Yulia A. Strekalova and Janice L. Krieger
Risk is a social construction, and its understanding by information consumers is shaped through interaction with messages, opinions, shared and learned experiences, and interpretations of the characteristics of risk. Social actors and information flows can provide heuristic cues about risks, their relative importance and unimportance, and the attention that an information consumer ought to pay to a particular risk. Social cues can also accentuate particular characteristics of risk, further amplifying or attenuating attention to it and shaping behaviors. This, in turn, can generate secondary and tertiary effects resultant from the public’s reaction to risk. The process of social amplification of risk, therefore, has structural components that include the social elements that get enacted in the process of the translation of risk information. Risk amplification is also affected by message factors, which can dramatize information, increase attention and uncertainty, and generate shared signals and symbols. And finally, social amplification of risks results in reactions that can shape pathways for risk assessment and management, frame views, fuel intergroup dynamics in response to risk, contribute to the accumulation of experiential knowledge and signals of different risk situations, and label and stigmatize some groups or outcomes as undesirable.
Steven H. Kelder, Deanna M. Hoelscher, and Ross Shegog
Social cognitive theory (SCT) is an action-oriented approach to understanding the personal cognitive, environmental, and behavioral influences on behaviors and to developing theory-based interventions to improve the health status and inequities of societies. It has broad applications across a diverse array of health-enhancing and health-compromising behaviors and has been used successfully in a variety of cultures, with many different intervention methods. Social cognitive theory provides empirically based concepts to explain health behavior and provides useful constructs and processes with which to design interventions.
Intervention design using SCT typically follows a sequence of information gathering and project development steps. Literature about the magnitude of the heath problem, its’ risk factors, and the success of previous intervention attempts is carefully reviewed and summarized. The review is presented to the community and qualitative and quantitative assessments are undertaken with the recipients of the intervention to identify the most salient and powerful SCT constructs that are associated with the targeted behavior. Taken together, these preliminary data are then used in the application of SCT constructs for intervention design. Given the recognized differences in how SCT constructs manifest with different ethnic and cultural groups, the careful delineation, tailoring, measurement, and application of these constructs are critical for successful interventions.
Before health and risk messaging can have the best possible effect, there needs to be an understanding of what might influence health and associated risky behaviors. A wide range of elements needs to be considered, given the many possible influences on health habits and risky exposures. Since “ecology” is defined as the relationship between organisms and their environments, ecological models enable this consideration to be made. As a result ecological approaches have been widely used in health behavior, health planning, and health education.
Ecological theory, with a communication focus, has also been developed, emerging specifically from the field of “information behavior.” Grounded in the work of Bronfenbrenner, on the experimental ecology of human development, the theory grew out of a study of older adults’ information and communication needs and uses, undertaken in the 1990s. The ecological model, as developed, enabled a wide range of personal and social influences on information seeking and communication to be explored with people aged 60 and older. Analysis of the impact of multilevel factors is facilitated by an ecological approach, increasing its value for the task of designing the content of health and risk messages. The “how” of designing health messaging is not addressed specifically by this approach.
Following the study of older adults, the ecological model was broadened, modified, and applied to the study of the information and communication behavior of different community groups, involving a range of topics. The flexibility of the approach is a key strength. A study of information seeking, by women with breast cancer, indicated that several “ecological” elements, such as age, ethnicity, and stage of disease, played a part in the type of information sought and in preferences for how information was communicated. Health and risk avoidance implications emerged from a study of information seeking for online investment, providing another good example of the ways in which the model can be adapted. A range of ecological factors were shown to influence investing behavior, including level of risk taking. A study of people in the Fourth Age (the last stage of life) resulted in a further refined and extended model, as well as making a contribution to the already substantial body of accumulated gerontological knowledge.
Social influence processes play an important role in the recovery process for alcoholics who affiliate with Alcoholics Anonymous (AA). Group norms at AA emphasize the sharing of stories about past difficulties with alcohol, the circumstances that led a person to join AA, and how life has changed since achieving sobriety. These narratives serve to increase collective identity among AA members via shared experiences and to reinforce AA ideology. In discussions and interpersonal interactions at AA meetings, AA ideology is also communicated and reinforced through AA literature and the discussion of central tenets, such as the Twelve Steps and Twelve Traditions, the idea that alcoholism is a progressive disease, and the need to be active in one’s sobriety. Moreover, AA meetings provide an opportunity for recovering alcoholics to find others who share similar experiences, an opportunity for greater social comparisons to other alcoholics than are typically available in primary social networks, and group-suggested role obligations that influence commitment to AA and long-term sobriety. These social influence processes have been linked to important health outcomes, including longer abstinence from alcohol use than with other treatment options, reduced stigma associated with alcoholism, reduced stress/depression, increased self-efficacy, and the acquisition of coping skills that are important to the recovery process.
R. Craig Lefebvre and P. Christopher Palmedo
Many ideas about best practices for risk communication share common ground with social marketing theory and practice: for example, segmentation, formative research, and a focus on behavioral outcomes. Social marketing first developed as a methodology to increase the public health impact of programs and to increase the acceptability and practice of behaviors that improve personal and social well-being. The core concepts of this approach are to be people-centered and to aim for large-scale behavior change. An international consensus definition of social marketing describes it as an integration of theory, evidence, best practices, and insights from people to be served. This integrated approach is used to design programs that are tailored to priority groups’ needs, problems, and aspirations and are responsive to a competitive environment. Key outcomes for social marketing efforts are whether they are effective, efficient, equitable, and sustainable.
The 4P social marketing mix of Products, Prices, Places, and Promotion offers both strategic and practical value for risk-communication theory and practice. The addition of products, for example, to communication efforts in risk reduction has been shown to result in significantly greater increases in protective behaviors. The Cover CUNY case demonstrates how full attention to, and consideration of, all elements of the marketing mix can be used to design a comprehensive risk-communication campaign focused on encouraging college student enrollment for health insurance. The second case, from the drug safety communication arena, shows how a systems-level, marketplace approach is used to develop strategies that focus on key areas where marketplace failures undermine optimal information-dissemination efforts and how they might be addressed.
S. Anne Moorhead
Social media used for communication purposes within healthcare contexts is increasing and becoming more acceptable. The users of social media for healthcare communication include members of the general public, patients, health professionals, and health organizations. The uses of social media for healthcare communication are various and include providing health information on a range of conditions; providing answers to medical questions; facilitating dialogue between patients and between patients and health professionals; collecting data on patient experiences and opinions used for health intervention, health promotion, and health education; reducing stigma; and providing online consultations. With emerging advances over time, including new platforms and purposes, these uses will change and expand, increasing usability and thus providing more opportunities to use social media in connection to healthcare in the future. However, both patients and health professionals may require training to fully maximize the uses of using social media in healthcare.
Social media has numerous benefits for healthcare communication, including increased interactions with others; more available, shared, and tailored information; increased accessibility and widening access; and increased peer/social/emotional support. While there may be further benefits of using social media in healthcare, there are many limitations of social media for healthcare communication as well. The main reported limitations include a lack of reliability; quality concerns; and lack of confidentiality and privacy. From the available evidence, it is clear that maintaining patient privacy as well as the security and integrity of information shared are concerns when using social media.
As patients and members of the general public use social media widely, some may expect it in healthcare, thus it important for health professionals and organizations to manage expectations of social media in healthcare communication. This results in challenges ranging from encouraging staff to use social media to dealing with user problems and complaints. It is recommended that organizations embrace social media but have a specific purpose for each activity and platform while continually monitoring traffic. Regardless of the nature or size of the healthcare organization, it is time to adopt appropriate guidelines for the use of the social media in healthcare communication to address the challenges and the growing expectations of using social media, especially within healthcare contexts. The key message is that social media has the potential to supplement and complement but not replace other methods to improve communication and interaction among members of the general public, patients, health professionals, and healthcare organizations.
Kristin Page Hocevar, Miriam Metzger, and Andrew J. Flanagin
Our understanding and perceptions of source credibility significantly drive how we process health and risk messages, and may also influence relevant behaviors. Source credibility is believed to be impacted by both perceptions of source trustworthiness and expertise, and the effect of credibility on changes in attitudes and behavior has been studied for decades in the persuasion literature. However, how we understand and define source credibility—particularly the dimension of expertise—has changed dramatically as social media and other online platforms are increasingly used to design and disseminate health messages. While earlier definitions of source credibility relied heavily on the source’s credentials as indicators of expertise on a given topic, more recent conceptualizations must also account for expertise held by laypeople who have experience with a health concern. This shifting conceptualization of source credibility may then impact both why and when people select, as well as how they perceive, process, and judge, health messaging across both novel and more traditional communication contexts.
The spiral of silence theory provides insight into the ways in which perceptions of public opinion can lead to changes in opinion expression behavior. Conceptualized in a political communication context, the central claim of the theory is that individuals’ fear of social isolation motivates them to continuously evaluate the climate of opinion through both experiences with the media and interpersonal communication. Upon assessment, individuals either find themselves in a situation where their opinion aligns with the majority or minority. Accordingly, those who find their opinion does not align with the dominant opinion are likely to conceal their opinions while those who find their opinion aligns with the majority are more likely to express them.
Empirical research testing the spiral of silence theory has predominately focused on measurement of focal variables and methods of empirical testing. Advances have been made in regard to micro-level factors, such as creating universally applicable measures of psychological attributes. However, limited work has explored macro-level factors, such as appropriateness of issues, application to computer-mediated communication environments, and tools used to identify circumstances vulnerable to spiral of silence effects. Nonetheless, the practical value of the spiral of silence theory for health and risk communicators can be utilized by modifying campaign efforts to anticipate and counteract fluxes in public opinion.
Persuasive messages use statistical evidence in order to convince an audience to accept a conclusion. Statistical evidence represents a compilation of experiences structured and collected in a manner that permits expression in mathematical form. Research demonstrates that the use of statistical evidence increases the persuasiveness of a message, and a message that uses both statistical and narrative evidence generates the greatest persuasiveness.
Statistical evidence can take the form of summarizing the collective opinion of experts on a topic or an expression of the collective set of experiences. The challenge becomes gaining acceptance of statistical expressions of experience versus what is perceived as the narrative or lived experience of the single person. Statistical evidence is often presented using a mathematical expression to indicate the size or force of the evidence.
The accumulation of statistical evidence often involves the use of meta-analysis to reduce Type I (false positive) and Type II (false negative) error. The use of evidence is strategic and can target specific elements of belief by understanding the structure of beliefs and the connectivity among elements. The use of the Subjective Probability Model provides a means to capitalize on the use of evidence by changing probabilities in beliefs to increase the effectiveness of a message campaign.
Statistical evidence, however, may be ineffective under circumstances referred to as the “base-rate fallacy.” The base-rate fallacy occurs when the presentation of statistical information is accepted, but examples are used that contradict the base-rate. The impact of the use of the example is to create a shift in the belief in the typicality of the example, despite knowledge of the base-rate.
Fear appeals provide a particularly useful and important application of statistical evidence in the pursuit of public health campaigns. The tenets of the Extended Parallel Processing Model indicate that message effectiveness relies on a combination of: (a) perceived severity of the threat, (b) perceived vulnerability to the threat, (c) perceived efficacy of the solution, and (d) perceived personal efficacy of the solution. Each element is largely impacted by the application and use of statistical information to make claims. The use of statistics generally outlines the argument and supports the conclusion offered in support of a conclusion offered to the message recipient.
Statistical evidence when used in a message often offers data or information that becomes the justification for a conclusion. A large part of a message becomes gaining acceptance of information by an audience, then explaining (reasoning) to the audience how those facts support a conclusion, often involving some type of recommendation for behavior. Understanding statistical evidence requires understanding how the material functions within the context of the belief system of the individual.
Rachel A. Smith, Xun Zhu, and Madisen Quesnell
Stigmas are profoundly negative stereotypes of a social group and its members that have diffused and normalized throughout a community. Being marked as a member of a stigmatized group does more than designate someone as different: stigmas denote people as discredited, devalued, and disgraced. Stigmas shape health and risk communication and are considered the leading—but least understood—barrier to health promotion.
Communication and stigmas are dynamically connected. Communication is critical to a stigma’s existence, spread, expression, coping, and elimination. Using mediated and interpersonal communication, community members are socialized to recognize and react to stigmatized people. People use communication to enact the devaluation and ostracism of stigmatized people, and stigmatized people use communication to cope with stigmatization. Stigmas also shape communication: stigmas compel non-marked persons to engage in stigmatization and ostracism of marked persons, reduce marked people’s disclosure and encourage secrecy, and shape the characteristics of personal and community networks. Last, campaigns have used communication to attempt to eliminate existing stigmas. The accumulating research, conducted from diverse assumptions about human behavior (cultural determinism, evolutionary, socio-functional), shows how easily and effectively stigmas may be socialized; how challenging they are to manage; how many facets of health and wellbeing are devastated by their existence; and how difficult it is to attenuate them.
While much has been uncovered about stigma, health, and risk, many questions remain. Among these include: How can one design messages that effectively alert the general public about imminent health threats and that successfully promote desirable behavioral changes without evoking stigma processes? How do different reactions to stigmatization influence targets and their social networks? What factors increase resistance or vulnerability to messages containing stigma-inducing content? How can one create an effective, reliable means to eliminate existing stigmas?
Joel Iverson, Tomeka Robinson, and Steven J. Venette
Risk can be defined using a mathematical formula—probability multiplied by consequences. An essential element of risk communication is a focus on messages within organizations. However, many health-related risks such as Ebola extend beyond an individual organization and risk is better understood as a social construction cogenerated within and between systems. Therefore, the process is influenced by systemic and supra-systemic values and predilections. Risk from a structurational perspective allows an understanding of the public as well as organizational responses to risk. Structuration theory provides a useful lens to move beyond seeing organizations as something that flows within an organization to understanding how organizations are enacted through communication. Structuration theory articulates the connections between systems and structures through the action of agents, whose practices produce and reproduce the rules and resources of social life. Within the structuration tradition, organizational communication scholars have shifted to an understanding of the communicative constitution of organizations (CCO). Specifically, one of the theories of CCO is the Four Flows Model. The four flows highlight the ways people enact organizations and provide a means to analyze the various ways communication constitutes organizations. The four flows are membership negotiation, activity coordination, reflexive self-structuring, and institutional positioning. Membership negotiation enacts the inner members and outsiders at a basic level including socialization, identity, and assimilation. Activity coordination produces collective action around a specific goal. Reflexive self-structuring is the decentralized enactment of structures for the organization through the communication of policies. Institutional positioning covers the macro-level actions where people in the organization act as an entity within the environment.
When considering the public reaction to Ebola, a simple way to evaluate risk perception is the intersection of dread and control. The U.S. public considered Ebola a serious risk. From a structuration perspective, the viral nature of twitter, media coverage, and public discussion generated resources for fear to be exacerbated. Structuration theory allows us to position the risk beliefs as rules and resources that are reproduced through discourse. The organizational implications fall primarily into the two flows of institutional positioning and reflexive self-structuring. For institutional positioning, U.S. healthcare organizations faced general public dread and perceived lack of control. Within the United States multiple policies and procedures were changed, thus fulfilling the second flow of organizational self-structuring. The Ebola risk had a significant impact on the communicative constitution of health-care organizations in the United States and beyond. Overall, risk is communicatively constituted, as are organizations. The interplay between risk and health-care organizations is evident through the analysis of American cases of Ebola. Structuration theory provides a means for exploring and understanding the communicative nature of risk and situates that risk within the larger systems of organizations.
Substance Abuse Prevention Message Generation: Engaging Adolescents in Health Message Planning and/or Production of Health Promotion Messages
Smita C. Banerjee and Kathryn Greene
Adolescent substance use remains a significant public health challenge, with recent approaches to address these problems including actively engaging adolescents in message planning and/or production as a prevention strategy. There are two benefits of this active involvement strategy. First, engaging adolescents in message planning or producing substance prevention messages is a form of participatory research that results in participant-generated messages for use in future intervention efforts. This participatory form of research is increasingly common in a wide range of topics and populations, particularly disenfranchised or stigmatized groups. It is important to focus on the second benefit of engaging adolescents in message planning and prevention: the effect of engaging in planning or producing substance prevention messages on the adolescents themselves. If done properly, the process of engaging adolescents in planning (or producing) anti-substance messages can provide longer-term benefits of delaying onset of substance use (strengthening resistance) as well as changing patterns for those already using. Some examples of this strategy exist with media literacy, although applied with a great deal of variability. The increased popularity of these planning/production approaches requires greater explication of how, when, and why they produce effects for participants. Two different theoretical perspectives address this active involvement intervention approach: narrative engagement theory and the theory of active involvement. Beyond these theories, sensation seeking is positioned as a moderator to explore for active involvement intervention effects.
Kristin L. Farris and Maureen P. Keeley
Social support in the context of chronic illness management is important, as individuals diagnosed with these conditions and their loved ones often experience increased distress, reduced relational quality, and diminished physical health as a result of coping with these long-term symptoms. Therefore, diagnosed individuals and their close relational partners rely on others to provide support in their time of need. The communication of social support is characterized by “verbal and nonverbal behavior produced with the intention of providing assistance to others perceived of needing that aid” (MacGeorge, Feng, & Burleson, 2011, p. 317). Individuals living with these chronic illnesses and their loved ones often turn to a variety of interpersonal others, including friends, family, health care providers, and support groups to manage the difficulties that accompany their physical symptoms. Although some researchers suggest that diagnosed individuals seek support most frequently from close relational partners, other scholars assert that chronic care support groups (whether meeting face to face or via computer-mediated channels) offer support recipients an opportunity to discuss their challenges and receive help from experientially similar others.
On the one hand, regardless of the support provider, individuals who have been diagnosed with chronic conditions generally perceive effective supportive communication to be messages in which their support providers enact competent tangible assistance in managing the illness, provide an opportunity for them to vent their feelings, and express messages of empathy and affection, among others. Ineffective messages, on the other hand, are those in which diagnosed individuals feel their partners are overly involved in helping them make decisions about their care or portraying negative attitudes or discomfort around them. Overall, research in this area suggests that support recipients and their relational partners have improved emotional, relational, and physical outcomes when they perceive support to be available or receive effective support from these resources.
Jessica Gasiorek and R. Kelly Aune
A majority of the extant literature in health and risk message processing focuses—for obvious reasons—on social influence and compliance-gaining. Interpersonal and relational issues with doctors and patients are a secondary focus. In contrast, research that specifically addresses comprehension of health and risk messaging is somewhat scant. However, other domains (e.g., cognitive psychology, reading studies) offer models and studies of comprehension that address message processing more generally. This material can usefully inform research in a health and risk context.
An important aspect of any communicative event is the degree to which that event allows interactivity. This can be described in terms of a continuum from static messaging to dynamic messaging. Message features may affect simple comprehension (in the former case) and active understanding (in the latter case) of messaging along this continuum. For static messaging, text features are the dominant focus; for dynamic messaging, how communicators cooperate, collaborate, and adjust their behavior relative to each other’s knowledge states is the focus. Moderators of these effects, which include sources’ dual goals informing and influencing targets, are also important to consider. Examples of this include direct-to-consumer-advertising (DTCA) of pharmaceutical medicines and pharmaceutical companies, which must meet the demands of the government regulatory bodies (e.g., fair and balanced presentation of benefits and risks) while simultaneously influencing the message processing experience of the target to minimize negative perceptions of their products. Impediments to creating understanding can arise in both the highly interactive setting of the face-to-face doctor-patient context as well as more static messaging situations such as PSAs, pamphlets, and pharmaceutical package inserts.
Making sense of message comprehension in health and risk communication is complex, and it is complex because it is broad in scope. Health and risk communication runs the gamut of static to dynamic messaging, employing everything from widely distributed patient information leaflets and public service announcements, to interactive web pages and massively connected social networking sites, to the highly interactive and personalized face-to-face meeting between doctor and patient. An equally comprehensive theoretical and methodological tool box must be employed to develop a thorough understanding of health and risk communication.
The ACT2 Program and Eliminating Racial and Ethnic Disparities in HIV and AIDS Clinical Trials: A Case Study in Health and Risk Messaging
Marya Gwadz and Amanda S. Ritchie
It is well documented that African American/Black and Hispanic individuals are underrepresented in biomedical research in the United States (U.S.), and leaders in the field have called for the proportional representation of varied populations in biomedical studies as a matter of social justice, economics, and science. Yet achieving appropriate representation is particularly challenging for health conditions that are highly stigmatized such as HIV/AIDS. African American/Black, and Hispanic individuals, referred to here as “people of color,” are greatly overrepresented among the 1.2 million persons living with HIV/AIDS in the United States. Despite this, people of color are substantially underrepresented in AIDS clinical trials. AIDS clinical trials are research studies to evaluate the safety and effectiveness of promising new treatments for HIV and AIDS and for the complications of HIV/AIDS, among human volunteers. As such, AIDS clinical trials are critical to the development of new medications and treatment regimens. The underrepresentation of people of color in AIDS clinical trials has been criticized on a number of levels. Of primary concern, underrepresentation may limit the generalizability of research findings to the populations most affected by HIV/AIDS. This has led to serious concerns about the precision of estimates of clinical efficacy and adverse effects of many treatments for HIV/AIDS among these populations. The reasons for the underrepresentation of people of color are complex and multifaceted. First, people of color experience serious emotional and attitudinal barriers to AIDS clinical trials such as fear and distrust of medical research. These experiences of fear and distrust are grounded largely in the well-known history of abuse of individuals of color by medical research institutions, and are complicated by current experiences of exclusion and discrimination in health care settings and the larger society, often referred to as structural racism or structural violence. In addition, people of color experience barriers to AIDS clinical trials at the level of social networks, such as social norms that do not support engagement in medical research and preferences for alternative therapies. People of color living with HIV/AIDS experience a number of structural barriers to clinical trials, such as difficulty accessing and navigating the trials system, which is often unfamiliar and daunting. Further, most health care providers are not well positioned to help people of color overcome these serious barriers to AIDS clinical trials in the context of a short medical appointment, and therefore are less likely to refer them to trials compared to their White peers. Last, some studies suggest that the trials’ inclusion and exclusion criteria exclude a greater proportion of people of color than White participants. Social/behavioral interventions that directly address the historical and contextual factors underlying the underrepresentation of people of color in AIDS clinical trials, build motivation and capability to access trials, and offer repeated access to screening for trials, hold promise for eliminating this racial/ethnic disparity. Further, modifications to study inclusion criteria will be needed to increase the proportion of people of color who enroll in AIDS clinical trials.
Kami J. Silk and Daniel Totzkay
The Breast Cancer and Environment Research Program (BCERP) is a transdisciplinary program of research created to investigate environmental exposures and their relationship to breast cancer with a particular focus on puberty as a potential window of increased susceptibility to environmental exposures. A transdisciplinary approach has a strong focus on translating scientific findings into usable health practices as well as health prevention messages so that current research informs practice as well as communication to the lay public. BCERP engaged in communication science to develop health messages for lay audiences, health professionals, and outreach organizations. The precautionary principle, used as a primary guide in regards to message translation and dissemination, yields a useful discussion of the BCERP organizational structure. An exploration of formative communication science efforts in BCERP, areas of sensitivity for creating BCERP messages, and resources created for BCERP toolkits serves to illustrate and describe this one approach to designing health and risk messages.
M. Jeffrey Farrar, Yao Guan, and Kaitlyn Erhardt
Humans live not only in a physical world but also in a mental world. Theory of mind reflects the understanding that the mind is comprised of different mental states, such as intentions, desires, and beliefs. This conception of the mind is a critical achievement in human development because it directly impacts effective communication and social interaction. It allows for the understanding of others’ behaviors by inferring their mental states. The formation of a theory of mind has been a central topic in psychology, neuroscience, cognitive science, and philosophy. It impacts related processes, such as communication skills, perspective-taking ability, and social cognition.
Across the life span, the understanding of the mind becomes increasingly complex. Early in development, infants and toddlers can discern the intentions of others. Later, more sophisticated reasoning about the mental states of others becomes possible. For instance, the ability to follow and understand the recursive thought that “Sam believes, that Mary said, that Jose wanted . . .” develops. Additionally, within distinctive developmental time periods, people differ in their ability to take into account mental states. Once people’s beliefs, including their misconceptions, are identified, it is possible to generate effective communication strategies designed to teach, learn, and even reduce risk-taking behaviors.
Kaite Yang and Emily Pronin
Social psychological research on thinking has generally focused on the attitudes, emotions, motivations, and biases that affect thinking and consequent behavior. What has received less attention is the speed of thinking: how quickly thinking occurs and whether thoughts accelerate or slow down. Communication design and processing may take for granted that the structure and reception of messages occur at a certain speed. Recent findings from the psychological study of thought speed shed light on ways that this research may be applied to health communication. Fast and slow rates of thinking are correlated with distinct patterns of affective, cognitive, physiological, and behavioral events. Fast thinking is associated with positive mood, energy, approach motivation, arousal, creativity, and risk-taking. Slow thinking is associated with negative mood and depression, low energy, and cognitive impairment. Potential theories exist for why psychological and physiological experiences are associated with thought speed.
Recent experimental research demonstrates that thought speed can be successfully manipulated to elicit psychological effects, and it can be manipulated independent of thought content. Researchers, healthcare practitioners, and communicators should be aware of the psychological correlates and consequences of thought speed and consider harnessing the effects of thought speed to augment communication. Thought acceleration and deceleration can be integrated into the design and processing of health communication.
Melanie C. Green and Kaitlin Fitzgerald
Transportation Theory: Narrative transportation theory focuses on the causes and consequences of an individual being immersed in a story, or transported into a narrative world. Transportation refers to the feeling of being so absorbed in a story that connection to the real world is lost for some time; it includes cognitive engagement, emotional experience, and the presence of mental imagery. This experience is a key mechanism underlying narrative influence on recipients’ attitudes and beliefs, particularly in combination with enjoyment and character identification. Narrative persuasion through transportation has been demonstrated with a wide variety of topics, including health, social issues, and consumer products. Transportation can occur across media (through written, audio, or video narratives) and for both factual and fictional stories. It is typically measured with a self-report scale, which has been well-validated (Green & Brock, 2000). Transportation is conceptually similar to flow (Csikszentmihalyi, 1990) and presence (Klimmt & Vorderer, 2003), although both flow and presence pertain more to being immersed in an experience, rather than specifically in a narrative. While individuals are transported, their mental systems and capacities become concentrated on events occurring in the story, causing them to lose track of time, lack awareness of the surrounding environment, and experience powerful emotions as a result of their immersion in the narrative. Transported recipients may also lose some access to real-world knowledge, making them more likely to adapt their real-world beliefs and behaviors to be more consistent with the story to which they are exposed. Transportation theory suggests several mechanisms to explain this phenomenon, including reduced counterarguing, connections with characters, heightened perceptions of realism, the formation of vivid mental imagery, and emotional engagement. Personality factors can also affect the extent of transportation: narrative recipients vary in transportability, or their dispositional tendency to become transported; and they may be influenced differently by narratives due to a difference in their need for affect (individuals high in need for affect are more likely to be transported into narratives). Additional factors such as story quality and points of similarity between the reader and the story can also influence transportation.
Seth M. Noar
The Transtheoretical Model (TTM) is an integrative health behavior change theory that describes the process of how people change their behavior. The central organizing construct in the theory is stages of change, which are five distinct stages of readiness to change behavior, ranging from not ready to change (precontemplation), thinking about change (contemplation), preparing to change (preparation), changing (action), and maintaining the change (maintenance). Movement through the stages may be nonlinear, and cycling and recycling through the stages is viewed as a natural part of the change process. Other model constructs explain what drives individuals forward through the stages of change. Decisional balance involves a weighing of pros and cons of changing behavior, while self-efficacy involves situation-specific confidence that one can change. Increases in pros, deceases in cons, and increases in self-efficacy propel people forward through the stages of change. The processes of change are experiential and behavioral strategies that people use to change their behavior. In early stages of change, people use experiential strategies while they use behaviorally oriented strategies in later stages of change. The TTM holds significant implications for message design. Most notably, messages should be targeted and tailored to stages of change, and where possible, to other model variables as well. Studies indicate that the TTM has been successfully applied to health communication campaigns, and to a larger extent, to computer-tailored interventions to change health behavior. Meta-analyses indicate that scores of computer-tailored interventions have been efficacious, including many based upon the TTM and stages of change. New applications of the model include a focus on novel health behaviors, multiple behavior change, and advancing an understanding of message design in the context of the TTM in combination with other theoretical approaches.