such theories as cognitive development, social influence, learning, motivation, information processing, etc. The popularity of life-spanning perspectives in studying human behavior extends to psychologists, sociologists, communications researchers and even some cognitive development theorists (Moschis 1981).

At this point, it is appropriate to reiterate that socialization is not restricted to pre-adult years (cf. Moschis 1981; Brim 1966). The life-long process indicates that the socialization experienced by an individual in childhood cannot prepare him for every role he will be expected to fill later as an adult (Moschis 1981). For example, there are numerous expectations with regard to preventive health activities for occupational roles. A pilot, professional athlete, or health care provider is probably expected to participate in more preventive health care activities than a secretary, lawyer, housewife or retiree. The socialization perspective is useful in explaining health behaviors within each of these occupational categories.

There are numerous definitions of preventive health care. This paper offers a definition drawn primarily from interpretations by Harris and Guten (1979) and Flexner. Preventive health care is defined as "actions performed by individuals, regardless of their perceived or actual health status, in order to protect, enhance or maintain personal health." These actions might include habits, purchases and the use of preventive health services such as immunizations, screening programs, physical examinations and family planning. This definition will be used in this paper as it is broad enough to encompass any behaviors which the learner or influencer in the socialization situation symbolizes as preventive health care behavior. In addition, the definition does not stipulate that a person views himself as "healthy" to participate in preventive health care activities. "Health" is most appropriately perceived as a continuum on which the individual's position varies and not as a dichotomy of "healthy" or "unhealthy."

This paper first presents a model of preventive health care consumer socialization (PHCCS) that seeks to facilitate the understanding of this process and then discusses the implications of this socialization process for influence agents. The consumer socialization discussion and the related implications are offered as a first step in theory building for consumer researchers interested in preventative health care. As noted earlier, this step is a necessary precursor for quality research efforts in the area.


Social learning theory, as proposed by Bandura (1977), provides the theoretical framework for a model of preventive health care consumer socialization. Social learning theory explains behavior in terms of a reciprocal interaction among environmental, behavioral and cognitive determinants. Social learning theory specifically acknowledges that human thought, affect and behavior are influenced by observations as well as direct experience. It purports that people use symbols to process and store experiences in representational forms that then serve as guides for future behavior. In addition, the theory states that individuals do not merely react to external influences, but actually select, organize and transform stimuli that impinge on them. Thus, social learning theory stresses the importance of vicarious, symbolic and self-regulatory processes in socialization in addition to the traditional reinforcement process of learning (Bandura 1977).

The model in Figure 1 presents the basic variables and processes believed to be relevant in the learning of behaviors for the preventive health care consumer role. The preventative health care consumer socialization model (PHCCS) is of value because it integrates the relevant literature/research that currently exists and presents a visual depiction of the relationships between significant variables. In addition to sensitizing the consumer behaviorist to these key variables and their relationships, the model can be used in the planning process to identify areas where consumer research is needed, to suggest appropriate consumer segments to target and to evaluate the appropriateness of influence strategies in light of the variables and relationships that affect health care consumer learning. Perhaps the most significant benefit of the model will be increasing the awareness on the part of consumer behaviorists, marketers and health care providers as to their impact on the learning of preventive health care consumer attitudes, knowledge and behavior.

The model contains three major components: the outcomes in preventive health care consumer socialization, the learning processes that yield the outcomes, and the antecedent variables that affect the learning processes. Each of these components is discussed in the following subsections.




The outcomes of the socialization process are the health care attitudes, skills; knowledge, and behaviors expected of a socialized individual. These outcomes might include partaking in immunization programs, feeling that an individual should have a physical examination once a year, or knowing the symptoms of hepatitis. This component leads to a fundamental question of who decides what are the desired outcomes. Socialization is discussed in the context of what society expects of an individual. However, should these outcomes be what society expects or the outcomes that experts think are best for society? Often these desired outcomes are not mutually exclusive. However, especially with regard to values, attitudes and moral issues, they may be different. For example, physicians may view increasing patients' feelings of responsibility for the monitoring of their health as a desired outcome. However, a sizable portion of our society may see this monitoring as the responsibility of physicians and not want to gain more personal knowledge in this area.


The antecedent variables affect the acquisition of preventive health care consumer behaviors (outcomes) both directly and indirectly through their impact on the learning processes (Moschis and Churchill 1978). These antecedent variables affect both the socialization agent and the learner.

Social Structural Variables

Social structural variables emphasize the social environment within which learning takes place. These variables might include culture, social class, sex, religion, education, family size and position in the family. Differences in these structural variables often influence consumption/behavior patterns among individuals (Zaltman and Wallendorf 1979). Various consumer research studies, for example, have shown that variations in socioeconomic, social class, sex and racial factors contribute to different behaviors (Moschis 1981).

Social structural variables will partially determine the preventive health care attitudes, behaviors and knowledge that are felt appropriate for the learner to accomplish. Social structural variables will have an impact both on the present learning process and on previous health care socialization. Rosenstock (1966) analyzed the major studies on the use of preventive health care services. With regard to the social structural variables, he found that such services were most used by consumers who were young or middle-aged, female, relatively well-educated, had higher incomes and were white.

Life Cycle Position

A second extremely important antecedent variable in preventative health care consumer socialization (PHCCS) is life cycle position. Life cycle position is important for two reasons. First, it gives some indication of the cognitive and psychological capacities of the learner at a given stage in the life cycle. Secondly, societal expectations vary for individuals at different points in the life cycle (Bandura 1977). As people mature, they move through a series of statuses corresponding to different stages in the life cycle. Some of the expectations of society are relatively stable throughout the life cycle, while others change from one stage to the next (Brim 1966). The points at which individuals move from one part of the life cycle to the next are likely to be characterized by disequilibrium.

Hirschman (1980) points out in her discussion of role accumulation that with each additional socially induced role, the individual confronts new consumption situations and must learn to adopt new products or use present ones in novel ways. This implies that there is a great deal of consumptive learning occurring at the time that a new role is undertaken. This increased potential for change at these critical junctures makes the person very susceptible to new socialization agents as he pays increased attention to cues which may signal appropriate behavior in order to decrease the disequilibrium and lack of reward being experienced. This search for new behaviors at certain times during the life cycle is not lost on hospitals and clinics that offer post-partum family planning, child care classes, and prenatal childbirth preparation classes. Other examples of recognition of the life cycle positions are seen among insurance companies whose plans offer coverage of well-baby visits and clergy that offer premarital counseling.

Thus, life cycle position will impact on preventive health care socialization in a number of ways. The societal demands and pressures with regard to preventive health attitudes, knowledge and behavior may be different at different points in the life cycle. As Zaltman and Vertinsky (1971) point out, in a medically advanced society there are societal sanctions against having a sick child. Consequently, it is likely that parents seek preventive health care for their children. An obese child or adolescent faces societal disapproval, whereas this disapproval is not as pronounced during middle age. Thus, there may be a concentrated effort at weight maintenance during certain times in the life cycle.

We can also view the Health Belief Model in light of life cycle position. This model was developed by Rosenstock (1966) and then revised and expanded by Becker and his associates (Becker 1974; Becker et al. 1974; Becker Maiman et al. 1977) to explain the demand and behavioral performance of preventive health care. According to current formulation, the model views health behaviors as most likely to be performed by individuals who:

"...(1) are motivated to perform them (express concern about health matters in general, are willing to and intend to comply with medical direction, and already engage in positive health activities), (2) perceive a value to reducing the threat of disease (perceive themselves susceptible to a given disease or vulnerable to disease in general, perceive disease as affecting them physically or socially, or currently perceive symptoms of disease), and (3) believe that health action will reduce this threat (perceive the action to be safe and effective), all modified by (4) a set of demographic, structural, and enabling factors (Harris and Guten 1979).

The model suggests that the consumer has a psychological state of readiness to take an action. The state of readiness is felt to be affected by the individual's perceived susceptibility to a disease and the perceived seriousness if contracted. It is likely that consumers will view themselves as more highly susceptible to a condition at certain times during the life cycle than others. For example, older men may perceive of themselves as more susceptible to a heart attack. Pregnant women may view themselves as more susceptible to viral infections or malnutrition. Parents may view preschoolers as more susceptible to measles and mumps.

And lastly, life cycle position may impact on the type and agent of influence that is most effective. Different interpersonal relationships have different meanings as influenced by social norms. Therefore, some relationships and some individuals expect to be more powerful or meaningful at different times. For instance, a mother of a ten-year-old may be very effective in influencing her child to eat her breakfast. The same mother may be totally ineffective in influencing her twenty-year-old child on how to raise her children.

Previous Socialization

The last antecedent variable, previous socialization, has an effect on the learning process because of the preventive health care attitudes, behaviors and knowledge brought into the learning situation. Additionally, past health related experiences that have been symbolized and stored will influence the present learning process. This previous PHCCS may present a problem to socialization agents trying to obtain specific outcomes. For example, an elderly individual who feels that a sweet baked dessert is part of any dinner may not be receptive to following the example of a grandchild who refuses to consume refined sugar. It is questionable whether modeling will occur in the situation where a young maternity nurse seeks to teach a mother of four how to bathe a newborn by demonstrating the bath.


During the life cycle, there are a number of socialization agents who have great influence on the learning of an individual because of their frequency of contact, their primacy and their control over rewards and punishments (Brim 1966). The significant implication of including specific influence agents in the socialization model is that the unit of analysis becomes the agent-learner relationship rather than the individual person being influenced (McLeod and O'Keefe 1972). Since the unit of analysis in PHCCS is the relationship of the influence agent and the influence, socialization occurs in both directions.

Early socialization research focused on the parents as influencers. More recently, there has been greater attention to siblings, peers, teachers, mass media and organizations (Moschis 1978; Shaffer 1979). Children may rely on older siblings and peers as models for specific modes of behavior that parents ordinarily do not provide. As children grow older most draw more heavily from peers and other extrafamilial models for several reasons. Under conditions of rapid social and technological change, many parental interests, attitudes and role behaviors that were appropriate at an earlier period may have little functional value for members of a younger generation. In fact, adolescents may often function as models for parents (e.g., nonsmoking, health food habits, meditation). As the child grows older, he spends less time with parents, thus decreasing the opportunities for influence. However, caution should be taken in generalizing. There may be product specific effects. It may be that since preventive health care behaviors do not result in the acquisition of a conspicuous product and the norm among some groups is to view health, both physical and mental, as a private, occasionally taboo subject, the influence of the family may prevail in health care matters for a relatively longer period of time.

Mass media has become an increasingly prominent socialization agent. This occupance has been a major public policy concern. With increased use of television and the resultant symbolic modeling, Bandura (1971) feels that-parents, teachers and other traditional role models may occupy less prominent roles in social learning. The average viewer is exposed to a continuous diet of "medical" shows on television and also to a large number of commercials for proprietary medicines. A national study by the Louis Harris Organization (1973) reported that mass media was second only to the individual's physician as a source of health information. In addition, much of the health information absorbed from television, in particular, is likely to be done under low involvement conditions. Thus processing without evaluation is likely. However, communications research consistently indicates that mass media acts mainly to reinforce present attitudes and behaviors and is not as apt to be able to bring about a change in behavior (Robertson and Wortzel 1978).

Rosenstock (1966) promoted the use of primary and secondary education to influence children both to develop desired health habits and desired health beliefs. Moschis and Churchill (1978) found that the effectiveness of consumer education programs in influencing students' behavior and attitudes has not been considerable. However, probably more frequently, preventive health care behavior is taught in health education classes versus consumer education classes where there may be different results.

Finally, it is important for health care providers to recognize the extent of their influence on PHCCS. Each experience with a provider is symbolically coded and stored for use in future similar situations. Rodin and Janis (1979) posit that health care providers see themselves as experts with special knowledge that would be of benefit to the consumer. The providers then assume that they have power over the patients because they can give or withhold information. Providers may expect the consumer to comply with their "orders" or requests because of this expertise. When patients do comply in this manner, we can expect that they will attribute their behavior to external sources and be less likely to perceive themselves as having control over their health-related behavior (Deci 1975). Research supports that greater feelings of control increase the likelihood of behavioral commitment and adherence to preventive health measures (Mahoney 1977).

The major preventive health care socialization agents are the family, peers, institutions, media and health care providers with their degree of influence varying with the learner's position in the life cycle and the specific situation in which the learning is occurring. In recent years we have seen cooperative efforts between two or more entities working together to promote health. The joint health/fitness programs of hospitals and employers are an example of socialization influences emanating from two mutually reinforcing agents. Another relatively recent development is represented by the increasing number of individuals assuming responsibility for their own health. Part of this self-reliance is due to dissatisfaction with the services provided by many traditional health care providers/influencers. Even these self-reliant people have been socialized in this personal characteristic by other influence agents. In reality the fitness orientation has permeated much of our culture.

Bandura (1977) suggests that learning occurs through reinforcement and/or modeling. Learning by response consequences (reinforcement) requires direct experience. As individuals respond to stimuli, some of their responses prove successful and others have no effect or result in punishing outcomes. Through this process of differential reinforcement, successful behaviors are selected and added to her/his repertoire of behavior and ineffective behaviors are discarded. Reinforcement offers an effective means of regulating behaviors that have already occurred, but it is relatively inefficient i in creating behaviors. Bandura (1977) believes that most learning phenomena occur on a vicarious basis by observing other people's behavior and its consequences to them. Modeling or imitation occurs when the learner tries to match behavioral responses to those cues provided by the socialization agent.

The self-regulatory component of the learning process is , the cognitive determinant of behavior to which Bandura (1977) refers. Many of the desired preventive health behaviors must rely on this self-regulatory process. This is especially true in the maintenance of new behaviors through self-reinforcement. Because there are often immediate rewards to such undesired behaviors as overeating and because the reinforcement process of learning requires monitoring, it is often necessary to rely on the consumer's ability to reward himself.


The previous discussion of the preventative health care consumer socialization (PHCCS) model offers a number of significant implications for consumer behaviorists, marketers and health care providers. Three situations can be identified as particularly appropriate for potential application of the model: 1) when new information and practices need to be disseminated, 2) when counter-marketing is needed, and 3) when activation is needed (Fox and Kotler 1980).

The first of these situations requires a lifelong consumer learning process as new health information becomes available throughout the lifetime of a consumer. By way of illustration, witness the changes in the past twenty years in prenatal care due to the new health information available--weight gain, nutrition, activity, environmental exposure, alcohol, delivery preparation. The second situation, where counter-marketing is needed, often requires resocialization. The learning and reinforcement of new health behaviors may be necessary as a countermeasure to large promotional campaigns undertaken by companies who encourage consumption of unhealthy products. The third situation emphasizes the behavioral aspect of learning. Often people cognitively acquire beliefs regarding what is healthful behavior but to not act according to those beliefs. Thus, health care providers often seek to move individuals from cognitive learning to behavior and then maintain these new learned behaviors. An individual may "know" that smoking is not good for him, but "do" nothing about it. Here the emphasis is on learning new behaviors and extinguishing old behaviors.

Using a marketing approach, Fox and Kotler (1980) have identified five elements that relate to these three situations: Social communication, marketing research, product development, and the use of incentives and facilitation. In the following discussion, each of these elements are discussed in terms of their implications for preventative health care consumer socialization.


Mass communication has been the emphasis of most preventive health idea marketing in the past. The PHCCS model points out a number of salient concerns here. First, who the influence agent will be. As discussed, given certain variables, it is likely that certain influence agents will be more successful than others. The recent controversy over the use of actress Brooke Shields in an advertisement oriented toward adolescents provides an example. During adolescence, peers have a great deal of influence upon each other in many areas, more so than many parents or "experts." Here the life cycle position provides information regarding how influential an agent is likely to be. The other antecedent variables also provide similar information--social class, formed attitudes, sex, education, etc.

Secondly, the-effectiveness of a particular influence agent is also dependent on the type of learning process that is attempted. As Robertson and Wortzel (1978) point out, mass media seems to be most effective in reinforcing present attitudes and behaviors rather than bringing about a change in behavior. The Stanford Heart Disease Prevention Program found that mass media alone was effective in bringing about long-term changes in habits and reduction in the risk for heart disease (Meyer and Maccoby 1978). However, one of the key features of this mass media program was the stimulation of interpersonal communication and influence. Overall, media-plus-direct-instruction was most effective in producing change. Thus, mass media may be most effective in reinforcing existing knowledge behaviors, but in general has not been as effective in changing behavior.

The modeling of a new behavior is difficult via mass media. Unless the agent is well known, the learner has little information about the model. While the organization who is sponsoring the message is likely to lend credence in reinforcement learning, modeling is a more personal process. The learner evaluates the appropriateness of an individual agent as a model. Again the Brooke Shields controversy exemplifies this learning process. Because of the information that adolescents have on this model, based on her movie roles, there is concern that not only will the nonsmoking behavior that she is advocating be accepted, but other of her movie behaviors will be integrated also.

Third, the self-regulatory aspect of learning must be taken into account. Through self-regulatory mechanisms, an individual may select the messages that he attends to. For example, a young person who does not feel that he is susceptible to heart disease may disregard a television message on prevention of heart disease. The model or influence agent that is used will have an impact on this perceived relevance.

Lastly, given the antecedent variables, mass communication messages must take into account the likely symbolization process that will occur. This has been especially apparent in preventive health campaigns in other cultures where symbolization regarding masculinity, good mothering and cleanliness have not been taken into account

Because of a general lack of effectiveness in the use of mass media for changing health behaviors, more emphasis is being placed on personal communications. With the personal communication aspect, an effort is made to utilize a network of influence agents who have direct contact with the learner. These agents might include doctors, health educators, peers, families, bosses, etc. Again, depending on the situation and antecedent variables, certain of these agents will be more effective. The advantage here with the direct contact is an opportunity to reinforce more constantly and to utilize existing models who may be viewed as more credible in learning preventive health skills, knowledge and behaviors. Thus socialization may first involve the socialization of these influence agents. Some medical schools are attempting to do this through the experiences and expectations that they have of medical students. Many provide interdisciplinary models to teach the "holistic" view of the client that-takes into account that individual's life position, social structural variables, and previous socialization in developing a health plan with the client. The impact and influence of the interpersonal relationship of the doctor and client on learning is stressed. The attitudes and behaviors of bosses also model accepted health care behaviors and, thus, can be valuable in developing the attitudes and behaviors of employees. Organizations such as Xerox, Phillips Petroleum, Gates Rubber and Kimberly-Clark have gone so far as to construct exercise facilities for their employees and families conveying an attitude about preventive health behaviors (Krietner, Wood and Friedman 1979). Mass media has also been used to stimulate this personal communication. An example of this is the recent television message encouraging peers not to let their friends drive drunk. This attempts to socialize peers to use their influence to obtain a certain behavior.

Product Development

The behavior or idea that is being promoted by the influence agent can be perceived of as a product. It is important to realize that many of the attempts at influencing preventive health behavior are intended to eliminate certain behaviors. It is much easier to maintain this elimination if new alternative behaviors are available to fill the void. In order to influence the acceptance of these new behaviors, it is important to realize what was reinforcing (a benefit) about the old behavior and what kinds of reinforcements (benefits) are desired of the new behavior. Too frequently it is assumed that the benefits of a new behavior are obvious and universal. However, the reward of a longer life from not smoking may not be as strong as the reward of a relaxed feeling that comes from smoking. Thus influence agents must be aware of the rewards of certain behaviors and the desired rewards of new behaviors. Many times, influence attempts fail because of the lack of consumer input into desired rewards. A lack of understanding of what the consumer perceives, based on antecedent variables, the situation and the learning process, as attributes and benefits of the behavior may doom the influence attempt.

Use of Incentives

Incentives are used in preventive health care to increase the level of motivation. Sales promotion ideas such as price specials on certain days, small gifts for participating in an immunization program, or samples given out seek to shape desired behavior and reward (reinforce) it. Incentives, however, must be used discriminantly as there is support that although incentives strengthen external motivation, they may weaken intrinsic motivation and self reward.


Realizing that time and energy are needed to learn new health knowledge, skills and behaviors, influence agents need to make this acquisition as easy as possible.

Convenient ways to learn new preventive health behaviors are increasing. Examples of this include prenatal classes located in a neighborhood church, school or home; businesses offering exercise facilities; screening programs or health care counseling at the business site; or schools that offer family life programs where a role playing "marriage" takes place and couples experience such activities as budgeting and decision making.

In addition to the acquisition of new behaviors, influence agents also need to find ways to facilitate the maintenance of existing behaviors. This can be done by reinforcement. Convenient monitoring of blood pressure at the firm, in a shopping center or at school, provides a more frequent opportunity for reinforcement of the monitoring plus the behavior leading-to the blood pressure reading

Consumer Research

From the previous discussion, it is obvious that the PHCCS model provides a framework to guide consumer research. Research of antecedent variables helps to identify appropriate consumer segments for influence attempts (e.g , those who are going through role acquisition, or those likely to have certain behaviors), to increase understanding of the consumer segment regarding likely attitudes, values, benefits sought. The research of these antecedent variables in conjunction-with the learning processes will help to determine the probable effectiveness of alternative influence strategies.


The effectiveness of preventive health care can be enhanced by understanding the process of consumer socialization. The preventive health care consumer socialization model provides a framework for selecting appropriate consumer segments to target, understanding the targets and developing influence strategies that utilize learning processes. There is the need for empirical study of the relationships of specific variables in the model. Many of the studies examining these relationships are outdated. They need to be replicated and extended. Technology, values, and legislation in the health care area change so rapidly that there is the danger of indefinitely accepting results of questionable validity

This paper was designed to introduce a potentially useful model for health care promotion. Further refinement or this model/approach is encouraged to strengthen theory development in the area. It is felt that the model also provides a basis for encouraging empirical work in the preventive health care area.


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