Jari Lyytimäki and Timo Assmuth
Communication is typically understood in terms of what is communicated. However, the importance of what is intentionally or unintentionally left out from the communication process is high in many fields, notably in communication about environmental and health risks. The question is not only about the absolute lack of information. The rapidly increasing amount and variability of available data require actors to identify, collect, and interpret relevant information and screen out irrelevant or misleading messages that may lead to unjustified scares or hopes and other unwanted consequences. The ideal of balanced, integrative, and careful risk communication can only rarely be seen in real-life risk communication, shaped by competition and interaction between actors emphasizing some risks, downplaying others, and leaving many kinds of information aside, as well as by personal factors such as emotions and values, prompting different types of responses. Consequently, risk communication is strongly influenced by the characteristics of the risks themselves, the kinds of knowledge on them and related uncertainties, and the psychological and sociocultural factors shaping the cognitive and emotive responses of those engaged in communication. The physical, economic, and cultural contexts also play a large role. The various roles and factors of absent information in integrative environmental and health risk communication are illustrated by two examples. First, health and environmental risks from chemicals represent an intensively studied and widely debated field that involves many types of absent information, ranging from purposeful nondisclosure aimed to guarantee public safety or commercial interests to genuinely unknown risks caused by long-term and cumulative effects of multiple chemicals. Second, light pollution represents an emerging environmental and health issue that has gained only limited public attention even though it is associated with a radical global environmental change that is very easy to observe. In both cases, integrative communication essentially involves a multidimensional comparison of risks, including the uncertainties and benefits associated with them, and the options available to reduce or avoid them. Public debate and reflection on the adequacy of risk information and on the needs and opportunities to gain and apply relevant information is a key issue of risk management. The notion of absent information underlines that even the most widely debated risk issues may fall into oblivion and re-emerge in an altered form or under different framings. A typology of types of absent information based on frameworks of risk communication can help one recognize its reasons, implications, and remediation.
Kathryn Greene, Smita C. Banerjee, Anne E. Ray, and Michael L. Hecht
Results of national epidemiologic surveys indicate that substance use rates among adolescents remain relatively steady or even show slight declines; however, some substance use rates, such as electronic cigarettes, are actually rising. Thus, the need for efficacious drug prevention efforts in the United States remains high. Active Involvement (AI) interventions are a promising avenue for preventing and reducing adolescent substance use, and they create opportunities for adolescents to experience a core feature of engagement that is common to these interventions, such as producing videos, posters, or radio ads; or generating themes and images for messages such as posters.
Existing interventions grounded in theories of Active Involvement include programs delivered face-to-face and via e-learning platforms. Narrative Engagement Theory and the Theory of Active Involvement guide the components of change in AI interventions. Youth develop message content during participation in Active Involvement interventions. Advanced analytic models can be applied to address new research questions related to the measure of components of AI interventions.
Claude H. Miller and Reinaldo Cortes Quantip
Within a range of health communication contexts, anger can be either a detriment to the receptivity of health promotion messages when poorly controlled, or a benefit to information processing when appropriately directed. In the former case, anger can disrupt cognitive processing, leading to a range of negative outcomes, including emotional turbulence and a preoccupation with anger-eliciting events that can severely limit the receptivity of health promotion and risk prevention messages. However, when properly directed and elicited in moderation, anger can motivate greater purpose and resolve in response to health threats, stimulate more active processing of health warnings, sharpen focus on argument quality, and direct greater attention to coping-relevant information concerning harmful health risks.
Rachel A. Smith
A premise in health promotion and disease prevention is that exposure to and consequences of illness and injury can be minimized through people’s actions. Health campaigns, broadly defined as communication strategies intentionally designed to encourage people to engage in the actions that prevent illness and injury and promote wellbeing, typically try to inspire more than one person to change. No two people are exactly alike with respect to their risk for illness and injury or their reactions to a campaign attempting to lower their risk. These variations between people are important for health messaging. Effective campaigns provide a target audience with the right persuasive strategy to inspire change based on their initial state and psychosocial predictors for change. It is often financially and logistically unreasonable to create campaigns for each individual within a population; it is even unnecessary to the extent to which people exist in similar states and share psychosocial predictors for change. A challenging problem for health campaigns is to define those who need to be reached, and then intelligently group people based on a complex set of variables in order to identify groups with similar needs who will respond similarly to a particular persuasive strategy. The premise of this chapter is that segmentation at its best is a systematic and explicit process of research to make informed decisions about how many audiences to consider, why the audience is doing what they are doing, and how to reach that audience effectively.
Roxanne L. Parrott, Amber K. Worthington, Rachel A. Smith, and Amy E. Chadwick
The public, including lay members who have no personal or familial experience with genetic testing or diagnosis, as well as individuals who have had such experiences, face many intrinsic decisions relating to understanding genetics. With the sequencing of the human genome and genetic science discoveries relating genes to cancer, heart disease, and diabetes, the scope of such decisions broadened from prenatal genetic testing related to reproductive choices to genetic testing for contributors to common causes of morbidity and mortality. The decision about whether to seek genetic testing encompasses concerns about stigma and discrimination. These issues lead some who can afford the cost to seek screening through online direct-to-consumer sites rather than in clinical settings. Many who may benefit from genetic testing lack awareness of family health history that could guide physicians to recommend these diagnostic tests. Families may not discuss health history due to genetic illiteracy, with the public’s genetic illiteracy increasing their illness uncertainty and decreasing the likelihood that physicians will engage in conversations about personalized medicine with their patients. Physicians may nonetheless order genetic tests based on patients’ symptoms, during preoperative workups, or as part of opportunistic screening and assessment associated with a specific genetic workup. Family members who receive positive genetic test results may not disclose them to life partners, other family members, or insurance companies based on worries and anxiety related to their own identity, as well as a lack of understanding about their family members’ risk probability. For many, misguided beliefs that genes absolutely determine health and disease status arise from media translations of genetic science. These essentialist beliefs negatively relate to personal actions to limit genetic expression, including failure to seek medical care, while contributing to stereotypes and stigma communication. As medical science continues to reveal roles for genes in health across a broad spectrum, communicating about the relationships that genes have for health will be increasingly complex. Policy associated with registering, monitoring, and controlling the activities of those with genetic mutations may be coercive and target individuals unable to access health care or technology. Communicating about genes, health, and risk will thus challenge health communicators throughout the 21st century.
Chris R. Sawyer
Communication scholarship has profited greatly by the rise of social science during the mid-20th century. This scientific progress has been marked by increased outlets for peer-reviewed research, thriving sub-disciplines, and a rapidly accumulating corpus of findings. Social scientists have accomplished this feat largely by conducting tests of empirical models and their associated constructs. Over the same span of time, the discipline’s most prolific researcher, James C. McCroskey, pioneered the study of the construct with which he is most closely associated. Communication apprehension (CA) has impelled generations of scholars to investigate possibly the greatest impediment to successful communication, namely the fear of interacting with fellow humans. Tracing its development reveals that CA meets the standards for theory bridges: truth, abstraction, progress, and applicability. Consequently, describing CA as a bridge construct rests on four interrelated claims. First, the primary aim of CA research is to discover the truth about social anxiety. Studies of CA have outstripped competitor explanations for speaker anxiety by yielding an extensive literature of peer-reviewed articles, books, and doctoral dissertations. These writings are predicated on the presumption that CA taps into the true nature of social anxiety. Second, self-reported measures of CA, such as the PRCA-24, allow for enough abstraction to support scientific generalization. This makes it possible for CA researchers to connect concrete observations to abstract principles. Third, CA research contributes to scientific progress in communication. Explanations for CA have generally reflected theories and perspectives at the horizon of the field. Last, CA research impacts on the quality of everyday life. Ultimately, CA researchers seek to develop treatment and educational strategies for the one-fifth of the general population afflicted with this condition. Taken together, CA has served as a bridge construct that enables scholars to pursue truth, formulate testable generalizations, achieve scientific progress, and potentially improve the quality of human life.
Sandra Petronio and Rachael Hernandez
Have you ever wondered why a complete stranger sitting next to you on a plane would tell you about a recent cancer diagnosis? Why your parents never disclosed that you were adopted, feeling shocked when you accidently find out as an adult? These and many other actions reflect decisions individuals make about managing their private information. Being aware of how individuals navigate decisions to disclose or protect their private information provides useful insights that aid in the development and sustainability of relationships with others. Given privacy plays an integral role in everyone’s life, knowing more about privacy management is critical. communication privacy management (CPM) theory was first introduced by Sandra Petronio in 2002. CPM is evidence-based and accordingly provides a dependable understanding of how decisions are made to disclose and protect private information. This theory uses plain language to understand privacy management in everyday life. CPM focuses on the relationship people have with each other in communicative contexts, such as face-to-face interactions, on social media, and in dyads or groups. CPM theory is based on a communicative-social behavioral perspective and not necessarily a legal point of view. CPM theory illustrates that privacy is not paradoxical but is sustainable through the process of a privacy management system used in everyday life. The theory of CPM has been employed in a number of contexts shedding light on antecedents, mechanisms, and outcomes of private information management. In addition, a number of researchers across multiple countries, such as the Netherlands, United Kingdom, Japan, Kenya, South Korea, and the United States, have used CPM theory in their research investigations. Learning more about the system of private information management allows for a better understanding of how people navigate managing their private information when others are involved. Literature illustrates patterns of privacy management and demonstrates the challenges as well as the positive outcomes of the way individuals regulate their private information.
Sandra Petronio and Maria K. Venetis
Communication privacy management theory (CPM) argues that disclosure is the process by which we give or receive private information. Private information is what people reveal. Generally, CPM theory argues that individuals believe they own their private information and have the right to control said information. Management of private information is not necessary until others are involved. CPM does not limit an understanding of disclosure by framing it as only about the self. Instead, CPM theory points out that when management is needed, others are given co-ownership status, thereby expanding the notion of disclosing information; the theory uses the metaphor of privacy boundary to illustrate where private information is located and how the boundary expands to accommodate multiple owners of private information. Thus, individuals can disclose not only their own information but also information that belongs to others or is owned by collectives such as families.
Making decisions to disclose or protect private information often creates a tension in which individuals vacillate between sharing and concealing their private information. Within the purview of health issues, these decisions have a potential to increase or decrease risk. The choice of disclosing health matters to a friend, for example, can garner social support to cope with health problems. At the same time, the individual may have concerns that his or her friend might tell someone else about the health problem, thus causing more difficulties.
Understanding the tension between disclosing and protecting private health information by the owner is only one side of the coin. Because disclosure creates authorized co-owners, these co-owners (e.g., families, friends, and partners) often feel they have right to know about the owner’s health conditions. The privacy boundaries are used metaphorically to indicate where private information is located. Individuals have both personal privacy boundaries around health information that expands to include others referred to as “authorized co-owners.” Once given this status, withholding to protect some part of the private information can risk relationships and interfere with health needs. Within the scheme of health, disclosure risks and privacy predicaments are not experienced exclusively by the individual with an illness. Rather, these risks prevail for a number of individuals connected to a patient such as providers, the patient’s family, and supportive friends. Everyone involved has a dual role. For example, the clinician is both the co-owner of a patient’s private health information and holds information within his or her own privacy boundary, such as worrying whether he or she diagnosed the symptoms correctly. Thus, there are a number of circumstances that can lead to health risks where privacy management and decisions to reveal or conceal health information are concerned.
CPM theory has been applied in eleven countries and in numerous contexts where privacy management occurs, such as health, families, organizations, interpersonal relationships, and social media. This theory is unique in offering a comprehensive way to understand the relationship between the notion of disclosure and that of privacy. The landscape of health-related risks where privacy management plays a significant role is both large and complex. The situations of HIV/AIDS, cancer care, and managing patient and provider disclosure of private information help to elucidate the ways decisions of privacy potentially lead to health risks.
Irina A. Iles and Xiaoli Nan
Counterfactual thinking is the process of mentally undoing the outcome of an event by imagining alternate antecedent states. For example, one might think that if they had given up smoking earlier, their health would be better. Counterfactuals are more frequent following negative events than positive events. Counterfactuals have both aversive and beneficial consequences for the individual. On the one hand, individuals who engage in counterfactual thinking experience negative affect and are prone to biased judgment and decision making. On the other hand, counterfactuals serve a preparative function, and they help people reach their goals in the future by suggesting effective behavioral alternatives.
Counterfactual thoughts have been found to influence an array of cognitive processes. Engaging in counterfactual thinking motivates careful, in-depth information processing, increases perceptions of self-efficacy and control, influences attitudes toward social matters, with consequences for behavioral intentions and subsequent behaviors. Although it is a heavily studied matter in some domains of the social sciences (e.g., psychology, political sciences, decision making), counterfactual thinking has received less attention in the communication discipline. Findings from the few studies conducted in communication suggest that counterfactual thinking is a promising message design strategy in risk and health contexts. Still, research in this area is critically needed, and it represents an opportunity to expand our knowledge.
Hearing loss is common, with approximately 17% of the population reporting some degree of a hearing deficit. Hearing loss has profound impacts on health literacy, health information accessibility, and learning. Much of existing health information is inaccessible. This is largely due to the lack of focus on tailoring the messages to the needs of deaf and hard of hearing (DHH) individuals with hearing loss. DHH individuals struggle with a variety of health knowledge gaps and health disparities. This demonstrates the importance of providing tailored and accessible health information for this population. While hearing loss is heterogeneous, there are still overlapping principles that can benefit everyone. Through adaptation, DHH individuals become visual learners, thus increasing the demand for appropriate visual medical aids. The development of health information and materials suitable for visual learners will likely impact not only DHH individuals, but will also be applicable for the general population. The principles of social justice and universal design behoove health message designers to ensure that their health information is not only accessible, but also equitable. Wise application of technology, health literacy, and information learning principles, along with creative use of social media, peer exchanges, and community health workers, can help mitigate much of the health information gaps that exist among DHH individuals.
Gary L. Kreps
Diffusion is the process through which new ideas, technologies, products, or processes are spread through communication among members of a social system via communication channels over time. Diffusion is a specialized form of communication that focuses on disseminating information about new ideas, products, technologies, services, or regulations. It is an especially important form of communication because it promotes social progress in the evaluation and adoption of important new ideas to address social issues. Diffusion helps to reduce uncertainty about how to address difficult issues and provides direction for achieving social goals.
A large body of research has been conducted from many disciplines on the diffusion of innovations since the original publication of Everett M. Rogers’ seminal book The Diffusion of Innovations in 1962, which is now in its fifth edition (2003). In this book, he introduced the Diffusion of Innovations (DOI) model, which describes a general process of adopting new ideas across multiple populations, cultures, and applications. This research has examined innovations in fields such as agriculture, engineering, sales, education, architecture, technology, public policy, and health care, and has been applied to a range of different issues, such as the adoption of new technologies, consumer purchasing behaviors, and public support for political issues and candidates, but has been especially influential in guiding strategic health promotion. The DOI model has contributed to a greater understanding of health behavior change, including adoption of health promotion recommendations. The model has led to a broad scope of practical applications for promoting public health.
The disruption information seeking and processing (DISP) model is a variation on the risk information seeking and processing (RISP) model. While both the DISP and the original RISP models seek to predict how individuals will search for and attend to information in response to a perceived hazard, DISP aims to broaden analysts’ view of the sorts of information individuals may seek in such situations. It does so by expanding the repertoire of social psychology theory on which the model is constructed to include ideas from the literatures on sensemaking and identity maintenance.
A major argument of DISP is that on many occasions the information that people seek in response to a risk will not be directly related to the risk itself. For example, if you hear a news bulletin on an outbreak of food poisoning associated with ground beef, the next thing you look for may not be information on the risks of E. Coli, but a recipe for chicken. While the observation that people seek non-risk-related information in response to risks is a broad one, the DISP concerns itself with one particularly important aspect of this idea.
Specifically, based on research in the sensemaking and identity maintenance traditions, the DISP model proposes that, for information seekers, the self and the various identities in which individuals are personally invested are often as much the objects in need of interpretation as the hazardous environment. The implication of this is that when faced with a risk, individuals are likely to pay attention not just to information on the risk itself (the sort of information prioritized by RISP), but on the identities impacted by the hazard—for example, how a person’s acceptance of or strategy for coping with the risk might affect her self-image as being a good parent, a conscientious employer, etc.
The DISP also proposes that some hazard situations are likely to be more disruptive to individuals’ sense of self than others—namely instances where the individual has a high vested interest in a particular identity that is challenged by the hazard combined with a low sense of self-efficacy with respect to remediating the hazard. A typical example would be a parent who prides herself on keeping her kids safe, who finds out about an environmental risk to children in her neighborhood, but who cannot afford to move.
According to the DISP model, in such a circumstance the individual would likely become more attuned to information about the countervailing positive aspects of the neighborhood, such as good schools or a low crime rate. These sorts of information, which do not pertain to the risk directly, but are nonetheless sought as a consequence of the risk, exemplify the manner in which DISP seeks to expand the focus of the original RISP model. In the parlance of DISP, the model adds a “self-relevant” information dimension to RISP’s original focus on “risk-relevant” information.
Finally, the DISP model proposes the notion of “norm trumping,” suggesting that individuals experiencing disruption in the face of a hazard—who run afoul of the set of social norms associated with an identity in which they are highly invested—are likely to pay particular attention to self-relevant information that emphasizes alternative sets of norms that help to preserve or reconstitute a desired sense of self.
This model has yet to be tested empirically.
Spring Chenoa Cooper and P. Christopher Palmedo
Embarrassment, according to Fischer and Tangney, is an “aversive state of mortification, abashment, and chagrin that follows public social predicaments.” It is usually related to our perceptions of how others perceive us as well as their judgments of us, and it is associated with a loss of self-esteem when we perceive that others have judged us as inadequate or incompetent. However, even mere exposure or attention publicly placed on someone can elicit embarrassment (think of someone pointing at you and laughing).
Embarrassment is considered a self-conscious emotion. Self-conscious emotions include those that are evoked by self-reflection and self-evaluation: embarrassment, shame, guilt, and pride. Shame, an intense form of embarrassment, also has structural and larger social contexts, while embarrassment is more individually experienced. Self-conscious emotions play an important role in regulating behavior; they assist us in behaving according to social standards and guide us in responding when those rules are broken. While these emotions provide feedback in social situations, they also provide feedback for anticipated outcomes.
Embarrassment can play an important role in health, both in communication and behavior, and occurs through different forms. Primary embarrassment is the first rush of blood to the face and increased heart rate that usually lasts a few moments. Secondary embarrassment is the after-effect that shapes future behavior. Anticipatory embarrassment is the emotion surrounding the potential for embarrassment in an upcoming situation. Solitary embarrassment is the one that no one actually observes.
Three stigmatized areas of health—mental health, healthcare, and sexual health—may be assessed as case studies through which to understand the literature around embarrassment, as both an affect and an emotion.
The design and dissemination of health and risk messages invariably involves moral and ethical issues. The choice of the topics, the focus on particular recommended practices, the choice of particular groups to be the intended recipients of the messages and their inclusion in or exclusion from the message development process, all raise ethical issues. Further, the persuasive tactics used to influence people to change their attitudes and beliefs and to adopt recommended changes in their lives also raise ethical concerns. For example, persuasive tactics may infringe on people’s privacy when people view images they may find intrusive, offensive, or cause them distress. Tactics that “tug” at people’s emotions may infringe on their unhindered ability to make a conscientious decision. Employing digital media and sophisticated advertising and marketing tactics also elicits ethical challenges both related to their manipulative potential and their differential reach: all of which may contribute to social and health disparities. In addition, the practices recommended in health and risk messages may conflict with values people cherish. For example, people could be urged to change the way they communicate with their spouses on intimate issues, relinquish the consumption of favorite traditional foods—or messages may raise issues that recipients find taboo according to their culture or religious beliefs. Health and risk messages may have unforeseen and unintended adverse effects that could affect people’s emotional and physical aspects by inadvertently contributing to people’s sense of guilt through shaming or stigmatization. Also, on the cultural and social level, such messages may contribute to an idealization of a certain lifestyle or commercialization of products and celebrities associated with the messages.
Philosophical and ethical frameworks typically used in communication ethics, bioethics, communication campaigns, and social marketing literature emphasize the central guiding principles of personal autonomy and privacy with the aim to ensure equity and fairness. The obligation to avoid “doing harm” includes concerns regarding labeling, stigmatizing, and depriving; the obligation to help; the obligation to respect people’s autonomy to make free choices, particularly concerns regarding persuasion tactics and manipulations and the use of threat tactics, provocative appeals, distressing images, framing tactics, cultural sensitivity, and moral relativism; the obligation to obtain consent; the obligation to truthfulness; the obligation to sincerity; the obligation to correctness, certitude, and reliability; the issue of personal responsibility; equity obligations including concerns regarding segmentation and “targeting”; the obligation to comprehensibility; the obligation of inclusion; utility and efficiency considerations; the “harm reduction” approach; and concerns regarding social value priorities and “distortions,” which includes prosocial values as moral appeals.
Patric R. Spence, David Westerman, and Robert G. Rice
Humans often prefer representations that are cognitively easier to store, and such representations are easier to retrieve later to make judgments about the social world. Exemplification theory draws on physiological memory mechanisms and argues that simple, iconic, concrete, and emotionally arousing depictions of events (exemplars) are favored and thus more likely to be stored and used than are abstract, inconsequential depictions or representations. Inconsequential information or representations are forgotten because they are not processed as being essential for survival. Exemplified events vary on a continuum of how accurately they represent a larger occurrence of events. Through specific uses of pictures, quotes and other depictive strategies, concrete, iconic, and emotionally arousing information is often added to a story. Research has documented the strength of specific exemplars in creating inaccurate estimations of events and perceptions of severity and susceptibility. Moreover, in the presence of a risk, portrayals with exemplars have been shown to motivate individuals to intend to change behavior. Exemplification is a strong theory that is understudied and underutilized. The theory has strong explanatory, predictive, and organizing power, and it has application to phenomena in contexts such as media effects, persuasion, crisis and risk communication, health communication and public relations.
Jessica Gall Myrick and Robin L. Nabi
Fear is a negatively valenced discrete emotional state that is an inherent part of the human experience. With strong evolutionary roots, fear serves important functions, including alerting people to present threats and motivating action to avoid future threats. As such, fear is an emotion that frequently attracts the attention of scholars and message designers who hope to persuade audiences to change their behavior in light of potential threats to well-being and public safety. Several theories have aimed to describe the effects of fear-based appeals on audiences, focusing largely on the cognitive correlates of fear (i.e., severity and susceptibility) and their subsequent impacts on persuasive outcomes. However, more recent theorizing has returned to a focus on the influence that the emotion of fear itself has on attitude and behavior change. Given that many health-oriented fear appeals have been shown to evoke multiple emotions, including anger, disgust, and sadness, current theorizing has taken a mixed-emotions or emotional flow perspective to provide a deeper understanding of fear appeal effects. Further, individual differences have been considered to determine who is most likely to experience fear during and after message consumption.
In addition to fear appeals that purposefully aim to scare audiences to motivate attitude and behavior change, recent work suggests that fear can be generated by other forms of messages (e.g., news accounts, social media posts, interpersonal conversations) that may influence receivers’ approaches to health issues. Moreover, research also suggests that fear may motivate social sharing of messages, which can in turn allow for more widespread influence of fear-based messages.
Paul Sebastian Ruppel and Günter Mey
Grounded theory methodology is one of the most widely used approaches to collect and analyze data within qualitative research. It can be characterized as a framework for study design, data collection, and analysis, which aims at the development of middle-range theories. The final result of such a study is called a “grounded theory,” and it consists of categories that are related to each other.
Health and risk message design researchers working with grounded theory methodology are explicitly invited to use any kind of data they consider suitable for a particular project. Grounded theory methodology studies were originally based on intense fieldwork data, but in the meantime, interviews have become the most widely used type of data. In addition, there is a growing interest in using visual data such as pictures or film. Grounded theory methodology originated from sociology, but has since been applied in many different disciplines. This widened application went along with modifications, new developments, and innovations, and led to several current variants of grounded theory methodology.
Basic features of grounded theory methodology include theoretical sampling, specific coding procedures with a comparative approach to analysis, and memo writing. The strategy of theoretical sampling requires that theoretical insights gained from the analysis of initially collected data guide subsequent data collection. Hence, during the research process data collection and analysis alternate and interact. For data analysis, different ways of coding enable the researcher to develop increasingly abstract conceptual ideas and reflections, first embodied in codes, later in categories. This analytical process allows for a step-by-step development of categories that are grounded in data. Category development entails comparisons at all stages, for example, of different cases during sampling, of different data pieces, and of different codes and categories during analysis. As a result, grounded theory methodology is also known as the constant comparative method. Throughout the research process the researcher writes memos and keeps track of the development of conceptual ideas, methodological reflections, and practical to-dos. Today, many researchers use software specifically developed to assist the process of qualitative data analysis.
Roxanne L. Parrott
Health and risk policymaking focuses on decisions made and actions undertaken to set standards and pass laws to promote healthcare and public health quality, while achieving global health security. Policymakers in governments and institutions deliberate for the purposes of achieving effective and efficient policies, revealing both acceptance and rejection of evidence from health and risk, prevention, and economic sciences, as well as gaps in these domains. Health and risk communicators function implicitly within the boundaries of these decisions and actions, while contributing to prevention science related to strategic messaging and information dissemination. Policymakers face barriers to their efforts residing in the sheer volume of health and risk sciences research; the lack of evidence demonstrating that policies lead to intended outcomes (often, because a policy has not been trialed/implemented); and the absence of economic analyses associated with costs of interventions proposed and undertaken. The precautionary principle (PP) based on adopting caution when evidence is absent, uncertain, or ambiguous regarding possible harm to humans or the environment may function as a guide in some situations. Advocates may draw attention to particular issues in other cases. Policies may be stalled owing to the policy context, including election cycles, legislative and institutional bureaucracies, competing agendas, and fragmented systems of healthcare. Health and risk communicators may collaborate with policymakers and work to translate evidence into useful formats to facilitate the application of evidence to policymaking decisions and actions.
Christopher B. Mayhorn and Michael S. Wogalter
Warnings are risk communication messages that can appear in a variety of situations within the healthcare context. Potential target audiences for warnings can be very diverse and may include health professionals such as physicians or nurses as well as members of the public. In general, warnings serve three distinct purposes. First, warnings are used to improve health and safety by reducing the likelihood of events that might result in personal injury, disease, death, or property damage. Second, they are used to communicate important safety-related information. In general, warnings likely to be effective should include a description of the hazard, instructions on how to avoid the hazard, and an indication of the severity of consequences that might occur as a result of not complying with the warning. Third, warnings are used to promote safe behavior and reduce unsafe behavior. Various regulatory agencies within the United States and around the globe may take an active role in determining the content and formatting of warnings.
The Communication-Human Information Processing (C-HIP) model was developed to describe the processes involved in how people interact with warnings and other information. This framework employs the basic stages of a simple communication model such that a warning message is sent from one entity (source) through some channel(s) to another (receiver). Once warning information is delivered to the receiver, processing may be initiated, and if not impeded, will continue through several stages including attention switch, attention maintenance, comprehension and memory, beliefs and attitudes, and motivation, possibly ending in compliance behavior. Examples of health-related warnings are presented to illustrate concepts. Methods for developing and evaluating warnings such as heuristic evaluation, iterative design and testing, comprehension, and response times are described.
Amy E. Chadwick
Hope has been defined in primarily two ways, and both have implications for message design within health and risk communication. First, hope has been defined as a way of thinking, or disposition, that affects how people pursue goals. Dispositional hope manifests in beliefs about one’s capacity to initiate and sustain action toward goals (agency) and one’s ability to generate ways to reach those goals. Dispositional hope has been associated with positive physical and mental health outcomes. For example, high-hope women have greater intentions to engage in cancer prevention behaviors than do low-hope women. Numerous studies have associated higher hope with better pain management, and people who are higher in hope have a greater pain tolerance than people lower in hope. Hope is also related to better psychological adjustment.
Much of the research on dispositional hope focuses on correlating hope with a variety of positive health and non-health outcomes; however, psychotherapeutic interventions have also been designed to increase dispositional hope. These interventions have shown improvements in health-related outcomes. Although their potential is not yet realized, interventions for developing dispositional hope could improve compliance with medical recommendations, increase adoption of health behaviors, and decrease risk behaviors.
The second way that hope has been defined is as a discrete emotion. Discrete emotions are brief, intense, psychological, and evaluative reactions directed at external stimuli (e.g., people, events, or objects). In response to these external stimuli, emotions help individuals adapt to their environment by activating a unique pattern of thoughts (cognitions), physiological changes, subjective feelings, motor expressions, and action (or behavioral) tendencies.
Lazarus’s cognitive-mediational theory has been one of the most influential theories of discrete emotions that includes a definition of hope. Lazarus identifies the core relational theme of hope as “fearing the worst but yearning for better.” Lazarus deems hope to be a problematic emotion because he believes hope contains both positive and negative elements. Despite uncertainty about the exact nature of hope, Lazarus believes that hope is vital to coping with stress. Hope enables people to believe in the possibility of better circumstances and therefore is critical as a coping mechanism against despair. Lazarus does not provide guidance for what a message might need to include to evoke hope.
Drawing on Lazarus and appraisal theories in general, MacInnis and de Mello suggest tactics that consumer marketing advertisements could use to induce hope. Specifically, the authors focus on turning “impossibility into possibility” and enhancing “yearning.” De Mello and MacInnis also theorize that hope can lead to motivated processing of information resulting in both positive (e.g., coping, well-being, and goal achievement) and negative (e.g., risky behavior, self-deception) outcomes. Unfortunately, the theorizing of de Mello and MacInnis was never empirically tested.
To further explore how feelings of hope are created, Prestin examined underdog narratives in entertainment media. Underdog narratives show characters who are attempting to meet a goal despite unfavorable circumstances and odds. These narratives evoke hope and make people more motivated to meet their own personal goals. Although their potential has not been fully explored, underdog narratives may assist individuals in overcoming challenging circumstances, such as battling addiction or developing new health habits. There are numerous mechanisms still to be examined that may explain the effects of underdog narratives beyond their ability to evoke hope.
Recently, Chadwick defined hope as a future-oriented, discrete emotion that focuses on an opportunity to achieve a desired future outcome. Her definition builds on the work of Lazarus and Roseman and has implications for the design of messages that evoke hope. According to Chadwick, hope is evoked by appraisals of a future outcome as (a) consistent with goals (goal congruence), (b) possible but not certain (possibility), (c) important (importance), and (d) leading to a better future (future expectation). All four of these appraisals combine to create a perception of opportunity and the discrete emotion hope. Hope motivates behavior by focusing one’s thoughts on capitalizing on an opportunity. Chadwick states that hope also involves (a) an approach action tendency that motivates individuals to take, or continue, action to achieve the desired outcome, (b) increased heart rate and skin conductance, (c) an open facial expression, heightened focus, and alert body posture, and (d) a feeling of eager attention.
Chadwick’s definition has clear implications for developing messages that evoke hope. Messages designed to create appraisals of the importance, goal congruence, positive future expectation, and possibility of a future event evoke hope and are called hope appeals. Like other theoretical explications of emotional appeals, a hope appeal has two components: (a) the inducement of hope through the presentation of an opportunity and (b) the presentation of recommended actions to achieve the desired outcome. The recommended actions component includes information designed to (a) increase the receiver’s perception of his or her ability to perform the recommended action (i.e., self-efficacy) and (b) demonstrate the ability of the recommended actions to achieve the desired outcome (i.e., response efficacy).
Empirically, scholars have tested the effects of hope and messages that evoke hope. Hope appeals increase attention to messages about climate change and increase mitigation behavioral intention and mitigation behavior. In addition, feelings of hope increase interest in climate change protection and are positively correlated with pro-environmental behaviors and support for climate change policies. Feelings of hope significantly predict interest in climate protection, self-efficacy, interpersonal communication intention, information seeking intention, and behavioral intention. Hope and hopeful narratives have also been associated with greater perceived message effectiveness and more agreement with the message content. After a stressful experience that accelerates heart rate, evoking hope decelerates heart rate and decreases state anxiety. This research provides evidence that messages that evoke hope can counter the psychological and physiological effects of stressful events. In addition, researchers have examined the effects of hope on a variety of health, persuasion, political communication, and marketing outcomes. Preliminary evidence indicates that hope appeals are equally as or more effective than guilt and fear appeals at increasing interpersonal communication intention, self-efficacy, information seeking intention, and behavioral intention. In addition, hope appeals create less reactance (anger) than fear appeals. Together these results indicate that hope and hope appeals have substantial potential to influence health and risk behavior.