Julie E. Volkman
In health and risk communication, evidence is a message feature that can add credibility, realism, and legitimacy to health and risk messages. Evidence is usually defined into two types: statistical or narrative. Statistical evidence employs quantifications of events, places, phenomena, or other facts, while narrative evidence involves stories, anecdotes, cases, or testimonials. While many health and risk messages employ statistical or factual information, narrative evidence holds appeal for health and risk communication for its utility in helping individuals learn their risks and illnesses through stories and personal experiences. In particular, narratives employed as evidence in a health or risk message especially hold value for their ability to communicate experiences and share knowledge, attitudes, beliefs, and ideas about complex health issues, propose behavior change, and assist individuals coping with disease. As a result, the personal experiences shared, whether they are from first-hand knowledge, or recounting another’s experience, can focus attention, enhance comprehension for risks, and recall of health and risk information. Furthermore, readers engage with the story and develop their own emotional responses which may align with the purpose of the health and risk message. Narratives, or stories, can occur in many ways or through various points of view, but the stories that “ring true” to readers often have a sense of temporality, coherence, and fidelity. As a result, formative research and pre-testing of health and risk messages with narratives becomes important to understand individual perceptions related to the health issue and the characters (or points of view). Constructs of perceived similarity, interest, identification, transportation, and engagement are helpful to assess in order to maximize the usefulness and persuasiveness of narratives as evidence within a health and risk message. Additionally, understanding the emotional responses to narratives can also contribute to perceptions of imagery and vividness that can make the narrative appealing to readers. Examining what is a narrative as evidence in health and risk messages, how they are conceptualized and operationalized and used in health and risk messages is needed to understand their effectiveness.
Brenda L. Berkelaar and LaRae Tronstad
How people negotiate the work–life interface remains a popular topic for scholars and the public. Work–life research is a large body of interdisciplinary scholarship that considers how people experience, navigate, and negotiate different roles, commitments, and boundaries within and across life domains—often with the goal of improving individual, organizational, and social well-being and success. Spurred by demographic, social, economic, and technological changes, scholars take difference perspectives on overlapping research areas which include work–life balance, work–life conflict, work–family conflict, boundary management, work–life enrichment or facilitation, as well as positive or negative spillover. Key issues addressed include the implications of framing work–life as a dichotomy, drivers of work–life outcomes, how ideals shape work–life negotiations, how individuals negotiate everyday work–life challenges and opportunities, and the influence of evolving information and communication technologies on the work–life interface. Research from multiple disciplines highlights the demographic, economic, moral, cultural, and national factors that affect work–life practices, processes, policies, tactics, and outcomes. This multidisciplinary perspective provides relevant insights for generative research and resilient practice for individuals, groups, organizations, or societies.
Holley A. Wilkin
When it comes to health and risk, “place” matters. People who live in lower-income neighborhoods are disproportionately affected by obesity and obesity-related diseases like heart disease, hypertension, and diabetes; asthma; cancers; mental health issues; etc., compared to those that live in higher-income communities. Contributing to these disparities are individual-level factors (e.g., education level, health literacy, healthcare access) and neighborhood-level factors such as the socioeconomic characteristics of the neighborhood; crime, violence, and social disorder; the built environment; and the presence or absence of health-enhancing and health-compromising resources. Social determinants of health—for example, social support, social networks, and social capital—may improve or further complicate health outcomes in low-income neighborhoods.
Social support is a type of transaction between two or more people intended to help the recipient in some fashion. For instance, a person can help provide someone who is grieving or dealing with a newly diagnosed health issue by providing emotional support. Informational support may be provided to someone trying to diagnose, manage, and/or treat a health problem. Instrumental support may come in the help of making meals for someone who is ill, running errands for them, or taking them to a doctor’s appointment. Unfortunately, those who may have chronic diseases and require a lot of support or who otherwise do not feel able to provide support may not seek it due to the expectation of reciprocity. Neighborhood features can enable or constrain people from developing social networks that can help provide social support when needed. There are different types of social networks: some can enhance health outcomes, while others may have a more limiting or even a detrimental effect on health. Social capital results in the creation of resources that may or may not improve health outcomes.
Communication infrastructure theory offers an opportunity to create theoretically grounded health interventions that consider the social and neighborhood characteristics that influence health outcomes. The theory states that every neighborhood has a communication infrastructure that consists of a neighborhood storytelling network—which includes elements similar to the social determinants of health—embedded in a communication action context that enables or constrains neighborhood storytelling. People who are more engaged in their neighborhood storytelling networks are in a better position to reduce health disparities—for example, to fight to keep clinics open or to clean up environmental waste. The communication action context features are similar to the neighborhood characteristics that influence health outcomes. Communication infrastructure theory may be useful in interventions to address neighborhood health and risk.
Frank Tutzauer and Thomas Hugh Feeley
A network is a collection of nodes that are somehow connected to each other. Typically, the pattern of ties among nodes is of central interest to scholars in communication and the allied social sciences, with particular salience for health and risk communication. Network analyses of patterns of communication began in the 1940s in work done at the Massachusetts Institute of Technology (MIT) and was popularized in the early 1980s in the communication discipline with the work of Everett Rogers, Larry Kincaid, and others. Networks are measured by using self-report or observational procedures to determine the presence and/or strength among nodes in a given structure. If there is a tie or relation between a pair of nodes, it is said that the two are adjacent to one another or that the two nodes are neighbors, and the neighborhood of a node consists of all nodes adjacent to this first node. Several measures describe networks, including measures of position and measures of the entire network. Positional measures consider the position of any given node in relation to others in the network, and centrality is a popular measure to account for one’s level of influence in a network. Density is an overall network measure of level of activity among network pairs. Finally, network measures allow researchers to compare dependent and independent networks. Network analysis represents one of the more powerful and elegant procedures for measuring small-group, organizational, and international communication patterns among nodes or actors of interest in health and risk communication.
Priscila G. Brust-Renck, Julia Nolte, and Valerie F. Reyna
The complexity of numerical information about health risks and benefits places demands on people that many are not prepared to meet. For example, much information about health is communicated numerically, such as treatment risks and effectiveness, lifestyle benefits, and the chances of side effects from medication. However, many people—especially the old, the poor, and the less educated—have difficulty understanding numerical information that would enable them to make informed health decisions. Some evidence also suggests cultural and gender differences (although their causes have been disputed). The ability to use and understand numbers (i.e., numeracy) plays an important role in how information should be displayed and communicated.
Measuring differences in numeracy provides a standard to guide one’s approach when communicating risk. Several surveys have been developed to allow for a descriptive assessment of basic and analytical mathematical skills in nationally representative samples (e.g., NAEP, NAAL, PISA, PIACC). Other measures assess specific skills, such as perception of numbers (e.g., number line, approximation, dots tasks), individual perception of one’s own ability (i.e., Subjective Numeracy Scale), and arithmetic computation ability (i.e., Objective Numeracy Scales, Abbreviated Numeracy Scale, and Berlin Numeracy Test).
Difficulties associated with low numeracy extend well beyond the inability to understand place value or perform computations. Understanding and remediating low numeracy requires getting below the surface of errors in judgment and decision making to the deeper level of scientific theory. Despite the relevance of numbers in decision making, there is a certain level of disagreement regarding the psychological mechanisms involved in numeracy. Studies show that people have a basic mental representation of numbers in which the discriminability of two magnitudes is a function of their ratio rather than their difference (psychophysical approaches). Numerical reasoning has been identified with quantitative and analytical processes, and such computation is often seen as an accurate and objective way to process information (traditional dual-process approaches as applied to numeracy). However, these approaches do not account for the contradictory evidence that reliance on analysis is not sufficient for many decisions and has been associated with worse performance for some decisions. Studies supporting a more recent dual-process approach—one that accounts for standard and paradoxical effects of numeracy on risk communication—emphasize the role of intuition: this is a kind of advanced thinking that operates on gist representations, which capture qualitative understanding of the meaning of numbers that is relevant in decision making (Fuzzy Trace Theory). According to Fuzzy Trace Theory, people encode both actual numbers (verbatim representations) and qualitative interpretations of their bottom-line meaning (gist representations) but prefer to rely on the qualitative gist representations when possible. Thus, potential difficulties in decision making arising from deficits in numeracy can be resolved through meaningful communication of risk. Creating narratives that emphasize the contextually relevant underlying gist of risk and using methods that convey the meaning behind numeric presentations (e.g., use of appropriate arrays to communicate linear trends, meaningful relations among magnitudes, and inclusion relations among classes) improve understanding and decision making for both numerate and innumerate individuals.
Nutrition Labeling in the United States and the Role of Consumer Processing, Message Structure, and Moderating Conditions
J. Craig Andrews, Scot Burton, and Laurel Aynne Cook
It has been since 1990 that the landmark Nutritional Labeling Education Act (NLEA) was passed in the United States, and since 1969 that the first White House Conference on Food, Nutrition and Health occurred. In the time since these important events, considerable research has been conducted on how U.S. consumers process and use nutritional labeling. An up-to-date review of nutritional labeling research must address key findings on the processing and use of nutrition facts panels (NFPs), restaurant labeling, front-of-pack (FOP) symbols, health and nutrient content claims, new labeling efforts (e.g., for meat products), and claims not regulated by the U.S. Food and Drug Administration (FDA). Message structure mediates the ways in which consumers process nutritional labeling while moderating conditions affect research outcomes associated with labeling efforts.
The most recent policy issues and problems to be considered (e.g., by the FDA) include nutritional labeling as well as identifying opportunities for consumer research in helping to promote healthy lifestyles and reducing obesity in the United States and throughout the world. For example, several unanswered research questions remain regarding how the proposed changes to the NFPs—beef, poultry, and seafood labeling; restaurant chain calorie labeling; alternative FOP formats; and regulated and unregulated health and nutrient content claims—will affect consumers. Researchers have yet to examine not only these different labeling and nutrition information formats, but also how they might interact with one another and the role of key moderating conditions (e.g., one’s motivation, ability opportunity to process nutrition information) in affecting consumer processing and behavior.
May O. Lwin, Jerrald Lau, Andrew Z. H. Yee, and Cyndy Au
Populated by a diverse spread of cultures, Southeast Asia is represented by the Association of Southeast Asian Nations (ASEAN), a regional organization comprising some 622 million people in ten countries. While food and beverage labeling policies differ across ASEAN member states, organizations such as the ASEAN Food and Beverage Alliance (AFBA) have pushed for standardization in the interest of facilitating interregional trade. Set against this backdrop of economic growth, nutrition labeling as a means of influencing consumer choices has become a significant area of focus for health authorities and researchers over the past two decades due to rising chronic disease levels within the region’s increasingly urbanized communities.
Food retail trends facing Southeast Asia challenge the state of existing regulations governing, as well as research on food labeling practices in the region. Two main points stand out. First, legislation has remained disparate among the ASEAN nations despite repeated calls for standardization by academics as well as other relevant bodies, with only Malaysia adopting mandatory regulations on food labeling and nutritional claims. Second, existing nutrition labeling research in ASEAN is sorely lacking. In addition, there is a lack of theoretical and methodological diversity in existing studies, leading to an incomplete understanding of nutritional label use in Asia and a crucial research gap that remains to be filled.
Responding to health messages about environmental risks and risky behaviors requires adjustments to what individuals do: how they organize and perform occupations, and their understanding of what occupations mean—for themselves and others. Encouraging people to make a change means influencing what they want to do, the possibilities open to them, and societal support and demand for healthful ways of life. Bringing an occupational perspective to the design of risk messages will generate new insights into the complexities of everyday occupations, revealing the dynamic territory into which health messages are targeted. Occupation, or everyday doing, is described as the means by which people experience their very nature, become what they have the potential to be, and sustain a sense of belonging in family, community and society. To influence what people do, designers of health messages are encouraged to consider what engages people in occupations and keeps them engaged; the identity and cultural meanings expressed through occupation; the exhilaration of challenge and risk; the satisfactions of competence and flow experiences that keep people engaged in what they are doing; whether or not people are fit and prepared for the occupations they embark on and what happens when they are not; and the pull of habits and routines, which hold existing patterns of occupation in place. Equally, health message designers need to engage with the occupational science literature, which recognizes how people are shaped toward particular occupations and occupational identities by social policy, institutional practices, and media messages. That means questioning the rhetoric that occupations are freely chosen, rather than shaped and patterned by the historical, sociocultural, political, and geographic context. Simultaneously, health message designers need to recognize that individuals incorporate specific occupations and occupational patterns into their lifestyle and sense of self, believing they have a measure of control over what they do while rationalizing failure to make health-supporting changes.
Joyce Lamerichs and Wyke Stommel
There is a need to focus on research conducted on online talk about mental health in the domains of ethnomethodology, Conversation Analysis (CA), Discursive Psychology (DP), and Membership Categorization Analysis (MCA). We use the notion of “talk” in this article, as opposed to what could be considered a more common term such as “discourse,” to highlight that we approach computer-mediated discourse as inherently interactional. It is recipient designed and unfolds sequentially, responding to messages that have come before and building a context for messages that are constructed next. We will refer to the above domains that all share this view as CA(-related) approaches.
A characterizing feature of interactional approaches to online mental health talk is their focus on in-depth analyses of relatively small amounts of data. With this focus at the center of their attention, they sit in the wider field of Discourse Analysis (DA), or Computer-Mediated Discourse Analysis (CMDA) who use language as their lens to understand human interaction. DA and CMDA research include a much wider set of both micro- and macro-analytic language-focused approaches to capture online discourse. Of all the CA(-related) work on online materials, a disproportionally large number of studies appear to deal with (mental) health talk.
We aim to answer the question what the field of research on online mental health talk has yielded in terms of findings and methodologies. Centrally, CA (-related) studies of online mental health talk have aimed to grasp the actions people accomplish and the identities they invoke when they address their health concerns. Examples of actions in online mental health talk in particular are presenting oneself, describing a problem, or offering advice. Relevant questions for the above approaches that consider language-as-social-action are how these different actions are brought off and how they are received, by closely examining contributions such as e-mail and chat postings and their subsequent responses.
With a focus on talk about mental health, this article will cover studies of online support groups (OSGs, also called online communities), and interaction in online counseling programs, mainly via online chat sessions.
This article is organized as follows. In the historiography, we present an overview of CA(-related) work on online mental health talk. We discuss findings from studies of online support groups (OSGs) first and then move to results from studies on online counseling. The start of our historiography section, however, sets out to briefly highlight how the Internet may offer several particularly attractive features for those with mental health problems or a mental illness.
After the historiography, we discuss what an interactional approach of online mental health talk looks like and focuses on. We offer examples of empirical studies to illustrate how written contributions to a forum, and e-mails or chat posts that are part of online counseling sessions are examined as interaction and which types of findings this results in. We conclude with a review of methodological issues that pertain to the field, address the most important ethical considerations that come into play when examining online mental health talk, and will lastly highlight some areas for future research.
Amanda J. Dillard and Erin M. Ellis
When individuals are asked whether they will someday own their own home, enjoy a productive career, or develop a myriad of diseases, many are optimistic. Generally, they think they will experience more good than bad outcomes in life and they view themselves as more likely than similar others to experience the good things and less likely than others to experience the bad things. In the area of health behavior and communication, there are three primary types of optimism that have been defined and operationalized: (1) Dispositional optimism is the generalized positive expectancy that one will experience good outcomes. (2) Comparative optimism refers to the belief that one is either more likely than others to experience positive events or less likely than others to experience negative events. (3) Unrealistic optimism refers to an underestimation of one’s actual risk of experiencing some negative event. Although the three types of optimism may be correlated, their associations may be modest. Also, unlike dispositional optimism, which is an individual difference, comparative and unrealistic optimism are often risk perceptions about specific events and therefore can be defined as accurate or inaccurate. For this reason, the latter two types of optimism have sometimes been labeled the optimistic bias. Research on all three varieties of optimism affords opportunities to understand how optimism influences information processing in a health message or one’s behavioral intentions following the message.
Haley Kranstuber Horstman, Alexie Hays, and Ryan Maliski
The parent–child relationship is one of the most influential, important, and meaningful relationships in an individual’s life. The communication between parents and children fuels their bond and functions to socialize children (i.e., gender, career and work, relationship values and skills, and health behaviors), provide social support, show affection, make sense of their life experiences, engage in conflict, manage private information, and create a family communication environment. How parents and children manage these functions changes over time as their relationship adapts over the developmental periods of their lives. Mothers and fathers may also respond differently to the changing needs of their children, given the unique relational cultures that typically exist in mother–child versus father–child relationships.
Although research on parent–child communication is vast and thorough, the constant changes faced by families in the 21st century—including more diverse family structures—provides ample avenues for future research on this complex relationship. Parent–child communication in diverse families (e.g., divorced/stepfamilies, adoptive, multiracial, LGBTQ, and military families) must account for the complexity of identities and experiences in these families. Further, changes in society such as advances in technology, the aging population, and differing parenting practices are also transforming the parent–child relationship. Because this relationship is a vital social resource for both parents and children throughout their lives, researchers will undoubtedly continue to seek to understand the complexities of this important family dyad.
Natoshia Askelson and Erica Spies
Parents can be the target of health and risk messages about their children and can be a channel by which children hear health messages. This dual role can make parents powerful agents for change in children’s health. Parents receive health messages from a variety of sources including health care providers, schools, the media, the government, and family. Parents tend to be a more frequent target for health messages when their children are infants or young. They receive many messages related to keeping their children safe. Most of these messages are not developed as part of a rigorous data-driven and theory-based intervention and often lack sophisticated message development and design. Furthermore, instead of segmenting parents and tailoring messages, parents are frequently treated as a monolith, with no diversity related to behavior or communication.
As children age, parents can become the channel by which children can hear a health message. Parents of school-age children and adolescents are continually communicating messages to their children and are often targeted to communicate messages related to health or risk behaviors. Intentional efforts to encourage parents to talk to their children are often related to risk behaviors among older children. Specifically, parents are asked to convey messages about sexual health, alcohol and drug use, and driving. Evidence points to parent–child communication in general and communication about specific risk behaviors as protective for children. Research has also suggested that adolescents want to hear health messages from their parents. Parents are a natural choice to communicate about health and risk throughout childhood and adolescence due to the parent–child relationship and the influence parents can have over children. However, this special relationship does not automatically translate into parents having good communication skills. Messages designed to encourage parents to communicate with their children about a health topic have often been developed with the assumption that parents know what to communicate and how to effectively communicate with their children. Deficits in communication skills among parents have been recognized by some campaign developers, and an emphasis on developing those skills has been a significant part of some messages targeting parents. Health communication campaigns have been developed to inform parents about when and how to talk to their children about health issues such as alcohol, drugs, and sex. Unfortunately, not all parent–child communication is positive or effective and this can have potential unintended consequences. Treating parents as an audience in a more nuanced manner, with greater emphasis on evidence-based message development, could result in more effective messages and better health outcomes.
William Mosley-Jensen and Edward Panetta
Health professionals and the public puzzle through new or controversial issues by deploying patterns of reasoning that are found in a variety of social contexts. While particular issues and vocabulary may require field specific training, the patterns of reasoning used by health advocates and authors reflect rhetorical forms found in society at large. The choices made by speakers often impact the types of evidence used in constructing an argument. For scholars interested in issues of policy, attending to the construction of arguments and the dominant cultural modes of reasoning can help expand the understanding of a persuasive argument in a health context. Argumentation scholars have been attentive to the patterns of reasoning for centuries. Deductive and inductive reasoning have been the most widely studied patterns in the disciplines of communication, philosophy, and psychology. The choice of reasoning, from generalization to specific case or from specific case to generalization, is often portrayed as an exclusive one. The classical pattern of deductive reasoning is the syllogism. Since its introduction to the field of communication in 1957, the Toulmin model has been the most impactful device used by critics to map inductive reasoning. Both deductive and inductive modes of argumentative reasoning draw upon implicit, explicit, and affective reasoning. While the traditional study of reasoning focused on the individual choice of a pattern of reasoning to represent a claim, in the last 40 years, there has been increasing attention to social deliberative reasoning in the field of communication. The study of social (public) deliberative reasoning allows argument scholars to trace patterns of argument that explain policy decisions that can, in some cases, exclude some rhetorical voices in public controversies, including matters of health and welfare.
Nancy Grant Harrington
The study of persuasive health messages—their design, dissemination, and impact—is ubiquitous in the communication discipline. Words, sounds, and images—alone or in combination—can move people to change their minds and their bodies. Micro-level topics surround questions of message content (argumentation scheme, evidence, qualifying language, and figurative language), structure (message sidedness, standpoint articulation, inoculation, and sequential strategies), and format (channel and audiovisual effects). Macro-level topics in this area include message sensation value, narrative, framing, emotional appeals, and tailoring. Central theoretical frameworks used to guide message design research, include health behavior change theories, information processing theories, and theories/frameworks for message design. In addition, some of the methodoligical issues inherent in message design research are questions of analysis, validity, and measurement. Four streams of past scholarship that inform persuasive health message design research: Greek rhetoric, mass communication research begun during World War II, the development of health communication as a research focus within the communication discipline, and the development of computer and telecommunications technology. Directions and challenges for future research include the need for a clear, coherent, and comprehensive taxonomy to classify message characteristics and attention to several methodological issues.
Kory Floyd, Corey A. Pavlich, and Dana R. Dinsmore
Research has shown that the expression of affection and other forms of prosocial communication between two or more people promotes wellness and has the potential to increase life expectancy. The human body contains multiple physiological subsystems that all contribute to the overall health and well-being of an individual; the simple act of engaging in prosocial communication has been shown to positively influence one’s health and well-being. The specific benefits of engaging in prosocial communication are not limited to one specific physiological subsystem; it is the pervasiveness of this benefit that is so important. The benefits of prosocial communication range from building the body’s defense systems to increasing the effectiveness of recovery; in essence, prosocial communication increases the body’s overall integrity and rejuvenating power. These benefits have been observed for a variety of prosocial behaviors, including the expression of affection, touch, social support and cohesion, and social influence. The health benefits of prosocial communication point to the importance of considering prosocial communication when designing health and risk messages.
This article discusses the various ways in which political concerns among government officials, scientists, journalists, and the public influence the production, communication, and reception of scientific knowledge. In so doing, the article covers a wide variety of topics, mainly with a focus on the U.S. context. The article begins by defining key terms under discussion and explaining why science is so susceptible to political influence. The article then proceeds to discuss: the government’s current and historical role as a funder, manager, and consumer of scientific knowledge; how the personal interests and ideologies of scientists can influence their research; the susceptibility of scientific communication to politicization and the concomitant political impact on audiences; the role of the public’s political values, identities, and interests in their understanding of science; and, finally, the role of the public, mainly through interest groups and think tanks, in shaping the production and public discussion of scientific knowledge. While the article’s primary goal is to provide an empirical description of these influences, a secondary, normative, goal is to clarify when political values and interests are or are not appropriate influences on the creation and dissemination of scientific knowledge in a democratic context.
Kimberly N. Kline
Popular media are a source of information, a powerful socializing agent, and generate sociopolitical and sociocultural meanings that impinge on health promotion and/or disease prevention efforts and individual lived experiences. Thus, motivated by the goal of improving individual and social health, multidisciplinary scholars attend to the implications of entertainment and news media with regard to a range of topics such as individual health threats related to prevention, health conditions and illnesses, patient–provider interactions and expectations, public health issues related to crisis management and health recommendations, and public policy. Scholarship in this line of research may approach the study of popular media guided by the social scientific tradition of media effects theory to explain and predict response or by critical theory to consider ideological implications and employ different methodologies to describe and evaluate the images of health and health-related matters to which people are being exposed or that focus on media representations or audience (both individual and societal) response.
Mengfei Guan and Jennifer L. Monahan
Positive emotional appeals can be an important, if often underutilized, component in health campaigns. Research reviewed from advertising, marketing, health communication, and social influence demonstrated how campaigns can promote risk-reduction behaviors by focusing on positive incentives, highlighting positive outcomes, and evoking positive feelings toward the health-related behavior. People who feel good during and after exposure to a health message tend to have favorable attitudes toward the message, which in turn establishes more open, rather than resistant, attitudes toward the issue or risk-reduction behavior promoted in the message. Along with influencing behavior via attitudes, positive affect can have a direct impact on behavior or intention. As suggested by broaden-and-build theory, positive affect broadens attention and thinking processes, increases openness to information, and helps form beliefs that the behavioral change promoted in the message is possible. Relatedly, positive affect tends to activate approach-oriented behaviors through the function of the behavioral activation system.
Two primary strategies have demonstrated efficacy at promoting positive feelings: the use of gain-framed appeals and evoking the core relational theme of happiness. Gain-framed appeals emphasize the rewards obtained by following message recommendations and can boost behavioral adoption, particularly of proscriptive behaviors, by highlighting positive outcomes and goal congruency. Happiness occurs when people believe they are making progress toward realizing their goals, and messages can be created to induce positive feelings like happiness by focusing on self-efficacy, response efficacy, and perceived benefits. Positive message appeals are especially useful for counteracting the potential drawbacks of traditional negative appeals in that they can reduce message fatigue, gain attention, and attenuate psychological reactance. Challenges for future research include increasing efforts to systematically understand how and when to best utilize the power of positive messages in campaigns. Another related challenge is to examine how positive affect is aroused at a particular stage of exposure to health risk messages, and how emotions (both negative and positive), flow, evolve, and transit from one to another (e.g., fear to relief, anxiety to happiness) during and after message exposure.
Arvind Singhal and Lucia Dura
The Positive Deviance (PD) approach is based on the premise that every community has individuals or groups whose uncommon behaviors and strategies enable them to find better solutions to problems than their peers although everyone has access to the same resources and challenges. In contrast to traditional problem-solving approaches that begin with an expert-driven analysis of “what is not working” with people—their explicit needs, deficits, problems, and risks—followed by attempts to plug those gaps, the PD approach focuses on identifying “what is working.” PD offers a systematic framework to identify assets, indigenous knowledge, and home-grown solutions, and to amplify them for wider adoption.
The PD approach was operationalized and systematized in the early 1990s in Vietnam to address malnutrition. At the time, 65% of children under five were malnourished. Instead of looking for the causes and applying best practices, PD pioneers looked for children from very poor families who were well-nourished. Through community-led efforts, they determined the existence of positive deviants, identified their behaviors and strategies, and amplified them. The process was replicated across 14 villages—each identifying its own batch of local practices—and malnutrition decreased by 85%. These actions led to PD as we know it today in the form of the “6 Ds”: Define, Determine, Discover, Design, Discern, and Disseminate.
PD has been used widely to address a large number of intractable social problems—many of them dealing with health and risk: reducing endemic malnutrition, decreasing neonatal and maternal mortality, reducing goiter and diseases of micronutrient deficiency, boosting organ transplantation rates and cancer screenings, increasing mental well-being and psychological resilience, preventing and controlling malaria and Chagas, and reducing hospital-acquired infections in healthcare.
From 2004 to 2008, six U.S. hospitals pioneered the use of PD to address the growing incidence of infections caused by the antibiotic resistant bacteria Methicillin-resistant Staphylococcus aureus (MRSA). PD was used to identify and amplify evidence-based infection prevention practices. Pilot outcomes included a 73% average reduction in healthcare-associated MRSA infections units and a subsequent decrease of between 33 and 84% at the different hospitals.
The PD approach to problem-solving holds important implications for public health scholars and practitioners, risk communicators, and message designers. The cases of Vietnam and one of the pilot hospitals are used to illustrate the ways that through language- and action-based strategies PD challenges traditional risk and health messaging, proposing instead an asset-based, participatory, and sustainable framework.
Shirley S. Ho and Andrew Z. H. Yee
Health communication research has often focused on how features of persuasive health messages can directly influence the intended target audience of the messages. However, scholars examining presumed media influence on human behavior have underscored the need to think about how various audience’s health behavior can be unexpectedly influenced by their exposure to media messages. Two central theoretical frameworks have been used to guide research examining the unintended effects: the third-person effect and the influence of presumed media influence (IPMI). The theoretical explanations for presumed media influence is built on attribution bias, self-enhancement, perceived exposure, perceived relevance, and self-categorization. Even though both the third-person effect and the IPMI share some theoretical foundations, and are historically related, the IPMI has been argued to be better suited to explaining a broader variety of behavioral consequences. One major way that presumed media influence can affect an individual’s health behavior is through the shifting of various types of normative beliefs: descriptive, subjective, injunctive, and personal norms. These beliefs can manifest through normative pressure that is theoretically linked to behavioral intentions. In other words, media have the capability to create the perception that certain behaviors are prevalent, inculcating a normative belief that can lead to the uptake of, or restrain, health behaviors. Scholars examining presumed media influence have since provided empirical support in a number of specific media and behavioral health contexts. Existing findings provide a useful base for health communication practitioners to think about how presumed media influence can be integrated into health campaigns and message design. Despite the proliferation of research in this area, there remains a need for future research to examine these effects in a new media environment, to extend research into a greater number of health outcomes, to incorporate actual behavioral measures, and to ascertain the hypothesized causal chain of events in the model.