The Transtheoretical Model (TTM) is an integrative health behavior change theory that describes the process of how people change their behavior. The central organizing construct in the theory is stages of change, which are five distinct stages of readiness to change behavior, ranging from not ready to change (precontemplation), thinking about change (contemplation), preparing to change (preparation), changing (action), and maintaining the change (maintenance). Movement through the stages may be nonlinear, and cycling and recycling through the stages is viewed as a natural part of the change process. Other model constructs explain what drives individuals forward through the stages of change. Decisional balance involves a weighing of pros and cons of changing behavior, while self-efficacy involves situation-specific confidence that one can change. Increases in pros, deceases in cons, and increases in self-efficacy propel people forward through the stages of change. The processes of change are experiential and behavioral strategies that people use to change their behavior. In early stages of change, people use experiential strategies while they use behaviorally oriented strategies in later stages of change. The TTM holds significant implications for message design. Most notably, messages should be targeted and tailored to stages of change, and where possible, to other model variables as well. Studies indicate that the TTM has been successfully applied to health communication campaigns, and to a larger extent, to computer-tailored interventions to change health behavior. Meta-analyses indicate that scores of computer-tailored interventions have been efficacious, including many based upon the TTM and stages of change. New applications of the model include a focus on novel health behaviors, multiple behavior change, and advancing an understanding of message design in the context of the TTM in combination with other theoretical approaches.
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Transtheoretical Model and Stages of Change in Health and Risk Messaging
Seth M. Noar
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Types of Explanations in Health and Risk Messaging
Katherine E. Rowan
Explanations designed to teach, rather than to support scientific claims in scholarly works, are essential in health and risk communication. Patients explain why they think their symptoms warrant medical attention. Clinicians elicit information from patients and explain diagnoses and treatments. Families and friends explain health and risk concerns to one another. In addition, there are websites, brochures, fact sheets, museum exhibits, health fairs, and news stories explaining health and risk to lay audiences. Unfortunately, research on this important discursive goal is less extensive than is research on persuasion, that is, efforts to gain agreement. One problem is that explanation-as-teaching has not been carefully conceptualized. Some confuse this communication goal and discursive type with its frequent verbal and visual features, such as simple wording or diagrams. Others believe explanation-as-teaching does not exist as a distinctive communication goal, maintaining that all communication is solely persuasive: that is, designed to gain agreement.
Explanation-as-teaching is a distinct and important health communication goal. Patient involvement in decision making requires that both clinicians and patients understand options underlying health-care choices. To explore types of explanation-as-teaching, research provides (a) several ways of categorizing health and risk explanations for lay audiences; (b) evidence that certain textual and graphic features overcome predictable confusions, and (c) illustrations of each explanation type. Additionally, explanation types succeed or fail in part because of the social or emotional conditions in which they are presented so it is important to note research on conditions that support patients, families, and clinicians in benefiting from explanations of health and risk complexities and curricula designed to enhance clinicians’ explanatory skill.
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Using Guilt to Motivate Individuals to Adopt Healthy Habits
Monique Mitchell Turner
In social marketing, the use of guilt appeals can be effective for influencing healthy behaviors. Guilt, being a moral, other-based emotion, can spur people to think of others, act honestly, and be empathetic. Likewise, collective guilt, the feeling that arises when people believe their in-group caused illegitimate harm to others, can lead people to feel positively toward the victimized others and desire policies that will help them. We can see then, that guilt, though often considered “negative” can lead to an array of prosocial, constructive, behaviors. In that vein, a number of researchers have assessed the possibility that guilt based persuasive appeals can induce such positive behaviors.
Clearly, guilt-appeals can be an effective tool for reducing risk (STI testing), increasing prevention practices (encouraging mammograms), and effecting altruistic health-related behaviors (donating blood). In the correct conditions, guilt appeals can induce guilty feelings, lead people to want to “right the wrong,” generate positive attitudes about the message’s advocacy, and intend to engage in a behavior.
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Using Maps to Display Geographic Risk, Personal Health Data, and Ownership
Suellen Hopfer and Genesis Gutierrez
Fundamental structural features of risk maps influence how health risk and burden information is understood. The mapping of health data by medical geographers in the 1800s has evolved into the field of geovisualization and the use of online, geographic information system (GIS) interactive maps. Thematic (statistical) map types provide basic principles for mapping geographic health data. It is important to match the nature of statistical data with map type to minimize the potential for communicating misleading messages. Strategic use of structural map features can facilitate or hinder accurate comprehension of health risk messages in maps. A key challenge remains in designing maps to communicate a clear message given the complexity of modern health risk burdens. Various structural map features such as symbols, color, grouping of statistical data, scale, and legend must be considered for their impact on accurate comprehension and message clarity. Cognitive theory in relationship to map comprehension plays a role, as do insights from research on visualizing uncertainty, future trends in developing predictive mapping tools for public health planning, the use of geo-social and “big data,” as well as data ownership.
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Using Pictures in Health and Risk Messages
Sarah C. Vos and Elisia Cohen
Using pictures (also called images) in health and risk messages increases attention to messages and facilitates increased retention of message content, especially in low-literate populations. In risk communication, researchers have found that pictorial warnings stimulate communication and that images without text can communicate risk information as effectively (or, in some cases, more effectively) than text. However, little empirically based guidance exists for designing images for health and risk messages because most studies use an absence-presence model and compare visual communication to textual communication, rather than compare different types of visual communication. In addition, visual communication theories focus on describing the “how” aspect of communication instead of offering proscriptive guidance for message design. Further complicating the design of visual messages is that the number of possibilities for a visual message is, like text-based messages, almost infinite. Choices include colors, shapes, arrangement, and the inclusion of text, logos, icons, and so on. As a result, best practices on visual messages often draw on design recommendations. Before the widespread advent of Internet use and the adoption of social networking sites like Facebook and Twitter, using images—especially color images—could be cost prohibitive. However, these online platforms facilitate the distribution of visual content, and many public health organizations use these platforms to distribute visual messages. The need for guidance and research on using pictures effectively is growing. Although there has been increasing focus on images in health messages, many questions still exist about how visual messages should be composed and what their effect is. The existing evidence suggests that visual information can improve persuasive and, on social networking sites, diffusion outcomes. However, visual information may be prone to misinterpretation. Researchers should also evaluate ethical considerations when choosing pictures. Message testing is highly recommended.
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Using Quotations in Health and Risk Message Design
Rhonda Gibson
Quotations, something that a person says or writes that is then used by someone else in another setting, have long been a staple of news stories. Reporters use quotations—both direct and paraphrased—to document facts, opinions, and emotions from human and institutional sources. From a journalistic standpoint, quotations are beneficial because they add credibility to a news report and allow readers/viewers to consider the source of information when evaluating its usefulness. Quotations are also valued because they are seen as adding a “human” element to a news report by allowing sources to present information in their own words—thus providing an unfiltered first-person perspective that audiences may find more compelling and believable than a detached third-person summary. Research into the effects of news report quotations has documented what journalists long assumed: Quotations, especially direct quotes using the exact words of a speaker, draw the attention of news consumers and are often attended to in news stories more than statistical information. Studies show that the first-person perspective is considered both more vivid and more credible, a phenomenon that newspaper and website designers often capitalize on through the use of graphic elements such as the extracted quote. Quotations in news stories have also been found to serve as a powerful persuasive tool with the ability to influence perception of an issue even in the face of contradictory statistical information. This is especially true when the topic under consideration involves potential risk. Direct quotations from individuals who perceive high levels of risk in a situation can sway audience perceptions, regardless of whether the quoted risk assessments are supported by reality. The power of quotations remains strong in other forms of communication involving risk, such as public service, health-related, or promotional messages. The vivid, first-person nature of quotes draws the attention of audiences and makes the quoted information more likely to be remembered and to influence future judgments regarding the issue in question. This presents the message creator, whether it be a journalist or other type of communicator, with a powerful tool that should be constructed and deployed purposefully in an effort to leave audiences with an accurate perception of the topic under consideration.
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Video Games and Gaming: Reaching Audiences With Health and Risk Messages
Anthony M. Limperos
Video games are a very popular form of entertainment media and have been the subject of much debate since their meteoric rise to popularity in the 1980s. Similar to the criticisms leveraged against other forms of media, video games have often been scrutinized for their potential to negatively influence those who play them. However, since the beginning of the 21st century, many new genres of video games have emerged and as a result, both public dialogue and research attention have shifted more toward understanding how certain games can be used for prosocial purposes. Exercise-based and active video games (AVGs) are a type of game which requires players to get up and move instead of simply sitting in front of the TV and pushing buttons. These types of games have received a lot of popular press and scholarly attention due to the fact that they encourage movement and may be used as a health intervention tool, especially to combat problems like obesity and overweight. Even though there has been significant research attention focused on the potential health benefits of playing these types of games, there is still much work to be done. While researchers have advanced a general understanding of why certain AVGs are effective or ineffective, there needs to be a greater emphasis on understanding the process by which these games can be motivating and influential. Shedding light on what makes AVGs potentially effective health management and intervention tools will not only be important for motivating people to become more active, but may also help inform research which focuses on how video games may be used in the health domain more generally.
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Viral Marketing and Exposure to Health and Risk Messages
Helena Sofia Rodrigues and Manuel José Fonseca
In the context of epidemiology, an epidemic is defined as the spread of an infectious disease to a large number of people, in a given population, within a short period of time. When we refer to the marketing field, a message is viral when it is broadly sent and received by the target market through person-to-person transmission. This marketing communication strategy is currently assumed to be an evolution by word of mouth, with the influence of information technologies, and called Viral Marketing. This stated similarity between an epidemic and the viral marketing process is notable yet the critical factors to this communication strategy’s effectiveness remain largely unknown. A literature review specifying some techniques and examples to optimize the use of viral marketing is therefore useful.
Advantages and disadvantages exist to using social networks for the reproduction of viral information. It is very hard to predict whether a campaign becomes viral. However, there are some techniques to improve advertising/marketing communication, which viral campaigns have in common and can be used for producing a better communication campaign overall. It is believed that the mathematical models used in epidemiology could be a good way to model a marketing communication in a specific field. Indeed, an epidemiological model SIR (Susceptible-Infected-Recovered) helps to reveal the effects of a viral marketing strategy. A comparison between the disease parameters and the marketing application, as well as simulations using Matlab software explores the parallelism between a virus and the viral marketing approach.
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Vision and Promoting Health
Marla L. Moon
A visual impairment can affect cognitive, emotional, neurological, and physical development. Visual impairment impairs reading speed and comprehension, and is often mistaken for a learning disability. Learning is accomplished through complex and interrelated processes, one of which is vision. As a result, visual impairments limit the range of experiences and kinds of information to which one is exposed. A reliance on visual cues in health and risk messages intensifies these effects with regard to health information. The millions of children and adults who are affected by visual impairments worldwide thus require specific consideration regarding how best to make health information accessible for them. The reliance on caretakers to address the health information needs of those living with visual impairments violates their privacy and threatens their emotional well-being. Technological and modality advances that rely on touchscreens that lack tactile or auditory cues marginalize a broad segment of society that is in need of gateways to overcome barriers to accommodating visual impairment. In designing strategic health and risk messages, consideration should be given to this scope of possible limitation and its implications for access to and processing of health and risk information. Health and risk message designers should understand both the realities of challenges to accessing information for the visually impaired and strategies for addressing these realities and the scope of the issue worldwide and across the lifespan.
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Vitality Theory
Benjamin King Smith, Martin Ehala, and Howard Giles
Group vitality is a widely invoked construct in the study of minority language maintenance and interethnic relations. Per the original framework introduced 40 years ago, the more vitality an ethnolinguistic group perceives itself to have, the more likely that it will thrive as a collective entity in an intergroup context. Consequently, research adopting this paradigm—herein termed vitality theory—has studied ways in which objective and subjective group vitality has manifested itself in the endurance of ethnolinguistic groups. The notion of objective vitality includes the factors of demographics, institutional support, and status that characterize the strength of a group in comparison to others present in an intergroup setting. Contrastively, subjective vitality was introduced to highlight how groups may cognitively and affectively perceive these same factors.
A large body of empirical research has been conducted within the vitality theory framework that has resulted in several stages of development. Evidence has shown that while the components of objective vitality (demographics, institutional support, status) do not typically manifest themselves as distinct components in the structure of subjective vitality, they do form a single component reflecting the perceived strength of the group. In addition, several other social psychological factors, such as perception of the legitimacy of intergroup relations, the level of ethnocentrism, and perception of intergroup distance, were incorporated into models of subjective vitality. Relatedly, these factors are shaped into group members’ discourse of vitality, which is a highly dialogical process of negotiation of subjective vitality of the groups engaged in intergroup contact.
The vitality framework has been usefully invoked beyond ethnolinguistic groups, embracing several intergroup settings including age, gender, and sexual orientation. Vitality, which has provoked some controversy in the literature, has also been widely adopted by very different approaches as an umbrella term to denote the long-term sustainability of a group. Scholars in linguistics, sociology, psychology, education, anthropology, and beyond have contributed much to the concept, helping to educate and raise awareness as to why languages die out and the effects of such languages dying out.
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Vividness
Patrick J. Ewell and Rosanna E. Guadagno
According to Nisbett and Ross, “Information may be described as vivid, that is, as likely to attract and hold our attention and excite the imagination to the extent that it is (a) emotionally interesting, (b) concrete and imagery-provoking, and (c) proximate in a sensory, temporal, or spatial way.” Despite a widespread belief held by scholars and practitioners alike that vividness enhances persuasion, most early studies on this topic found weak or nonexistent vividness effects. To further understand this relationship, subsequent research focused on explaining these inconsistent findings. Taylor and Thompson explored the different ways that vividness has been operationalized across studies. Guadagno, Okdie, Sagarin, DeCoster, and Rhoads elucidated the conditions under which vividness enhances or detracts from persuasion. Generally, the extant literature suggests that vividness is an effective means of enhancing persuasion when the main point of a communication is the sole component made vivid. These findings caution against attempts to persuade by increasing overall message vividness, because off-thesis or incongruent vividness has the unintended and undercutting consequence of distracting influence targets from the point of the communication. This conclusion is based on the results of individual empirical studies as well as meta-analytic findings. Literature on shock advertising as a specialized case of vividness also exists. Future research on vividness might further delineate when, how, and why vividness sometimes enhances and sometimes detracts from persuasion.
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Work as Opportunity and Problem When Trying to Impact Health and Risk
Keri K. Stephens and Millie A. Harrison
Attention to population health issues is growing, and considering that people spend more time at work than in any other organization outside their home, worksites may offer a solution. For more than 30 years, many worksites have included programs to address employee health, safety, and risk. While some of these initiatives are mandated through legislation, other programs (e.g., workplace health programs (WHPs) or wellness initiatives) are often voluntary in the United States. Programs vary around the globe because some countries merge health, risk, and safety into one overarching regulated category, and there is a growing trend toward expanding these focus areas to include mental health and workplace stress. These programs can be quite innovative. Some interventions use technologies as prompts, such as mobile apps reminding employees to take medication. Other programs incorporate concepts from behavioral psychology and economics such as providing sleep pods at work and pricing healthy food in the cafeteria lower than high fat foods. Governmental incentives are offered in some countries that encourage employers to have WHPs. Yet despite the surface-level advantages of using the reach and access found in employing organizations to impact health, employees do not necessarily participate, and these programs are rarely or poorly evaluated. Furthermore, it is difficult to know how to make WHPs inclusive and how to communicate the availability of these programs. With the dual goals of directly impacting workers’ health and saving employers money, understanding how work can be a site for intervention is a worthwhile challenge to explore.
WHPs struggle to achieve documentable objectives for several reasons; theory-driven research is suggesting new ways to understand what might improve the outcomes of WHPs. Privacy and surveillance concerns have dominated the WHP conversation in countries like the United States due to fears that health data might be used to fire employees. Another concern is the need to tailor workplace health messages for diverse cultures, ethnicities, and gender identities. Two other concerns relate the power differentials inherent in workplace hierarchies to overt and covert pressure employees feel to participate and meet what is defined as an ideal level of health. While these major concerns could be difficult to overcome, several theories provide guidance for improving participation and producing positive behavioral outcomes. Employees who feel a part of their organization, or are identified with their group, are more likely to positively view health information originating from their organization. Growing evidence indicates that certain technologies might also tap into feelings of identification and help promote the uptake of workplace health information. In addition, workplaces recognized as having norms for safety and health cultures might be more influential in improving health, safety, and risk behaviors. Recognizing boundaries between employee and workplace can also be fruitful in elucidating the ethics and legality of WHPs. Finally, program evaluation must become an integrated part of these programs to effectively evaluate their impact.
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Worry and Rumination as a Consideration When Designing Health and Risk Messages
Tamara D. Afifi, Ariana Shahnazi, and Kathryn Harrison
Rumination is typically thought of as pessimistic, repetitive thinking or mulling that is deleterious for one’s health. Rumination, however, can take several forms and is not always harmful. In fact, it could actually be helpful in certain circumstances. It is common and often helpful when something stressful happens, like a health scare or problematic health diagnosis, for people to ponder or reflect on why it happened and brainstorm potential solutions to it. This is referred to as reflective rumination. Rumination affects people’s risk perceptions related to their personal and relational health and decision-making about their health. Research on negative rumination and health and positive rumination and health focuses on the impact of these patterns of thinking on health outcomes such as mental health, physical health, and relational health and as perceptions of health messages and risk likelihood.
