Jari Lyytimäki and Timo Assmuth
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.
A Case Study of Sesame Workshop’s Cleaner, Happier, Healthier Intervention in Bangladesh, India, and Nigeria: Reporting on Exposure and Impact
Dina L. G. Borzekowski
The Cleaner, Happier, Healthier hygiene intervention was developed and tested in 2013, featuring the Sesame Workshop characters. Through broadcast television, four public service announcements (PSAs) addressed washing hands with soap, using a latrine, wearing sandals, and drinking clean water. The main audiences were young preschool children and their parents or guardians.
Research occurred in Bangladesh, India, and Nigeria, exploring the reach and impact of these PSAs. Although low percentages, from well-drawn samples of extremely vulnerable populations in these countries, reported awareness and recall of these messages, such percentages can reflect large numbers of viewers. Considering data from the participating children, measures of knowledge and attitudes were associated with engaging in several of the behavioral outcomes. As well, awareness and recall of the PSA messages predicted “all the time” for several of the hygiene behaviors. In contrast, parents’ reports of PSA awareness and recall were not associated with reports of children’s hygiene behaviors.
Conducting reach studies is extremely difficult, especially in developing countries and communities. Despite the challenges, this study is encouraging. Participants reported seeing the messages, and in several models, this “reach” predicted reports of hygiene and health behaviors. Lessons learned from this case study and research can offer valuable insight into the production of future health PSAs, especially with harder-to-reach populations.
Matthew W. Savage, Sarah E. Jones, Jenna E. Reno, and Shari Veil
University students, faculty, and staff are among those most vulnerable to cybersecurity risks due to their reliance on modern technologies, the nature of their online activities, and the open infrastructure of institutional networks. Furthermore, cyberbullying has emerged as a public health concern by the Centers for Disease Control and Prevention (CDC), which first warned of electronic aggression in 2008, or any type of harassment or bullying that occurs via email, chat, instant messaging, websites, blogs, or text messaging. Roberto and Eden emphasized the communicative nature of cyberbullying, defining it as the “deliberate and repeated misuse of communication technology by an individual or group to threaten or harm others” in 2010 (p. 201). In response to serious cybersecurity concerns and growing evidence of cyberbullying behavior, the national Stop.Think.Connect. (STC) campaign was developed to educate Americans on cybersecurity risks and equip citizens with tools for safe, respectful, and appropriate online behavior; however, it lacks targeted messaging for those on university campuses. Formative research is needed to ascertain the specific cybersecurity risks and challenges identified by those living and working on large university campuses. Research by Noar in 2006 demonstrates that formative evaluation leads to more successful campaigns. The process involves learning about target populations, discovering communicative determinants of behavior change, and testing message concepts. To that end, this case study is a first step in targeting STC campaign messages to university students, faculty, and staff. Specifically, we sought to identify the distinct cybersecurity needs faced by university students and personnel, their perceptions of the saliency of the problem, and potential motives for increasing their cybersecurity-enhancing behaviors. These activities are needed to implement the campaign on college campuses and to increase the likelihood of any future outcome evaluation efforts that yield evidence of campaign effectiveness. Currently, we are unaware of any outcome evaluation.
Focus group methodology was conducted to examine the target audiences’ knowledge, interests, needs, and attitudes regarding the management of cybersecurity threats. Additionally, practical recommendations for enhancing STC campaign implementation on university campuses were ascertained. Results emphasized key ways to improve the theoretical underpinnings of the campaign using the Integrated Behavioral Model (IBM). We identified how determinants of behavior change can be utilized to strengthen campaign messaging. Students displayed laissez-faire attitudes toward cybersecurity, while faculty and staff attitudes demonstrated a much higher level of concern. Social norms for personal cybersecurity action taking were notably low among students as well as faculty and staff. Students displayed limited personal agency in regards to enacting cybersecurity measures, while faculty and staff had greater knowledge of steps they could take, but little faith that these actions would be efficacious. Finally, thematic recommendations for implementing an effective cybersecurity campaign on a university campus were identified.
Kathryn Greene, Smita C. Banerjee, Anne E. Ray, and Michael L. Hecht
Results of national epidemiologic surveys indicate that substance use rates among adolescents remain relatively steady or even show slight declines; however, some substance use rates, such as electronic cigarettes, are actually rising. Thus, the need for efficacious drug prevention efforts in the United States remains high. Active Involvement (AI) interventions are a promising avenue for preventing and reducing adolescent substance use, and they create opportunities for adolescents to experience a core feature of engagement that is common to these interventions, such as producing videos, posters, or radio ads; or generating themes and images for messages such as posters.
Existing interventions grounded in theories of Active Involvement include programs delivered face-to-face and via e-learning platforms. Narrative Engagement Theory and the Theory of Active Involvement guide the components of change in AI interventions. Youth develop message content during participation in Active Involvement interventions. Advanced analytic models can be applied to address new research questions related to the measure of components of AI interventions.
Kelly Haskard-Zolnierek and Teresa L. Thompson
Patient adherence (sometimes referred to as patient compliance) is the extent to which a patient’s health behavior corresponds with the agreed-upon recommendations of the healthcare provider. The term patient compliance is generally synonymous with adherence but suggests that the patient played a more passive role in the healthcare professional’s prescription of treatment, whereas the term adherence suggests that the patient and healthcare professional have come to an agreement on the regimen through a collaborative, shared decision-making process. Another term related to the concept of adherence is persistence (i.e., taking a medication for the recommended duration). Some patients are purposefully or intentionally nonadherent, whereas others are unintentionally nonadherent due to forgetfulness or poor understanding of the regimen. Patients may be intentionally nonadherent because of a belief that the costs of the regimen outweigh the benefits, for example. Nonadherence behaviors in medication-taking include never filling a prescription, taking too much or too little medication, or taking a medication at incorrect time intervals. Patient adherence is relevant not only in medication-taking behaviors, but also in health behaviors such as following a specific dietary regimen, maintaining an exercise program, attending follow-up appointments, getting recommended screenings or immunizations, and smoking cessation, among others.
There are a number of factors that predict patient adherence to treatment, but the relationship between provider-patient communication and adherence to treatment will be stressed here. Focusing on recent research, this article examines the concept of patient adherence, describes how provider-patient communication can enhance patient adherence, explains what elements of communication are relevant for adherence, and illustrates how interventions to improve communication can improve adherence.
Michael Mackert and Marie Guadagno
Advertising as a field and industry often has a contentious relationship with both health communication and public health due to legitimate concerns about how advertising for certain products, such as alcohol and tobacco, could contribute to less-healthy decisions and behaviors. While acknowledging such concerns, advertisers and their approach to solving communication problems could also provide valuable lessons to those working in health communication. Indeed, advertising agencies are designed to develop creative and effective messages that change consumer behavior—and health communication practitioners and scholars aim to change population-level behavior as well. The perspective and approach of the account planner in the advertising agency—a role whose chief responsibility is to bring the consumer perspective into every step of the advertising development process and inspire effective and creative campaigns—would be particularly valuable to those working in health communication. It was account planning work that shifted traditional milk advertising from promoting it as a healthy drink to the iconic “got milk?” campaign, which positioned milk as a complement that makes other food better—an approach that drove positive sales after years of declining milk consumption. Yet many who work in health communication and public health often know little of how advertising agencies work or their internal processes that might be productively adopted. This lack of understanding can also lead to misperceptions of advertisers’ work and intentions. As an example, one might assume dense medical language in prescription drug advertising is intended to add unnecessary complexity to the advertisements and obscure side effects; instead, advertising professionals who work on prescription drug advertising have often been trained on clear communication—but cannot fully utilize that training because of regulations that require medically accurate terminology that might not be comprehensible to most viewers. Improved understanding of how advertisers can act as agents of change, and increased dialogue between the fields of advertising and health communication, could contribute to improved health communication research, practice, and policy.
Jen Ptacek, Kirstin N. Dolick, and Marifran Mattson
Advocacy can be defined as the systematic process set in motion by an individual or group of individuals to encourage, support, and empower others surrounding a topic in need of change. Individuals may become an advocacy group in support of an issue, such as health care, civil rights, environment, or labor. Advocacy groups often serve as mediators between vulnerable/underprivileged populations and policymakers or decision-makers. The Health Communication Advocacy Model (HCAM) is a tested advocacy model comprising five phases including assembling the team, formative research, message development, message implementation, and evaluation. HCAM also includes a correction loop allowing for revisions of campaign messages. The HCAM is an adaptable model that offers a perspective in which advocacy groups may be considered a dynamic framework for building successful campaigns. Once the advocacy group is established, members can agree upon goals and responsibilities and craft a position statement. The group can then develop messages to reach the intended target audience(s). Target audiences may include legislators, the population affected by the issue, and media organizations. When crafting messages, care should be taken to ensure messages are stimulating, motivational, culturally consistent, resource contingent, and without barriers. Advocacy groups may use a number of channels to send messages through, such as social media, rallies, press releases, and other media outlets. Overall, advocacy groups must address a variety of needs to effectively reach the target audiences and impact change.
Karyn Ogata Jones
Since McCombs and Shaw first introduced the theory in 1972, agenda setting has emerged as one of the most influential perspectives in the study of the effects of mass media. Broadly defined, “agenda setting” refers to the ability of mass media sources to identify the most salient topics, thereby “setting the agendas” for audiences. In telling us what to think about, then, mass media sources are perceived to play an influential role in determining priorities related to policies, values, and knowledge on a given topic or issue.
Scholars have studied this phenomenon according to both object (issue) salience and attribute salience and along aggregate and individual audience responses. The audience characteristics of need for orientation, uncertainty, relevance, and involvement are advanced as moderating and predicting agenda-setting effects. When agenda-setting theory is applied to the study of messaging related to health and risk communication, scholars have reviewed and identified common themes and topics that generally include media’s role in educating and informing the public about specific health conditions as well as public health priorities and administrative policies.
Agenda setting is often examined in terms of measuring mass media effects on audiences. Looking at interpersonal communication, such as that coming from medical providers, opinion leaders, or peer networks, in studies will allow research to examine the combined effects of interpersonal and mass communication. Testing possible interactions among differing sources of information along with assessment of issue and attribute salience among audiences according to an agenda-setting framework serves to document audience trends and lived experiences with regard to mass media, health, and risk communication.
The concept of ambiguity tolerance (TA), variously called Uncertainty Avoidance, Ambiguity Avoidance, or Intolerance, can be traced back nearly 70 years. It has been investigated by many different types of researchers from clinical and differential, to neuro- and work psychologists. Each sub-discipline has tended to focus on how their variable relates to beliefs and behaviors in their area of expertise, from religious beliefs to reactions to novel products and situations.
The basic concept is that people may be understood on a dimension that refers to their discomfort with, and hence attempts to avoid, ambiguity or uncertainty in many aspects of their lives. There have been many attempts to devise robust and valid measures of this dimension, most of which are highly inter-correlated and require self-reporting. There remains a debate as to whether it is useful having just one or more dimensions/facets of the concept.
Using these tests, there have been many correlational studies that have sought to validate the measure by looking at how those high and low on this dimension react to different situations. There have also been some, but many fewer, experimental studies, which have tested very specific hypotheses about how TA is related to information processing and reactions to specific stimuli. There is now a welcomed interest by neuroscientists to explore the concept from their perspective and using their methodologies.
These studies have been piecemeal, though most have supported the tested hypotheses. There has been less theoretical development, however, of the concept attempting to explain how these beliefs arise, what sustains them, and how, why, and when they may change. However, the concept has continued to interest researchers from many backgrounds, which attests to its applicability, fecundity, and novelty.
Claude H. Miller and Reinaldo Cortes Quantip
Within a range of health communication contexts, anger can be either a detriment to the receptivity of health promotion messages when poorly controlled, or a benefit to information processing when appropriately directed. In the former case, anger can disrupt cognitive processing, leading to a range of negative outcomes, including emotional turbulence and a preoccupation with anger-eliciting events that can severely limit the receptivity of health promotion and risk prevention messages. However, when properly directed and elicited in moderation, anger can motivate greater purpose and resolve in response to health threats, stimulate more active processing of health warnings, sharpen focus on argument quality, and direct greater attention to coping-relevant information concerning harmful health risks.