Preventive health care neglect falls within the wider topic of people behaving in unhealthy ways despite awareness, which is investigated mostly within a psychological framework. Although this topic is of utmost importance for the society, concerning the policies of public-health bodies in all jurisdictions, the research findings and results did not translated much into effective programs and interventions which to correct such behaviors, as indicates the statistics of the major public health organizations in this field (CDC, 2024; OECD, 2023).

Within a research-review project at PhilScience, we aimed to identify the limitations of the research in this field and analyze it from a foundational and meta-theoretical perspective, in order to draw new directions of research hypothesized to have a higher potential of application in clinical interventions.

Introduction

 Preventive and routine health behaviors – such as periodic blood tests, dental check‐ups, cancer screening, triggered pain, cardiovascular monitoring, and lifestyle evaluation – are widely recommended by health authorities to reduce morbidity, identify disease early, and promote long‐term well‐being. Yet many individuals fail to engage in such behaviors at recommended intervals. 

Just to mention one of the most important preventive checks for one’s health – regular blood testing – the rates of non-engagement are worrying:  A recent systematic review found the following median adherence rates for regular blood testing: 66.3 % for diabetes screening, 67.8 % for dyslipidaemia, 34 % for hepatitis C, and 36.8 % for HIV; for PSA screening in men about 37.2 % (Le et al., 2025).

Other preventive-health neglect sub-topics addressed intensively in the literature are dental care, cancer screening, cardiovascular and metabolic monitoring, pain-triggered care, genetic risk testing, and vaccination.

The gap between knowing what is good for you and doing it has been a persistent challenge in health psychology and public health. Beyond information/knowledge deficits, behavioral‐psychology research emphasizes a richer set of motives for health neglect.

Summing up motives and mechanisms

 Grouping motives in categories identified by related underlying cognitive-psychological mechanisms applying to all sub-topics of preventive-health neglect and we proposed the following taxonomy:

Cognitive appraisal failure: Low perceived susceptibility, low perceived benefit, high perceived barriers, low self‐efficacy, all consistent with HBM/TPB studies (Janz & Becker, 1984; Ritchie et al., 2021).

Temporal and decision biases: Present bias, optimism bias, and status‐quo bias lead to postponement and avoidance of preventive actions.

Self‐regulatory failure and habit weakness: Intention-behavior gaps are large (Feil et al., 2023) and, without planning, cues and reinforcement, preventive behaviors fail to translate from intention to action.

Affective and visceral avoidance motives: Fear, anxiety, disgust, embarrassment lead to avoidance or delay.

Structural/social motives: Cost, access, health literacy, cultural beliefs, trust and convenience moderate or override individual motives; they are inherent in COM‑B’s opportunity component.

Automatic/habitual process deficits: Preventive behaviors are not yet routine; the absence of stable cues means forgetting or deprioritising gains.

There is interactivity and heterogeneity of motives. Motives rarely act in isolation. For example, low health literacy may increase perceived barriers, higher cost amplifies present bias, and cultural norms may reduce perceived susceptibility. Crucially, single‐factor explanations (e.g., “people don’t go because they don’t know”) are insufficient. It follows that multi‐component interventions that address multiple motives simultaneously are more likely to succeed.

These joint motive structures are the best visible in dental care neglect, the only sub-topic discussed here.

Dental care (preventive visits, hygiene adherence)

Empirical evidence shows that dental attendance for preventive check‐ups is uneven and systematic reviews show multiple barriers. For example, people with disabilities report cost, inaccessibility, fear/anxiety, transport, communication issues as major barriers (Agarwal et al., 2024). For culturally and linguistically diverse (CALD) careers, affordability was the foremost barrier, followed by negative provider experiences and language/communication issues (Marcus et al., 2022). Dental‐care neglect thus is widespread and structurally embedded.

The following motives are specific to dental care neglect:

Aversion/fear. Dental anxiety is a major motive for avoidance; this affective barrier is strong and can establish a pattern of avoidance.

Perceived low benefit and low illness salience. Many skip dental check‐ups because “teeth are fine” or “no pain” – low perceived need.

Cost and economic barriers. Dental services are often not fully covered; the immediate cost looms large.

Access and opportunity cost. Transport, time off work, waiting lists – all raise the barrier.

Low habitual routine. Unless dental check‐ups are embedded in a regular routine, they are neglected.

Optimistic bias. People may underestimate the risk of dental disease and not see preventive visits as urgent.

Structural inequalities. Disadvantaged groups have higher dental‐neglect due to compounded cost, access, literacy and trust issues (Peres et al., 2019; Watt, 2012; Palència et al., 2014; Listl, 2011).

As intervention evidence, effective strategies for dental care often combine anxiety‐reduction (CBT for dental fear), subsidized services or insurance coverage, appointment reminders, and integration with primary‐care settings to reduce friction.

Intervention implications and evidence

Understanding motives helps guide intervention design. Behavioral‐psychology suggests that effective interventions should reduce barriers, strengthen motivation, support self‐regulation, and improve opportunity. The intervention strategies that have empirical support are listed briefly in what follows:

Reducing friction/opportunity cost: Simplifying booking systems, offering extended hours, walk‐in clinics, mobile services, and point‐of‐care testing. These are argued to reduce opportunity barriers (de Waard et al., 2018; Le et al., 2025).

Reminders and defaults: Automated reminders (SMS, email) and default scheduling (automatic appointments) exploit cueing and inertia, helping to overcome forgetting or procrastination.

Small immediate incentives or salient benefit feedback: Providing immediate reward or feedback for completing a preventive action combats present bias by increasing the salience of short‐term benefits.

Addressing affective barriers: Interventions for dental anxiety (CBT, exposure, distraction) reduce fear and enhance engagement; for blood testing, some use desensitization or patient‐friendly phlebotomy.

Improving self‐efficacy and planning: Implementation‐intention interventions (“If this, then I will do that”), action‐coping planning, and motivational interviewing increase the likelihood of action.

Communication and risk‐framing: Using absolute risk, visuals, and personalized feedback improves risk comprehension, counteracts optimistic bias, and strengthens perceived susceptibility and benefit (Ritchie et al., 2021).

Cost/insurance policy: At the structural level, reducing out‐of‐pocket cost for preventive services improves uptake (especially dental care) by removing one of the largest barriers.

Cultural and literacy tailoring: Tailoring interventions to the language, culture, and literacy level of target populations addresses social motives (Marcus et al., 2022).

Multi‐component integrated interventions

 Meta‐analysis of health‐promotion interventions targeting multiple behaviors found that interventions covering multiple domains show better effect (e.g., unhealthy behaviors) though diminishing returns at high numbers of simultaneous targets may occur (Wilson, 2015).

In preventive care contexts, combining several strategies (for instance, reminders plus simplification plus incentives plus planning) tends to be more effective than single strategy alone (Yakoubovitch et al., 2023).

From the empirical meta‐analyses, a systematic review of behavioral interventions for screening colonoscopy found that patient navigation and multicomponent interventions increased completion by about 54% compared to controls (Yakoubovitch et al., 2023). This suggests that addressing multiple barriers (navigation, reminders, planning, and so on) is beneficial.

For example, in the dental domain, combining anxiety‐reduction with reduced cost, reminder, and default scheduling is typically more effective than purely informational campaigns.

Importantly, intervention design should be guided by assessment of dominant motives in the target group: e.g., high anxiety warrants focused anxiety‐reduction; cost‐sensitive populations need subsidy; groups with low perceived risk need risk‐communication; and groups with access issues need system redesign.

Limitations in the literature and research gaps

Staying within the behavioral psychology framework, despite significant progress, several limitations in the literature remain, reflecting also research gaps:

Heterogeneity in measures and behaviors: Studies vary widely in how they define and measure preventive behaviors, barriers, and motives, which complicates synthesis across domains.

Intention–behavior gap remains large: Although intention is necessary, many interventions still struggle to convert intention into sustained behavior (Feil et al., 2023; Ritchie et al., 2021). The majority of studies examine uptake of a single preventive action, not maintenance across time.

Under‐representation of structural/inequality issues in behavioral frameworks: Many behavioral studies remain individual‐level, neglecting system‐level or policy‐level motives for neglect (e.g., insurance design or provider supply). The COM‐B model emphasizes opportunity, but empirical work often stops at individual barriers.

Limited long‐term follow‐up and habit formation data: Few studies evaluate how preventive behaviors are maintained over years or how habit formation can be supported.

Equity and context specificity: Many studies come from higher‐income countries and less is known about low‐ and middle‐income settings, or about diverse cultural contexts. For example, screening motives in culturally diverse groups often include language and cultural barriers but are under‐researched (Marcus et al., 2022).

Mediation and mechanism‐testing are scarce: While many interventions report outcomes, fewer examine which psychological mechanisms (e.g., increased self‐efficacy, reduced fear, etc.) mediate behavior change. Stronger mechanism‐based work would help refine theory and design.

Focus on single behaviors rather than integrated preventive care: Real‐world health maintenance often involves multiple behaviors (blood tests, dental visits, cancer screening, lifestyle, and so on). There is limited research on integrated preventive‐care behavior and the overlapping motives across domains (Ritchie et al., 2021).

Cost‐effectiveness and scalability: While many interventions show efficacy, fewer studies examine cost‐effectiveness, sustainability, and adaptation in routine clinical practice or public systems.

Interdisciplinary collaboration  

 At a meta-theoretical and methodological analysis, we found that the past research on the topic of  motives for health care neglect and their underlying mechanisms, entwined empirical and theoretical, was conducted and remained within a mere psychological framework, although psychiatry and a limited group of cognitive sciences contributed marginally.

Given that the topic is of utmost importance for health-care policies, a stronger interdisciplinary collaboration is required to go deeper into the mechanisms responsible for avoidance behaviors. In this respect, especially neurosciences and associated chemistry fields are called to contribute to the research directions mentioned above in order to fill the signaled gaps beyond the empirical setups.

The main argument supporting this call is that the matter of the discussed research falls within the more general topic of people behaving in unhealthy ways in condition of awareness about possible harms, which includes addictions. Addictions benefited effectively of the contributions from the aforementioned disciplines; however, in terms of effectiveness of research-based programs, interventions, and counseling schemes the addictions psychology still remained in debt. Therefore, I suggest that a comparative methodological and meta-theoretical analysis of the two fields (addictions and preventive health care neglect) would be beneficial for the research in all frameworks.

 References

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 de Waard, A. K. M., Wändell, P. E., Holzmann, M. J., Korevaar, J. C., Hollander, M., Gornitzki, C., ... & Carlsson, A. C. (2018). Barriers and facilitators to participation in a health check for cardiometabolic diseases in primary care: A systematic review. European journal of preventive cardiology, 25(12), 1326-1340.

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 Palència, L., Espelt, A., Cornejo‐Ovalle, M., & Borrell, C. (2014). Socioeconomic inequalities in the use of dental care services in Europe: what is the role of public coverage?. Community dentistry and oral epidemiology, 42(2), 97-105.

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