Communication is typically understood in terms of what is communicated. However, the importance of what is intentionally or unintentionally left out from the communication process is high in many fields, notably in communication about environmental and health risks. The question is not only about the absolute lack of information. The rapidly increasing amount and variability of available data require actors to identify, collect, and interpret relevant information and screen out irrelevant or misleading messages that may lead to unjustified scares or hopes and other unwanted consequences. The ideal of balanced, integrative, and careful risk communication can only rarely be seen in real-life risk communication, shaped by competition and interaction between actors emphasizing some risks, downplaying others, and leaving many kinds of information aside, as well as by personal factors such as emotions and values, prompting different types of responses. Consequently, risk communication is strongly influenced by the characteristics of the risks themselves, the kinds of knowledge on them and related uncertainties, and the psychological and sociocultural factors shaping the cognitive and emotive responses of those engaged in communication. The physical, economic, and cultural contexts also play a large role. The various roles and factors of absent information in integrative environmental and health risk communication are illustrated by two examples. First, health and environmental risks from chemicals represent an intensively studied and widely debated field that involves many types of absent information, ranging from purposeful nondisclosure aimed to guarantee public safety or commercial interests to genuinely unknown risks caused by long-term and cumulative effects of multiple chemicals. Second, light pollution represents an emerging environmental and health issue that has gained only limited public attention even though it is associated with a radical global environmental change that is very easy to observe. In both cases, integrative communication essentially involves a multidimensional comparison of risks, including the uncertainties and benefits associated with them, and the options available to reduce or avoid them. Public debate and reflection on the adequacy of risk information and on the needs and opportunities to gain and apply relevant information is a key issue of risk management. The notion of absent information underlines that even the most widely debated risk issues may fall into oblivion and re-emerge in an altered form or under different framings. A typology of types of absent information based on frameworks of risk communication can help one recognize its reasons, implications, and remediation.
Absent Information in Integrative Environmental and Health Risk Communication
Jari Lyytimäki and Timo Assmuth
A Case Study of Sesame Workshop’s Cleaner, Happier, Healthier Intervention in Bangladesh, India, and Nigeria: Reporting on Exposure and Impact
Dina L. G. Borzekowski
The Cleaner, Happier, Healthier hygiene intervention was developed and tested in 2013, featuring the Sesame Workshop characters. Through broadcast television, four public service announcements (PSAs) addressed washing hands with soap, using a latrine, wearing sandals, and drinking clean water. The main audiences were young preschool children and their parents or guardians. Research occurred in Bangladesh, India, and Nigeria, exploring the reach and impact of these PSAs. Although low percentages, from well-drawn samples of extremely vulnerable populations in these countries, reported awareness and recall of these messages, such percentages can reflect large numbers of viewers. Considering data from the participating children, measures of knowledge and attitudes were associated with engaging in several of the behavioral outcomes. As well, awareness and recall of the PSA messages predicted “all the time” for several of the hygiene behaviors. In contrast, parents’ reports of PSA awareness and recall were not associated with reports of children’s hygiene behaviors. Conducting reach studies is extremely difficult, especially in developing countries and communities. Despite the challenges, this study is encouraging. Participants reported seeing the messages, and in several models, this “reach” predicted reports of hygiene and health behaviors. Lessons learned from this case study and research can offer valuable insight into the production of future health PSAs, especially with harder-to-reach populations.
A Case Study: Targeting the Stop.Think.Connect. Cybersecurity Campaign to University Campuses
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.
Active Involvement Interventions in Health and Risk Messaging
Kathryn Greene, Smita C. Banerjee, Anne E. Ray, and Michael L. Hecht
Results of national epidemiologic surveys indicate that substance use rates among adolescents remain relatively steady or even show slight declines; however, some substance use rates, such as electronic cigarettes, are actually rising. Thus, the need for efficacious drug prevention efforts in the United States remains high. Active Involvement (AI) interventions are a promising avenue for preventing and reducing adolescent substance use, and they create opportunities for adolescents to experience a core feature of engagement that is common to these interventions, such as producing videos, posters, or radio ads; or generating themes and images for messages such as posters. Existing interventions grounded in theories of Active Involvement include programs delivered face-to-face and via e-learning platforms. Narrative Engagement Theory and the Theory of Active Involvement guide the components of change in AI interventions. Youth develop message content during participation in Active Involvement interventions. Advanced analytic models can be applied to address new research questions related to the measure of components of AI interventions.
Adherence and Communication
Teresa L. Thompson and Kelly Haskard-Zolnierek
Patient adherence (sometimes referred to as patient compliance) is the extent to which a patient’s health behavior corresponds with the agreed-upon recommendations of the healthcare provider. The term patient compliance is generally synonymous with adherence but suggests that the patient played a more passive role in the healthcare professional’s prescription of treatment, whereas the term adherence suggests that the patient and healthcare professional have come to an agreement on the regimen through a collaborative, shared decision-making process. Another term related to the concept of adherence is persistence (i.e., taking a medication for the recommended duration). Some patients are purposefully or intentionally nonadherent, whereas others are unintentionally nonadherent due to forgetfulness or poor understanding of the regimen. Patients may be intentionally nonadherent because of a belief that the costs of the regimen outweigh the benefits, for example. Nonadherence behaviors in medication taking include never filling a prescription, taking too much or too little medication, or taking a medication at incorrect time intervals. Patient adherence is relevant not only in medication-taking behaviors, but also in health behaviors such as following a specific dietary regimen, maintaining an exercise program, attending follow-up appointments, getting recommended screenings or immunizations, and smoking cessation, among others. A number of factors predict patient adherence to treatment, but the relationship between provider-patient communication and adherence to treatment will be stressed. Focusing on recent research, the article examines the concept of patient adherence, describes how provider-patient communication can enhance patient adherence, explains what elements of communication are relevant for adherence, and illustrates how interventions to improve communication can improve adherence.
Advertisers as Agents for Change in Health and Risk Messaging
Michael Mackert and Marie Guadagno
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.
Advocacy Groups as Agents for Change in Health and Risk Messaging
Jen Ptacek, Kirstin N. Dolick, and Marifran Mattson
Advocacy can be defined as the systematic process set in motion by an individual or group of individuals to encourage, support, and empower others surrounding a topic in need of change. Individuals may become an advocacy group in support of an issue, such as health care, civil rights, environment, or labor. Advocacy groups often serve as mediators between vulnerable/underprivileged populations and policymakers or decision-makers. The Health Communication Advocacy Model (HCAM) is a tested advocacy model comprising five phases including assembling the team, formative research, message development, message implementation, and evaluation. HCAM also includes a correction loop allowing for revisions of campaign messages. The HCAM is an adaptable model that offers a perspective in which advocacy groups may be considered a dynamic framework for building successful campaigns. Once the advocacy group is established, members can agree upon goals and responsibilities and craft a position statement. The group can then develop messages to reach the intended target audience(s). Target audiences may include legislators, the population affected by the issue, and media organizations. When crafting messages, care should be taken to ensure messages are stimulating, motivational, culturally consistent, resource contingent, and without barriers. Advocacy groups may use a number of channels to send messages through, such as social media, rallies, press releases, and other media outlets. Overall, advocacy groups must address a variety of needs to effectively reach the target audiences and impact change.
Affection Exchange Theory
Kory Floyd and Benjamin E. Custer
Affectionate communication constitutes verbal behaviors (e.g., saying “I love you”), nonverbal gestures (e.g., hugging, handholding), and socially supportive behaviors (e.g., helping with a project) that humans employ to develop and maintain close relationships with others. In addition to its relational benefits, affectionate communication contributes to health and wellness for both senders and receivers. Affection exchange theory (AET) addresses the questions of why humans engage in affectionate communication and why diverse benefits are associated with such behaviors. A robust empirical literature supports AET’s contention that both expressing and receiving affectionate behavior are associated with physical and mental health benefits. Despite these contributions, however, some compelling questions about affectionate communication remain to be addressed, and AET can provide a useful framework for doing so.
Agenda Setting in Health and Risk Messaging
Karyn Ogata Jones
Since McCombs and Shaw first introduced the theory in 1972, agenda setting has emerged as one of the most influential perspectives in the study of the effects of mass media. Broadly defined, “agenda setting” refers to the ability of mass media sources to identify the most salient topics, thereby “setting the agendas” for audiences. In telling us what to think about, then, mass media sources are perceived to play an influential role in determining priorities related to policies, values, and knowledge on a given topic or issue. Scholars have studied this phenomenon according to both object (issue) salience and attribute salience and along aggregate and individual audience responses. The audience characteristics of need for orientation, uncertainty, relevance, and involvement are advanced as moderating and predicting agenda-setting effects. When agenda-setting theory is applied to the study of messaging related to health and risk communication, scholars have reviewed and identified common themes and topics that generally include media’s role in educating and informing the public about specific health conditions as well as public health priorities and administrative policies. Agenda setting is often examined in terms of measuring mass media effects on audiences. Looking at interpersonal communication, such as that coming from medical providers, opinion leaders, or peer networks, in studies will allow research to examine the combined effects of interpersonal and mass communication. Testing possible interactions among differing sources of information along with assessment of issue and attribute salience among audiences according to an agenda-setting framework serves to document audience trends and lived experiences with regard to mass media, health, and risk communication.
Alzheimer’s, Age Panic, Neuroscience: Media Discourses of Dementia and Care
E. Ann Kaplan and Sally Chivers
Age discrimination, long habitual internationally, is now developing into age panic as longevity becomes the norm. People are increasingly living through their 80s and 90s, threatening social systems—not just health care, but also education, transportation, and economics. A by-product of longevity is Alzheimer’s disease (AD) or dementia more broadly, and this the focus of our essay. Five million people in the United States (the greater part women) currently have Alzheimer’s or dementia, and the figure is projected to grow exponentially as the baby boom generation ages. Fear, and other powerful affects, are generated in the aging Eurocentric public through overwhelmingly negative images of dementia. Prominent circulating AD images portray white, middle-class women and men; they are typically cared for by heroic family members, with the occasional, backgrounded appearances of racialized care workers. Such discourses betray a noticeable ageism, together with gendering, racialization, and medicalization of the illness. The reification of neuroscience studies of AD perpetuates understanding of AD subjects as having lost their subjectivity and as a burden to health-care systems. As the politics of care becomes ever more fraught with the increase in numbers of diagnosed elderly people, media discourses take on particular significance. Largely negative, images have obvious implications for long-term care in discourse and in practice. Since improving care depends on how the AD subject is visualized and conceptualized, critical analyses of works dealing with age panic, and especially how it arises in relation to cultural understandings of dementia, are essential. Critiques by humanists and psychologists may contribute to improving care of AD subjects, both in long-term facilities and “in place.” Improved care can contribute to transforming the popular understanding of a dementia crisis, thus addressing the central impetus of age panic. Meanwhile, new films, fiction, memoirs, and graphic arts projects are powerful complements to psychological studies aimed at developing new ways of seeing AD subjects.
Ambiguity Intolerance Considerations when Designing Health and Risk Messages
The concept of ambiguity tolerance (TA), variously called Uncertainty Avoidance, Ambiguity Avoidance, or Intolerance, can be traced back nearly 70 years. It has been investigated by many different types of researchers from clinical and differential, to neuro- and work psychologists. Each sub-discipline has tended to focus on how their variable relates to beliefs and behaviors in their area of expertise, from religious beliefs to reactions to novel products and situations. The basic concept is that people may be understood on a dimension that refers to their discomfort with, and hence attempts to avoid, ambiguity or uncertainty in many aspects of their lives. There have been many attempts to devise robust and valid measures of this dimension, most of which are highly inter-correlated and require self-reporting. There remains a debate as to whether it is useful having just one or more dimensions/facets of the concept. Using these tests, there have been many correlational studies that have sought to validate the measure by looking at how those high and low on this dimension react to different situations. There have also been some, but many fewer, experimental studies, which have tested very specific hypotheses about how TA is related to information processing and reactions to specific stimuli. There is now a welcomed interest by neuroscientists to explore the concept from their perspective and using their methodologies. These studies have been piecemeal, though most have supported the tested hypotheses. There has been less theoretical development, however, of the concept attempting to explain how these beliefs arise, what sustains them, and how, why, and when they may change. However, the concept has continued to interest researchers from many backgrounds, which attests to its applicability, fecundity, and novelty.
Anger in Health and Risk Messaging
Claude H. Miller and Reinaldo Cortes Quantip
Within a range of health communication contexts, anger can be either a detriment to the receptivity of health promotion messages when poorly controlled, or a benefit to information processing when appropriately directed. In the former case, anger can disrupt cognitive processing, leading to a range of negative outcomes, including emotional turbulence and a preoccupation with anger-eliciting events that can severely limit the receptivity of health promotion and risk prevention messages. However, when properly directed and elicited in moderation, anger can motivate greater purpose and resolve in response to health threats, stimulate more active processing of health warnings, sharpen focus on argument quality, and direct greater attention to coping-relevant information concerning harmful health risks.
Regret is the prototypical decision related emotion. It is felt when the outcome of a non-chosen alternative is better than the outcomes obtained. Regret is a functional emotion that helps people to correct mistakes. It is also functional because people can anticipate regret beforehand, then choose in such a way as to avoid regret from happening. Researchers in economics proposed regret theory, an alternative to rational choice theory, which takes into account the anticipation of regret and its influence in choice. Researchers in psychology studied how anticipations of regret influence decision making in a variety of domains, including health behaviors. The findings suggest that interventions can be developed that are based on the idea that people are regret averse.
Anxiety, Uncertainty, and Intercultural Communication
The effects of uncertainty and anxiety are profiled in association with intercultural communication and the initiation and development of intercultural relationships. Uncertainty is cognitive and refers to what one knows about another and one’s level of predictability about another. Anxiety is the affective equivalent of uncertainty and refers to the level of discomfort associated with interacting with a stranger. Two major theories are associated with this process, including uncertainty reduction theory and anxiety/uncertainty management theory. Other communicative factors also affect uncertainty and anxiety reduction and management during intercultural communication.
Appeals to Morality in Health and Risk Messaging
Ann Neville Miller
Many health- and risk-related behaviors have moral implications. Most obvious are altruistic behaviors like blood donation. However, issues related to promoting the wellbeing of friends and family members, such as being sure that they don’t drive drunk, and the generalized obligations that attend environmentally relevant behaviors like participating in recycling programs, also tap into moral concerns. For promoting such issues, moral appeals may be appropriate. Moral appeals are messages that acknowledge individuals’ evaluative beliefs about universal rights and wrongs. Appeals to morality produce a sense of obligation and responsibility because morals are viewed as self-evident facts. Three explanations for why people engage in moral behavior are discernible in current scholarship, each with implications for structuring moral appeals: activation of social expectations, activation of personal norms, and arousal of emotion. The first of these is based on the subjective expected utility tradition. From this perspective, the key to successfully encouraging morally relevant behavior is maximizing benefits and minimizing costs. Because prosocial behaviors are enforced by social sanctions, many of these costs and benefits are socially bestowed. Thus, altruism at its core is hedonism. Theories that focus on activation of personal norms, in contrast, contend that people sometimes make decisions to donate blood, demonstrate for healthcare reform, recycle, and so on simply because they view it as their duty and responsibility to do so. When people realize in a concrete situation that their actions have consequences for the welfare of others, and that they are personally responsible for those outcomes, personal norms for the specific case are generated from internalized moral values. In this view, a central concern with moral appeals is ensuring that messages are aligned with internalized norms and that relevance and personal responsibilities are clearly communicated. Finally, theories of emotional arousal stress that although cognitive appraisals of personal and social norms are necessary, they are insufficient to incite people to selfless behavior. Rather, people engage in helping or altruistic behavior because moral appeals are emotionally arousing. Emotions associated with such appeals include empathic concern and guilt. Guilt appeals especially have been found to be as effective in eliciting compliance when behaviors have moral significance as other popular compliance-gaining strategies. Positive emphasis on responsibility and induction of hypocrisy are also techniques that rely on the appeal to moral beliefs.
Appeal to Bystander Interventions: A Normative Approach to Health and Risk Messaging
Shawn Meghan Burn
Bystander intervention is a form of helping that occurs when onlookers intercede to provide direct or indirect aid to a victim. When bystanders step in to prevent or reduce harm to others, they act as agents of primary and secondary health prevention. But theory and research suggest the bystander intervention process is complex and multiple social-psychological and situational barriers imperil bystander action. Bystanders are often ill-prepared to intervene when others are at risk for emotional or physical harm. They may not notice that someone needs help due to distraction from self-focus, engagement in social interaction, intoxication, or aspects of the situation like crowding or noise. Due to inadequate knowledge, bystanders may misdiagnose the situation and believe intervention is unnecessary. The negative consequences of nonintervention may be unknown to them such that the situation fails to increase their empathic arousal and motivate their action. Lacking knowledge, they may not recognize the seriousness of the situation and or the potential costs of inaction, and so are insufficiently alarmed. Pluralistic ignorance can arise when multiple uncertain bystanders conceal their concern and hesitate to act, assuming others’ inaction means intervention is inappropriate or unnecessary. When there are multiple witnesses, bystanders may assume their help is unneeded, place intervention responsibility on others, or feel less responsible for helping due to diffusion of responsibility. When the victim is not a member of their in-group, or is assumed at fault for their predicament, they may feel less empathy and a reduced responsibility to help. Or, bystanders may assign responsibility for intervention to the victim’s friends or fellow in-group members, or to those “in charge” of the setting. Even when bystanders realize help is needed and take responsibility for helping, they may not act if they do not know how or lack confidence in their ability to successfully carry out the actions required to help. When they have the skills, they may not help if they perceive the costs of action to outweigh the benefits of action. Audience inhibition arising from group norms supporting inaction and from bystander worry about what others will think about them if they act unnecessarily or ineptly can prevent bystander action by increasing bystanders’ perceived helping costs. Recognition of bystanders as a potentially valuable public health asset has increased interest in promoting bystander intervention. Bystander intervention promotion and communications empower bystander action by combating intervention- and audience-specific barriers to bystander intervention using targeted information, communications, and skills training. Theory and research suggest that effective promotions and communications foster context-specific attitudes, beliefs, norms, and skills such that bystanders: (1) are able to quickly and accurately identify a situation as intervention-appropriate; (2) experience action-motivating arousal (including empathy) in the face of the event; (3) have positive attitudes towards intervention and perceive the benefits of action as outweighing the perceived costs; (4) are empowered to act and feel confident in their ability to effectively intervene (bystander efficacy); and (5) are resistant to evaluation apprehension and norms contraindicating action. Effective bystander intervention promotion draws on social psychology and communications studies, and best practices for health promotion and prevention programs. The application of social marketing and formative and summative program evaluation methods enhance the potential of bystander intervention promotions and communications to empower bystander action.
Argument Quality and Strength in Health and Risk Messaging
In an ideal world, people would adopt a positive attitude toward a healthy lifestyle as a result of carefully considering relevant and strong arguments. Attitudes based upon such considerations are believed to be stable and good predictors of related behavior, and less vulnerable to counterattitudinal messages. However, carefully evaluating arguments in such messages is difficult. First, people need to identify what information can serve as an argument and construe the argumentative relation between the information and the advocated claim. Next, they need to assess the extent to which the argument satisfies the criteria for a strong argument. What these criteria are depends on the type of argument at hand: an argument from analogy, for instance, should be evaluated with different criteria than an argument from authority. Argument scrutiny thus entails reconstruction, identification, and evaluation. The good news is that even though argument scrutiny is a complex task, it seems that people are pretty well equipped to carry it out. Meta-analyses have shown that messages containing strong arguments are more persuasive than those containing weak arguments. In addition, there is evidence that people are sensitive to what extent a specific argument satisfies relevant criteria when evaluating arguments. The bad news is that people may use these skills not so much to make objective evaluations to reach a better decision, but rather to defend the type of behavior that they already feel they want to perform. That is, they use their argument evaluation skills to reason why the arguments in support of the behavior that they favor are stronger than the arguments against that behavior.
Audience Segmentation Techniques
Rachel A. Smith
A premise in health promotion and disease prevention is that exposure to and consequences of illness and injury can be minimized through people’s actions. Health campaigns, broadly defined as communication strategies intentionally designed to encourage people to engage in the actions that prevent illness and injury and promote wellbeing, typically try to inspire more than one person to change. No two people are exactly alike with respect to their risk for illness and injury or their reactions to a campaign attempting to lower their risk. These variations between people are important for health messaging. Effective campaigns provide a target audience with the right persuasive strategy to inspire change based on their initial state and psychosocial predictors for change. It is often financially and logistically unreasonable to create campaigns for each individual within a population; it is even unnecessary to the extent to which people exist in similar states and share psychosocial predictors for change. A challenging problem for health campaigns is to define those who need to be reached, and then intelligently group people based on a complex set of variables in order to identify groups with similar needs who will respond similarly to a particular persuasive strategy. The premise of this chapter is that segmentation at its best is a systematic and explicit process of research to make informed decisions about how many audiences to consider, why the audience is doing what they are doing, and how to reach that audience effectively.
Behavioral Journalism in Health and Risk Messaging
Behavioral journalism is a term used to describe a theory-based health communication messaging strategy that is based on conveying “role model stories” about real people and how they achieve healthy behavior changes. The aim is to stimulate imitation of these models by audiences of their peers. Theoretical foundations for the strategy itself are in Albert Bandura’s social cognitive theory and Everett Rogers’s model of diffusion of innovations, but it can be used flexibly to convey various kinds of theory-driven message content. Behavioral journalism emerged as an explicit health communication technique in the late 1970s and was developed as a distinct alternative to the social marketing approach and its focus on centrally generated messages devised by experts. It has been used subsequently to promote smoking cessation, improvements in nutrition and physical activity, avoidance of sexually transmitted diseases and unplanned pregnancy, reduced intergroup hostility, advocacy for healthy policy and environmental changes, and many other diverse health promotion objectives. Formats used for behavioral journalism include reality television programs, broadcast and print news media, printed newsletters for special audiences, documentary film and video, digital and mobile communication, and new social media. Behavioral journalism is intended for use in concert with community organization and actions to prompt and reinforce the imitation of role models and to facilitate and enable behavior change, and its use in that context has yielded many reports of significant impact on behavior. With citations of use growing steadily in the past two decades, behavioral journalism has proven to be readily adaptable to new and emerging communication technologies.
Big Data’s Role in Health and Risk Messaging
Bradford William Hesse
The presence of large-scale data systems can be felt, consciously or not, in almost every facet of modern life, whether through the simple act of selecting travel options online, purchasing products from online retailers, or navigating through the streets of an unfamiliar neighborhood using global positioning system (GPS) mapping. These systems operate through the momentum of big data, a term introduced by data scientists to describe a data-rich environment enabled by a superconvergence of advanced computer-processing speeds and storage capacities; advanced connectivity between people and devices through the Internet; the ubiquity of smart, mobile devices and wireless sensors; and the creation of accelerated data flows among systems in the global economy. Some researchers have suggested that big data represents the so-called fourth paradigm in science, wherein the first paradigm was marked by the evolution of the experimental method, the second was brought about by the maturation of theory, the third was marked by an evolution of statistical methodology as enabled by computational technology, while the fourth extended the benefits of the first three, but also enabled the application of novel machine-learning approaches to an evidence stream that exists in high volume, high velocity, high variety, and differing levels of veracity. In public health and medicine, the emergence of big data capabilities has followed naturally from the expansion of data streams from genome sequencing, protein identification, environmental surveillance, and passive patient sensing. In 2001, the National Committee on Vital and Health Statistics published a road map for connecting these evidence streams to each other through a national health information infrastructure. Since then, the road map has spurred national investments in electronic health records (EHRs) and motivated the integration of public surveillance data into analytic platforms for health situational awareness. More recently, the boom in consumer-oriented mobile applications and wireless medical sensing devices has opened up the possibility for mining new data flows directly from altruistic patients. In the broader public communication sphere, the ability to mine the digital traces of conversation on social media presents an opportunity to apply advanced machine learning algorithms as a way of tracking the diffusion of risk communication messages. In addition to utilizing big data for improving the scientific knowledge base in risk communication, there will be a need for health communication scientists and practitioners to work as part of interdisciplinary teams to improve the interfaces to these data for professionals and the public. Too much data, presented in disorganized ways, can lead to what some have referred to as “data smog.” Much work will be needed for understanding how to turn big data into knowledge, and just as important, how to turn data-informed knowledge into action.