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.
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Fear Arousal and Health and Risk Messaging
Jessica Gall Myrick and Robin L. Nabi
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Health-Related Warning Message Processing
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.
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Hope and Health and Risk Messaging
Amy E. Chadwick
Hope has been defined in primarily two ways, and both have implications for message design within health and risk communication. First, hope has been defined as a way of thinking, or disposition, that affects how people pursue goals. Dispositional hope manifests in beliefs about one’s capacity to initiate and sustain action toward goals (agency) and one’s ability to generate ways to reach those goals. Dispositional hope has been associated with positive physical and mental health outcomes. For example, high-hope women have greater intentions to engage in cancer prevention behaviors than do low-hope women. Numerous studies have associated higher hope with better pain management, and people who are higher in hope have a greater pain tolerance than people lower in hope. Hope is also related to better psychological adjustment.
Much of the research on dispositional hope focuses on correlating hope with a variety of positive health and non-health outcomes; however, psychotherapeutic interventions have also been designed to increase dispositional hope. These interventions have shown improvements in health-related outcomes. Although their potential is not yet realized, interventions for developing dispositional hope could improve compliance with medical recommendations, increase adoption of health behaviors, and decrease risk behaviors.
The second way that hope has been defined is as a discrete emotion. Discrete emotions are brief, intense, psychological, and evaluative reactions directed at external stimuli (e.g., people, events, or objects). In response to these external stimuli, emotions help individuals adapt to their environment by activating a unique pattern of thoughts (cognitions), physiological changes, subjective feelings, motor expressions, and action (or behavioral) tendencies.
Lazarus’s cognitive-mediational theory has been one of the most influential theories of discrete emotions that includes a definition of hope. Lazarus identifies the core relational theme of hope as “fearing the worst but yearning for better.” Lazarus deems hope to be a problematic emotion because he believes hope contains both positive and negative elements. Despite uncertainty about the exact nature of hope, Lazarus believes that hope is vital to coping with stress. Hope enables people to believe in the possibility of better circumstances and therefore is critical as a coping mechanism against despair. Lazarus does not provide guidance for what a message might need to include to evoke hope.
Drawing on Lazarus and appraisal theories in general, MacInnis and de Mello suggest tactics that consumer marketing advertisements could use to induce hope. Specifically, the authors focus on turning “impossibility into possibility” and enhancing “yearning.” De Mello and MacInnis also theorize that hope can lead to motivated processing of information resulting in both positive (e.g., coping, well-being, and goal achievement) and negative (e.g., risky behavior, self-deception) outcomes. Unfortunately, the theorizing of de Mello and MacInnis was never empirically tested.
To further explore how feelings of hope are created, Prestin examined underdog narratives in entertainment media. Underdog narratives show characters who are attempting to meet a goal despite unfavorable circumstances and odds. These narratives evoke hope and make people more motivated to meet their own personal goals. Although their potential has not been fully explored, underdog narratives may assist individuals in overcoming challenging circumstances, such as battling addiction or developing new health habits. There are numerous mechanisms still to be examined that may explain the effects of underdog narratives beyond their ability to evoke hope.
Recently, Chadwick defined hope as a future-oriented, discrete emotion that focuses on an opportunity to achieve a desired future outcome. Her definition builds on the work of Lazarus and Roseman and has implications for the design of messages that evoke hope. According to Chadwick, hope is evoked by appraisals of a future outcome as (a) consistent with goals (goal congruence), (b) possible but not certain (possibility), (c) important (importance), and (d) leading to a better future (future expectation). All four of these appraisals combine to create a perception of opportunity and the discrete emotion hope. Hope motivates behavior by focusing one’s thoughts on capitalizing on an opportunity. Chadwick states that hope also involves (a) an approach action tendency that motivates individuals to take, or continue, action to achieve the desired outcome, (b) increased heart rate and skin conductance, (c) an open facial expression, heightened focus, and alert body posture, and (d) a feeling of eager attention.
Chadwick’s definition has clear implications for developing messages that evoke hope. Messages designed to create appraisals of the importance, goal congruence, positive future expectation, and possibility of a future event evoke hope and are called hope appeals. Like other theoretical explications of emotional appeals, a hope appeal has two components: (a) the inducement of hope through the presentation of an opportunity and (b) the presentation of recommended actions to achieve the desired outcome. The recommended actions component includes information designed to (a) increase the receiver’s perception of his or her ability to perform the recommended action (i.e., self-efficacy) and (b) demonstrate the ability of the recommended actions to achieve the desired outcome (i.e., response efficacy).
Empirically, scholars have tested the effects of hope and messages that evoke hope. Hope appeals increase attention to messages about climate change and increase mitigation behavioral intention and mitigation behavior. In addition, feelings of hope increase interest in climate change protection and are positively correlated with pro-environmental behaviors and support for climate change policies. Feelings of hope significantly predict interest in climate protection, self-efficacy, interpersonal communication intention, information seeking intention, and behavioral intention. Hope and hopeful narratives have also been associated with greater perceived message effectiveness and more agreement with the message content. After a stressful experience that accelerates heart rate, evoking hope decelerates heart rate and decreases state anxiety. This research provides evidence that messages that evoke hope can counter the psychological and physiological effects of stressful events. In addition, researchers have examined the effects of hope on a variety of health, persuasion, political communication, and marketing outcomes. Preliminary evidence indicates that hope appeals are equally as or more effective than guilt and fear appeals at increasing interpersonal communication intention, self-efficacy, information seeking intention, and behavioral intention. In addition, hope appeals create less reactance (anger) than fear appeals. Together these results indicate that hope and hope appeals have substantial potential to influence health and risk behavior.
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Measuring Graph Literacy
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.
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Physiological Measures of Wellness and Message Processing
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.
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Public Service Announcements and Exposure to Health and Risk Messages
William DeJong
Public service announcements (PSAs) emerged after World War II in the United States as a promising strategy for increasing awareness of important social issues and changing beliefs, attitudes, and behavior. Research at that time showed that PSA campaigns had limited success in changing attitudes and behavior. Even so, both in the U.S. and internationally, sponsoring agencies and organizations continued to produce PSAs, hoping they would create significant behavior change.
In the 1980s, a more informed view of what PSAs can achieve began to emerge as practitioners of social marketing demonstrated that media campaigns can produce behavior change when they are designed and executed according to the principles and best practices followed by the advertising industry. Beginning in the 1990s, PSA-based campaigns to promote public action through programs and policy change became more common. Research has shown that such campaigns can play a key role in shaping the public agenda, changing perceptions of social norms, reinforcing school- and community-based programs, and building support for and then publicizing changes in public policy, all of which can foster individual behavior change.
PSAs and other media executions are best designed using a planning scheme that is grounded in advertising best practices and behavior change theory and that uses those media executions as part of a broader intervention effort. These various elements can be brought together by using a media planning guide that outlines how the campaign will work in sync with other intervention activities and what its key messages will be.
In the United States, federal regulations that outlined broadcasters’ public service obligations were loosened in the 1980s, making it increasingly difficult to get donated time for PSAs and other public service messages. More broadly, the increased focus of broadcasters, cable networks, and print publications on generating revenue has magnified this problem. Faced with strong competition, campaign planners need a strategy for convincing media gatekeepers to give priority to their messaging.
The rise of social media (e.g., Facebook, Instagram, Twitter) has opened up a new means of putting PSAs before the public. For example, once a message is posted on a video-sharing website such as YouTube, it can be linked to the sponsoring organization’s website, where additional intervention-related material can be found, as well as to websites hosted by other groups. Promotional efforts through national, state, and community organizations can draw an initial audience, with the hope that they will share the link with their social media and email contacts and that eventually the message will “go viral.”
PSAs remain a viable media alternative for public communication campaigns, despite the fact that major media outlets do not often provide donated time or space for such advertising. In some cases, a PSA-driven campaign will be supported by a large budget, but while such campaigns have a better chance of success, the resources required are seldom available. The emergence of social media has created a new way to build an audience. Successful examples of social media campaigns are emerging, but why some campaigns take off and others do not requires additional study.
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Reasoned Action As an Approach to Understanding and Predicting Health Message Outcomes
Marco Yzer
The reasoned action approach is a behavioral theory that has been developed since the 1960s in a sequence of reformulations. It comprises the theory of reasoned action; the theory of planned behavior; the integrative model of behavioral prediction; and its current formulation, the reasoned action approach to explaining and changing behavior. Applied to health messages, reasoned action theory proposes a behavioral process that can be described in terms of four parts. First, together with a multitude of other potential sources, health messages are a source of beliefs about outcomes of a particular health behavior, about the extent of social support for performing that behavior from specific other people, and about factors that may hamper or facilitate engaging in the behavior. Second, these beliefs inform attitude toward performing the behavior, perceptions of normative influence, and perceptions of control with respect to performing the behavior. Third, attitude, perceived norms, and perceived control inform the intention to perform the behavior. Fourth, people will act on their intention if they have the required skills to do so and if there are no environmental obstacles that impede behavioral performance.
The theory’s conceptual perspective on beliefs as the foundation of behavior offers a theoretical understanding of the role of health messages in behavior change. The theory also can be used as a practical tool for identifying those beliefs that may be most promising to address in health messages, which makes the theory useful for those designing health message interventions. Reasoned action theory is one of the most widely used theories in health behavior research and health intervention design, yet is not without its critics. Some critiques appear to be misconceptions, such as the incorrect contention that reasoned action theory is a theory of rational, deliberative decision making. Others are justified, such as the concern that the theory does not generate testable hypotheses about when which variable is most likely to predict a particular behavior.
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Resistance Induction in the Context of Health Decision Making
Marieke L. Fransen and Saar Mollen
During the past few decades we have witnessed increased academic attention on resistance to persuasion. This comes as no surprise, as people are often persuaded by external forces when making important decisions that may affect their health. Public health professionals, scholars, and other concerned parties have developed numerous trainings, interventions, and regulations to teach or assist people to resist unwanted persuasion, deriving from media exposure (e.g., advertising) or social pressure. The extant literature on resistance induction encompasses strategies such as inoculation, media literacy interventions, trainings on specific persuasive techniques, warnings, and social influence interventions. Although the research findings of the discussed strategies vary in how straightforward they are, they do offer promising avenues for policymakers and health communication professionals. Furthermore, several avenues worthy of further study can be identified.
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Spiral of Silence in Health and Risk Messaging
Sherice Gearhart
The spiral of silence theory provides insight into the ways in which perceptions of public opinion can lead to changes in opinion expression behavior. Conceptualized in a political communication context, the central claim of the theory is that individuals’ fear of social isolation motivates them to continuously evaluate the climate of opinion through both experiences with the media and interpersonal communication. Upon assessment, individuals either find themselves in a situation where their opinion aligns with the majority or minority. Accordingly, those who find their opinion does not align with the dominant opinion are likely to conceal their opinions while those who find their opinion aligns with the majority are more likely to express them.
Empirical research testing the spiral of silence theory has predominately focused on measurement of focal variables and methods of empirical testing. Advances have been made in regard to micro-level factors, such as creating universally applicable measures of psychological attributes. However, limited work has explored macro-level factors, such as appropriateness of issues, application to computer-mediated communication environments, and tools used to identify circumstances vulnerable to spiral of silence effects. Nonetheless, the practical value of the spiral of silence theory for health and risk communicators can be utilized by modifying campaign efforts to anticipate and counteract fluxes in public opinion.
