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.
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.
Bradford William Hesse
The presence of large-scale data systems can be felt, consciously or not, in almost every facet of modern life, whether through the simple act of selecting travel options online, purchasing products from online retailers, or navigating through the streets of an unfamiliar neighborhood using global positioning system (GPS) mapping. These systems operate through the momentum of big data, a term introduced by data scientists to describe a data-rich environment enabled by a superconvergence of advanced computer-processing speeds and storage capacities; advanced connectivity between people and devices through the Internet; the ubiquity of smart, mobile devices and wireless sensors; and the creation of accelerated data flows among systems in the global economy. Some researchers have suggested that big data represents the so-called fourth paradigm in science, wherein the first paradigm was marked by the evolution of the experimental method, the second was brought about by the maturation of theory, the third was marked by an evolution of statistical methodology as enabled by computational technology, while the fourth extended the benefits of the first three, but also enabled the application of novel machine-learning approaches to an evidence stream that exists in high volume, high velocity, high variety, and differing levels of veracity.
In public health and medicine, the emergence of big data capabilities has followed naturally from the expansion of data streams from genome sequencing, protein identification, environmental surveillance, and passive patient sensing. In 2001, the National Committee on Vital and Health Statistics published a road map for connecting these evidence streams to each other through a national health information infrastructure. Since then, the road map has spurred national investments in electronic health records (EHRs) and motivated the integration of public surveillance data into analytic platforms for health situational awareness. More recently, the boom in consumer-oriented mobile applications and wireless medical sensing devices has opened up the possibility for mining new data flows directly from altruistic patients. In the broader public communication sphere, the ability to mine the digital traces of conversation on social media presents an opportunity to apply advanced machine learning algorithms as a way of tracking the diffusion of risk communication messages. In addition to utilizing big data for improving the scientific knowledge base in risk communication, there will be a need for health communication scientists and practitioners to work as part of interdisciplinary teams to improve the interfaces to these data for professionals and the public. Too much data, presented in disorganized ways, can lead to what some have referred to as “data smog.” Much work will be needed for understanding how to turn big data into knowledge, and just as important, how to turn data-informed knowledge into action.
Janice L. Krieger and Jordan M. Neil
Strategic communication is an essential component in the science and practice of recruiting participants to clinical research studies. Unfortunately, many clinical research studies do not consider the role of communication in the recruitment process until efforts to enroll patients in a timely manner have failed. The field of communication is rich with theory and research that can inform the development of an effective recruitment plan from the inception of a clinical research study through informed consent. The recruitment context is distinct from many other health contexts in that there is often not a behavioral response that can be universally promoted to patients. The appropriateness of a clinical research study for an individual is based on a number of medical, psychological, and contextual factors, making it impossible to recommend that everyone who is eligible for a clinical research study enroll. Instead, clinical research study recruitment efforts must utilize strategic communication principles to ensure that messages promote awareness of clinical research, maximize personal relevance, minimize information overload, and facilitate informed choice. This can be accomplished through careful consideration of various aspects of the communication context described in this chapter, including audience segmentation, message content, message channels, and formative, process, and outcome evaluation, as well as the enrollment encounter.
A community of practice (CoP) situated in a health and risk context is an approach to collaboration among members that promotes learning and development. In a CoP, individuals come together virtually or physically and coalesce around a common purpose. CoPs are defined by knowledge, rather than task, and encourage novices and experienced practitioners to work together to co-create and embed sustainable outputs that impact on theory and practice development. As a result, CoPs provide an innovative approach to incorporating evidence-based research associated with health and risk into systems and organizations aligned with public well-being.
CoPs provide a framework for constructing authentic and collaborative learning. Jeanne Lave and Etienne Wenger are credited with the original description of a CoP as an approach to learning that encompasses elements of identity, situation, and active participation. CoPs blend a constructivist view of learning, where meaningful experience is set in the context of “self” and the relationship of “self” with the wider professional community. The result is an integrated approach to learning and development achieved through a combination of social engagement and collaborative working in an authentic practice environment. CoPs therefore provide a strategic approach to acknowledging cultural differences related to translating health and risk theory into practice.
In health and risk settings, CoPs situate and blend theory and practice to create a portal for practitioners to generate, shape, test, and evaluate new ideas and innovations. Membership of a CoP supports the development of professional identity within a wider professional sphere and may support community members to attain long range goals.
Mohan Jyoti Dutta, Satveer Kaur-Gill, and Naomi Tan
Cultivation theory examines the effects of the media, mainly television on viewer perception over an extended period of time. Television is seen by people throughout the globe, with many spending considerable amounts of time watching the medium. The act of watching television has been described as the first leisure activity to cut across social and ethnic divisions in society. This made it a unique mass media tool because mass message dissemination to diverse groups in a population was made possible. Cultivation scholars have studied the effects of the medium, trying to understand how television content can alter one’s social reality. Heavy viewers are considered to be most susceptible to the effects of cultivation. The reality of these effects poses important questions for health communication scholars considering the role television plays in disseminating health messages. Health communication scholars became interested in studying cultivation to understand the health-related effects the medium could have on viewers. Understanding the health effects of television is pivotal, considering that television and the structures that constitute television content set the agendas for many health topics, often disseminating negative and positive messages that can impact society, especially the young and impressionable. With television content addressing health issues such as nutrition, diet, body image, tobacco, cancer, drugs, obesity, and women’s health, cultivation theory can offer health communication scholars a framework to understand how health behaviors are shaped by the mass media and the roles these media play in reinforcing unhealthy behaviors. By establishing a basis for studying how such portrayals have direct health-related effects on viewers, cultivation theory creates openings for questioning the structures of the media that put out unhealthy content and for interrogating the roles and responsibilities of media agenda in inculcating positive health messages. Directions for future research include looking at contextually contrasting populations that share different cultural and community values, and different ways of consuming television. Research questions exploring the roles of community structures with different sets of subjective norms, or with different roles of community norms, in the realm of cultivation effects offer new areas for exploration.
Hearing loss is common, with approximately 17% of the population reporting some degree of a hearing deficit. Hearing loss has profound impacts on health literacy, health information accessibility, and learning. Much of existing health information is inaccessible. This is largely due to the lack of focus on tailoring the messages to the needs of deaf and hard of hearing (DHH) individuals with hearing loss. DHH individuals struggle with a variety of health knowledge gaps and health disparities. This demonstrates the importance of providing tailored and accessible health information for this population. While hearing loss is heterogeneous, there are still overlapping principles that can benefit everyone. Through adaptation, DHH individuals become visual learners, thus increasing the demand for appropriate visual medical aids. The development of health information and materials suitable for visual learners will likely impact not only DHH individuals, but will also be applicable for the general population. The principles of social justice and universal design behoove health message designers to ensure that their health information is not only accessible, but also equitable. Wise application of technology, health literacy, and information learning principles, along with creative use of social media, peer exchanges, and community health workers, can help mitigate much of the health information gaps that exist among DHH individuals.
Sun Joo (Grace) Ahn and Jesse Fox
Immersive virtual environments (IVEs) are systems comprised of digital devices that simulate multiple layers of sensory information so that users experience sight, sound, and even touch like they do in the physical world. Users are typically represented in these environments in the form of virtual humans and may interact with other virtual representations such as health-care providers, coaches, future selves, or treatment stimuli (e.g., phobia triggers, such as crowds of people or spiders). These virtual representations can be controlled by humans (avatars) or computers algorithms (agents). Embodying avatars and interacting with agents, patients can experience sensory-rich simulations in the virtual world that may be difficult or even impossible to experience in the physical world but are sufficiently real to influence health attitudes and behaviors. Avatars and agents are infinitely customizable to tailor virtual experiences at the individual level, and IVEs are able to transcend the spatial and temporal boundaries of the physical world. Although still preliminary, a growing number of studies demonstrate IVEs’ potential as a health promotion and therapy tool, complementing and enhancing current treatment regimens. Attempts to incorporate IVEs into treatments and intervention programs have been made in a number of areas, including physical activity, nutrition, rehabilitation, exposure therapy, and autism spectrum disorders. Although further development and research is necessary, the increasing availability of consumer-grade IVE systems may allow clinicians and patients to consider IVE treatment as a routine part of their regimen in the near future.
Jonathan van 't Riet, Jorinde Spook, Paul E. Ketelaar, and Arief Hühn
Many of us use smartphones, and many smartphones are equipped with the Global Positioning System (GPS). This enables health promoters to send us messages on specific locations where healthy behavior is possible or where we are at risk of unhealthy behavior. Until now, the practice of sending location-based messages has been mostly restricted to commercial advertisements, most often in retail settings. However, opportunities for health promotion practice are vast. For one, location-based messages can be used to complement environmental interventions, where the environment is changed to promote health behavior. Second, location-based messages incorporate opportunities to tailor these messages to individual characteristics of the recipient, increasing perceived relevance. Finally, location-based messages offer the distinct possibility to communicate context-dependent social norm information. Five preliminary studies tested the effects of location-based messages targeting food choice. The results suggest that sending location-based messages is feasible and can be effective. Future studies should explore which messages are most effective under which circumstances.