Kimberly A. Kaphingst
Direct-to-consumer advertising of prescription drugs (DTCA) is a multibillion-dollar industry in the United States, affecting the health-care landscape. DTCA has been controversial, since a major increase in this type of advertising resulted from re-interpretation of existing regulations in the late 20th century. Health and risk communication research can inform many of the controversial issues, assisting physicians, policymakers, and the public in understanding how consumers respond to DTCA. Prior research addresses four major topics: (1) the content of DTCA in different channels, (2) consumers’ perceptions of and responses to DTCA, (3) individual-level factors that affect how consumers respond to DTCA, and (4) message factors that impact consumers’ responses. Such research shows that the presentation of risk and benefits information is generally not balanced in DTCA, likely affecting consumers’ attitudes toward and comprehension of the risk information. In addition, despite consumers’ generally somewhat negative or neutral perceptions of DTCA, this advertising seems to affect their health information seeking and communication behaviors. Finally, a wide range of individual-level and message factors have been shown to have an impact on how consumers process and respond to DTCA. Consumers’ responses, including how they process the information, request prescription drugs from providers, and share information about prescription drugs, have an important impact on the effects of DTCA. The fields of health and risk communication therefore bring theories and methodologies that are essential to better understanding the impact of this advertising.
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.
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.
Understanding the role of gender in the newsroom involves tracing a shift from an initial consensus that women’s only journalistic role was to write with “a woman’s touch” about women, for women readers, to a claim that women should be allowed to produce the same “unmarked” news as men. The claim became that women’s forms—women’s sections or other materials intended for women audiences—represented professional ghettos, and that women were needed to produce better, more ethical journalism. That is, within the newsroom, gender was first dichotomized, rendering the interests of women and men as opposites, and then it claimed to be irrelevant. Feminist scholars point out that, over time, men have consistently tried to protect their status, jobs, and salaries, and have failed to acknowledge how journalism was set up as a male enclave with “macho” values and a culture that disadvantaged women, especially mothers, with its tradition of long and irregular hours and lack of childcare.
Research on gender and journalism can be divided into two categories: (a) gender “at work” in newsrooms (including opportunities or inequities in jobs, promotions, and salaries, as well as sexism), and (b) representations of women. Scholars often assume that the first issue over-determines the second. On both issues, research shows improvement, but also continuing problems. Now women journalists appear to be well established; the news includes issues associated with women’s quotidian concerns, and it takes women seriously. Yet a variety of gender divides continue to characterize journalism. Researchers find gendered patterns in coverage, especially in politics and sports. Women television journalists are routinely sexualized, and their high visibility in television broadcasting—through explicit scrutiny of their bodies, hairstyles, clothing, and voices—is countered by their invisibility in management. Gendered double standards and a glass ceiling continue to stymie the promotion of women to key decision-making and governance positions in print and broadcast news organizations. Moreover, women are far from enjoying equity in the online context.
Women continue to be concentrated in low-status media outlets and beats: they dominate community, small-town, and regional news organizations, and they produce “soft news,” human-interest stories and features. Men still dominate, although they do not monopolize, most of the high status areas of news production, particularly politics and business, as well as the lucrative and popular area of sports, a highly gendered and sexist domain. The most overtly gendered arena is war correspondence. Women who report on war and conflict are judged by very different standards than men. In particular, mothers are condemned when they go off to dangerous conflict areas, although fathers who cover war continue to be largely immune from public criticism. Women war reporters run a high risk of sexual violence and harassment, although women who have been sexually attacked rarely tell their supervisors—probably for fear of being pulled off an assignment.
Countless platforms are now available to citizens to disseminate their views as citizen journalists, including blogs and Twitter; these provide opportunities for challenging gender roles and democratizing relations between men and women. On the other hand, social media threaten the business model of professional journalism; the resulting trend to part-time, freelance, and even unpaid work creates a precarious and potentially highly feminized labor force.
Worldwide, key behavioral risk factors for ill-health and premature death include smoking, alcohol, too much or too little of several dietary factors, and low physical activity. At least three structural factors (biological attributes and functions, population size and structure, and wealth and income disparities) modify the global impact that the risk factors have on health; without accounting for these structural drivers, the effect of government-driven incentives to act on the behavioral risk factors for improved health will be suboptimal. The risk factors and their impact on health are further driven by malleable circumstantial drivers, including technological developments, exposure to products, social influences and attitudes, and potency of products. Government-driven incentives, which can be both positive and negative, can act on the circumstantial drivers and can impact on the behavioral risk factors to improve or worsen health. Government-driven incentives include a range of policies and measures: policies that reduce exposure; regulation of the private sector; research and development to reduce potency; resource allocation for advice and treatment; direct incentives on individual behavior; and, managing co-benefits and adverse side effects. Within a framework of government-driven whole-of-society approaches to improve health, an accountability system is needed to identify who or what causes what harm to health to whom. A health footprint, modeled on the carbon footprint is proposed as the accounting system.
Christopher B. Mayhorn and Michael S. Wogalter
Warnings are risk communication messages that can appear in a variety of situations within the healthcare context. Potential target audiences for warnings can be very diverse and may include health professionals such as physicians or nurses as well as members of the public. In general, warnings serve three distinct purposes. First, warnings are used to improve health and safety by reducing the likelihood of events that might result in personal injury, disease, death, or property damage. Second, they are used to communicate important safety-related information. In general, warnings likely to be effective should include a description of the hazard, instructions on how to avoid the hazard, and an indication of the severity of consequences that might occur as a result of not complying with the warning. Third, warnings are used to promote safe behavior and reduce unsafe behavior. Various regulatory agencies within the United States and around the globe may take an active role in determining the content and formatting of warnings.
The Communication-Human Information Processing (C-HIP) model was developed to describe the processes involved in how people interact with warnings and other information. This framework employs the basic stages of a simple communication model such that a warning message is sent from one entity (source) through some channel(s) to another (receiver). Once warning information is delivered to the receiver, processing may be initiated, and if not impeded, will continue through several stages including attention switch, attention maintenance, comprehension and memory, beliefs and attitudes, and motivation, possibly ending in compliance behavior. Examples of health-related warnings are presented to illustrate concepts. Methods for developing and evaluating warnings such as heuristic evaluation, iterative design and testing, comprehension, and response times are described.
Amy E. Chadwick
Hope has been defined in primarily two ways, and both have implications for message design within health and risk communication. First, hope has been defined as a way of thinking, or disposition, that affects how people pursue goals. Dispositional hope manifests in beliefs about one’s capacity to initiate and sustain action toward goals (agency) and one’s ability to generate ways to reach those goals. Dispositional hope has been associated with positive physical and mental health outcomes. For example, high-hope women have greater intentions to engage in cancer prevention behaviors than do low-hope women. Numerous studies have associated higher hope with better pain management, and people who are higher in hope have a greater pain tolerance than people lower in hope. Hope is also related to better psychological adjustment.
Much of the research on dispositional hope focuses on correlating hope with a variety of positive health and non-health outcomes; however, psychotherapeutic interventions have also been designed to increase dispositional hope. These interventions have shown improvements in health-related outcomes. Although their potential is not yet realized, interventions for developing dispositional hope could improve compliance with medical recommendations, increase adoption of health behaviors, and decrease risk behaviors.
The second way that hope has been defined is as a discrete emotion. Discrete emotions are brief, intense, psychological, and evaluative reactions directed at external stimuli (e.g., people, events, or objects). In response to these external stimuli, emotions help individuals adapt to their environment by activating a unique pattern of thoughts (cognitions), physiological changes, subjective feelings, motor expressions, and action (or behavioral) tendencies.
Lazarus’s cognitive-mediational theory has been one of the most influential theories of discrete emotions that includes a definition of hope. Lazarus identifies the core relational theme of hope as “fearing the worst but yearning for better.” Lazarus deems hope to be a problematic emotion because he believes hope contains both positive and negative elements. Despite uncertainty about the exact nature of hope, Lazarus believes that hope is vital to coping with stress. Hope enables people to believe in the possibility of better circumstances and therefore is critical as a coping mechanism against despair. Lazarus does not provide guidance for what a message might need to include to evoke hope.
Drawing on Lazarus and appraisal theories in general, MacInnis and de Mello suggest tactics that consumer marketing advertisements could use to induce hope. Specifically, the authors focus on turning “impossibility into possibility” and enhancing “yearning.” De Mello and MacInnis also theorize that hope can lead to motivated processing of information resulting in both positive (e.g., coping, well-being, and goal achievement) and negative (e.g., risky behavior, self-deception) outcomes. Unfortunately, the theorizing of de Mello and MacInnis was never empirically tested.
To further explore how feelings of hope are created, Prestin examined underdog narratives in entertainment media. Underdog narratives show characters who are attempting to meet a goal despite unfavorable circumstances and odds. These narratives evoke hope and make people more motivated to meet their own personal goals. Although their potential has not been fully explored, underdog narratives may assist individuals in overcoming challenging circumstances, such as battling addiction or developing new health habits. There are numerous mechanisms still to be examined that may explain the effects of underdog narratives beyond their ability to evoke hope.
Recently, Chadwick defined hope as a future-oriented, discrete emotion that focuses on an opportunity to achieve a desired future outcome. Her definition builds on the work of Lazarus and Roseman and has implications for the design of messages that evoke hope. According to Chadwick, hope is evoked by appraisals of a future outcome as (a) consistent with goals (goal congruence), (b) possible but not certain (possibility), (c) important (importance), and (d) leading to a better future (future expectation). All four of these appraisals combine to create a perception of opportunity and the discrete emotion hope. Hope motivates behavior by focusing one’s thoughts on capitalizing on an opportunity. Chadwick states that hope also involves (a) an approach action tendency that motivates individuals to take, or continue, action to achieve the desired outcome, (b) increased heart rate and skin conductance, (c) an open facial expression, heightened focus, and alert body posture, and (d) a feeling of eager attention.
Chadwick’s definition has clear implications for developing messages that evoke hope. Messages designed to create appraisals of the importance, goal congruence, positive future expectation, and possibility of a future event evoke hope and are called hope appeals. Like other theoretical explications of emotional appeals, a hope appeal has two components: (a) the inducement of hope through the presentation of an opportunity and (b) the presentation of recommended actions to achieve the desired outcome. The recommended actions component includes information designed to (a) increase the receiver’s perception of his or her ability to perform the recommended action (i.e., self-efficacy) and (b) demonstrate the ability of the recommended actions to achieve the desired outcome (i.e., response efficacy).
Empirically, scholars have tested the effects of hope and messages that evoke hope. Hope appeals increase attention to messages about climate change and increase mitigation behavioral intention and mitigation behavior. In addition, feelings of hope increase interest in climate change protection and are positively correlated with pro-environmental behaviors and support for climate change policies. Feelings of hope significantly predict interest in climate protection, self-efficacy, interpersonal communication intention, information seeking intention, and behavioral intention. Hope and hopeful narratives have also been associated with greater perceived message effectiveness and more agreement with the message content. After a stressful experience that accelerates heart rate, evoking hope decelerates heart rate and decreases state anxiety. This research provides evidence that messages that evoke hope can counter the psychological and physiological effects of stressful events. In addition, researchers have examined the effects of hope on a variety of health, persuasion, political communication, and marketing outcomes. Preliminary evidence indicates that hope appeals are equally as or more effective than guilt and fear appeals at increasing interpersonal communication intention, self-efficacy, information seeking intention, and behavioral intention. In addition, hope appeals create less reactance (anger) than fear appeals. Together these results indicate that hope and hope appeals have substantial potential to influence health and risk behavior.
Questions related to identity have been central to discussions on online communication since the dawn of the Internet. One of the positions advocated by early Internet pioneers and scholars on computer-mediated communication was that online communication would differ from face-to-face communication in the way traditional markers of identity (such as gender, age, etc.) would be visible for interlocutors. It was theorized that these differences would manifest both as reduced social cues as well as greater control in the way we present ourselves to others. This position was linked to ideas about fluid identities and identity play inherent to post-modern thinking. Lately, the technological and societal developments related to online communication have promoted questions related to, for example, authenticity and traceability of identity.
In addition to the individual level, scholars have been interested in issues of social identity formation and identification in the context of online groups and communities. It has been shown, for example, how the apparent anonymity in initial interactions can lead to heightened identification/de-individuation on the group level. Another key question related to this one is the way group identity and identification with the group relates to intergroup contact in online settings. How do people perceive others’ identity, as well as their own, in such contact situations? To what extent is intergroup contact still intergroup contact, if the parties involved do not perceive it as such? As online communication continues to offer a key platform for contact between various types of social groups, questions of identity and identification remain at the forefront of scholarship into human communication behavior in technology-mediated settings.
Richard T. Craig
Who filters through information and determines what information is shared with media audiences? Who filters through information and determines what information will not be shared with media audiences? Ultimately, who controls the flow of information in the media? At times commentary pertaining to media content references media as an omnipotent individual entity selecting the content transmitted to the public, reminiscent of a Wizard of Oz manner of the all-powerful being behind the curtain. Overlooked in this perception is the reality that in mass media, there are various individuals in positions of power making decisions about the information accessed by audiences of various forms of media. These individuals are considered gatekeepers: wherein the media functions as a gate permitting some matters to be publicized and included into the public discourse while restricting other matters from making it to the public conscience.
Media gatekeepers (i.e., journalists, editors) possess the power to control the gate by determining the content delivered to audiences, opening and closing the gate of information. Gatekeepers wield power over those on the other side of the gate, those seeking to be informed (audiences), as well as those seeking to inform (politics, activists, academics, etc.). The earliest intellectual explanation of gatekeeping is traced to Kurt Lewin, describing gatekeeping as a means to analyze real-world problems and observing the effects of cultural values and subjective attitudes on those problems like the distribution of food in Lewins’s seminal study, and later modified by David Manning White to examine the dissemination of information via media. In an ideal situation, the gatekeepers would be taking on the challenge of weighing the evidence of importance in social problems when selecting among the options of content and information to exhibit. Yet, decisions concerning content selection are not void of subjective viewpoints and encompass values, beliefs, and ideals of gatekeepers. The subjective attitudes of gatekeepers influence their perspective of what qualifies as newsworthy information. Hence, those in the position to determine the content transmitted through media exercise the power to shape social reality for media audiences. In the evolution of media gatekeeping theory three models have resulted from the scholarship: (1) examination of the one-way flow of information passing through a series of gates before reaching audiences, (2) the process of newsroom personnel interacting with people outside of the newsroom, and (3) the direct communication of private citizens and public officials. In traditional media and newer forms of social media, gatekeeping examination revolves around analysis of these media organizations’ news routines and narratives. Gatekeeping analysis observes human behavior and motives in order to make conceptualizations about the social world.
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.