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Article

Occupation and the Risk Message Recipient  

Clare Hocking

Responding to health messages about environmental risks and risky behaviors requires adjustments to what individuals do: how they organize and perform occupations, and their understanding of what occupations mean—for themselves and others. Encouraging people to make a change means influencing what they want to do, the possibilities open to them, and societal support and demand for healthful ways of life. Bringing an occupational perspective to the design of risk messages will generate new insights into the complexities of everyday occupations, revealing the dynamic territory into which health messages are targeted. Occupation, or everyday doing, is described as the means by which people experience their very nature, become what they have the potential to be, and sustain a sense of belonging in family, community and society. To influence what people do, designers of health messages are encouraged to consider what engages people in occupations and keeps them engaged; the identity and cultural meanings expressed through occupation; the exhilaration of challenge and risk; the satisfactions of competence and flow experiences that keep people engaged in what they are doing; whether or not people are fit and prepared for the occupations they embark on and what happens when they are not; and the pull of habits and routines, which hold existing patterns of occupation in place. Equally, health message designers need to engage with the occupational science literature, which recognizes how people are shaped toward particular occupations and occupational identities by social policy, institutional practices, and media messages. That means questioning the rhetoric that occupations are freely chosen, rather than shaped and patterned by the historical, sociocultural, political, and geographic context. Simultaneously, health message designers need to recognize that individuals incorporate specific occupations and occupational patterns into their lifestyle and sense of self, believing they have a measure of control over what they do while rationalizing failure to make health-supporting changes.

Article

Communication Campaigns that Emphasize Environmental Influences on Health and Risk  

Kami J. Silk, Sarah Sheff, Maria Lapinski, and Alice Hoffman

The environment influences health and risk outcomes, and communication campaigns often strive to reduce risk and promote positive health outcomes by raising awareness, increasing knowledge, influencing attitudes, and impacting intentions and behavior. Communication campaigns should be based on good formative research and theory, and they should be implemented with fidelity and a clear evaluation plan. Communication campaigns that address environmental influences are typically focused on promoting human, animal, or environmental outcomes despite the fact that all three are interconnected and would benefit from being considered in a larger ecological framework. The One Health approach reconceptualizes environmental influences by focusing not just on the environmental but also connections with human and animal health. One Health can be applied to communication campaigns to support efforts that acknowledge and promote the complexity of these relationships. Campaigns about environmental influences on health and risk range from a longstanding campaign built on individual activities to reduce environmental and personal risk to a sun smart campaign to reduce sun exposure risk to a lead-free campaign and an asthma-control campaign concerned about air quality. Other environmental campaigns focus on tobacco prevention, obesity prevention by addressing environmental influences as part of their strategy, climate control, and ocean species preservation—and that is only a sampling of popular campaign topics. These communication campaigns face similar challenges like lack of formative research and evaluation plans as well as atheoretical approaches to influence outcomes.

Article

Stigma and Health/Risk Communication  

Rachel A. Smith, Xun Zhu, and Madisen Quesnell

Stigmas are profoundly negative stereotypes of a social group and its members that have diffused and normalized throughout a community. Being marked as a member of a stigmatized group does more than designate someone as different: stigmas denote people as discredited, devalued, and disgraced. Stigmas shape health and risk communication and are considered the leading—but least understood—barrier to health promotion. Communication and stigmas are dynamically connected. Communication is critical to a stigma’s existence, spread, expression, coping, and elimination. Using mediated and interpersonal communication, community members are socialized to recognize and react to stigmatized people. People use communication to enact the devaluation and ostracism of stigmatized people, and stigmatized people use communication to cope with stigmatization. Stigmas also shape communication: stigmas compel non-marked persons to engage in stigmatization and ostracism of marked persons, reduce marked people’s disclosure and encourage secrecy, and shape the characteristics of personal and community networks. Last, campaigns have used communication to attempt to eliminate existing stigmas. The accumulating research, conducted from diverse assumptions about human behavior (cultural determinism, evolutionary, socio-functional), shows how easily and effectively stigmas may be socialized; how challenging they are to manage; how many facets of health and wellbeing are devastated by their existence; and how difficult it is to attenuate them. While much has been uncovered about stigma, health, and risk, many questions remain. Among these include: How can one design messages that effectively alert the general public about imminent health threats and that successfully promote desirable behavioral changes without evoking stigma processes? How do different reactions to stigmatization influence targets and their social networks? What factors increase resistance or vulnerability to messages containing stigma-inducing content? How can one create an effective, reliable means to eliminate existing stigmas?

Article

Critical Food Studies  

Helene A. Shugart

If food studies is an inherently interdisciplinary field of enquiry, communication is central to its uptake in any scholarly context, for food is inherently relational, symbolic, and deeply cultural, a powerful discourse in its own right and imbricated in a host of other discourses. Accordingly, while food studies is a relatively new area of study within the communication discipline, scholarship in that vein has had rather seamless entrée into the broader scholarly arena and has proliferated along the same general lines of investigation that characterize the field in general. Originally rooted in cultural anthropology, early studies of the cultural significance of food assessed how food both reflects and accomplishes social identity and status, a focus that has been sustained and expanded in more contemporary studies as relevant to how food signals and mobilizes particular identities, such as race/ethnicity, nation, class, gender, and sexuality. Matters of identity are sometimes apparent in studies of the role(s) of food in global flows, including globalization, colonization, immigration, diaspora, and tourism. Much of this scholarship also or instead takes up food in terms of production and consumption, assessing the politics, economics, and geographies of food. Endeavors in this vein, in global, national, and local contexts, examine food policies and patterns of industry and how they privilege certain interests while disenfranchising others: food safety, security, and justice feature prominently in these investigations. These motifs are reflected, as well, in scholarship that examines social movements around food that seek to disrupt or resist problematic industry and farming policies and/or practices as relevant to, for example, environmental exigencies, animal welfare, eradication of the local, and availability of and/or access to safe, healthy foods. The mediation of food is perhaps a natural subject of study for communication scholars, ranging from representations of food in film to food packaging and advertising. The recent rise of “foodie” culture has generated a proliferation of media fare, signaled by indices ranging from the now recognized genre of “food films,” to multiple television networks devoted to food, to the rise of “celebrity chefs”; food is, moreover, an increasing presence on the Internet, proliferating especially across social media. The imaginaries of authenticity and egalitarianism and the materialities of class that frequently drive foodie culture have been the focus of much of this scholarship, and they have been further identified as figuring prominently in urban practices ranging from the establishment of farmers’ markets to gentrification. Even within the communication discipline, food studies is a wide-ranging topic, but it is not simply a diverse subject of study for communication scholars. The inherently liminal and malleable nature of food renders it difficult if not impossible to engage or theorize in terms of conventional binaries or rifts that characterize many if not most fields, such as subject/object and self/other; perhaps most salient for the communication discipline, food denies the particularly nettlesome materiality/discursivity binary. Accordingly, food studies holds considerable promise for the field relevant to theoretical innovation and expansion.

Article

Interpersonal Communication Processes Within the Provider-Patient Interaction  

Maria K. Venetis

The degree to which patients are active and communicative in interactions with medical providers has changed in recent decades. The biomedical model, a model that minimizes patient agency in the medical interaction, is being replaced with a model of patient-centered care, an approach that prioritizes the individual patient in their healthcare and treatment decisions. Tenets of patient-centered care support that patients must be understood within their psychosocial and cultural preferences, should have the freedom to ask questions, and are encouraged to disclose health-relevant information. In short, this model promotes patient involvement in medical conversations and treatment decision-making. Research continues to examine approaches to effective patient-centered communication. Two interpersonal processes that promote patient-centered communication are patient question-asking and patient disclosure. Patient question-asking and disclosure serve to inform medical providers of patient preferences, hesitations, and information needs. Individuals, including patients, make decisions to pursue or disclose information. Patients are mindful that the act of asking questions or disclosing information, particularly stigmatized information such as sexual behavior or drug use, could make them vulnerable to perceived negative provider evaluations or responses. Thus, decisions to ask questions or share information, processes essential to the understanding of patient perspectives and concerns, may be challenging for patients. Various theoretical models explain how individuals consider if they will perform actions such as seeking or disclosing information. Research also explains the barriers that patients experience in asking questions or disclosing relevant health information to providers. A review of pertinent research offers suggestions to aid in facilitating improved patient-centered communication and care.

Article

Communicating about Genes, Health, and Risk  

Roxanne L. Parrott, Amber K. Worthington, Rachel A. Smith, and Amy E. Chadwick

The public, including lay members who have no personal or familial experience with genetic testing or diagnosis, as well as individuals who have had such experiences, face many intrinsic decisions relating to understanding genetics. With the sequencing of the human genome and genetic science discoveries relating genes to cancer, heart disease, and diabetes, the scope of such decisions broadened from prenatal genetic testing related to reproductive choices to genetic testing for contributors to common causes of morbidity and mortality. The decision about whether to seek genetic testing encompasses concerns about stigma and discrimination. These issues lead some who can afford the cost to seek screening through online direct-to-consumer sites rather than in clinical settings. Many who may benefit from genetic testing lack awareness of family health history that could guide physicians to recommend these diagnostic tests. Families may not discuss health history due to genetic illiteracy, with the public’s genetic illiteracy increasing their illness uncertainty and decreasing the likelihood that physicians will engage in conversations about personalized medicine with their patients. Physicians may nonetheless order genetic tests based on patients’ symptoms, during preoperative workups, or as part of opportunistic screening and assessment associated with a specific genetic workup. Family members who receive positive genetic test results may not disclose them to life partners, other family members, or insurance companies based on worries and anxiety related to their own identity, as well as a lack of understanding about their family members’ risk probability. For many, misguided beliefs that genes absolutely determine health and disease status arise from media translations of genetic science. These essentialist beliefs negatively relate to personal actions to limit genetic expression, including failure to seek medical care, while contributing to stereotypes and stigma communication. As medical science continues to reveal roles for genes in health across a broad spectrum, communicating about the relationships that genes have for health will be increasingly complex. Policy associated with registering, monitoring, and controlling the activities of those with genetic mutations may be coercive and target individuals unable to access health care or technology. Communicating about genes, health, and risk will thus challenge health communicators throughout the 21st century.

Article

Memorable Messages in Families  

Haley Kranstuber Horstman, Ellen Jordan, and Jinwen Yue

Families are (one of) the first and most influential socializing agents of our lives. Among the innumerable messages family members convey to each other, a select few are regarded as “memorable.” Memorable messages are “distinct communication units considered influential over the course of a person’s life.” Those messages that are most memorable are typically brief, direct, oral messages delivered by a higher-status, older, and likable individual to the recipient during their teen or young adult years. Although memorable messages were initially regarded as having positive implications for the receiver’s life, newer research has provided space for the negative implications and perceptions of these messages. Nonverbal communication elements and relational contexts and qualities are influential to the receptivity of memorable messages. Although memorable messages often originate from a family member, the sources of memorable messages can also be friends/peers, teachers, coworkers, or, in some cases, the media. Research on memorable messages has been largely concentrated in health and interpersonal/family communication contexts; organizational and instructional contexts have also been explored. Memorable message research in families has focused much on health topics (i.e., mental health, sexual health, body image and weight), socialization (i.e., around school, work, race, other topics), and coping with hardship. In these studies, memorable messages have largely been investigated through mixed-method survey-based research, but also through purely quantitative (i.e., survey-based) and qualitative (i.e., interview) methods as well. This research has been largely atheoretical but has been grounded in control theory and, more recently, the theory of memorable messages and communicated narrative sense-making theory. Future research and practical applications of family memorable message research include informing health campaigns and family life education programming.

Article

Perceptions of the Childfree  

Elizabeth A. Hintz and Rachel Tucker

Being voluntarily childless (i.e., “childfree”) is a growing trend in the United States and around the world. Although most childfree people know early in life that they do not wish to become parents, the decision to forgo having children is an ongoing process that requires childfree people to construct a life that deviates from the normative family life cycle. Increasing rates of voluntary childlessness is a trend spurred by a variety of shifting social, economic, and environmental factors. Yet despite the increasing normalcy of voluntary childlessness, childfree people (and especially childfree women) face social sanctions for deciding not to become parents, being broadly perceived more negatively than childless people (who do not have children but want them) and parents. Such sanctions include social confrontations in which others (e.g., family members) question or contest the legitimacy of their childfree identity. Media coverage of voluntary childlessness forwards the notion that motherhood and femininity are inseparable and that voluntary childlessness is an issue that primarily concerns and affects women. Furthermore, childfree people face discrimination in health care contexts when seeking voluntary sterilization and in workplace contexts when “family-friendly” policies create unequal distributions of labor for those without children. Members of the childfree community use the Internet to share resources and seek support to navigate challenging interactions with outsiders. Beyond this, although some studies have begun to interrogate the roles of geographic location, race, and sexual orientation in shaping the experience of voluntary childlessness, at present, a largely White, wealthy, able-bodied, cisgender, heteronormative, and Western view of this topic is still perpetuated in the literature.

Article

Ehealth Communication  

Gary L. Kreps

Ehealth, also known as E-health, is a relatively new area of health communication inquiry that examines the development, implementation, and application of a broad range of evolving health information technologies (HITs) in modern society to disseminate health information, deliver health care, and promote public health. Ehealth applications include (a) the widespread development of specialized health information websites (often hosted by government agencies, health care systems, corporations, professional societies, health advocacy organizations, and other for-profit and nonprofit organizations); (b) the widespread use of electronic health record (EHR) systems designed to preserve and disseminate health information for health care providers, administrators, and consumers; (c) an array of mobile health education and support applications that have often been developed for use with smartphones; (d) mobile health behavior monitoring, tracking, and alerting equipment (such as wearable devices and systems imbedded in vehicles, clothing, and sporting equipment); (e) interactive telemedicine systems for collecting health data and delivering health care services remotely; (f) interactive adaptive tailored health information systems to support health education, motivate health behaviors, and to inform health decision making; (g) online social support groups for health care consumers, caregivers, and providers; (h) health promotion focused digital games to engage consumers in health education and train both providers and consumers about health promoting procedures; (i) dedicated computer portals that can deliver a variety of digital health information tools and functions to consumers, caregivers, and providers; and (j) interactive and adaptive virtual human agent systems that can gather and provide relevant health information, virtual reality programs that can simulate health environments for training and therapeutic purposes, and an ever-increasing number of digital applications (apps) for addressing a range of health conditions and activities. As information technology evolves, new ehealth applications and programs are being developed and introduced to provide a wide range of powerful ehealth systems to assist with health care and health promotion. Ehealth technologies have been found by many researchers, practitioners, and consumers to hold tremendous promise for enhancing the delivery of health care and promotion of health, ultimately improving health outcomes. Many popularly adopted ehealth applications (such as health websites, health care portals, decision support systems, and wearable health information devices) are transforming the modern health care system by supplementing and extending traditional channels for health communication. The use of new ehealth applications enables the broad dissemination of relevant health information that can be personalized to the unique communication orientations, backgrounds, and information needs of individuals. New ehealth communication channels can provide health care consumers and providers with the relevant health information that they need to make informed health care decisions. These ehealth communication channels can provide this information to people exactly when and where they need it, which is especially important for addressing fast-moving and dangerous health threats. Yet, with all the promise of ehealth communication, there is still a tremendous amount of work to be done to make the wide array of new ehealth applications as useful as possible for promoting health with different audiences. This article describes the current state of knowledge about the development and use of HITs, as well as about strategies for improving ehealth communication applications to enhance the delivery of health care and the promotion of public health.

Article

Health Care Teams as Agents for Change in Health and Risk Messaging  

Kevin Real and Andy Pilny

Effective communication in health care teams is central to the delivery of high-quality, safe, dependable, and efficient patient care. Understanding how health care team communication operates within healthcare systems is important. Viewing health care teams in hospital settings as creators and channels for diffusions of health and risk messages is an important contribution to health communication scholarship. Health care teams are essential elements of healthcare systems. In many instances, they are components of multiteam systems embedded within larger network ecosystems. These teams are not identical, thus, considering how team type (e.g., unidisciplinary, multidisciplinary, interdisciplinary) shapes distinct communication processes offers a better understanding of how these teams facilitate health and risk message diffusion. TeamSTEPPS is an important framework for essential teamwork behaviors that facilitate team processes in healthcare systems. Significantly, we develop specific communication competencies drawn from observation work that facilitate health care team effectiveness. Ideas developed by Kurt Lewin are utilized to consider how different types of multiteam systems can be effective as channels and facilitators of health and risk messages. We end the chapter with examples from field research. A set of hospital nursing unidisciplinary teams comprise a network of teams that form a heterarchical structure with important messages flowing between teams. An innovative form of hospital interdisciplinary rounds relies on specific communication practices to create and exchange health and risk messages to patients, families, health care team members, and other healthcare stakeholders.

Article

Text Features Related to Message Comprehension  

Jessica Gasiorek and R. Kelly Aune

A majority of the extant literature in health and risk message processing focuses—for obvious reasons—on social influence and compliance-gaining. Interpersonal and relational issues with doctors and patients are a secondary focus. In contrast, research that specifically addresses comprehension of health and risk messaging is somewhat scant. However, other domains (e.g., cognitive psychology, reading studies) offer models and studies of comprehension that address message processing more generally. This material can usefully inform research in a health and risk context. An important aspect of any communicative event is the degree to which that event allows interactivity. This can be described in terms of a continuum from static messaging to dynamic messaging. Message features may affect simple comprehension (in the former case) and active understanding (in the latter case) of messaging along this continuum. For static messaging, text features are the dominant focus; for dynamic messaging, how communicators cooperate, collaborate, and adjust their behavior relative to each other’s knowledge states is the focus. Moderators of these effects, which include sources’ dual goals informing and influencing targets, are also important to consider. Examples of this include direct-to-consumer-advertising (DTCA) of pharmaceutical medicines and pharmaceutical companies, which must meet the demands of the government regulatory bodies (e.g., fair and balanced presentation of benefits and risks) while simultaneously influencing the message processing experience of the target to minimize negative perceptions of their products. Impediments to creating understanding can arise in both the highly interactive setting of the face-to-face doctor-patient context as well as more static messaging situations such as PSAs, pamphlets, and pharmaceutical package inserts. Making sense of message comprehension in health and risk communication is complex, and it is complex because it is broad in scope. Health and risk communication runs the gamut of static to dynamic messaging, employing everything from widely distributed patient information leaflets and public service announcements, to interactive web pages and massively connected social networking sites, to the highly interactive and personalized face-to-face meeting between doctor and patient. An equally comprehensive theoretical and methodological tool box must be employed to develop a thorough understanding of health and risk communication.

Article

Metaphor in Health and Risk Communication  

Pradeep Sopory

Metaphor equates two concepts or domains of concepts in an A is B form, such that a comparison is implied between the two parts leading to a transfer of features typically associated with B (called source) to A (called target). Metaphor is evident in written, spoken, gestural, and pictorial modalities. It is also present as latent patterns of thought in the form of conceptual mappings between domains of experience called conceptual metaphor. Metaphor is found commonly in a variety of health and risk communication contexts, including public discourse, public understanding and perceptions, medical encounters, and clinical assessment. Often metaphor use is beneficial to achieving desired message effects; however, sometimes its use in a message can lead to unintended undesirable effects. There is a general consensus, although not complete agreement, that metaphors in messages are processed through engagement with corresponding conceptual mappings. This matching process can be taken as a general principle for design of metaphor-based health and risk messages.

Article

Substance Abuse Prevention Message Generation: Engaging Adolescents in Health Message Planning and/or Production of Health Promotion Messages  

Smita C. Banerjee and Kathryn Greene

Adolescent substance use remains a significant public health challenge, with recent approaches to address these problems including actively engaging adolescents in message planning and/or production as a prevention strategy. There are two benefits of this active involvement strategy. First, engaging adolescents in message planning or producing substance prevention messages is a form of participatory research that results in participant-generated messages for use in future intervention efforts. This participatory form of research is increasingly common in a wide range of topics and populations, particularly disenfranchised or stigmatized groups. It is important to focus on the second benefit of engaging adolescents in message planning and prevention: the effect of engaging in planning or producing substance prevention messages on the adolescents themselves. If done properly, the process of engaging adolescents in planning (or producing) anti-substance messages can provide longer-term benefits of delaying onset of substance use (strengthening resistance) as well as changing patterns for those already using. Some examples of this strategy exist with media literacy, although applied with a great deal of variability. The increased popularity of these planning/production approaches requires greater explication of how, when, and why they produce effects for participants. Two different theoretical perspectives address this active involvement intervention approach: narrative engagement theory and the theory of active involvement. Beyond these theories, sensation seeking is positioned as a moderator to explore for active involvement intervention effects.

Article

Neighborhood Considerations for Social Determinants of Health and Risk  

Holley A. Wilkin

When it comes to health and risk, “place” matters. People who live in lower-income neighborhoods are disproportionately affected by obesity and obesity-related diseases like heart disease, hypertension, and diabetes; asthma; cancers; mental health issues; etc., compared to those that live in higher-income communities. Contributing to these disparities are individual-level factors (e.g., education level, health literacy, healthcare access) and neighborhood-level factors such as the socioeconomic characteristics of the neighborhood; crime, violence, and social disorder; the built environment; and the presence or absence of health-enhancing and health-compromising resources. Social determinants of health—for example, social support, social networks, and social capital—may improve or further complicate health outcomes in low-income neighborhoods. Social support is a type of transaction between two or more people intended to help the recipient in some fashion. For instance, a person can help provide someone who is grieving or dealing with a newly diagnosed health issue by providing emotional support. Informational support may be provided to someone trying to diagnose, manage, and/or treat a health problem. Instrumental support may come in the help of making meals for someone who is ill, running errands for them, or taking them to a doctor’s appointment. Unfortunately, those who may have chronic diseases and require a lot of support or who otherwise do not feel able to provide support may not seek it due to the expectation of reciprocity. Neighborhood features can enable or constrain people from developing social networks that can help provide social support when needed. There are different types of social networks: some can enhance health outcomes, while others may have a more limiting or even a detrimental effect on health. Social capital results in the creation of resources that may or may not improve health outcomes. Communication infrastructure theory offers an opportunity to create theoretically grounded health interventions that consider the social and neighborhood characteristics that influence health outcomes. The theory states that every neighborhood has a communication infrastructure that consists of a neighborhood storytelling network—which includes elements similar to the social determinants of health—embedded in a communication action context that enables or constrains neighborhood storytelling. People who are more engaged in their neighborhood storytelling networks are in a better position to reduce health disparities—for example, to fight to keep clinics open or to clean up environmental waste. The communication action context features are similar to the neighborhood characteristics that influence health outcomes. Communication infrastructure theory may be useful in interventions to address neighborhood health and risk.

Article

Positive Deviance: A Non-Normative Approach to Health and Risk Messaging  

Arvind Singhal and Lucia Dura

The Positive Deviance (PD) approach is based on the premise that every community has individuals or groups whose uncommon behaviors and strategies enable them to find better solutions to problems than their peers although everyone has access to the same resources and challenges. In contrast to traditional problem-solving approaches that begin with an expert-driven analysis of “what is not working” with people—their explicit needs, deficits, problems, and risks—followed by attempts to plug those gaps, the PD approach focuses on identifying “what is working.” PD offers a systematic framework to identify assets, indigenous knowledge, and home-grown solutions, and to amplify them for wider adoption. The PD approach was operationalized and systematized in the early 1990s in Vietnam to address malnutrition. At the time, 65% of children under five were malnourished. Instead of looking for the causes and applying best practices, PD pioneers looked for children from very poor families who were well-nourished. Through community-led efforts, they determined the existence of positive deviants, identified their behaviors and strategies, and amplified them. The process was replicated across 14 villages—each identifying its own batch of local practices—and malnutrition decreased by 85%. These actions led to PD as we know it today in the form of the “6 Ds”: Define, Determine, Discover, Design, Discern, and Disseminate. PD has been used widely to address a large number of intractable social problems—many of them dealing with health and risk: reducing endemic malnutrition, decreasing neonatal and maternal mortality, reducing goiter and diseases of micronutrient deficiency, boosting organ transplantation rates and cancer screenings, increasing mental well-being and psychological resilience, preventing and controlling malaria and Chagas, and reducing hospital-acquired infections in healthcare. From 2004 to 2008, six U.S. hospitals pioneered the use of PD to address the growing incidence of infections caused by the antibiotic resistant bacteria Methicillin-resistant Staphylococcus aureus (MRSA). PD was used to identify and amplify evidence-based infection prevention practices. Pilot outcomes included a 73% average reduction in healthcare-associated MRSA infections units and a subsequent decrease of between 33 and 84% at the different hospitals. The PD approach to problem-solving holds important implications for public health scholars and practitioners, risk communicators, and message designers. The cases of Vietnam and one of the pilot hospitals are used to illustrate the ways that through language- and action-based strategies PD challenges traditional risk and health messaging, proposing instead an asset-based, participatory, and sustainable framework.

Article

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.

Article

Meta-Analysis in Health and Risk Messaging  

Simon Zebregs and Gert-Jan de Bruijn

Meta-analyses are becoming increasingly popular in the field of health and risk communication—meta-analyses allow for more precise estimations of the magnitude of effects and the robustness of those effects across empirical studies in a particular domain. Despite its popularity, most scholars are not trained in the basic methods involved with meta-analyses. There are advantages to meta-analysis in comparison to other forms of research synthesis. An overview of the methods involved in conducting and reporting meta-analytical research is helpful. However, the methods involved with meta-analyses are not as clear-cut as they may first appear. Numerous issues must be considered and various arbitrary decisions are required during the process. These issues and decisions relate to various topics such as inclusion criteria, the selection of sources, quality assessments for eligible studies, and publication bias. Basic knowledge of these issues and decisions is important for interpreting the outcomes of a meta-analysis correctly.

Article

Limited English Proficiency as a Consideration When Designing Health and Risk Messages  

Maricel G. Santos, Holly E. Jacobson, and Suzanne Manneh

For many decades, the field of risk messaging design, situated within a broader sphere of public health communication efforts, has endeavored to improve its response to the needs of U.S. immigrant and refugee populations who are not proficient speakers of English, often referred to as limited English proficient (LEP) populations. Research and intervention work in this area has sought to align risk messaging design models and strategies with the needs of linguistically diverse patient populations, in an effort to improve patient comprehension of health messages, promote informed decision-making, and ensure patient safety. As the public health field has shifted from person-centered approaches to systems-centered thinking in public health outreach and communication, the focus in risk messaging design, in turn, has moved from a focus on the effects of individual patient misunderstanding and individual patient error on health outcomes, to structural and institutional barriers that contribute to breakdown in communication between patients and healthcare providers. While the impact of limited proficiency in English has been widely documented in multiple spheres of risk messaging communication research, the processes by which members of immigrant and refugee communities actually come to understand sources of risk and act on risk messaging information remain poorly researched and understood. Advances in risk messaging efforts are constrained by outdated views of language and communication in healthcare contexts: well-established lines of thinking in sociolinguistics and language education provide the basis for critical reflection on enduring biases in public health about languages other than English and the people who speak them. By drawing on important findings about language ideologies and language learning, an alternative approach would be to cultivate a deeper appreciation for the linguistic diversity already shaping our everyday lives and the competing views on this diversity that constrain our risk messaging efforts. The discourse surrounding the relationship between LEP and risk messaging often omits a critical examination of the deficit-based narrative that tends to infuse many risk messaging design efforts in the United States. Sociolinguists and language education specialists have documented the enduring struggle against a monolingual bias in U.S. education and healthcare policy that often privileges proficiency in English, and systematically impedes and discriminates against emerging bilingualism and multilingualism. The English-only bias tends to preclude the possibility that risk messaging comprehension for many immigrant and refugee communities may represent a multilingual capacity, as patients make use of multiple linguistic and cultural resources to make sense of healthcare messages. Research in sociolinguistics and immigration studies have established that movement across languages and cultures—a translingual, transcultural competence—is a normative component of the immigrant acculturation process, but these research findings have yet to be fully integrated into risk messaging theory and design efforts. Ultimately, critical examination of the role of language and linguistic identity (not merely a focus on proficiency in English) in risk messaging design should provide a richer, more nuanced picture of the ways that patients engage with health promotion initiatives, at diverse levels of English competence.

Article

Nutrition Labeling in Health and Risk Messaging in Asia  

May O. Lwin, Jerrald Lau, Andrew Z. H. Yee, and Cyndy Au

Populated by a diverse spread of cultures, Southeast Asia is represented by the Association of Southeast Asian Nations (ASEAN), a regional organization comprising some 622 million people in ten countries. While food and beverage labeling policies differ across ASEAN member states, organizations such as the ASEAN Food and Beverage Alliance (AFBA) have pushed for standardization in the interest of facilitating interregional trade. Set against this backdrop of economic growth, nutrition labeling as a means of influencing consumer choices has become a significant area of focus for health authorities and researchers over the past two decades due to rising chronic disease levels within the region’s increasingly urbanized communities. Food retail trends facing Southeast Asia challenge the state of existing regulations governing, as well as research on food labeling practices in the region. Two main points stand out. First, legislation has remained disparate among the ASEAN nations despite repeated calls for standardization by academics as well as other relevant bodies, with only Malaysia adopting mandatory regulations on food labeling and nutritional claims. Second, existing nutrition labeling research in ASEAN is sorely lacking. In addition, there is a lack of theoretical and methodological diversity in existing studies, leading to an incomplete understanding of nutritional label use in Asia and a crucial research gap that remains to be filled.

Article

Using Pictures in Health and Risk Messages  

Sarah C. Vos and Elisia Cohen

Using pictures (also called images) in health and risk messages increases attention to messages and facilitates increased retention of message content, especially in low-literate populations. In risk communication, researchers have found that pictorial warnings stimulate communication and that images without text can communicate risk information as effectively (or, in some cases, more effectively) than text. However, little empirically based guidance exists for designing images for health and risk messages because most studies use an absence-presence model and compare visual communication to textual communication, rather than compare different types of visual communication. In addition, visual communication theories focus on describing the “how” aspect of communication instead of offering proscriptive guidance for message design. Further complicating the design of visual messages is that the number of possibilities for a visual message is, like text-based messages, almost infinite. Choices include colors, shapes, arrangement, and the inclusion of text, logos, icons, and so on. As a result, best practices on visual messages often draw on design recommendations. Before the widespread advent of Internet use and the adoption of social networking sites like Facebook and Twitter, using images—especially color images—could be cost prohibitive. However, these online platforms facilitate the distribution of visual content, and many public health organizations use these platforms to distribute visual messages. The need for guidance and research on using pictures effectively is growing. Although there has been increasing focus on images in health messages, many questions still exist about how visual messages should be composed and what their effect is. The existing evidence suggests that visual information can improve persuasive and, on social networking sites, diffusion outcomes. However, visual information may be prone to misinterpretation. Researchers should also evaluate ethical considerations when choosing pictures. Message testing is highly recommended.