Speaking of Health Assessing Health Communication Strategies for Diverse Populations (2002) / Chapter Skim
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28 2 Theory This chapter synthesizes the main theories of communication and behavior change, including media advocacy and the diffusion of innovations, as they apply to health behavior change by diverse populations in the United States. Our perspective is restricted to those elements that appear to be most relevant to modifying a person's health-directed activities through communication.
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Theory 29 Perhaps the most critical determinant of whether a person does or does not perform a given behavior is the person's beliefs about performing that behavior. Thus, behavioral theory, when properly applied, allows one to identify the beliefs that should be changed or reinforced to influence a given behavior change in a given population.
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30 SPEAKING OF HEALTH sage content. If one's friends respond to an antismoking or a dental hygiene message with anger or derision, the context may be converted into one of resistance rather than careful processing and possible acceptance of the message content.
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Theory 31 • Theory of Subjective Culture and Interpersonal Relations (e.g., Triandis, 1972) ; • Transtheoretical Model of Behavior Change (Prochaska and DiClemente, 1983, 1986, 1992; Prochaska, DiClemente, and Norcross, 1992; Prochaska et al., 1994)
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32 SPEAKING OF HEALTH straints (or barriers) that impede or prevent behavioral performance.
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Theory 33 tion perspective, it is important to know whether and why people do or do not hold a given intention. Behavioral change theories suggest that only a limited number of variables directly influence the strength of intentions.
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34 SPEAKING OF HEALTH havior will be painful"; "will be expensive"; "will make my partner angry") or prevent positive consequences (e.g., "will not make me feel better"; "will not make me healthy")
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Theory 35 Personal Agency Agency is a belief that one has the necessary skills and abilities to perform the behavior in question. Two types of considerations underlie a person's sense of personal agency.
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36 SPEAKING OF HEALTH perspective, knowledge that another person "X" thinks one should not perform a given behavior will only influence performance of that behavior if this normative belief leads to an outcome expectancy, such as "My performing this behavior will make person X angry." Despite these differences, and regardless of the exact theoretical model one adopts, communication interventions to change health behavior should increase skills, remove or help individuals overcome environmental constraints, or change intention (by changing attitudes, norms, or a sense of personal agency; i.e., by changing the factors that directly or indirectly influence intention and behavior)
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Theory 37 not have a sense of personal agency or self-efficacy with respect to performing that behavior)
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38 SPEAKING OF HEALTH of getting a mammogram may be very different from those associated with taking a PSA test (a blood test for detecting prostate cancer) , or getting genetic screening.
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Theory 39 afraid that they may have, breast cancer, may have beliefs about "My getting a mammogram" that are very different from women who do not believe they are at risk. Thus, factors that may influence one's beliefs include perceived risk; moods and emotions as well as personality, culture, knowledge, and attitudes toward objects or institutions; and stigma.
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40 SPEAKING OF HEALTH vaccination is determined primarily by the outcome expectancy (or behavioral belief) that "My getting a flu shot will protect me from getting the flu." Assume that those who intended to get (or who actually got)
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Theory 41 However, one must ask whether one should try to increase perceived risk, or if one should use the information that perceived risk is related to the target belief to develop a message directed at changing the target belief per se. From a behavior theory perspective, if the distal variable cannot be shown to be causally related to the target belief, this latter strategy is more likely to increase the likelihood that members of the target audience will intend to get (and actually will get)
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42 SPEAKING OF HEALTH havior, while attitudes, norms, and self-efficacy are viewed as the primary determinants of intention. These three determinants of intention are themselves determined by underlying behavioral, normative, and efficacy beliefs.
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Theory 43 distal variables also may be important, but these variables have, at best, an indirect influence on behavior change, depending on whether they do or do not influence underlying beliefs. Figure 21 implies that changing health behavior ultimately will depend on changing behavioral, normative, or efficacy beliefs.
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44 SPEAKING OF HEALTH The selection of a target behavior depends on many factors. First and foremost, sound epidemiological evidence should link that behavior to a given health outcome.
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Theory 45 tween those who do or do not (intend to) perform the behavior.
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46 SPEAKING OF HEALTH nication, directly or indirectly, address the question of "Who says what to whom, through what channel, with what effect? " This single framework, suggested by Harold Lasswell in 1939, often has been criticized because it has been interpreted as focusing all attention on the efforts of the communicator.
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Theory 47 For example, a nutrition campaign intended for Hispanics and non-Hispanic whites from the Southwestern United States may choose to further segment by age, but select the age groupings differently for the two ethnic groups, based on differences in lifestyle factors. Young, single whites not living with their parents may be a separate segment requiring specific health communication messages, while young Hispanics, who are more likely to live with their parents, may receive a nutrition message that is similar to the one developed for their parents.
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48 SPEAKING OF HEALTH havior. As indicated earlier, the most effective messages are those designed to change one or more well-defined behaviors.
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Theory 49 tion (or other type of intervention)
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50 SPEAKING OF HEALTH tremely likely") could influence their intentions (and behavior)
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Theory 51 strengthen the association between these variables and intentions (or behavior)
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52 SPEAKING OF HEALTH refute counterarguments) are usually more effective than one-sided messages (Hovland, Janis, and Kelley, 1953; Hovland, Lumsdaine, and Sheffield, 1949; Allen, 1998)
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Theory 53 2. Contemplation, where the individual has formed an intention to perform the new behavior sometime in the future, but has not yet done so.
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54 SPEAKING OF HEALTH intentions. Thus, it becomes important to design messages that take into account what stage people are in during the process of change.
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Theory 55 lations will relate to, and be more or less influenced by, different messengers. The appropriate messenger may vary with the health issue of focus, the characteristics of the intended audience, and the purpose and style of the message.
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56 SPEAKING OF HEALTH be communicated most effectively by authority figures or representatives of law enforcement agencies. Generally speaking, the most effective communication sources are those that are viewed as trustworthy and as having expertise in the relevant behavioral domain (Eagley and Chaiken, 1993)
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Theory 57 songs; dramatic presentations; community events; point-of-purchase materials; and the Internet (Weinreich, 1999)
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58 SPEAKING OF HEALTH show program for a message about domestic violence, but the nature of the talk show, which may be sympathetic to the message but whose primary purpose is attracting audiences, will affect the final shape of the message. A health communication campaign that depends on "free" exposure is forced to use channels over which it has less control.
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Theory 59 nels (and sources) may also be in conflict.
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60 SPEAKING OF HEALTH sports programs. Some messages are distributed through social networks, generating "buzz," while other messages do not attract such social multiplication.
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Theory 61 diverse channels may convey the meta-message that society cares about this health issue. Similarly, repeated exposure to a message in multiple channels may increase the probability of interpersonal discussion of the message, further multiplying exposure and diffusion of a communication message.
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62 SPEAKING OF HEALTH consequences, so they form more negative attitudes and intentions and therefore are less likely to try marijuana. This new knowledge is assumed to have immediate consequences on their beliefs and behaviors.
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Theory 63 5. Institutional diffusion.
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64 SPEAKING OF HEALTH The diffusion model focuses attention on the social process surrounding health communication interventions. Messages may not only persuade individuals directly, but also stimulate interpersonal discussion about health behavior change.
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Theory 65 leadership groups, public health and social advocates, and public health researchers (Wallack et al., 1993; Wallack et al., 1999)
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66 SPEAKING OF HEALTH the focus is on elaborating policy options; identifying the person, group, or organization with the power to create the necessary change; and identifying organizations that can apply pressure to advance the policy and create change. (For example, in Oakland, California, various elements of the community were organized to apply pressure on the zoning commission, mayor's office, city council, and state legislature, which were all targets at various points in the campaign.)
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Theory 67 is properly implemented. Thus, it is important to develop strategies to maintain the media spotlight on the policy issue on a continuing basis.
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68 SPEAKING OF HEALTH 34 percent; and (5) laggards -- the last 16 percent of the individuals in a system to adopt an innovation.
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Theory 69 utilized by another. Moreover, production values and formats in communication messages that positively appeal to one population may be viewed as unpleasant or boring by another.
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70 SPEAKING OF HEALTH spective of the particular population with whom they are dealing. That is, they need to know whether, in that population, a given health behavior is controlled by attitudes, perceived norms, or issues of personal agency.
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Theory 71 ommended action outweigh the perceived barriers to (and/or costs of) performing the preventive action.
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72 SPEAKING OF HEALTH In effecting large-scale change, communication systems operate through two pathways (Bandura, 2002a)
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Theory 73 Taken together, these three theories identify a limited number of variables that serve as determinants of any given health behavior change. All or some of these variables are found in nearly all other behavioral theories (e.g., the Information, Motivation, Behavioral Skills Model, Prochaska's Stages of Change Model)
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74 SPEAKING OF HEALTH name of the disease and the symptoms identifying its presence, likely duration and time of onset, cause, consequences (physical, social, economic) , and controllability)
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Theory 75 amplify or reduce fear associated with health threats and treatment procedures (Leventhal, Robitaille and Hudson, 1997)
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