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Conflicting Information and Message Competition in Health and Risk Messaging  

Rebekah H. Nagler and Susan M. LoRusso

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


Behavioral Journalism in Health and Risk Messaging  

Alfred McAlister

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.


Types of Explanations in Health and Risk Messaging  

Katherine E. Rowan

Explanations designed to teach, rather than to support scientific claims in scholarly works, are essential in health and risk communication. Patients explain why they think their symptoms warrant medical attention. Clinicians elicit information from patients and explain diagnoses and treatments. Families and friends explain health and risk concerns to one another. In addition, there are websites, brochures, fact sheets, museum exhibits, health fairs, and news stories explaining health and risk to lay audiences. Unfortunately, research on this important discursive goal is less extensive than is research on persuasion, that is, efforts to gain agreement. One problem is that explanation-as-teaching has not been carefully conceptualized. Some confuse this communication goal and discursive type with its frequent verbal and visual features, such as simple wording or diagrams. Others believe explanation-as-teaching does not exist as a distinctive communication goal, maintaining that all communication is solely persuasive: that is, designed to gain agreement. Explanation-as-teaching is a distinct and important health communication goal. Patient involvement in decision making requires that both clinicians and patients understand options underlying health-care choices. To explore types of explanation-as-teaching, research provides (a) several ways of categorizing health and risk explanations for lay audiences; (b) evidence that certain textual and graphic features overcome predictable confusions, and (c) illustrations of each explanation type. Additionally, explanation types succeed or fail in part because of the social or emotional conditions in which they are presented so it is important to note research on conditions that support patients, families, and clinicians in benefiting from explanations of health and risk complexities and curricula designed to enhance clinicians’ explanatory skill.