Roxanne L. Parrott
Health and risk policymaking focuses on decisions made and actions undertaken to set standards and pass laws to promote healthcare and public health quality, while achieving global health security. Policymakers in governments and institutions deliberate for the purposes of achieving effective and efficient policies, revealing both acceptance and rejection of evidence from health and risk, prevention, and economic sciences, as well as gaps in these domains. Health and risk communicators function implicitly within the boundaries of these decisions and actions, while contributing to prevention science related to strategic messaging and information dissemination. Policymakers face barriers to their efforts residing in the sheer volume of health and risk sciences research; the lack of evidence demonstrating that policies lead to intended outcomes (often, because a policy has not been trialed/implemented); and the absence of economic analyses associated with costs of interventions proposed and undertaken. The precautionary principle (PP) based on adopting caution when evidence is absent, uncertain, or ambiguous regarding possible harm to humans or the environment may function as a guide in some situations. Advocates may draw attention to particular issues in other cases. Policies may be stalled owing to the policy context, including election cycles, legislative and institutional bureaucracies, competing agendas, and fragmented systems of healthcare. Health and risk communicators may collaborate with policymakers and work to translate evidence into useful formats to facilitate the application of evidence to policymaking decisions and actions.
Kevin Real and Andy Pilny
Effective communication in health care teams is central to the delivery of high-quality, safe, dependable, and efficient patient care. Understanding how health care team communication operates within healthcare systems is important. Viewing health care teams in hospital settings as creators and channels for diffusions of health and risk messages is an important contribution to health communication scholarship. Health care teams are essential elements of healthcare systems. In many instances, they are components of multiteam systems embedded within larger network ecosystems. These teams are not identical, thus, considering how team type (e.g., unidisciplinary, multidisciplinary, interdisciplinary) shapes distinct communication processes offers a better understanding of how these teams facilitate health and risk message diffusion. TeamSTEPPS is an important framework for essential teamwork behaviors that facilitate team processes in healthcare systems. Significantly, we develop specific communication competencies drawn from observation work that facilitate health care team effectiveness. Ideas developed by Kurt Lewin are utilized to consider how different types of multiteam systems can be effective as channels and facilitators of health and risk messages. We end the chapter with examples from field research. A set of hospital nursing unidisciplinary teams comprise a network of teams that form a heterarchical structure with important messages flowing between teams. An innovative form of hospital interdisciplinary rounds relies on specific communication practices to create and exchange health and risk messages to patients, families, health care team members, and other healthcare stakeholders.
Health Disparities, a Social Determinant of Health and Risk: Considerations for Health and Risk Messaging
Nancy Grant Harrington
Health disparities are differences in health outcomes between socially disadvantaged and advantaged groups. This essay provides a brief review of the voluminous literature on health disparities, with a focus on several major threads including populations of interest, incidence and prevalence of morbidity and mortality, determinants of health, health literacy and health information seeking, media influences on health disparities, and efforts to reduce disparities. Populations of interest tend to be defined primarily by socioeconomic status (income/education), race, ethnicity, and sex or gender; however, differences in sexual orientation, immigrant status, geography, and physical and mental disability are also of concern. Determinants of health can be categorized along a number of dimensions, but common designations consider behavioral, social, and environmental factors that lead to health disparities, as well as differences in access to health care and health services. Of central interest to communication researchers, differences in health literacy and health information seeking are revealed between advantaged and disadvantaged groups. Media influences involve the effects of access or exposure to different kinds of health information on the health behavior and health outcomes of different groups, as well as the effects of health disparity media coverage on public support for initiatives to reduce health disparities. Efforts to reduce health disparities are extensive and involve government and foundation efforts and research-driven interventions.
Taking a broader view, this essay briefly discusses trends in scholarship on health disparities, noting the precipitous increase in academic journal article publications on the topic, including the publication of journals specifically focused on publishing health disparities scholarship. Future directions for research are suggested, and recommendations for interventions to improve health disparities offered by the Principal Investigators of the 10 Centers for Population Health and Health Disparities are presented. Finally, an annotated list of primary sources (books, special issues of journals, reports) and a list of sources for further reading are offered to provide a starting point for beginning scholars to orient themselves to research in health disparities.
Michael Mackert and Sara Champlin
This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of Communication. Please check back later for the full article.
Health literacy—defined as the ability of an individual to obtain, process, understand, and communicate about health information—contributes significantly to poorer health outcomes and increased costs to the U.S. healthcare system. Approximately one-third of U.S. adults struggle with health information, including understanding patient education materials, reading medication labels, and communicating with healthcare providers. Low health literacy is more common among the elderly, those who speak English as a second language, and those of lower socioeconomic status. In addition to conceptualizing health literacy as an individual-level skill, it can also be considered an organizational or community-level ability.
Increased attention to the field of health literacy has resulted in debates about the definition of health literacy and the best ways to assess an individual’s health literacy. As healthcare providers have recognized the importance of health literacy, workshops and training programs have been developed and evaluated to improve the care of low health-literate patients. Similarly, health promotion professionals have developed best practices for reaching low health-literate audiences with traditional and new digital media. Researchers and practitioners together are advancing understanding of health literacy, its relationship to health outcomes and healthcare costs, and improved strategies for improving the health of lower health-literate patients.
Dennis Myers, Terry A. Wolfer, and Maria L. Hogan
A complex web of attitudinal, cultural, economic, and structural variables condition the decision to respond to communications promoting healthy behavior and participation in risk reduction initiatives. A wide array of governmental, corporate, and voluntary sector health-related organizations focus on effective messaging and health care options, increasing the likelihood of choices that generate and sustain wellness. Researchers also recognize the significant and multifaceted ways that religious congregations contribute to awareness and adoption of health-promoting behaviors. These religiously based organizations are credible disseminators of health education information and accessible providers of venues that facilitate wellness among congregants and community members. The religious beliefs, spirituality, and faith practices at the core of congregational cultural life explain the trustworthiness of their messaging, the health of their adherents, and the intention of their care provision.
Considerable inquiry into the impact of religion and spirituality on health reveals substantive correlations with positive psychological factors known to sustain physical and psychological health—optimism, meaning and purpose, hope, well-being, self-esteem, gratefulness, social support, and marital stability. However, the beliefs and practices that create receptivity to health-related communications, care practices, and service provision can also be a deterrent to message impact and participation in healthy behaviors. When a productive relationship between spirituality and health exists, congregational membership offers rituals (e.g., worship, education, mission) and relationships that promote spiritual well-being. Research demonstrates increased life satisfaction and meaning in life, with health risk reduction associated with a sense of belonging, enriched social interactions, and shared experiences.
Congregations communicate their commitment to wellness of congregants and community members alike through offering a variety of congregationally based and collaborative wellness and risk reduction programs. These expressions of investment in individual and community health range across all age, gender, and ethnic demographics and address most of the prominent diagnostic categories. These programs are ordered along three dimensions: primary prevention (health care messaging and education), secondary prevention (risk education), and tertiary prevention (treatment). Applying the dimensions of sponsorship, goal/mission, focus, services, staffing, and intended outcome highlights the similarities and differences among them. Several unique facets of congregational life energize the effectiveness of these programs. Inherent trust and credibility empower adherence, and participation decisions and financial investment provide service availability. These assets serve as attractive contributions in collaborations among congregations and between private and public health care providers.
Current research has not yet documented the best practices associated with program viability. However, practice wisdom in the planning, implementation, and evaluation of congregationally based and collaborative health-related programs suggests guidelines for future investigation. Congregational leaders and health care professionals emphasize well-designed needs assessment. Effective congregational health promotion and risk reduction may be linked to the availability and expertise of professionals and volunteers enacting the roles of planner/program developer, facilitator, convener/mediator, care manager/advocate, health educator, and direct health care service provider.
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.
John C. Meyer and Steven J. Venette
Humor is ubiquitous in communication and is thus worthy of study as part of messages relating to risks and health. Humor’s widely acknowledged effects invite systematic explanation and application by communication scholars interested in health and risk communication. Humor’s influence upon health and risk messages results from the theories of humor origin (incongruity, superiority, and relief), elements of humor perception (unifying or comic perspectives as opposed to tragic or divisive perspectives), and humor functions in social interactions (identification, clarification, enforcement, and differentiation). Humor can be used in messages to mitigate high ego involvement, high levels of fear, and a low sense of efficacy in terms of ability to respond to risk or health messages. Humor can serve to enhance relationships, allowing for more creative discussion of risks and health improvement, yet also can serve to pointedly tease or express a memorable perspective to capture attention regarding a risk or health issue.
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.
Referred to as the “most consistent and reliable method for conferring resistance to persuasion” by Miller et al. in 2013, over the past 50 years inoculation has exerted significant influence in shaping theoretical and contextual resistance research and message design. Used as a message strategy, inoculation elicits threat, or realized attitudinal/behavioral vulnerability, which motivates individuals to shore up attitudinal/behavioral defenses by providing both material and guided practice aiding the process of effective counterarguing, which in turn increases individuals’ resistance to attitudinal/behavioral challenges. The motivation is responsible for sustaining the inoculation effect over an extended period of time. Inoculation messages, however, do much more than just inspire a robust defense. They motivate individuals to engage others regarding the attitudinal/behavioral topic in an attempt to reassure and advocate their positions, thus diffusing the inoculation message over social networks. The attitudinal/behavior protection elicited by inoculation messages is not limited to the message’s target attitude/behavior, but instead spreads over related attitudes/behaviors as well, thus increasing the pragmatic utility of this message strategy. Inoculation’s effectiveness extends beyond the realm of resistance, as inoculation messages are also effective in both shaping and changing attitudes/behaviors.
Because of its success, inoculation-based message strategies have been applied in numerous contexts and with numerous topics. Some of inoculation’s applied contexts include commercial, instruction/education, interpersonal, political, corporate, public relations, cross-cultural, health, and risk. More specifically, in the health and risk contexts, inoculation has been applied in promotion or prevention capacity on topics such as politically-motivated violent acts, smoking, drinking, unprotected sex, vaccination, and health-related policy, with current research exploring its efficacy in addiction interventions and indoor tanning-bed usage prevention. Inoculation may also be used as a strategy to reduce recidivism in criminal prison inmates and preventing verbal aggression in schools. Additional promising areas for application of inoculation-based strategies may include the promotion and protection of healthy eating habits as well as positive attitudes/behaviors toward mammograms, colonoscopies, breastfeeding, and regular exercise, just to name a few. As Ivanov suggested, the “application of the strategy [is] boundless.”