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The Preconscious Awareness to Action Framework: An Application to Promote Testicular Awareness

Saab, Mohamad, M.; Landers, Margaret; Hegarty, Josephine

doi: 10.1097/NNR.0000000000000268

Background Health outcomes among men are markedly poorer than women. Testicular disorders can be life-threatening if left untreated. Few studies promoting awareness of testicular disorders have been underpinned by theory. Theory-based interventions are more likely to achieve positive health outcomes than interventions that lack a theoretical foundation.

Objectives The purpose of the study is to present a theory-focused analysis of the preconscious awareness to action framework (PAAF), developed to enhance testicular awareness and help-seeking intentions and behaviors among men.

Methods The following approach was used to develop the PAAF: The empirical literature on men’s awareness of testicular disorders was reviewed. A qualitative study was conducted to explore men’s awareness of testicular disorders, help-seeking intentions for testicular symptoms, and preferred learning strategies in relation to testicular disorders and symptoms. An iterative narrative review process of the theoretical literature on health promotion and symptom appraisal was undertaken.

Results The PAAF comprises seven steps: preconscious awareness, unconscious awareness, conscious awareness, unconscious appraisal, conscious appraisal, intention, and behavior. The concept of testicular awareness was developed to familiarize men with their own testes and promote timely help-seeking.

Discussion Researchers are encouraged to use the PAAF to design health-promoting interventions aimed at enhancing testicular awareness, symptom appraisal, and help-seeking.

Mohamad M. Saab, PhD, MSc, BSc, RN, PGCTLHE, is Lecturer;

Margaret Landers, PhD, MSc, BSc, RNT, RGN, is Lecturer; and

Josephine Hegarty, PhD, MSc, BSc, RNT, RGN, is Professor, Catherine McAuley School of Nursing and Midwifery, University College Cork, Ireland.

Accepted for publication September 6, 2017.

Editorial note: The manuscript was accepted under the editorship of Susan J. Henly.

The authors have no conflicts of interest to report.

Corresponding author: Mohamad M. Saab, Catherine McAuley School of Nursing and Midwifery, University College Cork, Brookfield Health Sciences Complex, College Road, Cork, Ireland (e-mail:;

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