Implementation of a new system typically results in significant change for users’ work processes who engage in adaptation processes to cope with the change. Coping theory explains how people choose adaptation behaviors after a series of appraisal processes. Primary appraisal results in the categorization of the IT artifact as a threat or an opportunity. Understanding these primary appraisals, specifically what antecedents produce various appraisal results, allows better prediction of user behaviors and ultimately of implementation success. Drawing on observations during a case study of a telehealth pilot project in six sites, we offer a theoretical model to better understand the antecedents of primary appraisal.