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Article

Referred to as the “most consistent and reliable method for conferring resistance to persuasion” by Miller et al. in 2013, over the past 50 years inoculation has exerted significant influence in shaping theoretical and contextual resistance research and message design. Used as a message strategy, inoculation elicits threat, or realized attitudinal/behavioral vulnerability, which motivates individuals to shore up attitudinal/behavioral defenses by providing both material and guided practice aiding the process of effective counterarguing, which in turn increases individuals’ resistance to attitudinal/behavioral challenges. The motivation is responsible for sustaining the inoculation effect over an extended period of time. Inoculation messages, however, do much more than just inspire a robust defense. They motivate individuals to engage others regarding the attitudinal/behavioral topic in an attempt to reassure and advocate their positions, thus diffusing the inoculation message over social networks. The attitudinal/behavior protection elicited by inoculation messages is not limited to the message’s target attitude/behavior, but instead spreads over related attitudes/behaviors as well, thus increasing the pragmatic utility of this message strategy. Inoculation’s effectiveness extends beyond the realm of resistance, as inoculation messages are also effective in both shaping and changing attitudes/behaviors. Because of its success, inoculation-based message strategies have been applied in numerous contexts researchers and clinicians beganand with numerous topics. Some of inoculation’s applied contexts include commercial, instruction/education, interpersonal, political, corporate, public relations, cross-cultural, health, and risk. More specifically, in the health and risk contexts, inoculation has been applied in promotion or prevention capacity on topics such as politically-motivated violent acts, smoking, drinking, unprotected sex, vaccination, and health-related policy, with current research exploring its efficacy in addiction interventions and indoor tanning-bed usage prevention. Inoculation may also be used as a strategy to reduce recidivism in criminal prison inmates and preventing verbal aggression in schools. Additional promising areas for application of inoculation-based strategies may include the promotion and protection of healthy eating habits as well as positive attitudes/behaviors toward mammograms, colonoscopies, breastfeeding, and regular exercise, just to name a few. As Ivanov suggested, the “application of the strategy [is] boundless.”

Article

Carla L. Fisher and Thomas Roccotagliata

From birth to death, our interactions with others are what inform our identity and give meaning to life. Ultimately, it is interpersonal communication that is the bedrock of wellness. Much of the scholarship on interpersonal communication places communication in the background, characterized merely as a resource, symptom, or contributing factor to change. In the study of our interpersonal experiences, communication must be at the forefront. As a pragmatic lens concerned with real-world issues, a life-span perspective of interpersonal scholarship provides boundless opportunities for bridging science and practice in meaningful ways that improve social life on multiple levels, from families to schools to government to hospitals. Interpersonal communication research that is concerned with life-span issues tends to prioritize communicative phenomena and bring the communication dynamics of our relational lives to the surface. Typically, this scholarship is organized around the various stages or phases of life. In other words, researchers concerned with interpersonal communication often contextualize this behavior based on dimensions of human development and life changes we typically encounter across the life course, those major life experiences from birth to death. Much of that scholarship also centers on how we develop competence in communication across time or how communication competence is critical to our ability to attain relational satisfaction as well as a high psychological and physical quality of life. This research also highlights the influential role of age, human development, and generational differences, recognizing that our place in the life span impacts our goals and needs and that our sociocultural-historical experiences also inform our communication preferences. A life-span perspective of interpersonal communication also encompasses various theoretical paradigms that have been developed within and outside the communication discipline. Collectively, this scholarship helps illustrate the communicative nature of human life across the entire life trajectory.

Article

The degree to which patients are active and communicative in interactions with medical providers has changed in recent decades. The biomedical model, a model that minimizes patient agency in the medical interaction, is being replaced with a model of patient-centered care, an approach that prioritizes the individual patient in their healthcare and treatment decisions. Tenets of patient-centered care support that patients must be understood within their psychosocial and cultural preferences, should have the freedom to ask questions, and are encouraged to disclose health-relevant information. In short, this model promotes patient involvement in medical conversations and treatment decision-making. Research continues to examine approaches to effective patient-centered communication. Two interpersonal processes that promote patient-centered communication are patient question-asking and patient disclosure. Patient question-asking and disclosure serve to inform medical providers of patient preferences, hesitations, and information needs. Individuals, including patients, make decisions to pursue or disclose information. Patients are mindful that the act of asking questions or disclosing information, particularly stigmatized information such as sexual behavior or drug use, could make them vulnerable to perceived negative provider evaluations or responses. Thus, decisions to ask questions or share information, processes essential to the understanding of patient perspectives and concerns, may be challenging for patients. Various theoretical models explain how individuals consider if they will perform actions such as seeking or disclosing information. Research also explains the barriers that patients experience in asking questions or disclosing relevant health information to providers. A review of pertinent research offers suggestions to aid in facilitating improved patient-centered communication and care.

Article

Adolescent substance use and abuse has long been the target of public health prevention messages. These messages have adopted a variety of communication strategies, including fear appeals, information campaigns, and social marketing/branding strategies. A case history of keepin’ it REAL, a narrative-based substance abuse prevention intervention that exemplifies a translational research approach, involves theory development testing, formative and evaluation research, dissemination, and assessment of how the intervention is being used in the field by practitioners. The project, which started as an attempt to test the notion that the performance of personal narratives was an effective intervention strategy, has since produced two theories, an approach to implementation science that focused on communication processes, and, of course, a school-based curriculum that is now the most widely disseminated drug prevention program in the world. At the core of the keepin’ it REAL program are the narratives that tell the story of how young people manage their health successfully through core skills or competencies, such as decision-making, risk assessment, communication, and relationship skills. Narrative forms not only the content of curriculum (e.g., what is taught) but also the pedagogy (e.g., how it is taught). This has enabled the developers to step inside the social worlds of youth from early childhood through young adulthood to describe how young people manage problematic health situations, such as drug offers. This knowledge was motivated by the need to create curricula that recount stories rather than preaching or scaring, that re-story health decisions and behaviors by providing skills that enable people to live healthy, safe, and responsible lives. Spin-offs from the main study have led to investigations of other problematic health situations, such as vaccination decisions and sexual pressure, in order to address crucial public health issues, such as cancer prevention and sex education, through community partnerships with organizations like D.A.R.E. America, 4-H clubs, and Planned Parenthood.

Article

Ashley R. Kennard, Courtney Anderegg, and David Ewoldsen

Knowledge and comprehension are essential components of an individual’s understanding of a health text. Whether reading a health pamphlet or watching a health campaign in the form of a public service announcement (PSA), or watching edutainment programming, individuals gain knowledge about the health topic being discussed. Knowledge, however, can only be retained if the individual can also comprehend the text or video. Often comprehension in a health context focuses on health literacy or the degree to which individuals can process and understand health information in order to make informed health decisions. Health literacy is commonly viewed in terms of the readability (e.g., reading level, complexity) of the health text or script. However, in order for individuals to gain knowledge and use that knowledge appropriately and effectively in making health decisions, individuals need to comprehend or understand what the text is conveying. Because comprehension is such an important component of gaining and using health knowledge, we must understand how we store health knowledge in memory. A schema is a mental representation that stores knowledge as interrelated pieces of information. Schemas tend to be a fairly static representation of knowledge. A mental model is a more dynamic mental representation in that we use mental models to process, organize, and comprehend incoming information. In a mental model, there is a correspondence between an external entity and the constructed mental model of that entity that allows people to counterfactually manipulate information and engage in problem solving. A situation model is the most contextualized mental representation because it encompasses a specific event or set of interrelated events. There are several ways in which to examine comprehension processes. One way is to examine the most basic level of comprehension by investigating the importance of language and semantic representation of a text. A more complex way to examine comprehension is to view the activation levels of various words or concepts important in creating a representation of the story structure in memory. One model that specifically examines concept activation is the landscape model. The model posits that greater frequency of activation and the strength of activation of a concept determine the concept’s overall activation level. The higher the activation level of a concept in a text or video, the more likely the concept will be included in the mental representation for the text or video and stored in memory. A third way to study comprehension is to examine how concepts change throughout a text and how the concepts relate to one another. The event-indexing model describes how individuals create situation models based on five dimensions of information: time, space, protagonist, causality, and intentionality. Throughout the process of gaining information, the individual updates the situation models for a text on each of the five dimensions. When events have similar dimensions in common, the events are connected in memory; thus, describing health information with similar dimensions in common (e.g., a protagonist the entire way through the text, events happening in the same amount of time) will be better recalled later. Empirical work on comprehension of both text and video messages has demonstrated the landscape model and event-indexing model’s ability to examine comprehension processes based on the format, language, and organization of the information. Health message design can benefit from utilizing these comprehension models to ensure that knowledge is received by the intended audience and comprehended, and thus able to be used in future experiences.

Article

Erik Löfmarck

How do individuals relate to risk in everyday life? Poorly, judging by the very influential works within psychology that focus upon the heuristics and biases inherent to lay responses to risk and uncertainty. The point of departure for such research is that risks are calculable, and, as lay responses often under- or overestimate statistical probabilities, they are more or less irrational. This approach has been criticized for failing to appreciate that risks are managed in relation to a multitude of other values and needs, which are often difficult to calculate instrumentally. Thus, real-life risk management is far too complex to allow simple categorizations of rational or irrational. A developing strand of research within sociology and other disciplines concerned with sociocultural aspects transcends the rational/irrational dichotomy when theorizing risk management in everyday life. The realization that factors such as emotion, trust, scientific knowledge, and intuition are functional and inseparable parts of lay risk management have been differently conceptualized: as, for example, bricolage, in-between strategies, and emotion-risk assemblage. The common task of this strand is trying to account for the complexity and social embeddedness of lay risk management, often by probing deep into the life-world using qualitative methods. Lay risk management is structured by the need to “get on” with life, while at the same time being surrounded by sometimes challenging risk messages. This perspective on risk and everyday life thus holds potentially important lessons for risk communicators. For risk communication to be effective, it needs to understand the complexity of lay risk management and the interpretative resources that are available to people in their lifeworld. It needs to connect to and be made compatible with those resources, and it needs to leave room for agency so that people can get on with their lives while at the same time incorporating the risk message. It also becomes important to understand and acknowledge the meaning people attribute to various practices and how this is related to self-identity. When this is not the case, risk messages will likely be ignored or substantially modified. In essence, communicating risk requires groundwork to figure out how and why people relate to the risks in question in their specific context.

Article

Health and risk message design theories do not currently incorporate a lifespan view of communication. The lifespan communication perspective can therefore advance theorizing in this area by considering how the fundamental developmental differences that exist within and around individuals of different ages impact the effectiveness of persuasive message strategies. Designing health messages for older adults therefore requires an examination of how theoretical frameworks used in health and risk message design can be adapted to be age sensitive and to effectively target older adults. Additionally, older adults often make health decisions in conjunction with informal caregivers, including their adult children or spouses, and/or formal caregivers. Message design scholars should thus also consider this interdependent influence on health behaviors in older adults. Strategic messages targeting these caregivers can appeal to, for example, a caregiver’s perception of responsibility to care for the older adult. These messages can also be designed to not only promote the older adults’ health but also to alleviate caregiver stress and burden. Importantly, there is an unfounded stereotype that all older adults are alike, and message designers should consider the most beneficial segments of the older adult audience to target.

Article

Maricel G. Santos, Holly E. Jacobson, and Suzanne Manneh

For many decades, the field of risk messaging design, situated within a broader sphere of public health communication efforts, has endeavored to improve its response to the needs of U.S. immigrant and refugee populations who are not proficient speakers of English, often referred to as limited English proficient (LEP) populations. Research and intervention work in this area has sought to align risk messaging design models and strategies with the needs of linguistically diverse patient populations, in an effort to improve patient comprehension of health messages, promote informed decision-making, and ensure patient safety. As the public health field has shifted from person-centered approaches to systems-centered thinking in public health outreach and communication, the focus in risk messaging design, in turn, has moved from a focus on the effects of individual patient misunderstanding and individual patient error on health outcomes, to structural and institutional barriers that contribute to breakdown in communication between patients and healthcare providers. While the impact of limited proficiency in English has been widely documented in multiple spheres of risk messaging communication research, the processes by which members of immigrant and refugee communities actually come to understand sources of risk and act on risk messaging information remain poorly researched and understood. Advances in risk messaging efforts are constrained by outdated views of language and communication in healthcare contexts: well-established lines of thinking in sociolinguistics and language education provide the basis for critical reflection on enduring biases in public health about languages other than English and the people who speak them. By drawing on important findings about language ideologies and language learning, an alternative approach would be to cultivate a deeper appreciation for the linguistic diversity already shaping our everyday lives and the competing views on this diversity that constrain our risk messaging efforts. The discourse surrounding the relationship between LEP and risk messaging often omits a critical examination of the deficit-based narrative that tends to infuse many risk messaging design efforts in the United States. Sociolinguists and language education specialists have documented the enduring struggle against a monolingual bias in U.S. education and healthcare policy that often privileges proficiency in English, and systematically impedes and discriminates against emerging bilingualism and multilingualism. The English-only bias tends to preclude the possibility that risk messaging comprehension for many immigrant and refugee communities may represent a multilingual capacity, as patients make use of multiple linguistic and cultural resources to make sense of healthcare messages. Research in sociolinguistics and immigration studies have established that movement across languages and cultures—a translingual, transcultural competence—is a normative component of the immigrant acculturation process, but these research findings have yet to be fully integrated into risk messaging theory and design efforts. Ultimately, critical examination of the role of language and linguistic identity (not merely a focus on proficiency in English) in risk messaging design should provide a richer, more nuanced picture of the ways that patients engage with health promotion initiatives, at diverse levels of English competence.

Article

Jonathan van 't Riet, Jorinde Spook, Paul E. Ketelaar, and Arief Hühn

Many of us use smartphones, and many smartphones are equipped with the Global Positioning System (GPS). This enables health promoters to send us messages on specific locations where healthy behavior is possible or where we are at risk of unhealthy behavior. Until now, the practice of sending location-based messages has been mostly restricted to commercial advertisements, most often in retail settings. However, opportunities for health promotion practice are vast. For one, location-based messages can be used to complement environmental interventions, where the environment is changed to promote health behavior. Second, location-based messages incorporate opportunities to tailor these messages to individual characteristics of the recipient, increasing perceived relevance. Finally, location-based messages offer the distinct possibility to communicate context-dependent social norm information. Five preliminary studies tested the effects of location-based messages targeting food choice. The results suggest that sending location-based messages is feasible and can be effective. Future studies should explore which messages are most effective under which circumstances.

Article

Who filters through information and determines what information is shared with media audiences? Who filters through information and determines what information will not be shared with media audiences? Ultimately, who controls the flow of information in the media? At times commentary pertaining to media content references media as an omnipotent individual entity selecting the content transmitted to the public, reminiscent of a Wizard of Oz manner of the all-powerful being behind the curtain. Overlooked in this perception is the reality that in mass media, there are various individuals in positions of power making decisions about the information accessed by audiences of various forms of media. These individuals are considered gatekeepers: wherein the media functions as a gate permitting some matters to be publicized and included into the public discourse while restricting other matters from making it to the public conscience. Media gatekeepers (i.e., journalists, editors) possess the power to control the gate by determining the content delivered to audiences, opening and closing the gate of information. Gatekeepers wield power over those on the other side of the gate, those seeking to be informed (audiences), as well as those seeking to inform (politics, activists, academics, etc.). The earliest intellectual explanation of gatekeeping is traced to Kurt Lewin, describing gatekeeping as a means to analyze real-world problems and observing the effects of cultural values and subjective attitudes on those problems like the distribution of food in Lewins’s seminal study, and later modified by David Manning White to examine the dissemination of information via media. In an ideal situation, the gatekeepers would be taking on the challenge of weighing the evidence of importance in social problems when selecting among the options of content and information to exhibit. Yet, decisions concerning content selection are not void of subjective viewpoints and encompass values, beliefs, and ideals of gatekeepers. The subjective attitudes of gatekeepers influence their perspective of what qualifies as newsworthy information. Hence, those in the position to determine the content transmitted through media exercise the power to shape social reality for media audiences. In the evolution of media gatekeeping theory three models have resulted from the scholarship: (1) examination of the one-way flow of information passing through a series of gates before reaching audiences, (2) the process of newsroom personnel interacting with people outside of the newsroom, and (3) the direct communication of private citizens and public officials. In traditional media and newer forms of social media, gatekeeping examination revolves around analysis of these media organizations’ news routines and narratives. Gatekeeping analysis observes human behavior and motives in order to make conceptualizations about the social world.

Article

Rocio Garcia-Retamero, Dafina Petrova, Adam Feltz, and Edward T. Cokely

Graphical displays generally facilitate the communication of complex information and are ubiquitous in media. Unfortunately, people differ in their ability to extract data and meaning from graphical representations of quantitative information (i.e., graph literacy). This means that for some people, even well-designed, simple graphs will cause confusion and misunderstanding. Research on the psychology of graph comprehension focuses on two instruments that efficiently assess fundamental graph literacy among diverse adults. The Objective Graph literacy scale is a well-established instrument with good psychometric properties that measures skill via cognitive performance testing (e.g., interpreting and evaluating various graphs). The recently developed Subjective Graph Literacy scale is a brief self-report of graph literacy that can outperform the objective test in notable ways, while reducing text anxiety. Emerging applications in clinical research and practice, including computerized decision aids, can personalize content as a function of one’s graph literacy.

Article

Media literacy describes the ability to access, analyze, evaluate, and produce media messages. As media messages can influence audiences’ attitudes and behaviors toward various topics, such as attitudes toward others and risky behaviors, media literacy can counter potential negative media effects, a crucial task in today’s oversaturated media environment. Media literacy in the context of health promotion is addressed by analyzing the characteristics of 54 media literacy programs conducted in the United States and abroad that have successfully influenced audiences’ attitudes and behaviors toward six health topics: prevention of alcohol use, prevention of tobacco use, eating disorders and body image, sex education, nutrition education, and violent behavior. Because media literacy can change how audiences perceive the media industry and critique media messages, it could also reduce the potential harmful effects media can have on audiences’ health decision-making process. The majority of the interventions have focused on youth, likely because children’s and adolescents’ lack of cognitive sophistication may make them more vulnerable to potentially harmful media effects. The design of these health-related media literacy programs varied. Many studies’ interventions consisted of a one-course lesson, while others were multi-month, multi-lesson interventions. The majority of these programs’ content was developed and administered by a team of researchers affiliated with local universities and schools, and was focused on three main areas: reduction of media consumption, media analysis and evaluations, and media production and activism. Media literacy study designs almost always included a control group that did not take part in the intervention to confirm that potential changes in health and risk attitudes and behaviors among participants could be attributed to the intervention. Most programs were also designed to include at least one pre-intervention test and one post-intervention test, with the latter usually administered immediately following the intervention. Demographic variables, such as gender, age or grade level, and prior behavior pertaining to the health topic under study, were found to affect participants’ responses to media literacy interventions. In these 54 studies, a number of key media literacy components were clearly absent from the field. First, adults—especially those from historically underserved communities—were noticeably missing from these interventions. Second, media literacy interventions were often designed with a top-down approach, with little to no involvement from or collaboration with members of the target population. Third, the creation of counter media messages tailored to individuals’ needs and circumstances was rarely the focus of these interventions. Finally, these studies paid little attention to evaluating the development, process, and outcomes of media literacy interventions with participants’ sociodemographic characteristics in mind. Based on these findings, it is recommended that health-related media literacy programs fully engage community members at all steps, including in the critical analysis of current media messages and the production and dissemination of counter media messages. Health-related media literacy programs should also impart participants and community members with tools to advocate for their own causes and health behaviors.

Article

Soyoon Kim and Brian G. Southwell

Typical discussion about the success of mediated health communication campaigns focuses on the direct and indirect links between remembered campaign exposure and outcomes; yet, what constitutes information exposure and how it is remembered remain unclearly defined in much health communication research. This problem mainly stems from the complexity of understanding the concept of memory. Prolific discussions about memory have occurred in cognitive psychology in recent decades, particularly owing to advances in neuroimaging technologies. The evolution of memory research—from unitary or dichotomous perspectives to multisystem perspectives—has produced substantial implications for the topics and methods of studying memory. Among the various conceptualizations and types of memory studied, what has been of particular interest to health-communication researchers and practitioners is the notion of “encoded exposure.” Encoded exposure is a form of memory at least retrievable by a potential audience member through a conscious effort to recollect his or her past engagement with any particular unit of campaign content. While other aspects of memory (e.g., non-declarative or implicit memory) are certainly important for communication research, the encoded exposure assessed under a retrieval condition offers a critical point at which to establish the exposure-outcome link for the purpose of campaign design and evaluation. The typical methods to assess encoded exposure include recall and recognition tasks, which can be exercised in various ways depending on retrieval cues provided by a researcher to assess different types and levels of cognitive engagement with exposed information. Given that encoded exposure theoretically relies on minimal memory trace, communication scholars have suggested that recognition-based tasks are more appropriate and efficient indicators of encoded exposure compared to recall-based tasks that require a relatively high degree of current-information salience and accessibility. Understanding the complex nature of memory also has direct implications for the prediction of memory as one of the initial stages of communication effects. Some prominent message-level characteristics (e.g., variability in the structural and content features of a health message) or message recipient-level characteristics (e.g., individual differences in cognitive abilities) might be more or less predictive of different memory systems or information-processing mechanisms. In addition, the environments (e.g., bodily and social contexts) in which people are exposed to and interact with campaign messages affect individual memory. While the effort has already begun, directions for future memory research in health communication call for more attention to sharpening the concept of memory and understanding memory as a unique or combined function of multilevel factors.

Article

Ann Bostrom

Mental models of health risks are the causal beliefs that comprise one’s inference engines for the interpretation and prediction of health and illness experiences and messages. Mental models of health risks can be parsed into a handful of common elements, including beliefs about causes, consequences, and cures as well as identifying information such as symptoms and timing. Mental models research deriving from a risk and decision analysis framework emphasizes exposure sources and pathways as part of causal thinking as well as how interventions may reduce or increase the risk. Mental models can be developed as a function of one’s goals or the problem in a specific context, rather than as coherent, stable knowledge structures in long-term memory. For this reason they can be piecemeal and inconsistent in the absence of expertise or experience with the risk. Derived often by analogy with more familiar risks, mental models of health risks can lead to effective health behaviors but also to costly inaction or misplaced action. Assessing mental models of hazardous processes can contribute to the design of effective risk communications by identifying the concrete information message recipients need to cope with health risks, thereby making or strengthening common-sense links between risk and action representations. Although a wide variety of research methods are used to investigate mental models, achieving this level of specificity requires attention to substantive details. Researchers are beginning to better understand the interactions between mental models of risk and their social, cultural, and physical contexts, but much remains to explore.

Article

Kathryn E. Anthony, Timothy L. Sellnow, Steven J. Venette, and Sean P. Fourney

Much current scholarship in the realm of information processing and decision making, particularly in the context of health risks, is derived from the logical-empiricist paradigm, involving a strong focus on cognition, routes of psychological processing of messages, and message heuristics. The message convergence framework (MCF), derived heavily from the writings of Perelman and Olbrechts-Tyteca, contributes to this body of literature by emphasizing the fact that people make decisions on health risks while being exposed to arguments from multiple sources on the same topic. The MCF offers an explanation for how people reconcile myriad messages to arrive at decisions. MCF differs from other theories of message processing because of its distinct and unique focus on arguments, messages, and the ways various arguments interact to create “convergence” in individuals’ minds. The MCF focuses on the ways that multiple messages converge to create meaning and influence in the minds of listeners. Convergence occurs when messages from multiple sources overlap in ways recognized by observers, creating perceptions of credibility and influencing their risk decisions. Perelman and Olbrechts-Tyteca explain that convergence occurs when “several distinct arguments lead to a single conclusion.” Individuals assess the strengths and weaknesses of the claims, and according to the scholars, the “strength” of the arguments “is almost always recognized.” Three key propositions focusing on message convergence articulate that audiences recognize message convergence, that they actively seek convergence in matters of concern, such as health risk, and that this convergence is potentially fleeting as new messages are introduced to the discussion. Conversely, Perelman and Olbrechts-Tyteca also discuss message divergence, and the rationale for wanting to intentionally create divergence among interacting arguments. Divergence is particularly appropriate in the realm of health and risk messages when scholars must challenge potentially harmful beliefs or correct misinformation. Some strategies for invoking divergence in include: dissociation, in which the speaker attempts to reframe the argument to create novel understandings; identification of the stock, hackneyed, and obsolete, where the speaker attempts to make existing claims appear commonplace or obsolete to the listener; refutation of fallacies, where the speaker points out the fallacious reasoning of the opponent; clash of interpretation, where the speaker publicly articulates that individuals have understood the convergence to mean different things; weakening through reaction, which involves the speaker’s attempting to incite a reactionary approach by the opponent; and finally, highlighting the consequence of invalid convergence, where the speaker describes the negative outcomes that may occur from following a false convergence based on incorrect information. For message design, environmental scanning enables scholars and practitioners to assess the messages in a particular health-risk context. This assessment can assist practitioners in emphasizing or building convergence among reputable sources and in introducing divergence in cases where misunderstanding or a lack of evidence has contributed to an unproductive perception of convergence. Ultimately, the MCF can assist practitioners in scanning their health-risk environments for opportunities to establish or bolster convergence based on credible evidence and for introducing divergence to challenge inaccurate or misleading interpretations and evidence.

Article

Many health-related message variations have been described as variations in the framing of the message. What different applications of the term message framing have in common is that, in each case, something gets described in different ways (with researchers having a special interest in the consequences of these different descriptions). But what that “thing” is and how the descriptions of it differ vary across different uses of the term framing. In research on health-related messages, at least three different variations have been described using “framing” as a label. One concerns variation in consequence-based arguments in persuasive messages. In this kind of framing, what varies is the description of the antecedent or consequent in arguments designed to persuade people to adopt some course of action. For example, the antecedent in an argument designed to encourage sunscreen use might be expressed as “if you wear sunscreen” or “if you don’t wear sunscreen,” and the consequent of such arguments might emphasize sunburns or skin cancer. A second concerns variation in the description of some news event, public policy issue, or health subject. For example, news media might describe obesity as controllable or as something over which one has limited control. A third concerns variation in the description of an attribute of a course of action. For example, a surgical procedure might be described as having a “90% success rate” or a “10% failure rate.”

Article

Self-efficacy is the personal belief in one’s ability to meet a goal or perform a specific task. Although it can be applied to any type of human endeavor, the construct of self-efficacy is thought to be central to changing behaviors to improve health outcomes. For this reason, message designers have been attempting to understand how messages detract from or enhance self-efficacy. Persuasive messages have and can be used to enhance perceived self-efficacy related to health and risk behavior. Self-efficacy-strengthening messages and interventions in health promotion can be assessed in general or specfically in regards to fear appeals. Other aspects of self-efficacy interventions include collective efficacy and professional self-efficacy.

Article

Successfully conveying information about the risk of potential threats to an individual’s physical and mental health is a serious challenge for healthcare practitioners. Adding to the challenge is the role of individual differences in people’s tendencies to want to learn (or in their choice to passively avoid) new information. These characteristic motives can be both curious and incurious in nature and interact with the perceived locus of the relevant health threat, which must be taken into account first. Some health threats are relatively “external,” and involve addressing the potential risk of an undesired event (e.g., developing illness, encountering relationship troubles). Research indicates that individuals who view external threats as “controllable” are more likely to respond positively to relevant information, but perception of control alone does not determine whether health-relevant information is likely to be sought or acted on. Besides perceived controllability, individual differences in incurious worry reduction motives (IWRM) play an important role as well. Two different kinds of IWRM have been identified: focus on distress (IWRM-FD) and focus on relief (IWRM-FR). Dispositional tendencies toward IWRM-FD are associated with greater willingness to seek out information when risk is perceived as low (i.e., information about the potential external threat is expected to make one feel better), but a tendency to passively avoid any information when risk is considered high (i.e., information is expected to intensify distress). In contrast, tendencies toward IWRM-FR reflect wanting more information about potential threats when risk is believed to be high, while passively avoiding news when perceived risk is low. In regard to coping with perceived risk, IWRM-FD scores predict avoidant coping, whereas IWRM-FR levels are associated with proactive coping and seeking others’ advice. Other risks are more “internal,” and involve threats to an individual’s certainty about his or her self-concept, purpose in life, or the wisdom of past behavior; in short, an “identity crisis.” Such threats underlie wondering things like “Who am I, really?” and are associated with less self-awareness, lower self-esteem, and greater overall distress. In response to internal threats, intrapersonal curiosity (InC) motivates individuals to engage in introspective self-exploration that may help them to clarify, to elaborate on, and to improve their understanding of their self-concept. Recent research has found that individual differences in InC are positively associated with IWRM, suggesting that dealing with identity crises involves the desire to better know oneself, as well as wishing to mitigate worries about experiencing self-doubt. Bearing the above in mind, research on individual differences in tendencies to avail oneself of different coping strategies indicates that proactive coping (e.g., positive reframing, seeking advice) tends to result in beneficial outcomes, such as personal growth and improved health, but some proactive strategies are “double-edged” and may lead to some negative outcomes as well. In particular, proactive strategies like acceptance of one’s limitations or discussing them with others when seeking social support were helpful, but they also had the potential to leave individuals feeling less sure of themselves. These findings suggest that practitioners who wish to more effectively communicate information about risk of potential health threats should consider whether the nature of the threat is internal or external, the role of individual differences in IWRM and InC, and how to help their patients to focus on the positive benefits of acceptance (i.e., identify solvable problems) and seeking social support (i.e., acquiring useful advice) over the negative aspects (i.e., admitting limitations).

Article

Message sensation value (MSV) is defined as the degree to which a message’s format and content features elicit sensory, affective, and arousal responses. MSV research has received considerable scholarly and professional attention for more than two decades. The seminal work, to date, has been conducted by the Kentucky School. MSV was initially operationalized as perceived message sensation value (PMSV). The activation model of information exposure (AMIE) provides the basis for explaining the functional mechanism of MSV and PMSV. The AMIE proposes that exposure is a function of the interaction between an individual’s sensation-seeking tendency and sensation-enhancing attributes of the message itself. There are three primary types of message features that contribute to MSV: (a) the formal video dimension, (b) the formal audio dimension, and (c) the content dimension. There is an important distinction between subjective reactions to the message (PMSV) and the format and content features contributing to these reactions (MSV). In general, messages of high relative to low in sensation value have elicited greater message processing and more favorable evaluations across a range of outcome variables in health communication. Some health communication campaigns have employed high sensation value messages to target high sensation seekers. This sensation-seeking targeting approach, SENTAR, however, has received mixed and limited support. The influence of MSV on message effectiveness might be very similar for the two groups. Recently, some scholars have attempted to situate AMIE in a broader context of persuasion. First, AMIE and the elaboration likelihood model (ELM) offer competing predictions in terms of the role of MSV in persuasion, such that AMIE stresses a straightforward attention-getting effect, whereas ELM predicts a distracting effect of MSV interfering with message’s content. The very few studies conducted thus far reveal limited and mixed findings. Second, in the integration of MSV research with the appraisal theory and excitation-transfer theory, MSV may function as an arousal generator to amplify the influence of discrete emotions on perceived message effectiveness. Third, according to the psychological reactance theory, there are challenges with implementing high sensation value (HSV) messages, in that they potentially could backfire among the target audiences. Messages with HSV may garner better-perceived effectiveness when they tone down the controlling language. Future studies should investigate the relationships between specific MSV-enhancing features and message processing. They can expand the literature by studying the impact of MSV in a variety of media message contexts (e.g., broadcast journalism). Future experiments might also incorporate psychophysiological measures (e.g., skin response and heart-rate deceleration) to complement self-reported measures. Future studies should continue to explore other features (e.g., visual-verbal redundancy) that might affect attention and message processing jointly with MSV, and other individual difference variables, such as need for cognition, trait reactance, locus of control, and etc.

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In today’s saturated media environment, it is incumbent for designers of health education materials to find more effective and efficient ways of capturing the attention of the public, particularly when the intent is to influence individual behavior change. Tailoring is a message design strategy that has been shown to amplify the effectiveness of health messages at an individual level. It is a data-driven and theory-informed strategy for crafting a message using knowledge of various factors that might influence the individual’s responsiveness to the message, such as their information needs, beliefs, motivations, and health behaviors. It also enhances the persuasiveness of a message by increasing its perceived relevance, drawing attention to the message, and encouraging deeper elaboration of the information. Tailoring content based on known antecedents of the intended behavioral outcomes has been shown to enhance tailoring effectiveness. Compared to generic messages, tailored messages are perceived to be more personally relevant, command greater attention, are recalled more readily, and encourage more positive evaluations of the information overall. Various meta-analyses have demonstrated the effectiveness of tailored interventions promoting a number of health behaviors, such as smoking cessation, healthy diet and nutrition, physical activity, and regular recommended health screenings. Advances in information and communication technologies have led to more sophisticated, multimodal tailored interventions with improved reach, and more powerful expert systems and data analysis models. Web technologies have made it possible to scale the production and delivery of tailored messages to multiple individuals at relatively low cost and to improve access to expert feedback, particularly among hard-to-reach population groups.