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Article

Matthew W. Savage, Sarah E. Jones, Jenna E. Reno, and Shari Veil

University students, faculty, and staff are among those most vulnerable to cybersecurity risks due to their reliance on modern technologies, the nature of their online activities, and the open infrastructure of institutional networks. Furthermore, cyberbullying has emerged as a public health concern by the Centers for Disease Control and Prevention (CDC), which first warned of electronic aggression in 2008, or any type of harassment or bullying that occurs via email, chat, instant messaging, websites, blogs, or text messaging. Roberto and Eden emphasized the communicative nature of cyberbullying, defining it as the “deliberate and repeated misuse of communication technology by an individual or group to threaten or harm others” in 2010 (p. 201). In response to serious cybersecurity concerns and growing evidence of cyberbullying behavior, the national Stop.Think.Connect. (STC) campaign was developed to educate Americans on cybersecurity risks and equip citizens with tools for safe, respectful, and appropriate online behavior; however, it lacks targeted messaging for those on university campuses. Formative research is needed to ascertain the specific cybersecurity risks and challenges identified by those living and working on large university campuses. Research by Noar in 2006 demonstrates that formative evaluation leads to more successful campaigns. The process involves learning about target populations, discovering communicative determinants of behavior change, and testing message concepts. To that end, this case study is a first step in targeting STC campaign messages to university students, faculty, and staff. Specifically, we sought to identify the distinct cybersecurity needs faced by university students and personnel, their perceptions of the saliency of the problem, and potential motives for increasing their cybersecurity-enhancing behaviors. These activities are needed to implement the campaign on college campuses and to increase the likelihood of any future outcome evaluation efforts that yield evidence of campaign effectiveness. Currently, we are unaware of any outcome evaluation. Focus group methodology was conducted to examine the target audiences’ knowledge, interests, needs, and attitudes regarding the management of cybersecurity threats. Additionally, practical recommendations for enhancing STC campaign implementation on university campuses were ascertained. Results emphasized key ways to improve the theoretical underpinnings of the campaign using the Integrated Behavioral Model (IBM). We identified how determinants of behavior change can be utilized to strengthen campaign messaging. Students displayed laissez-faire attitudes toward cybersecurity, while faculty and staff attitudes demonstrated a much higher level of concern. Social norms for personal cybersecurity action taking were notably low among students as well as faculty and staff. Students displayed limited personal agency in regards to enacting cybersecurity measures, while faculty and staff had greater knowledge of steps they could take, but little faith that these actions would be efficacious. Finally, thematic recommendations for implementing an effective cybersecurity campaign on a university campus were identified.

Article

Advertising as a field and industry often has a contentious relationship with both health communication and public health due to legitimate concerns about how advertising for certain products, such as alcohol and tobacco, could contribute to less-healthy decisions and behaviors. While acknowledging such concerns, advertisers and their approach to solving communication problems could also provide valuable lessons to those working in health communication. Indeed, advertising agencies are designed to develop creative and effective messages that change consumer behavior—and health communication practitioners and scholars aim to change population-level behavior as well. The perspective and approach of the account planner in the advertising agency—a role whose chief responsibility is to bring the consumer perspective into every step of the advertising development process and inspire effective and creative campaigns—would be particularly valuable to those working in health communication. It was account planning work that shifted traditional milk advertising from promoting it as a healthy drink to the iconic “got milk?” campaign, which positioned milk as a complement that makes other food better—an approach that drove positive sales after years of declining milk consumption. Yet many who work in health communication and public health often know little of how advertising agencies work or their internal processes that might be productively adopted. This lack of understanding can also lead to misperceptions of advertisers’ work and intentions. As an example, one might assume dense medical language in prescription drug advertising is intended to add unnecessary complexity to the advertisements and obscure side effects; instead, advertising professionals who work on prescription drug advertising have often been trained on clear communication—but cannot fully utilize that training because of regulations that require medically accurate terminology that might not be comprehensible to most viewers. Improved understanding of how advertisers can act as agents of change, and increased dialogue between the fields of advertising and health communication, could contribute to improved health communication research, practice, and policy.

Article

Due to their sheer scope in trying to reach large sections of a population, and the costs necessary to implement them, evaluation is vital at every stage of the health communication campaign process. No stage is more important than the formative evaluation stage. At the formative stage, campaign designers must determine if a campaign is even necessary, and if so, determine what the campaign’s focus needs to be. Clear, measurable, and realistically attainable objectives need to be a primary output of formative evaluation, as these objectives help to guide the creation of all future campaign efforts. The formative stage also includes pilot testing any messages and strategies with the target audience prior to full-scale implementation. Once the campaign is implemented, process evaluation should be performed to determine if the campaign is being implemented as planned (i.e., fidelity), and also to document the dose of campaign exposure. Identifying problem areas during process evaluation can ensure they get fixed prior to the completion of the campaign. Detailed process evaluation also allows for greater ease in replicating a successful campaign attempt in the future, but additionally can provide potential reasons for why a campaign was not successful. The last stage is outcome evaluation—determining if the objectives of the campaign were achieved. While it is the last stage of campaign evaluation, campaign designers need to ensure they have planned for it in the formative stages. If even just one of these stages of evaluation is minimized in campaign design, or relegated to an after-thought, developers need to realize that the ultimate effectiveness of their campaigns is likely to be minimized as well.

Article

Celebrities are famous individuals, well known by many members of the public, who appear frequently in media content. When celebrities appear in the media alongside another cause, be it selling soap or promoting public health, the message becomes a celebrity appeal. Celebrity appeals are messages where a celebrity advocates for or is implicitly associated with a target behavior. In the context of health and risk-related messages, celebrity appeals can take the form of public service announcements, advertisements for health and risk-related products, or even news coverage of a celebrity’s personal struggles with a health issue or risky behavior. Research on celebrity appeals overlaps with the marketing literature investigating the effects of celebrity endorsements on product preferences and purchasing behavior. This work on the persuasiveness of celebrity endorsements demonstrates that celebrities can draw attention to a product or idea, but also that many other factors, like involvement, familiarity, source credibility, and endorser gender can moderate how persuasive a celebrity-based appeal is. Additionally, research on celebrity disclosures of illnesses reveal that these de facto awareness campaigns can elicit emotions in audiences and motivate behavior change. However, media coverage of celebrities has also been associated with harmful effects on lay individuals’ wellbeing, suggesting important caveats for message designers who rely on celebrities to garner attention for a cause or to motivate lay individuals to change their own health and risk-related behaviors. The existing empirical evidence on celebrity appeals and additional theoretical perspectives for understanding their potential persuasiveness provides many insights for message designers.

Article

Janice L. Krieger and Jordan M. Neil

Strategic communication is an essential component in the science and practice of recruiting participants to clinical research studies. Unfortunately, many clinical research studies do not consider the role of communication in the recruitment process until efforts to enroll patients in a timely manner have failed. The field of communication is rich with theory and research that can inform the development of an effective recruitment plan from the inception of a clinical research study through informed consent. The recruitment context is distinct from many other health contexts in that there is often not a behavioral response that can be universally promoted to patients. The appropriateness of a clinical research study for an individual is based on a number of medical, psychological, and contextual factors, making it impossible to recommend that everyone who is eligible for a clinical research study enroll. Instead, clinical research study recruitment efforts must utilize strategic communication principles to ensure that messages promote awareness of clinical research, maximize personal relevance, minimize information overload, and facilitate informed choice. This can be accomplished through careful consideration of various aspects of the communication context described in this chapter, including audience segmentation, message content, message channels, and formative, process, and outcome evaluation, as well as the enrollment encounter.

Article

Clinicians, medical and public health researchers, and communication scholars alike have long been concerned about the effects of conflicting health messages in the broader public information environment. Not only have these messages been referred to in many ways (e.g., “competing,” “contradictory,” “inconsistent,” “mixed,” “divergent”), but they have been conceptualized in distinct ways as well—perhaps because they have been the subject of study across health, science, and political communication domains. Regardless of specific terminology and definitions, the concerns have been consistent throughout: conflicting health messages exist in the broader environment, they are noticed by the public, and they impact public understanding and health behavior. Yet until recently, the scientific evidence base to substantiate these concerns has been remarkably thin. In the past few years, there has been a growing body of rigorous empirical research documenting the prevalence of conflicting health messages in the media environment. There is also increasing evidence that people perceive conflict and controversy about several health topics, including nutrition and cancer screening. Although historically most studies have stopped short of systematically capturing exposure to conflicting health messages—which is the all-important first step in demonstrating effects—there have been some recent efforts here. Taken together, a set of qualitative (focus group) and quantitative (observational survey and experimental) studies, guided by diverse theoretical frameworks, now provides compelling evidence that there are adverse outcomes of exposure to conflicting health information. The origins of such information vary, but understanding epidemiology and the nature of scientific discovery—as well as how science and health news is produced and understood by the public—helps to shed light on how conflicting health messages arise. As evidence of the effects of conflicting messages accumulates, it is important to consider not just the implications of such messages for health and risk communication, but also whether and how we can intervene to address the effects of exposure to message conflict.

Article

Mohan Jyoti Dutta, Satveer Kaur-Gill, and Naomi Tan

Cultivation theory examines the effects of the media, mainly television on viewer perception over an extended period of time. Television is seen by people throughout the globe, with many spending considerable amounts of time watching the medium. The act of watching television has been described as the first leisure activity to cut across social and ethnic divisions in society. This made it a unique mass media tool because mass message dissemination to diverse groups in a population was made possible. Cultivation scholars have studied the effects of the medium, trying to understand how television content can alter one’s social reality. Heavy viewers are considered to be most susceptible to the effects of cultivation. The reality of these effects poses important questions for health communication scholars considering the role television plays in disseminating health messages. Health communication scholars became interested in studying cultivation to understand the health-related effects the medium could have on viewers. Understanding the health effects of television is pivotal, considering that television and the structures that constitute television content set the agendas for many health topics, often disseminating negative and positive messages that can impact society, especially the young and impressionable. With television content addressing health issues such as nutrition, diet, body image, tobacco, cancer, drugs, obesity, and women’s health, cultivation theory can offer health communication scholars a framework to understand how health behaviors are shaped by the mass media and the roles these media play in reinforcing unhealthy behaviors. By establishing a basis for studying how such portrayals have direct health-related effects on viewers, cultivation theory creates openings for questioning the structures of the media that put out unhealthy content and for interrogating the roles and responsibilities of media agenda in inculcating positive health messages. Directions for future research include looking at contextually contrasting populations that share different cultural and community values, and different ways of consuming television. Research questions exploring the roles of community structures with different sets of subjective norms, or with different roles of community norms, in the realm of cultivation effects offer new areas for exploration.

Article

Direct-to-consumer advertising of prescription drugs (DTCA) is a multibillion-dollar industry in the United States, affecting the health-care landscape. DTCA has been controversial, since a major increase in this type of advertising resulted from re-interpretation of existing regulations in the late 20th century. Health and risk communication research can inform many of the controversial issues, assisting physicians, policymakers, and the public in understanding how consumers respond to DTCA. Prior research addresses four major topics: (1) the content of DTCA in different channels, (2) consumers’ perceptions of and responses to DTCA, (3) individual-level factors that affect how consumers respond to DTCA, and (4) message factors that impact consumers’ responses. Such research shows that the presentation of risk and benefits information is generally not balanced in DTCA, likely affecting consumers’ attitudes toward and comprehension of the risk information. In addition, despite consumers’ generally somewhat negative or neutral perceptions of DTCA, this advertising seems to affect their health information seeking and communication behaviors. Finally, a wide range of individual-level and message factors have been shown to have an impact on how consumers process and respond to DTCA. Consumers’ responses, including how they process the information, request prescription drugs from providers, and share information about prescription drugs, have an important impact on the effects of DTCA. The fields of health and risk communication therefore bring theories and methodologies that are essential to better understanding the impact of this advertising.

Article

Suruchi Sood, Amy Henderson Riley, and Kristine Cecile Alarcon

Entertainment-education (EE) began as a communication approach that uses both entertainment and education to engender individual and social change, but is emerging as a distinct theoretical, practice, and evidence-based communication subdiscipline. EE has roots in oral and performing arts traditions spanning thousands of years, such as morality tales, religious storytelling, and the spoken word. Modern-day EE, meanwhile, is produced in both fiction and nonfiction designs that include many formats: local street theater, music, puppetry, games, radio, television, and social media. A classic successful example of EE is the children’s television program Sesame Street, which is broadcast in over 120 countries. EE, however, is a strategy that has been successfully planned, implemented, and evaluated in countries around the world for children and adults alike. EE scholarship has traditionally focused on asking, “Does it work?” but more recent theorizing and research is moving toward understanding how EE works, drawing from multidisciplinary theories. From a research standpoint, such scholarship has increasingly showcased a wide range of methodologies. The result of these transformations is that EE is becoming an area of study, or subdiscipline, backed by an entire body of theory, practice, and evidence. The theoretical underpinnings, practice components, and evidence base from EE may be surveyed via the peer-reviewed literature published over the past 10 years. However, extensive work in social change from EE projects around the world has not all made it into the published literature. EE historically began as a communication approach, one tool in the communication toolbox. Over time, the nascent approach became its own full-fledged strategy focused on individual change. Backed by emerging technologies, innovative examples from around the globe, and new variations in implementation, it becomes clear that the field of EE is emerging into a discrete theoretical, practice, and evidence-based subdiscipline within communication that increasingly recognizes the inherent role of individuals, families, communities, organizations, and policies on improving the conditions needed for lasting social change.

Article

Jessica Gall Myrick and Robin L. Nabi

Fear is a negatively valenced discrete emotional state that is an inherent part of the human experience. With strong evolutionary roots, fear serves important functions, including alerting people to present threats and motivating action to avoid future threats. As such, fear is an emotion that frequently attracts the attention of scholars and message designers who hope to persuade audiences to change their behavior in light of potential threats to well-being and public safety. Several theories have aimed to describe the effects of fear-based appeals on audiences, focusing largely on the cognitive correlates of fear (i.e., severity and susceptibility) and their subsequent impacts on persuasive outcomes. However, more recent theorizing has returned to a focus on the influence that the emotion of fear itself has on attitude and behavior change. Given that many health-oriented fear appeals have been shown to evoke multiple emotions, including anger, disgust, and sadness, current theorizing has taken a mixed-emotions or emotional flow perspective to provide a deeper understanding of fear appeal effects. Further, individual differences have been considered to determine who is most likely to experience fear during and after message consumption. In addition to fear appeals that purposefully aim to scare audiences to motivate attitude and behavior change, recent work suggests that fear can be generated by other forms of messages (e.g., news accounts, social media posts, interpersonal conversations) that may influence receivers’ approaches to health issues. Moreover, research also suggests that fear may motivate social sharing of messages, which can in turn allow for more widespread influence of fear-based messages.

Article

Worldwide, key behavioral risk factors for ill-health and premature death include smoking, alcohol, too much or too little of several dietary factors, and low physical activity. At least three structural factors (biological attributes and functions, population size and structure, and wealth and income disparities) modify the global impact that the risk factors have on health; without accounting for these structural drivers, the effect of government-driven incentives to act on the behavioral risk factors for improved health will be suboptimal. The risk factors and their impact on health are further driven by malleable circumstantial drivers, including technological developments, exposure to products, social influences and attitudes, and potency of products. Government-driven incentives, which can be both positive and negative, can act on the circumstantial drivers and can impact on the behavioral risk factors to improve or worsen health. Government-driven incentives include a range of policies and measures: policies that reduce exposure; regulation of the private sector; research and development to reduce potency; resource allocation for advice and treatment; direct incentives on individual behavior; and, managing co-benefits and adverse side effects. Within a framework of government-driven whole-of-society approaches to improve health, an accountability system is needed to identify who or what causes what harm to health to whom. A health footprint, modeled on the carbon footprint is proposed as the accounting system.

Article

Christopher B. Mayhorn and Michael S. Wogalter

Warnings are risk communication messages that can appear in a variety of situations within the healthcare context. Potential target audiences for warnings can be very diverse and may include health professionals such as physicians or nurses as well as members of the public. In general, warnings serve three distinct purposes. First, warnings are used to improve health and safety by reducing the likelihood of events that might result in personal injury, disease, death, or property damage. Second, they are used to communicate important safety-related information. In general, warnings likely to be effective should include a description of the hazard, instructions on how to avoid the hazard, and an indication of the severity of consequences that might occur as a result of not complying with the warning. Third, warnings are used to promote safe behavior and reduce unsafe behavior. Various regulatory agencies within the United States and around the globe may take an active role in determining the content and formatting of warnings. The Communication-Human Information Processing (C-HIP) model was developed to describe the processes involved in how people interact with warnings and other information. This framework employs the basic stages of a simple communication model such that a warning message is sent from one entity (source) through some channel(s) to another (receiver). Once warning information is delivered to the receiver, processing may be initiated, and if not impeded, will continue through several stages including attention switch, attention maintenance, comprehension and memory, beliefs and attitudes, and motivation, possibly ending in compliance behavior. Examples of health-related warnings are presented to illustrate concepts. Methods for developing and evaluating warnings such as heuristic evaluation, iterative design and testing, comprehension, and response times are described.

Article

Hope has been defined in primarily two ways, and both have implications for message design within health and risk communication. First, hope has been defined as a way of thinking, or disposition, that affects how people pursue goals. Dispositional hope manifests in beliefs about one’s capacity to initiate and sustain action toward goals (agency) and one’s ability to generate ways to reach those goals. Dispositional hope has been associated with positive physical and mental health outcomes. For example, high-hope women have greater intentions to engage in cancer prevention behaviors than do low-hope women. Numerous studies have associated higher hope with better pain management, and people who are higher in hope have a greater pain tolerance than people lower in hope. Hope is also related to better psychological adjustment. Much of the research on dispositional hope focuses on correlating hope with a variety of positive health and non-health outcomes; however, psychotherapeutic interventions have also been designed to increase dispositional hope. These interventions have shown improvements in health-related outcomes. Although their potential is not yet realized, interventions for developing dispositional hope could improve compliance with medical recommendations, increase adoption of health behaviors, and decrease risk behaviors. The second way that hope has been defined is as a discrete emotion. Discrete emotions are brief, intense, psychological, and evaluative reactions directed at external stimuli (e.g., people, events, or objects). In response to these external stimuli, emotions help individuals adapt to their environment by activating a unique pattern of thoughts (cognitions), physiological changes, subjective feelings, motor expressions, and action (or behavioral) tendencies. Lazarus’s cognitive-mediational theory has been one of the most influential theories of discrete emotions that includes a definition of hope. Lazarus identifies the core relational theme of hope as “fearing the worst but yearning for better.” Lazarus deems hope to be a problematic emotion because he believes hope contains both positive and negative elements. Despite uncertainty about the exact nature of hope, Lazarus believes that hope is vital to coping with stress. Hope enables people to believe in the possibility of better circumstances and therefore is critical as a coping mechanism against despair. Lazarus does not provide guidance for what a message might need to include to evoke hope. Drawing on Lazarus and appraisal theories in general, MacInnis and de Mello suggest tactics that consumer marketing advertisements could use to induce hope. Specifically, the authors focus on turning “impossibility into possibility” and enhancing “yearning.” De Mello and MacInnis also theorize that hope can lead to motivated processing of information resulting in both positive (e.g., coping, well-being, and goal achievement) and negative (e.g., risky behavior, self-deception) outcomes. Unfortunately, the theorizing of de Mello and MacInnis was never empirically tested. To further explore how feelings of hope are created, Prestin examined underdog narratives in entertainment media. Underdog narratives show characters who are attempting to meet a goal despite unfavorable circumstances and odds. These narratives evoke hope and make people more motivated to meet their own personal goals. Although their potential has not been fully explored, underdog narratives may assist individuals in overcoming challenging circumstances, such as battling addiction or developing new health habits. There are numerous mechanisms still to be examined that may explain the effects of underdog narratives beyond their ability to evoke hope. Recently, Chadwick defined hope as a future-oriented, discrete emotion that focuses on an opportunity to achieve a desired future outcome. Her definition builds on the work of Lazarus and Roseman and has implications for the design of messages that evoke hope. According to Chadwick, hope is evoked by appraisals of a future outcome as (a) consistent with goals (goal congruence), (b) possible but not certain (possibility), (c) important (importance), and (d) leading to a better future (future expectation). All four of these appraisals combine to create a perception of opportunity and the discrete emotion hope. Hope motivates behavior by focusing one’s thoughts on capitalizing on an opportunity. Chadwick states that hope also involves (a) an approach action tendency that motivates individuals to take, or continue, action to achieve the desired outcome, (b) increased heart rate and skin conductance, (c) an open facial expression, heightened focus, and alert body posture, and (d) a feeling of eager attention. Chadwick’s definition has clear implications for developing messages that evoke hope. Messages designed to create appraisals of the importance, goal congruence, positive future expectation, and possibility of a future event evoke hope and are called hope appeals. Like other theoretical explications of emotional appeals, a hope appeal has two components: (a) the inducement of hope through the presentation of an opportunity and (b) the presentation of recommended actions to achieve the desired outcome. The recommended actions component includes information designed to (a) increase the receiver’s perception of his or her ability to perform the recommended action (i.e., self-efficacy) and (b) demonstrate the ability of the recommended actions to achieve the desired outcome (i.e., response efficacy). Empirically, scholars have tested the effects of hope and messages that evoke hope. Hope appeals increase attention to messages about climate change and increase mitigation behavioral intention and mitigation behavior. In addition, feelings of hope increase interest in climate change protection and are positively correlated with pro-environmental behaviors and support for climate change policies. Feelings of hope significantly predict interest in climate protection, self-efficacy, interpersonal communication intention, information seeking intention, and behavioral intention. Hope and hopeful narratives have also been associated with greater perceived message effectiveness and more agreement with the message content. After a stressful experience that accelerates heart rate, evoking hope decelerates heart rate and decreases state anxiety. This research provides evidence that messages that evoke hope can counter the psychological and physiological effects of stressful events. In addition, researchers have examined the effects of hope on a variety of health, persuasion, political communication, and marketing outcomes. Preliminary evidence indicates that hope appeals are equally as or more effective than guilt and fear appeals at increasing interpersonal communication intention, self-efficacy, information seeking intention, and behavioral intention. In addition, hope appeals create less reactance (anger) than fear appeals. Together these results indicate that hope and hope appeals have substantial potential to influence health and risk behavior.

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

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.

Article

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.

Article

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.

Article

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.

Article

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.