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Article

Ann Bostrom

Mental models of health risks are the causal beliefs that comprise one’s inference engines for the interpretation and prediction of health and illness experiences and messages. Mental models of health risks can be parsed into a handful of common elements, including beliefs about causes, consequences, and cures as well as identifying information such as symptoms and timing. Mental models research deriving from a risk and decision analysis framework emphasizes exposure sources and pathways as part of causal thinking as well as how interventions may reduce or increase the risk. Mental models can be developed as a function of one’s goals or the problem in a specific context, rather than as coherent, stable knowledge structures in long-term memory. For this reason they can be piecemeal and inconsistent in the absence of expertise or experience with the risk. Derived often by analogy with more familiar risks, mental models of health risks can lead to effective health behaviors but also to costly inaction or misplaced action. Assessing mental models of hazardous processes can contribute to the design of effective risk communications by identifying the concrete information message recipients need to cope with health risks, thereby making or strengthening common-sense links between risk and action representations. Although a wide variety of research methods are used to investigate mental models, achieving this level of specificity requires attention to substantive details. Researchers are beginning to better understand the interactions between mental models of risk and their social, cultural, and physical contexts, but much remains to explore.

Article

Hye-Jin Paek and Thomas Hove

Risk perception refers to people’s subjective judgments about the likelihood of negative occurrences such as injury, illness, disease, and death. Risk perception is important in health and risk communication because it determines which hazards people care about and how they deal with them. Risk perception has two main dimensions: the cognitive dimension, which relates to how much people know about and understand risks, and the emotional dimension, which relates to how they feel about them. Several theoretical models have been developed to explain how people perceive risks, how they process risk information, and how they make decisions about them: the psychometric paradigm, the risk perception model, the mental noise model, the negative dominance model, the trust determination model, and the social amplification of risk framework. Laypeople have been found to evaluate risks mostly according to subjective perceptions, intuitive judgments, and inferences made from media coverage and limited information. Experts try to base their risk perceptions more on research findings and statistical evidence. Risk perceptions are important precursors to health-related behaviors and other behaviors that experts recommend for either dealing with or preventing risks. Models of behavior change that incorporate the concept of risk perception include the Health Belief Model, Protection Motivation Theory, the Extended Parallel Process Model, and the Risk Perception Attitude framework. Public awareness and perceptions of a risk can be influenced by how the media cover it. A variety of media factors have been found to affect the public’s risk perceptions, including the following: (1) amount of media coverage; (2) frames used for describing risks; (3) valence and tone of media coverage; (4) media sources and their perceived trustworthiness; (5) formats in which risks are presented; and (6) media channels and types. For all of these media factors, albeit to varying degrees, there is theoretical and empirical support for their relevance to risk perceptions. Particularly related to media channels and genres, two hypotheses have emerged that specify different kinds of media influences. The impersonal impact hypothesis predicts that news media mainly influence how people see risks as affecting other individuals, groups, nations, or the world population in general (societal-level risk perceptions). By contrast, the differential impact hypothesis predicts that, while news media influence people’s societal-level risk perceptions, entertainment media have stronger effects on how people see risks as affecting themselves (personal-level risk perceptions). As the media environment become increasingly diverse and fragmented, future research on risk perception needs to examine more of the influences that various media, including social media, have on risk perception. Also, the accounts of how those influences work need to be further refined. Finally, since people’s risk perceptions lead them to either adopt or reject recommended health behaviors, more research needs to examine how risk perceptions are jointly affected by media, audience characteristics, and risk characteristics.

Article

Rocio Garcia-Retamero, Dafina Petrova, Adam Feltz, and Edward T. Cokely

Graphical displays generally facilitate the communication of complex information and are ubiquitous in media. Unfortunately, people differ in their ability to extract data and meaning from graphical representations of quantitative information (i.e., graph literacy). This means that for some people, even well-designed, simple graphs will cause confusion and misunderstanding. Research on the psychology of graph comprehension focuses on two instruments that efficiently assess fundamental graph literacy among diverse adults. The Objective Graph literacy scale is a well-established instrument with good psychometric properties that measures skill via cognitive performance testing (e.g., interpreting and evaluating various graphs). The recently developed Subjective Graph Literacy scale is a brief self-report of graph literacy that can outperform the objective test in notable ways, while reducing text anxiety. Emerging applications in clinical research and practice, including computerized decision aids, can personalize content as a function of one’s graph literacy.

Article

Fundamental structural features of risk maps influence how health risk and burden information is understood. The mapping of health data by medical geographers in the 1800s has evolved into the field of geovisualization and the use of online, geographic information system (GIS) interactive maps. Thematic (statistical) map types provide basic principles for mapping geographic health data. It is important to match the nature of statistical data with map type to minimize the potential for communicating misleading messages. Strategic use of structural map features can facilitate or hinder accurate comprehension of health risk messages in maps. A key challenge remains in designing maps to communicate a clear message given the complexity of modern health risk burdens. Various structural map features such as symbols, color, grouping of statistical data, scale, and legend must be considered for their impact on accurate comprehension and message clarity. Cognitive theory in relationship to map comprehension plays a role, as do insights from research on visualizing uncertainty, future trends in developing predictive mapping tools for public health planning, the use of geo-social and “big data,” as well as data ownership.

Article

Patric R. Spence, David Westerman, and Robert G. Rice

Humans often prefer representations that are cognitively easier to store, and such representations are easier to retrieve later to make judgments about the social world. Exemplification theory draws on physiological memory mechanisms and argues that simple, iconic, concrete, and emotionally arousing depictions of events (exemplars) are favored and thus more likely to be stored and used than are abstract, inconsequential depictions or representations. Inconsequential information or representations are forgotten because they are not processed as being essential for survival. Exemplified events vary on a continuum of how accurately they represent a larger occurrence of events. Through specific uses of pictures, quotes and other depictive strategies, concrete, iconic, and emotionally arousing information is often added to a story. Research has documented the strength of specific exemplars in creating inaccurate estimations of events and perceptions of severity and susceptibility. Moreover, in the presence of a risk, portrayals with exemplars have been shown to motivate individuals to intend to change behavior. Exemplification is a strong theory that is understudied and underutilized. The theory has strong explanatory, predictive, and organizing power, and it has application to phenomena in contexts such as media effects, persuasion, crisis and risk communication, health communication and public relations.

Article

Referred to as the “most consistent and reliable method for conferring resistance to persuasion” by Miller et al. in 2013, over the past 50 years inoculation has exerted significant influence in shaping theoretical and contextual resistance research and message design. Used as a message strategy, inoculation elicits threat, or realized attitudinal/behavioral vulnerability, which motivates individuals to shore up attitudinal/behavioral defenses by providing both material and guided practice aiding the process of effective counterarguing, which in turn increases individuals’ resistance to attitudinal/behavioral challenges. The motivation is responsible for sustaining the inoculation effect over an extended period of time. Inoculation messages, however, do much more than just inspire a robust defense. They motivate individuals to engage others regarding the attitudinal/behavioral topic in an attempt to reassure and advocate their positions, thus diffusing the inoculation message over social networks. The attitudinal/behavior protection elicited by inoculation messages is not limited to the message’s target attitude/behavior, but instead spreads over related attitudes/behaviors as well, thus increasing the pragmatic utility of this message strategy. Inoculation’s effectiveness extends beyond the realm of resistance, as inoculation messages are also effective in both shaping and changing attitudes/behaviors. Because of its success, inoculation-based message strategies have been applied in numerous contexts researchers and clinicians beganand with numerous topics. Some of inoculation’s applied contexts include commercial, instruction/education, interpersonal, political, corporate, public relations, cross-cultural, health, and risk. More specifically, in the health and risk contexts, inoculation has been applied in promotion or prevention capacity on topics such as politically-motivated violent acts, smoking, drinking, unprotected sex, vaccination, and health-related policy, with current research exploring its efficacy in addiction interventions and indoor tanning-bed usage prevention. Inoculation may also be used as a strategy to reduce recidivism in criminal prison inmates and preventing verbal aggression in schools. Additional promising areas for application of inoculation-based strategies may include the promotion and protection of healthy eating habits as well as positive attitudes/behaviors toward mammograms, colonoscopies, breastfeeding, and regular exercise, just to name a few. As Ivanov suggested, the “application of the strategy [is] boundless.”

Article

Jessica Gall Myrick and Robin L. Nabi

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

Article

The turn of the 21st century has seen an explosion of frameworks that account for individuals’ decisions to seek or avoid information related to health risks. The four dominant frameworks are Risk Perception Attitude Framework, the Risk Information Seeking and Process model, the Planned Risk Information Seeking Model, and the Theory of Motivated Information Management. A comparison of the constructs within each and an examination of the related empirical tests reveal important insights into (a) factors that have consistently been shown to shape these decisions across these approaches and (b) constructs in need of additional theorizing and empirical testing. Specifically, the analysis suggests that uncertainty, efficacy, affect, risk perceptions, and subjective norms all play crucial roles in accounting for decisions to seek or avoid risk-related information. However, inconsistencies in the direction of influence for uncertainty or information discrepancy, risk perceptions, and negative affect argue for the need for considerably more theoretical clarity and empirical rigor in investigations of the ways in which these experiences shape decision making in these contexts.

Article

Narcissism is a personality trait characterized by perceptions of grandiosity, superiority, and the need for attention and admiration. There has been an increase in focus on examining the development of narcissism and how the trait influences a range of social and health behaviors. A key feature of narcissism is that it is characterized by high self-esteem with a simultaneously fragile ego that requires continual monitoring and manipulation. Therefore, much of the behaviors narcissists engage in are linked to the drive to maintain perceptions of superiority and grandiosity. In the area of health and well-being, narcissism has been positively correlated with psychological health, a relationship that may be accounted for by self-esteem. However, there has been less research on the relationship between narcissism and physical health and well-being. There is some evidence that narcissism is linked to a variety of physical appearance-oriented health behaviors (i.e., behaviors that could affect body weight or other aspects of physical appearance, including eating and exercise). Narcissism has also been positively linked to risk-taking behaviors, including use of substances, as well as risks that could significantly impact others, including sexual behaviors and risky driving. The relationship between narcissism and health is therefore complex, with some positive correlates (e.g., physical activity), but also various health risk behaviors. In considering how narcissism might interact with health messages, communicators have to keep in mind that narcissists seem to have some deficits in judgment and decision-making, such as overconfidence and a narrow focus on rewards associated with behaviors. Their behaviors tend to be driven by managing their own ego and by drawing attention and admiration from others to maintain perceptions of superiority and grandiosity. In turn, health communicators may need to rely on creative strategies that tap into these domains of narcissism in order to effectively modify health behaviors among narcissistic individuals. Further research on the influence of narcissism in healthcare seeking and related preventive behaviors would also help to provide a more detailed understanding for how the trait influences health decisions, information that would be useful for both health researchers and practitioners.

Article

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.

Article

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

When individuals are asked whether they will someday own their own home, enjoy a productive career, or develop a myriad of diseases, many are optimistic. Generally, they think they will experience more good than bad outcomes in life and they view themselves as more likely than similar others to experience the good things and less likely than others to experience the bad things. In the area of health behavior and communication, there are three primary types of optimism that have been defined and operationalized: (1) Dispositional optimism is the generalized positive expectancy that one will experience good outcomes. (2) Comparative optimism refers to the belief that one is either more likely than others to experience positive events or less likely than others to experience negative events. (3) Unrealistic optimism refers to an underestimation of one’s actual risk of experiencing some negative event. Although the three types of optimism may be correlated, their associations may be modest. Also, unlike dispositional optimism, which is an individual difference, comparative and unrealistic optimism are often risk perceptions about specific events and therefore can be defined as accurate or inaccurate. For this reason, the latter two types of optimism have sometimes been labeled the optimistic bias. Research on all three varieties of optimism affords opportunities to understand how optimism influences information processing in a health message or one’s behavioral intentions following the message.

Article

Paul Sebastian Ruppel and Günter Mey

Grounded theory methodology is one of the most widely used approaches to collect and analyze data within qualitative research. It can be characterized as a framework for study design, data collection, and analysis, which aims at the development of middle-range theories. The final result of such a study is called a “grounded theory,” and it consists of categories that are related to each other. Health and risk message design researchers working with grounded theory methodology are explicitly invited to use any kind of data they consider suitable for a particular project. Grounded theory methodology studies were originally based on intense fieldwork data, but in the meantime, interviews have become the most widely used type of data. In addition, there is a growing interest in using visual data such as pictures or film. Grounded theory methodology originated from sociology, but has since been applied in many different disciplines. This widened application went along with modifications, new developments, and innovations, and led to several current variants of grounded theory methodology. Basic features of grounded theory methodology include theoretical sampling, specific coding procedures with a comparative approach to analysis, and memo writing. The strategy of theoretical sampling requires that theoretical insights gained from the analysis of initially collected data guide subsequent data collection. Hence, during the research process data collection and analysis alternate and interact. For data analysis, different ways of coding enable the researcher to develop increasingly abstract conceptual ideas and reflections, first embodied in codes, later in categories. This analytical process allows for a step-by-step development of categories that are grounded in data. Category development entails comparisons at all stages, for example, of different cases during sampling, of different data pieces, and of different codes and categories during analysis. As a result, grounded theory methodology is also known as the constant comparative method. Throughout the research process the researcher writes memos and keeps track of the development of conceptual ideas, methodological reflections, and practical to-dos. Today, many researchers use software specifically developed to assist the process of qualitative data analysis.

Article

Health and risk policymaking focuses on decisions made and actions undertaken to set standards and pass laws to promote healthcare and public health quality, while achieving global health security. Policymakers in governments and institutions deliberate for the purposes of achieving effective and efficient policies, revealing both acceptance and rejection of evidence from health and risk, prevention, and economic sciences, as well as gaps in these domains. Health and risk communicators function implicitly within the boundaries of these decisions and actions, while contributing to prevention science related to strategic messaging and information dissemination. Policymakers face barriers to their efforts residing in the sheer volume of health and risk sciences research; the lack of evidence demonstrating that policies lead to intended outcomes (often, because a policy has not been trialed/implemented); and the absence of economic analyses associated with costs of interventions proposed and undertaken. The precautionary principle (PP) based on adopting caution when evidence is absent, uncertain, or ambiguous regarding possible harm to humans or the environment may function as a guide in some situations. Advocates may draw attention to particular issues in other cases. Policies may be stalled owing to the policy context, including election cycles, legislative and institutional bureaucracies, competing agendas, and fragmented systems of healthcare. Health and risk communicators may collaborate with policymakers and work to translate evidence into useful formats to facilitate the application of evidence to policymaking decisions and actions.

Article

Joel Iverson, Tomeka Robinson, and Steven J. Venette

Risk can be defined using a mathematical formula—probability multiplied by consequences. An essential element of risk communication is a focus on messages within organizations. However, many health-related risks such as Ebola extend beyond an individual organization and risk is better understood as a social construction cogenerated within and between systems. Therefore, the process is influenced by systemic and supra-systemic values and predilections. Risk from a structurational perspective allows an understanding of the public as well as organizational responses to risk. Structuration theory provides a useful lens to move beyond seeing organizations as something that flows within an organization to understanding how organizations are enacted through communication. Structuration theory articulates the connections between systems and structures through the action of agents, whose practices produce and reproduce the rules and resources of social life. Within the structuration tradition, organizational communication scholars have shifted to an understanding of the communicative constitution of organizations (CCO). Specifically, one of the theories of CCO is the Four Flows Model. The four flows highlight the ways people enact organizations and provide a means to analyze the various ways communication constitutes organizations. The four flows are membership negotiation, activity coordination, reflexive self-structuring, and institutional positioning. Membership negotiation enacts the inner members and outsiders at a basic level including socialization, identity, and assimilation. Activity coordination produces collective action around a specific goal. Reflexive self-structuring is the decentralized enactment of structures for the organization through the communication of policies. Institutional positioning covers the macro-level actions where people in the organization act as an entity within the environment. When considering the public reaction to Ebola, a simple way to evaluate risk perception is the intersection of dread and control. The U.S. public considered Ebola a serious risk. From a structuration perspective, the viral nature of twitter, media coverage, and public discussion generated resources for fear to be exacerbated. Structuration theory allows us to position the risk beliefs as rules and resources that are reproduced through discourse. The organizational implications fall primarily into the two flows of institutional positioning and reflexive self-structuring. For institutional positioning, U.S. healthcare organizations faced general public dread and perceived lack of control. Within the United States multiple policies and procedures were changed, thus fulfilling the second flow of organizational self-structuring. The Ebola risk had a significant impact on the communicative constitution of health-care organizations in the United States and beyond. Overall, risk is communicatively constituted, as are organizations. The interplay between risk and health-care organizations is evident through the analysis of American cases of Ebola. Structuration theory provides a means for exploring and understanding the communicative nature of risk and situates that risk within the larger systems of organizations.

Article

Irina A. Iles and Xiaoli Nan

Counterfactual thinking is the process of mentally undoing the outcome of an event by imagining alternate antecedent states. For example, one might think that if they had given up smoking earlier, their health would be better. Counterfactuals are more frequent following negative events than positive events. Counterfactuals have both aversive and beneficial consequences for the individual. On the one hand, individuals who engage in counterfactual thinking experience negative affect and are prone to biased judgment and decision making. On the other hand, counterfactuals serve a preparative function, and they help people reach their goals in the future by suggesting effective behavioral alternatives. Counterfactual thoughts have been found to influence an array of cognitive processes. Engaging in counterfactual thinking motivates careful, in-depth information processing, increases perceptions of self-efficacy and control, influences attitudes toward social matters, with consequences for behavioral intentions and subsequent behaviors. Although it is a heavily studied matter in some domains of the social sciences (e.g., psychology, political sciences, decision making), counterfactual thinking has received less attention in the communication discipline. Findings from the few studies conducted in communication suggest that counterfactual thinking is a promising message design strategy in risk and health contexts. Still, research in this area is critically needed, and it represents an opportunity to expand our knowledge.

Article

Communication privacy management theory (CPM) argues that disclosure is the process by which we give or receive private information. Private information is what people reveal. Generally, CPM theory argues that individuals believe they own their private information and have the right to control said information. Management of private information is not necessary until others are involved. CPM does not limit an understanding of disclosure by framing it as only about the self. Instead, CPM theory points out that when management is needed, others are given co-ownership status, thereby expanding the notion of disclosing information; the theory uses the metaphor of privacy boundary to illustrate where private information is located and how the boundary expands to accommodate multiple owners of private information. Thus, individuals can disclose not only their own information but also information that belongs to others or is owned by collectives such as families. Making decisions to disclose or protect private information often creates a tension in which individuals vacillate between sharing and concealing their private information. Within the purview of health issues, these decisions have a potential to increase or decrease risk. The choice of disclosing health matters to a friend, for example, can garner social support to cope with health problems. At the same time, the individual may have concerns that his or her friend might tell someone else about the health problem, thus causing more difficulties. Understanding the tension between disclosing and protecting private health information by the owner is only one side of the coin. Because disclosure creates authorized co-owners, these co-owners (e.g., families, friends, and partners) often feel they have right to know about the owner’s health conditions. The privacy boundaries are used metaphorically to indicate where private information is located. Individuals have both personal privacy boundaries around health information that expands to include others referred to as “authorized co-owners.” Once given this status, withholding to protect some part of the private information can risk relationships and interfere with health needs. Within the scheme of health, disclosure risks and privacy predicaments are not experienced exclusively by the individual with an illness. Rather, these risks prevail for a number of individuals connected to a patient such as providers, the patient’s family, and supportive friends. Everyone involved has a dual role. For example, the clinician is both the co-owner of a patient’s private health information and holds information within his or her own privacy boundary, such as worrying whether he or she diagnosed the symptoms correctly. Thus, there are a number of circumstances that can lead to health risks where privacy management and decisions to reveal or conceal health information are concerned. CPM theory has been applied in eleven countries and in numerous contexts where privacy management occurs, such as health, families, organizations, interpersonal relationships, and social media. This theory is unique in offering a comprehensive way to understand the relationship between the notion of disclosure and that of privacy. The landscape of health-related risks where privacy management plays a significant role is both large and complex. The situations of HIV/AIDS, cancer care, and managing patient and provider disclosure of private information help to elucidate the ways decisions of privacy potentially lead to health risks.

Article

Xiaoquan Zhao

Self-affirmation theory posits that people are motivated to maintain an adequate sense of self-integrity. It further posits that the self-system is highly flexible such that threats to one domain of the self can be better endured if the global sense of self-integrity is protected and reinforced by self-resources in other, unrelated domains. Health and risk communication messages are often threatening to the self because they convey information that highlights inadequacies in one’s health attitudes and behaviors. This tends to lead to defensive response, particularly among high-risk groups to whom the messages are typically targeted and most relevant. However, self-affirmation theory suggests that such defensive reactions can be effectively reduced if people are provided with opportunities to reinforce their sense of self-integrity in unrelated domains. This hypothesis has generated substantial research in the past two decades. Empirical evidence so far has provided relatively consistent support for a positive effect of self-affirmation on message acceptance, intention, and behavior. These findings encourage careful consideration of the theoretical and practical implications of self-affirmation theory in the genesis and reduction of defensive response in health and risk communication. At the same time, important gaps and nuances in the literature should be noted, such as the boundary conditions of the effects of self-affirmation, the lack of clarity in the psychological mechanisms underlying the observed effects, and the fact that self-affirmation can be easily implemented in some health communication contexts, but not in others. Moreover, the research program may also benefit from greater attention to variables and questions of more direct interest to communication researchers, such as the role of varying message attributes and audience characteristics, the potential to integrate self-affirmation theory with health communication theories, and the spontaneous occurrence of positive self-affirmation in natural health communication settings.

Article

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

Ashley R. Kennard, Courtney Anderegg, and David Ewoldsen

Knowledge and comprehension are essential components of an individual’s understanding of a health text. Whether reading a health pamphlet or watching a health campaign in the form of a public service announcement (PSA), or watching edutainment programming, individuals gain knowledge about the health topic being discussed. Knowledge, however, can only be retained if the individual can also comprehend the text or video. Often comprehension in a health context focuses on health literacy or the degree to which individuals can process and understand health information in order to make informed health decisions. Health literacy is commonly viewed in terms of the readability (e.g., reading level, complexity) of the health text or script. However, in order for individuals to gain knowledge and use that knowledge appropriately and effectively in making health decisions, individuals need to comprehend or understand what the text is conveying. Because comprehension is such an important component of gaining and using health knowledge, we must understand how we store health knowledge in memory. A schema is a mental representation that stores knowledge as interrelated pieces of information. Schemas tend to be a fairly static representation of knowledge. A mental model is a more dynamic mental representation in that we use mental models to process, organize, and comprehend incoming information. In a mental model, there is a correspondence between an external entity and the constructed mental model of that entity that allows people to counterfactually manipulate information and engage in problem solving. A situation model is the most contextualized mental representation because it encompasses a specific event or set of interrelated events. There are several ways in which to examine comprehension processes. One way is to examine the most basic level of comprehension by investigating the importance of language and semantic representation of a text. A more complex way to examine comprehension is to view the activation levels of various words or concepts important in creating a representation of the story structure in memory. One model that specifically examines concept activation is the landscape model. The model posits that greater frequency of activation and the strength of activation of a concept determine the concept’s overall activation level. The higher the activation level of a concept in a text or video, the more likely the concept will be included in the mental representation for the text or video and stored in memory. A third way to study comprehension is to examine how concepts change throughout a text and how the concepts relate to one another. The event-indexing model describes how individuals create situation models based on five dimensions of information: time, space, protagonist, causality, and intentionality. Throughout the process of gaining information, the individual updates the situation models for a text on each of the five dimensions. When events have similar dimensions in common, the events are connected in memory; thus, describing health information with similar dimensions in common (e.g., a protagonist the entire way through the text, events happening in the same amount of time) will be better recalled later. Empirical work on comprehension of both text and video messages has demonstrated the landscape model and event-indexing model’s ability to examine comprehension processes based on the format, language, and organization of the information. Health message design can benefit from utilizing these comprehension models to ensure that knowledge is received by the intended audience and comprehended, and thus able to be used in future experiences.