safety model

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Joumal of Safety Research, Vol. 27, No. 2, pp. 61-72.1996
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Theoretical Models of Health Behavior and
Workplace Self-Protective Behavior
David M. DeJoy
This paper provides a critical review of the applicability of theoretical
models of health behavior to workplace self-protective behavior. Value-
expectancy, environmental/contextual, and behavior change models are
reviewed. On this basis, an integrative framework is proposed that
conceptualizes self-protective behavior as consisting of four stages or
phases: hazard appraisal, decision making, initiation, and adherence. In
addition, five general constructs are identified as being of either primary or
secondary importance at each stage: threat-related beliefs, response efficacy,
self-efficacy, facilitating conditions, and safety climate. The proposed
framework highlights the need to target interventions to each of the four
stages. Particular emphasis is also assigned to environmental or situational
factors in enabling and reinforcing self-protective behavior in the workplace.
INTRODUCTION
With very few exceptions, research on work-
place self-protective behavior has been piecemeal
and atheoretical. Studies have generally taken
one of three approaches. First, a number of stud-
ies have examined various employee characteris-
tics and their relationships to safety performance
and injury experience. Characteristics studied
have included: hazard and safety-related attitudes
and beliefs (e.g., Cox & Cox, 1991; Dedobbeleer
& German, 1987; Leather, 1988; Walters &
Haines, 1988); personality dimensions and risk-
taking tendencies (e.g., Jones & Wuebker, 1985;
Landeweerd, Urlings, DeJong, Nijhuis, & Bouter,
1990); subjective risk assessments (e.g., Edwards
David M. DeJoy is Professor and Head of the Department
of Health Promotion and Behavior at the University of
Georgia. He received his PhD from Penn State University.
Summer 1996Nolume 27hVumber 2
& Hahn, 1980; Goldberg, Dar-el, & Rubin, 1991;
Howarth, 1987; Zimolong, 1985); and job
demands and other stressors (e.g., Cooper &
Sutherland, 1987; Levenson, Hirschfeld, &
Hirschfeld, 1980; Murphy, 1984; Smith, Colligan,
Fmckt, & Tastn, 1982).
A second group of studies has attempted to
modify the safety-related behaviors of workers
through the use of contingent reinforcement or
operant-based approaches. Reinforcers have includ-
ed information feedback, goal setting, social mcog-
nition, and praise, as well as more conventional
rewards and incentives. Reinforcement protocols
have been used to improve the use of protective
eyewear (Smith, Anger, & Uslan, 1978) and hear-
ing protectors (Zohar, Cohen, & Azar, 1980), and
to increase compliance with safety regulations
(Rhoton, 1980). Other studies within this group
have been somewhat broader in scope and have
tried to influence multiple safety-related behaviors
61

2. and overall safety performance (e.g., Komaki,
Barwick, & Scott, 1978; Sulzer-Azaroff &
DeSantamaria. 1980). Supervisory behavior has
also been examined using this general approach
(Komaki, Zlotnick, 8 Jensen, 1986; Mattila,
Hyttinen, & Rantaneu 1994).
The third group of studies has focused on the
organizational and environmental correlates of
good safety performance. Most of these studies
have sought to identify the programmatic fea-
tures of effective safety programs (e.g., Cohen,
Smith, & Cohen, 1975; Cohen & Cleveland,
1983; Fiedler, Bell, Chemers, & Patrick, 1984;
Planek & Feam, 1993; Simonds & Shafai-Sahmi,
1977; Smith, Cohen, Cohen, & Cleveland, 1978)
or the major dimensions of positive or supportive
organizational safety climates (e.g., Brown &
Holmes, 1986; Dedobbeleer 8z Beland, 1991;
Mattila, Rantanen, & Hyttinen, 1994; Niskanen,
1994; Zohar, 1980).
This research has been useful but it has not
provided a comprehensive understanding of
worker self-protection. More is now known
about the importance of certain individual and
organizational characteristics, but there has
been very little comparability from one study to
another, and few generalizable conclusions can
be drawn. For example, it is difficult to make
predictions about which factors are likely to be
important in a given work situation or how
these factors might interact with each other.
Almost nothing is known about the interplay of
individual and organizational factors in influ-
encing the safety-related actions of workers on
the job.
A number of conceptual models of workplace
safety and health have been proposed to help
organize research findings and guide the devel-
opment of occupational safety and health pro-
grams (e.g., Cohen, Smith, & Anger, 1979; DeJoy,
1990;DeJoy & Southem, 1993; Smith & Beringer,
1987). These models are useful in a heuristic
sense because they underscore the need to con-
sider the characteristics of the worker, the tasks
and jobs being performed, the total work envi-
ronment, and the organizational structure. But
for the most part, they fall far short of being
comprehensive or testable models. In view of
these limitations, it may be worthwhile to look
to related areas for more sophisticated and appli-
cable models. The general area of health behav-
ior offers a number of theoretical models that
have been tested and refined over the years.
62
Theoretical Models of Health Behavior
A variety of models have been developed to
explain why people do or do not engage in vari-
ous health enhancing and medically beneficial
activities. These models have been applied to a
wide variety of preventive and lifestyle behav-
iors (e.g. vaccinations, safe sex practices, smok-
ing, exercise, seat belt usage), screening or early
detection activities (e.g., breast self-examina-
tion, cholesterol and blood pressure testing,
genetic screening), sick role behaviors (e.g..
clinic utilization, physician visits), and adher-
ence to medical and other therapeutic regimens
(e.g., hypertension, diabetes). Although there
would appear to be an obvious link between
these models and workplace self-protective
behavior, very little attention has been given to
examining how they might apply to actions that
workers are asked to take to protect themselves
from job-related hazards.
Three categories of models are considered in
this paper. The first category includes the deci-
sion making or cost-benefit models derived
from value-expectancy theory. These models
have occupied a prominent position in the health
behavior literature during the last 30 years
(Glauz, Lewis, & Rimer, 1990, Weinstein, 1993).
The second category is referred to here as envi-
ronmental or contextual models. These models
attempt to go beyond person-focused variables
and take a more ecological or interactionist
approach to analyzing the determinants of health
behavior. The fmal category of models focuses
on the behavior change process itself. Models in
this category typically portray behavior change
as a series of qualitatively distinct stages.
Value-Expectaucy Models
Value-expectancy models are based on the
premise that people estimate the seriousness of
risks, evaluate the costs and benefits of various
actions, and then choose a course of action that
will maximize the expected outcome (Cleat-y,
1987). Value-expectancy models have taken a
variety of forms, and three prominent examples
are discussed here: the Health Belief Model
(Becker, 1974); the Theory of Reasoned Action
(Ajzen & Fishbein, 1980); and Protection
Motivation Theory (Rogers, 1983). The three
models are each different to some extent, but
they all emphasize the individual’s threat-related
Journal of Safety Research

3. beliefs or perceptions. Weinstein, (1993) argues
that value-expectancy models have four charac-
teristics in common: (a) that motivation for self-
protective behavior arises from the anticipation
of negative consequences and the desire to mini-
mize these outcomes, (b) that the impact of an
anticipated negative outcome on motivation
depends on beliefs about the likelihood that this
outcome will occur, (c) that motivation to act
arises from the expectation that the action will
reduce the likelihood or severity of harm, and
(d) that the expected benefits of a particular
action must be weighed against the expected
costs of taking the action.
Health Belief Model (HBM). Of the models pre-
sented in this section, the HBM has produced
the largest body of health-related research. It is
also the only one that was specifically devel-
oped to explain health behavior. The HBM
model has four basic components: (a) perceived
susceptibility to the health problem or condition
in question, (b) the perceived seriousness of the
problem or condition, (c) the perceived benefits
associated with taking a particular action, and
(d) the perceived barriers associated with taking
the action.
Published reviews of the HBM literature
(Becker, 1974; Harrison, Mullen, & Green, 1992;
Janz & Becker, 1984) show considerable support
for the model and offer some general conclu-
sions about the relative importance of its major
components. Perceived barriers have been shown
to be the most powerful single predictor across
all studies and behaviors. Perceived susceptibili-
ty and perceived benefits are also important,
with susceptibility being more important for pre-
ventive than sick role behaviors. As might be
expected, benefits are more important than sus-
ceptibility for sick role behaviors. In terms of
the total literature, perceived severity appears to
be the weakest of the four dimensions.
One of the major criticisms of the I-IBM is
that is does not specify relationships among the
major variables. Indeed, it has sometimes been
referred to as being more a list of variables than
a theoretical model (Wallston & Wallston, 1984;
Weinstein, 1993). Most applications of the
HBM combine the variables in a linear or addi-
tive fashion to test the model: susceptibility +
severity + (benefits - barriers). However, some
of the earlier writing on the model (e.g.,
Maiman & Becker, 1974) would appear to sug-
Summer 1996/Mohme 27LWmber 2
gest a multiplicative model: susceptibility x
severity x (benefits - barriers).
Theory of reasoned action (TRA). The TRA
posits that behavioral intention is the immediate
determinant of behavior and that all factors that
influence a particular behavior are mediated
through intention. Intention is determined by
two components: (a) attitude toward the behav-
ior, which consists of beliefs about the conse-
quences of performing the behavior and the
evaluation of those consequences; and (b) sub-
jective norms, which consist of normrutive
beliefs about what salient others think and the
individual’s motivation to comply with those
wishes. According to the model, intention can be
predicted by the linear combination of attitude
and normative beliefs multiplied by motivation
to comply with the beliefs. The model is
expressed as a multiple regression equation, with
the weights assigned to the major components
determined by multiple regression procedures.
The TRA has been applied with considerable
success to a number of health behaviors, inalud-
ing exercise, weight loss, child safety seats,
smoking, condom usage, and alcohol and drug
use (see Cleary, 1987; Kirscht, 1983; Sutton,
1987 for reviews). Besides its focus on behav-
ioral intention, the most obvious difference
between the TRA and HBM is that the TRA
includes subjective norms as a major determinant
of health-related behavior. The TRA also goes
further in specifying how its constructs should be
measured and how they combine to form behav-
ioral intention. On the negative side, much of the
research on the TRA has been confimed to pre-
dicting behavior intention rather than aatual
behavior (Baranowski, 1992-1993).
More recent versions of both the HBM
(Rosenstock, Strecher, & Becker, 1988) and the
TRA (Ajzen, 1985) have added self-efficacy
(Bandura, 1986) as an important component. The
principal argument for including self-efficacy is
that people must feel confident that they are
capable of performing the behaviors required to
produce the desired outcomes. Self-efficacy
appears to be especially important for lifestyle
modifications and other behaviors involving
long-term change and maintenance (Streaher,
DeVelLis,Becker, & Rosenstock, 1986).
Protection motivation theory (PMT). This model
features two cognitive processes, threat appraisal
63

4. and coping appraisal, which combine to form
protection motivation. Protection motivation
(typically measured as behavioral intention) is
conceptualized as an intervening variable that
activates coping behavior. Threat appraisal eval-
uates the intrinsic (e.g., pleasure) and extrinsic
(e.g., social approval) rewards that increase the
probability of making a maladaptive response
against perceptions of vulnerability and outcome
severity that decrease the probability. Threat
appraisal is the algebraic sum of these variables.
Coping appraisal consists of judgments about
the efficacy of a preventive response (response
efficacy) plus the assessment of one’s ability to
successfully perform the necessary responses or
behaviors (self-efficacy) minus the costs associ-
ated with the response.
Protection motivation is assumed to be great-
est when: (a) the perceived threat is severe, (b)
the individual feels vulnerable, (c) the adaptive
response is believed to be effective, (d) the per-
son is confident of his or her abilities to complete
the adaptive response, (e) the rewards of the mal-
adaptive behavior are small, and (f) the costs of
the adaptive behavior are low. Although this is an
additive model within each of the two appraisal
processes, interactive effects can occur between
threat and coping appraisal processes (e.g., self-
efficacy x severity). Presumably, this allows the
model to predict outcomes that are contrary to
totally rational decision making (Prentice-Dunn
& Rogers, 1986). Although less extensively
researched than the two previous models, the
major components of PMT have been supported
(Prentice-Dunn & Rogers; Rogers, 1983). Much
of this work has involved fear-arousing commu-
nications and attitude change.
Applicability to Workplace Setf-Protective
Behavior
Aside from some consideration of HBM con-
structs with respect to personal protective equip-
ment (e.g., Cleveland, 1984; DeJoy, 1986;
Terrell, 1984), very little effort has been made to
apply the value-expectancy models to worker
safety and health. However, viewed as a group,
these models do highlight several constructs that
should be relevant to workplace self-protective
behavior. These constructs include: (a) threat-
related beliefs, (b) self-efficacy, (c) response
efficacy, (d) barriers, and (e) normative expecta-
tions (see Table 1).
64
Threat-related beliefs. Beliefs about susceptibili-
ty (probability) and severity are featured in each
of the models. The interrelationship of suscepti-
bility and severity tends to be treated differently
in the various models, but a multiplicative rela-
tionship would appear to be most in line with the
value-expectancy tradition. For example, a high
level of perceived susceptibility may not neces-
sarily lead to self-piotective behavior if the
severity of the threat is minimal. On the other
hand, for a highly lethal outcome, perceived sus-
ceptibility may be the major dimension.
Self-efficacy. In one form or another, self-efftca-
cy has been incorporated into each of the value-
expectancy models. Because most instances of
worker self-protection involve the performance
of a set of prescribed actions on a long-term
basis, self-efficacy should be an important fac-
tor. Workers need to feel confident about their
ability to perform required behaviors on a regu-
lar and long-term basis.
Response efficacy. Beliefs about the conse-
quences or effectiveness of preventive action
also play a role in each of the models. They are
treated as benefits in the HBM, as part of atti-
tudes in the TRA, and as response efficacy in
PMT. In most workplace applications, response
efficacy involves perceptions about the effective-
ness of prescribed work practices or protective
equipment in preventing hazardous exposures.
Barriers. Barriers are considered explicitly in
the HBM and the PMT, and indirectly in the
TRA. Indeed, the HBM literature (Janz &
Becker, 1984) suggests that barriers or costs are
the single best predictor of health behavior.
Relevant to the workplace, research on the use
of personal protective equipment shows that job
related barriers are often a major factor in non-
compliance (Acton, 1977; Cleveland, 1984;
Terrell, 1984).
Normative expectations. The TRA is the model
that considers the effects of the social environ-
ment most directly. Social influences are also
considered, somewhat tangentially, in the intrin-
sic-extrinsic rewards portion of PMT. Research
on safety program effectiveness (e.g., Cohen &
Cleveland, 1983; Fiedler et al., 1984; Planek &
Feat-n, 1993; Simonds & Shafai-Sahrai, 1977)
and safety climate (e.g., Dedobbeleer & Beland,
Journal of Safety Research

5. TABLE 1
VALUE-EXPECTANCY CONSTRUCTS APPLIED TO WORKPLACE SELF-PROTECTIVE BEHAVIOR
COll~tnrCt
Threat-related beliefs
Self-efficacy
Response efficacy
Barriers
Normative expectations
Definition
Beliefs about hazard susceptibility and severity
Beliefs about one’s ability to follow indicated
safety measures successfully
Perceived effectiveness of available safety
measures
Factors that interfere with the use of available
safety measures
Social/organizational factors that influence
worker self-protection
Workplace Example
Construction worker’s beliefs about his/her
likelihood of falling off scaffolding
Emergency medical technician’s beliefs about
being able to dispose of used needles safely
Underground coal miner’s confidence in
automated carbon monoxide detection
system
Physical discomfort associated with wearing
hearing protectors in textile plant
Supervisor’s indifference to safe lifting
oractices in warehousino ooeration
1991; Mattila et al., 1994; Niskanen, 1994;
Zohar, 1980) highlight the important role of
social-organizational factors in supporting good
safety performance. The safety literature also
contains a number of studies indicating that per-
formance and other types of feedback from
supervisors and coworkers can be an important
factor in shaping work-related safety behavior
(see review by McAfee & Winn, 1989).
ning health education programs. This basic
framework has been adapted to workplace self-
protective behavior (Dedobbeleer & German,
1987; DeJoy, 1986; Peters, 1991).
Contextual or Environmental Models
The models discussed thus far have been pri-
marily concerned with how the individual’s atti-
tudes, beliefs, and expectations influence his or
her reaction to various health threats. Only lim-
ited attention is given to social or environmental
factors, or to the context in which the individual
operates. The need for a person x situation or
interactionist approach to workplace safety and
health has been discussed in general terms by
several authors (e.g., DeJoy & Southern, 1993;
DeJoy, Wilson, & Huddy, 1995; Sheehy &
Chapman, 1987; Smith & Beringer, 1987). The
interactionist perspective holds that individual
and situational (environmental) factors combine
multiplicatively in influencing worker behavior.
PRECEDE model. The PRECEDE model devel-
oped by Green and colleagues (Green & Kreuter,
1991; Green, Kreuter, Deeds, & Partridge, 1980)
would appear to qualify as a contextual model.
“PRECEDE” is an acronym for “predisposing,
reinforcing, and enabling causes in educational
diagnosis and evaluation,” and this model was
developed as a framework to be used in plan-
In the PRECEDE model, three sets of diag-
nostic or behavioral factors drive the develop-
ment of prevention strategies. Predisposing
factors are the characteristics of the individual
(beliefs, attitudes, values, etc.) that facilitate or
hinder self-protective behavior. Predisposing
factors are conceptualized as providing the
motivation for behavior. The threat-related
beliefs and efficacy expectancies that are promi-
nent features of the value-expectancy models
would be included here. Enabling factors refer
to objective aspects of the environment or sys-
tem that block or promote self-protective action.
Green and colleagues (Green et al., 1980) define
enabling factors as “factors antecedent to behav-
ior that allow motivation or aspiration to be
realized” (p. 68). The skill and knowledge
necessary to follow prescribed actions would be
included here, as would the availability and
accessibility of protective equipment and other
resources. Most barriers or costs would be clas-
sified as enabling factors. Reinforcing factors
involve any reward or punishment that follows
or is anticipated as a consequence of the behav-
ior. Performance feedback and the social
approval/disapproval received from coworkers,
supervisors, and managers would qualify as
reinforcing factors in workplace settings.
The PRECEDE model was developed as a
program-planning framework rather than as a
causal model of health behavior (Green et al.,
1980). The three diagnostic categories were
Summ~ I996Nolume 27LVumber 2 65

6. intended primarily as reference points for ana-
lyzing the determinants of behavior that would
be most responsive to health education efforts.
As such, little attention was given to delimiting
the categories or to specifying combinational
rules. The PRECEDE model has been used
extensively to plan and evaluate health educa-
tion and related programs in a variety of set-
tings, including the workplace (Green &
Kreuter, 1991). However, there have been rela-
tively few formal tests of this model.
Applicability to Workplace Self-Protective
Behavior
The PRECEDE model increases the salien-
cy of environmental or contextual variables in
two important ways: (a) by directing attention
to the skills and resources that are prerequisite
to the achievement of behavioral goals, and
(b) by viewing the environment as an impor-
tant source of support and reinforcement for
behavior change and maintenance. The recent-
ly revised version of the PRECEDE model, the
PRECEDE/PROCEED model (Green & Kreuter,
1991) is even more distinctly environmental.
The revised version proposes that an environ-
mental diagnosis should occur along with the
behavioral diagnosis, and that special atten-
tion should be given to the interaction of
behavioral and environmental factors. This
encourages the selection of both behavioral
and environmental targets for change within
the intervention program.
However, it is the interactive nature of the
three diagnostic factors that is probably of
greatest potential importance to understanding
worker behavior. In particular, efforts to influ-
ence the beliefs and attitudes of workers and,
thus, motivate them to follow safe practices
may fail if the environment is nonsupportive.
This calls attention to the importance of job-
related barriers, the ready availability of safety
equipment and devices, and the importance of
skill-based training in facilitating self-protec-
tive behavior. A second point is that even well-
motivated and well-trained workers may not
respond appropriately if doing so is not
acknowledged or reinforced by peers, supervi-
sors, and management. Performance feedback
and the safety-related attitudes and actions of
management would appear to be especially
important in this regard.
66
Behavior Change Models
The final category of models includes those
that focus on the process of behavior change.
The Transtheoretical Model (Prochaska &
DiClemente, 1982) and the Precaution-Adoption
Process (Weinstein, 1988) are perhaps the best
exemplars of this general category. Both of these
models portray the change process as a series of
stages. A fundamental tenet of the stage change
perspective is that people at different points in
the change process require different types of
information and assistance to move to the next
stage. The variables or factors important at one
stage may be quite unimportant at another stage.
For example, beliefs about susceptibility or
severity may be important early in the change
process, such as during initial awareness and
decision making, but become less important
once actual behavior change is underway.
Transtheoretical Model. Prochaska and col-
leagues (Prochaska, DiClemente, & Norcross,
1992) describe the process of behavior change as
consisting of five principal stages: (a) precontem-
plation, (b) contemplation, (c) preparation, (d)
action, and (e) maintenance. Precontemplation is
the stage in which the person is not seriously
thinking about changing his or her behavior.
Contemplation begins when the person starts to
think seriously about changing in the near future
(i.e., about 6 months). Preparation denotes that
the person intends to make a change in the very
near future, and that he or she has a plan for
action and has already made small or preliminary
behavior changes (thus, preparation has both
intentional and behavioral dimensions). Action is
the period following initial behavior change (usu-
ally about 6 months). Maintenance extends from
this point until termination.
A growing body of evidence exists for the
basic stages of change construct, mostly involv-
ing addictive behaviors and psychotherapy
(Prochaska & DiClemente, 1992). Work with
this model has also sought to uncover the pro-
cesses of change, or the activities that individuals
engage in when they attempt to modify problem
behaviors. Of considerable importance is the
observation that the processes of change appear
to be quite similar across a variety of different
behaviors (Prochaska et al., 1992). That is, for
many behaviors, information-seeking and con-
sciousness-raising activities are relevant for peo-
ple entering contemplation, and stimulus control
Journal of Safety Research

7. and social support are important processes for
those in the action and maintenance stages. The
ultimate goal is to integrate the stages and pro
cesses of change, and to identify the most effec-
tive strategies for moving people from one stage
to the next (DiClemente et al., 1991).
Precaution-adoption process. The precaution-
adoption process (Weinstein, 1988) also has five
stages: (a) has heard of hazard, (b) believes in
susceptibility for others, (c) acknowledges per-
sonal susceptibility, (d) decides to take precau-
tion, and (e) takes precaution. A central feature
of this model is that personal susceptibility is
treated as a series of three stages rather than as a
single dimension or continuum. This conceptual-
ization derives from the idea that people are
likely to have little interest in taking precautions
unless they feel personally vulnerable. A further
complication is that people tend to be optimisti-
cally biased in judging their personal levels of
risk. That is, for many different hazards, people
consider their own risk to be considerably less
than that of most other people (Weinstein, 1980,
1982, 1987). The decision making stage in this
model involves many of the same hazard-related
beliefs and cost-benefit considerations that are
featured in the value-expectancy literature.
However, since the stages are cumulative, deci-
sion making does not begin until the require-
ments of stage three have been met. Barriers are
particularly important in translating a decision
into action (stage 5). Weinstein and colleagues
have tested this model in several studies of home
radon testing (Weinstein & Sandman, 1992).
Applicability to Workplace Self-Protective
Behavior
Inherent in both stage models is the view that
different kinds of information and interventions
will have different saliencies depending on
where the individual is in the change process.
For example, minimizing the costs or barriers
associated with following a particular self-pro-
tective action will have very little impact on peo-
ple who are not yet aware of the threat or who
do not think that they are personally susceptible
to it. Value-expectancy models, in contrast,
assume that the probability of action is essential-
ly an algebraic function of the individual’s
beliefs and that this same predictive equation
applies across the entire behavior change pro-
Summer 1996Nohne 27/Number 2
cess. The stage change perspective argues that
different equations are needed for each stage.
Providing workers with information about
particular job-related hazards is likely to be
most useful for increasing awareness and a
sense of personal susceptibility. But beyond this
point, such information is likely to be of limited
effectiveness in changing and maintaining rele-
vant work practices. Once awareness and per-
sonal susceptibility are established, attention
might better be focused on related skill develop-
ment and self-efficacy enhancement, and with
actions that reduce barriers and create more
favorable cost-benefit ratios for safe behavior.
Long-term adherence ultimately requires con-
structing task and work environments that sup-
port safe behavior, even under the most adverse
workload conditions. Borrowing from relapse
prevention research (e.g., Marlatt & Gordon,
1985), conscious efforts are needed to assess the
situations and circumstances under which adher-
ence is likely to fail. Alternative strategies or
coping responses should be available to workers
for use in such situations. The identification and
analysis of special requirements and high risk
situations should be an important feature of a
comprehensive safety program.
The importance of environmental supports
during the action and maintenance stages blends
nicely with the preceding discussion of enabling
and reinforcing factors within the PRECEDE
framework. In the final analysis, high levels of
both individual and collective control may be
critical to successful long-term adherence.
Presumably, efforts to enhance self-efficacy have
the direct effect of increasing the individual’s
sense of personal control. However, groups of
people may also possess a sense of control.
Peterson and Stunkard (1989) describe collective
control as: “a norm - or shared belief - about
the way that the group works, what it is that the
group can and cannot accomplish by what
actions” (p. 822). As described by these authors,
collective control bears considerable resem-
blance to Zohar’s (1980) concept of safety cli-
mate. For Zohar, safety climate is: “a summary
of molar perceptions that employees share about
their work environments” (p. 96). It is generally
thought that safety climate serves as a frame of
reference for guiding relevant behavior in the
workplace and that employees develop reason-
ably coherent expectations regarding behavior-
outcome contingencies in their environment (cf.
67

8. Schneider, 1975). It follows that collective con-
trol or safety climate should be an important con-
sideration in fostering long-term and broad-based
adherence to safe work practices.
Au Integrative Framework for Workplace
Self-Protective Behavior
Each of the categories of models reviewed
thus far has something to contribute to under-
standing workplace self-protective behavior. The
value-expectancy models provide a fairly cir-
cumscribed set of person-focused variables that
are likely to be important to any type of self-pto-
tective behavior. The PRECEDE model, as an
environmental or contextual model, directs
attention to the interaction of person and situa-
tional factors, and to how the work environment,
broadly defined, can enable and reinforce self-
protective actions. The stage models emphasize
that precautionary behavior is inherently dynam-
ic and comprised of qualitatively different phas-
es or stages.
Figure 1 portrays self-protective behavior as
consisting of four stages: hazard appraisal, deci-
sion making, initiation, and adherence. These
stages may be viewed as representing different
levels of motivational readiness to engage in
self-protective behavior. However, the factors
that influence this readiness are not limited to
person-focused variables. Table 2 features five
general constructs that are likely to be important
to self-protective actions in the workplace. The
constructs build on those portrayed earlier (see
Table l), with two modifications. The termfacil-
i&.&g conditions expands the concept of barri-
ers relative to its usage in the value-expectancy
models and emphasizes the importance of envi-
ronmental supports in self-protective behavior.
Also, safety climate is used to represent the man-
ifold of social and organizational factors that
may impinge on workplace behavior. Each of the
five constructs can be further described in terms
of specific variables.
Because current knowledge is not sufficient
to exclude any of the constructs at a particular
stage, the five constructs in Table 2 are labeled
as being of either primary or secondary impor-
tance for each stage. As with other stage models,
the stages should be treated as cumulative; for
example, the individual must believe that a par-
ticular hazard represents a serious threat before
he or she will enter the decision making stage.
Efficacy considerations and facilitating condi-
tions will be of little importance for those who
are unaware of the hazard or for those who have
appraised the hazard as insignificant. A discus-
sion of the four stages follows.
Hazard appraisal. The individual’s threat-relat-
ed beliefs are of primary importance during this
stage. As discussed earlier, perceived suscepti-
bility (likelihood) and severity can be expected
to interact to form perceived threat. Response
efficacy, or the availability of effective preven-
tive strategies, may also be important at this
stage. Defensive or self-protective motives (e.g.,
Miller & Ross, 1975) may cause the individual
to dismiss or discount a hazard for which pre-
ventive strategies are unavailable or of limited
effectiveness. Unwarranted optimism or overcon-
fidence may also play a role in hazard appraisal
(Weinstein, 1987). At this stage, workers should
benefit from information about the hazard itself,
including risk estimates, exposure modes, avail-
able control measures, and so forth. The impor-
tance of having workers personalize the risks
should not be ignored.
FIGLJRE 1
STAGE OR SEQUENTIAL MODEL OF WORKPLACE SELF-PROTECTIVE BEHAVIOR
T
Appraisal I_C
Yes Decision- Yes I.tiation
Making-
No No No
ererice
No
+ + +
Exposure
toinjury/illness
68 Journal of Safety Research

9. TABLE 2
SELF-PROTECTIVE BEHAVIOR CONSTRUCTS AND THE STAGES OF SELF-PROTECTIVE BEHAVIOR
Construct Hazard Appraisal Decision-making Initiation Adherenoe
Threat-related beliefs ................ P s S S
Response efficacy .................. P P S S
Self-efficacy ...................... S P S S
Facilitating conditions ................ S P P P
Safety climate S P P P
Note: P= primary unponance: S =secondary importance
Decision making. Efficacy considerations
and the costs and benefits associated with
alternative courses of action become impor-
tant during the decision making stage. Efficacy
considerations include those related to the
effectiveness of available precautionary actions
(response efficacy), as well as the individu-
al’s perceptions of his or her ability to success-
fully accomplish these actions (self-efficacy).
Self-efficacy can be developed through educa-
tion/ training and skill-building exercises, as
well as actual experience in performing the
relevant behaviors. The modeling of these
behaviors by coworkers may also enhance
self-efficacy expectancies.
The cost-benefit portion focuses on weigh-
ing the benefits of the self-protective action
against the costs incurred. Costs may include
time constraints, actual or imagined reductions
in productivity or skilled performance, physical
discomfort, and any other encumbrances that
reduce “quality of life” on the job. Facilitating
conditions serve to counteract costs, and might
include the ready availability of needed safety
equipment, training in the correct usage of this
equipment, and redesigned jobs and equipment
that make self-protection easier and more effec-
tive. The cost-benefit analysis might also
include safety climate considerations.
Initiation. Facilitating conditions and safety
climate are the principal constructs during the
initiation stage. At this stage, attention shifts to
the environmental and organizational factors
that support and reinforce self-protective
action. These factors become very important as
behavioral intention is translated into action,
and as workers try out new behaviors.
Although safety climate remains a rather elu-
Summer I99tWohme 27/iVumber 2
sive concept, it appears reasonable to conclude
that the attitudes and actions of management
play a prominent role in the safety climate of
the organization (Brown & Holmes, 1986;
Dedobbeleer & Beland, 1991; Zohar, 1980).
Safety performance information and other
types of feedback received from coworkers and
supervisors is also likely to be an important
aspect of safety climate.
Adherence. Environmental and organizational
factors can be expected to play major roles in
sustaining long-term adherence. As workers
successfully follow prescribed actions, their
self-efficacy should increase, and with that, their
resistance to nonadherence. Many self-protec-
tive actions become relatively automatic over
time, and this should also help to sustain long-
term adherence. Response efficacy should also
increase with time as workers become more
confident of the effectiveness of the actions in
question. Still, efficacy considerations remain
secondary to barriers and safety climate at this
stage. Long-term maintenance ultimately
depends on creating task and work environ-
ments that support safe behavior, even under the
most stressful or demanding conditions.
Although this proposed framework certainly
needs to be tested and validated, there are sev-
eral lines of inquiry that support the general
organization of the framework and the assign-
ment of various self-protective behavior con-
structs to particular stages. First, it is generally
acknowledged that awareness and knowledge
are necessary but often insufficient to produce
and sustain behavior change, including self-
protective actions in the workplace. This sup-
ports the focus on threat-related beliefs and
response efficacy in the first stage, and the
69

10. view that hazard appraisal is only one stage in
the process. Second, there is considerable
agreement that behavior change and mainte-
nance are different processes. As such, a con-
struct or factor that is important in bringing
about initial behavior change may not play the
same role in sustaining the.change over time.
Third, there is broad agreement that the individ-
ual’s subjective beliefs related to costs and ben-
efits play a central role in most health- and
safety-related decision making. And fourth,
organizational and environmental factors appear
to be particularly important in facilitating and
sustaining desired behaviors. Indeed, the occu-
pational safety and health literature suggests
that these factors may be critically important in
workplace settings.
CONCLUSIONS
This paper reviewed three categories of theo-
retical models that have been used to analyze
and predict health-related behavior. On this
basis, an integrative framework was proposed
that conceptualizes workplace self-protective
behavior as consisting of four sequential stages:
hazard appraisal, decision making, initiation,
and adherence. The proposed framework is inte-
grative in that its basic structure comes from the
behavior change models, while the constructs or
factors considered relevant at each stage are
derived from the value-expectancy and environ-
mental/contextual models.
The principal implication of this framework
is that different constructs or factors can be
expected to be important at different stages.
Threat-related beliefs and response efficacy are
likely to be most important during hazard
appraisal. During this stage, workers determine
both what is dangerous and whether they can
protect themselves by taking specific actions
and/or by using specific protective equipment.
Efficacy considerations (response and self-
efficacy) and cost-benefit factors assume
increased importance during the decision mak-
ing stage. Workers determine that available safe-
ty protocols are both effective and practical. The
personal weighing of costs and benefits is at the
very heart of this stage. This calculus takes into
consideration beliefs about the threat itself,
expectancies surrounding the required actions,
barriers and environmental supports, and infer-
70
ences about the attitudes and actions of peers,
supervisors, and management.
During the initiation and adherence stages,
facilitating conditions and safety climate are the
primary factors. Attention is focused on the
environmental and organizational factors that
support and reinforce self-protective actions.
Performance feedback may be a particularly
valuable tool for encouraging workers to accept
that the self-protective actions in question are
effective and practical. Adherence, as the final
stage, requires the creation of task and work
environments that support safe behavior under
all conditions. High levels of both individual
and collective control may be critical to long-
term adherence, and creating a positive safety
climate may be the best way to foster perceived
control at both levels.
In practical terms, there is a need to match
interventions and stages; the utility of any inter-
vention depends on where the individual worker
is in the change process. For example, interven-
tions to improve worker self-protection typical-
ly revolve around hazard communication and
information-based training in safe work prac-
tices. Such efforts are likely to be most beneti-
cial during the hazard appraisal and decision
making stages. These particular interventions
are much less relevant to the factors hypothe-
sized to be most important during initiation and
adherence. It follows that programs to maxi-
mize self-protective behavior in the workplace
need to be multifaceted and should feature
interventions targeted to workers at each of the
four stages.
As a fmal point, the proposed framework also
highlights the importance of situational or envi-
ronmental factors in workplace self-protective
behavior. As Table 2 shows, the individual’s per-
sonal beliefs about the hazard and the effective-
ness of precautionary action are most important
during the first stage (hazard appraisal). But,
beyond this point, environmental factors become
increasingly more important, and become critical
as intention is converted into action (initiation),
and as self-protective behavior is sustained
(adherence). Given the interactive aspect of indi-
vidual and situational factors, even well-designed
efforts to influence the hazard-related beliefs and
attitudes of workers may fail if the environment
is nonsupportive. The importance of the environ-
ment in enabling and reinforcing safe workplace
behavior cannot be overemphasized.
Journal of Safety Research

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