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Article

Marcel Zeelenberg

Regret is the prototypical decision related emotion. It is felt when the outcome of a non-chosen alternative is better than the outcomes obtained. Regret is a functional emotion that helps people to correct mistakes. It is also functional because people can anticipate regret beforehand, then choose in such a way as to avoid regret from happening. Researchers in economics proposed regret theory, an alternative to rational choice theory, which takes into account the anticipation of regret and its influence in choice. Researchers in psychology studied how anticipations of regret influence decision making in a variety of domains, including health behaviors. The findings suggest that interventions can be developed that are based on the idea that people are regret averse.

Article

Nancy Grant Harrington

The study of persuasive health messages—their design, dissemination, and impact—is ubiquitous in the communication discipline. Words, sounds, and images—alone or in combination—can move people to change their minds and their bodies. Micro-level topics surround questions of message content (argumentation scheme, evidence, qualifying language, and figurative language), structure (message sidedness, standpoint articulation, inoculation, and sequential strategies), and format (channel and audiovisual effects). Macro-level topics in this area include message sensation value, narrative, framing, emotional appeals, and tailoring. Central theoretical frameworks used to guide message design research, include health behavior change theories, information processing theories, and theories/frameworks for message design. In addition, some of the methodoligical issues inherent in message design research are questions of analysis, validity, and measurement. Four streams of past scholarship that inform persuasive health message design research: Greek rhetoric, mass communication research begun during World War II, the development of health communication as a research focus within the communication discipline, and the development of computer and telecommunications technology. Directions and challenges for future research include the need for a clear, coherent, and comprehensive taxonomy to classify message characteristics and attention to several methodological issues.

Article

R. Craig Lefebvre and P. Christopher Palmedo

Many ideas about best practices for risk communication share common ground with social marketing theory and practice: for example, segmentation, formative research, and a focus on behavioral outcomes. Social marketing first developed as a methodology to increase the public health impact of programs and to increase the acceptability and practice of behaviors that improve personal and social well-being. The core concepts of this approach are to be people-centered and to aim for large-scale behavior change. An international consensus definition of social marketing describes it as an integration of theory, evidence, best practices, and insights from people to be served. This integrated approach is used to design programs that are tailored to priority groups’ needs, problems, and aspirations and are responsive to a competitive environment. Key outcomes for social marketing efforts are whether they are effective, efficient, equitable, and sustainable. The 4P social marketing mix of Products, Prices, Places, and Promotion offers both strategic and practical value for risk-communication theory and practice. The addition of products, for example, to communication efforts in risk reduction has been shown to result in significantly greater increases in protective behaviors. The Cover CUNY case demonstrates how full attention to, and consideration of, all elements of the marketing mix can be used to design a comprehensive risk-communication campaign focused on encouraging college student enrollment for health insurance. The second case, from the drug safety communication arena, shows how a systems-level, marketplace approach is used to develop strategies that focus on key areas where marketplace failures undermine optimal information-dissemination efforts and how they might be addressed.

Article

The Transtheoretical Model (TTM) is an integrative health behavior change theory that describes the process of how people change their behavior. The central organizing construct in the theory is stages of change, which are five distinct stages of readiness to change behavior, ranging from not ready to change (precontemplation), thinking about change (contemplation), preparing to change (preparation), changing (action), and maintaining the change (maintenance). Movement through the stages may be nonlinear, and cycling and recycling through the stages is viewed as a natural part of the change process. Other model constructs explain what drives individuals forward through the stages of change. Decisional balance involves a weighing of pros and cons of changing behavior, while self-efficacy involves situation-specific confidence that one can change. Increases in pros, deceases in cons, and increases in self-efficacy propel people forward through the stages of change. The processes of change are experiential and behavioral strategies that people use to change their behavior. In early stages of change, people use experiential strategies while they use behaviorally oriented strategies in later stages of change. The TTM holds significant implications for message design. Most notably, messages should be targeted and tailored to stages of change, and where possible, to other model variables as well. Studies indicate that the TTM has been successfully applied to health communication campaigns, and to a larger extent, to computer-tailored interventions to change health behavior. Meta-analyses indicate that scores of computer-tailored interventions have been efficacious, including many based upon the TTM and stages of change. New applications of the model include a focus on novel health behaviors, multiple behavior change, and advancing an understanding of message design in the context of the TTM in combination with other theoretical approaches.

Article

In today’s saturated media environment, it is incumbent for designers of health education materials to find more effective and efficient ways of capturing the attention of the public, particularly when the intent is to influence individual behavior change. Tailoring is a message design strategy that has been shown to amplify the effectiveness of health messages at an individual level. It is a data-driven and theory-informed strategy for crafting a message using knowledge of various factors that might influence the individual’s responsiveness to the message, such as their information needs, beliefs, motivations, and health behaviors. It also enhances the persuasiveness of a message by increasing its perceived relevance, drawing attention to the message, and encouraging deeper elaboration of the information. Tailoring content based on known antecedents of the intended behavioral outcomes has been shown to enhance tailoring effectiveness. Compared to generic messages, tailored messages are perceived to be more personally relevant, command greater attention, are recalled more readily, and encourage more positive evaluations of the information overall. Various meta-analyses have demonstrated the effectiveness of tailored interventions promoting a number of health behaviors, such as smoking cessation, healthy diet and nutrition, physical activity, and regular recommended health screenings. Advances in information and communication technologies have led to more sophisticated, multimodal tailored interventions with improved reach, and more powerful expert systems and data analysis models. Web technologies have made it possible to scale the production and delivery of tailored messages to multiple individuals at relatively low cost and to improve access to expert feedback, particularly among hard-to-reach population groups.

Article

Suruchi Sood, Amy Henderson Riley, and Kristine Cecile Alarcon

Entertainment-education (EE) began as a communication approach that uses both entertainment and education to engender individual and social change, but is emerging as a distinct theoretical, practice, and evidence-based communication subdiscipline. EE has roots in oral and performing arts traditions spanning thousands of years, such as morality tales, religious storytelling, and the spoken word. Modern-day EE, meanwhile, is produced in both fiction and nonfiction designs that include many formats: local street theater, music, puppetry, games, radio, television, and social media. A classic successful example of EE is the children’s television program Sesame Street, which is broadcast in over 120 countries. EE, however, is a strategy that has been successfully planned, implemented, and evaluated in countries around the world for children and adults alike. EE scholarship has traditionally focused on asking, “Does it work?” but more recent theorizing and research is moving toward understanding how EE works, drawing from multidisciplinary theories. From a research standpoint, such scholarship has increasingly showcased a wide range of methodologies. The result of these transformations is that EE is becoming an area of study, or subdiscipline, backed by an entire body of theory, practice, and evidence. The theoretical underpinnings, practice components, and evidence base from EE may be surveyed via the peer-reviewed literature published over the past 10 years. However, extensive work in social change from EE projects around the world has not all made it into the published literature. EE historically began as a communication approach, one tool in the communication toolbox. Over time, the nascent approach became its own full-fledged strategy focused on individual change. Backed by emerging technologies, innovative examples from around the globe, and new variations in implementation, it becomes clear that the field of EE is emerging into a discrete theoretical, practice, and evidence-based subdiscipline within communication that increasingly recognizes the inherent role of individuals, families, communities, organizations, and policies on improving the conditions needed for lasting social change.

Article

Jada G. Hamilton, Jennifer L. Hay, and Colleen M. McBride

It was expected that personalized risk information generated by genetic discovery would motivate risk-reducing behaviors. However, though research in this field is relatively limited, most studies have found no evidence of strong negative nor positive psychological or behavioral influences of providing genetic information to improve individual health behaviors. As noted by systematic reviews and agenda-setting commentaries, these null findings may be due to numerous weaknesses in the research approaches taken to date. These include issues related to study samples and design, as well as the motivational potency of risk communications. Moreover, agenda-setting commentaries have suggested areas for improvement, calling for expanded consideration of health outcomes beyond health behaviors to include information exchange and information-seeking outcomes and to consider these influences at the interpersonal and population levels. A new generation of research is adopting these recommendations. For example, there is a growing number of studies that are using communication theory to inform the selection of potential moderating factors and their effects on outcomes in understanding interpersonal effects of shared genetic risk. Researchers are taking advantage of natural social experiments to assess the general public’s understanding of genetics and inform approaches to improve their facility with the information. Additionally, there are examples of risk communication approaches addressing the complexity of genetic and environmental contributors to health outcomes. Although the pace of this translation research continues to lag behind genetic discovery research, there are numerous opportunities for future communications research to consider how emerging genomic discovery might be applied in the context of health promotion and disease prevention.

Article

Self-efficacy is the personal belief in one’s ability to meet a goal or perform a specific task. Although it can be applied to any type of human endeavor, the construct of self-efficacy is thought to be central to changing behaviors to improve health outcomes. For this reason, message designers have been attempting to understand how messages detract from or enhance self-efficacy. Persuasive messages have and can be used to enhance perceived self-efficacy related to health and risk behavior. Self-efficacy-strengthening messages and interventions in health promotion can be assessed in general or specfically in regards to fear appeals. Other aspects of self-efficacy interventions include collective efficacy and professional self-efficacy.

Article

Public service announcements (PSAs) emerged after World War II in the United States as a promising strategy for increasing awareness of important social issues and changing beliefs, attitudes, and behavior. Research at that time showed that PSA campaigns had limited success in changing attitudes and behavior. Even so, both in the U.S. and internationally, sponsoring agencies and organizations continued to produce PSAs, hoping they would create significant behavior change. In the 1980s, a more informed view of what PSAs can achieve began to emerge as practitioners of social marketing demonstrated that media campaigns can produce behavior change when they are designed and executed according to the principles and best practices followed by the advertising industry. Beginning in the 1990s, PSA-based campaigns to promote public action through programs and policy change became more common. Research has shown that such campaigns can play a key role in shaping the public agenda, changing perceptions of social norms, reinforcing school- and community-based programs, and building support for and then publicizing changes in public policy, all of which can foster individual behavior change. PSAs and other media executions are best designed using a planning scheme that is grounded in advertising best practices and behavior change theory and that uses those media executions as part of a broader intervention effort. These various elements can be brought together by using a media planning guide that outlines how the campaign will work in sync with other intervention activities and what its key messages will be. In the United States, federal regulations that outlined broadcasters’ public service obligations were loosened in the 1980s, making it increasingly difficult to get donated time for PSAs and other public service messages. More broadly, the increased focus of broadcasters, cable networks, and print publications on generating revenue has magnified this problem. Faced with strong competition, campaign planners need a strategy for convincing media gatekeepers to give priority to their messaging. The rise of social media (e.g., Facebook, Instagram, Twitter) has opened up a new means of putting PSAs before the public. For example, once a message is posted on a video-sharing website such as YouTube, it can be linked to the sponsoring organization’s website, where additional intervention-related material can be found, as well as to websites hosted by other groups. Promotional efforts through national, state, and community organizations can draw an initial audience, with the hope that they will share the link with their social media and email contacts and that eventually the message will “go viral.” PSAs remain a viable media alternative for public communication campaigns, despite the fact that major media outlets do not often provide donated time or space for such advertising. In some cases, a PSA-driven campaign will be supported by a large budget, but while such campaigns have a better chance of success, the resources required are seldom available. The emergence of social media has created a new way to build an audience. Successful examples of social media campaigns are emerging, but why some campaigns take off and others do not requires additional study.

Article

Whether viewed as a domain-specific behavior or as an enduring tendency, procrastination is a common form of self-regulation failure that is increasingly recognized as having implications for health-related outcomes. Central to procrastination is the prioritization of reducing immediate negative mood at the cost of decisions and actions that provide long-term rewards, such as engaging in health behaviors. Because people tend to procrastinate on tasks they find difficult, unpleasant, or challenging, many health-promoting behaviors are possible candidates for procrastination. As modifiable risk factors for the prevention of disease and disability, health behaviors are often the target of health risk communications aimed at health behavior change and reducing health procrastination. Research has consistently demonstrated the deleterious effects of chronic procrastination on health outcomes, including poor physical health, fewer health promoting behaviors, and higher stress in healthy adults and those already living with a chronic health condition. Examining the factors and psychological characteristics associated with chronic procrastination can provide insights into the processes involved in procrastination more generally, as well as the qualities of the health messages that can promote or prevent procrastination of the targeted behaviors. Low future orientation, avoidant coping, low tolerance for negative emotions, and low self-efficacy need to be considered when designing effective health risk communications to reduce procrastination of health behaviors. Yet, health risk communications aimed at reducing procrastination of important health behaviors such as healthy eating, regular physical activity, screening behaviors, and cessation of risky health behaviors often use fear appeals to motivate taking protective actions to reduce health risks. Such approaches may not be effective because they amplify the negative feelings towards the health behaviors, which can engender maladaptive coping responses and motivate procrastination rather than adaptive responding. This is especially likely among individuals prone to procrastination more generally, or specifically with respect to health. Health risk communication approaches that minimize the negative emotions associated with risk messages and instead highlight short-term benefits of engaging in health behaviors may be necessary to reduce further health behavior procrastination among individuals prone to this form of self-regulation failure.

Article

Mengfei Guan and Jennifer L. Monahan

Positive emotional appeals can be an important, if often underutilized, component in health campaigns. Research reviewed from advertising, marketing, health communication, and social influence demonstrated how campaigns can promote risk-reduction behaviors by focusing on positive incentives, highlighting positive outcomes, and evoking positive feelings toward the health-related behavior. People who feel good during and after exposure to a health message tend to have favorable attitudes toward the message, which in turn establishes more open, rather than resistant, attitudes toward the issue or risk-reduction behavior promoted in the message. Along with influencing behavior via attitudes, positive affect can have a direct impact on behavior or intention. As suggested by broaden-and-build theory, positive affect broadens attention and thinking processes, increases openness to information, and helps form beliefs that the behavioral change promoted in the message is possible. Relatedly, positive affect tends to activate approach-oriented behaviors through the function of the behavioral activation system. Two primary strategies have demonstrated efficacy at promoting positive feelings: the use of gain-framed appeals and evoking the core relational theme of happiness. Gain-framed appeals emphasize the rewards obtained by following message recommendations and can boost behavioral adoption, particularly of proscriptive behaviors, by highlighting positive outcomes and goal congruency. Happiness occurs when people believe they are making progress toward realizing their goals, and messages can be created to induce positive feelings like happiness by focusing on self-efficacy, response efficacy, and perceived benefits. Positive message appeals are especially useful for counteracting the potential drawbacks of traditional negative appeals in that they can reduce message fatigue, gain attention, and attenuate psychological reactance. Challenges for future research include increasing efforts to systematically understand how and when to best utilize the power of positive messages in campaigns. Another related challenge is to examine how positive affect is aroused at a particular stage of exposure to health risk messages, and how emotions (both negative and positive), flow, evolve, and transit from one to another (e.g., fear to relief, anxiety to happiness) during and after message exposure.

Article

Health and risk message design theories do not currently incorporate a lifespan view of communication. The lifespan communication perspective can therefore advance theorizing in this area by considering how the fundamental developmental differences that exist within and around individuals of different ages impact the effectiveness of persuasive message strategies. Designing health messages for older adults therefore requires an examination of how theoretical frameworks used in health and risk message design can be adapted to be age sensitive and to effectively target older adults. Additionally, older adults often make health decisions in conjunction with informal caregivers, including their adult children or spouses, and/or formal caregivers. Message design scholars should thus also consider this interdependent influence on health behaviors in older adults. Strategic messages targeting these caregivers can appeal to, for example, a caregiver’s perception of responsibility to care for the older adult. These messages can also be designed to not only promote the older adults’ health but also to alleviate caregiver stress and burden. Importantly, there is an unfounded stereotype that all older adults are alike, and message designers should consider the most beneficial segments of the older adult audience to target.