Self-affirmation theory posits that people are motivated to maintain an adequate sense of self-integrity. It further posits that the self-system is highly flexible such that threats to one domain of the self can be better endured if the global sense of self-integrity is protected and reinforced by self-resources in other, unrelated domains. Health and risk communication messages are often threatening to the self because they convey information that highlights inadequacies in one’s health attitudes and behaviors. This tends to lead to defensive response, particularly among high-risk groups to whom the messages are typically targeted and most relevant. However, self-affirmation theory suggests that such defensive reactions can be effectively reduced if people are provided with opportunities to reinforce their sense of self-integrity in unrelated domains. This hypothesis has generated substantial research in the past two decades.
Empirical evidence so far has provided relatively consistent support for a positive effect of self-affirmation on message acceptance, intention, and behavior. These findings encourage careful consideration of the theoretical and practical implications of self-affirmation theory in the genesis and reduction of defensive response in health and risk communication. At the same time, important gaps and nuances in the literature should be noted, such as the boundary conditions of the effects of self-affirmation, the lack of clarity in the psychological mechanisms underlying the observed effects, and the fact that self-affirmation can be easily implemented in some health communication contexts, but not in others. Moreover, the research program may also benefit from greater attention to variables and questions of more direct interest to communication researchers, such as the role of varying message attributes and audience characteristics, the potential to integrate self-affirmation theory with health communication theories, and the spontaneous occurrence of positive self-affirmation in natural health communication settings.
Nancy Grant Harrington
Sensation seeking is a biologically based personality trait that is characterized by the need to seek a variety of sensations and experiences and the willingness to take risks to achieve them. There is a large volume of literature on sensation seeking that delineates important conceptual and operational distinctions, including several prominent measures of sensation seeking. Issues related to research design and data analysis include whether researchers treat sensation seeking as an independent or dependent variable, use total scale versus subscale scores in analyses, treat scores as continuous or grouped variables, and consider demographic variables in their analyses. Research may relate sensation seeking to a range of behaviors, from maladaptive behaviors such as substance use and risky sex to more neutral or even adaptive behaviors such as preferences for music and art or preferences for certain careers. Research may establish a genetic basis for sensation seeking and/or associate sensation seeking with neurological and physiological responsiveness. Research also explores the associations of sensation seeking to perceptions of risk, as well as the sex and age of individuals and groups in an international context.
Before health and risk messaging can have the best possible effect, there needs to be an understanding of what might influence health and associated risky behaviors. A wide range of elements needs to be considered, given the many possible influences on health habits and risky exposures. Since “ecology” is defined as the relationship between organisms and their environments, ecological models enable this consideration to be made. As a result ecological approaches have been widely used in health behavior, health planning, and health education.
Ecological theory, with a communication focus, has also been developed, emerging specifically from the field of “information behavior.” Grounded in the work of Bronfenbrenner, on the experimental ecology of human development, the theory grew out of a study of older adults’ information and communication needs and uses, undertaken in the 1990s. The ecological model, as developed, enabled a wide range of personal and social influences on information seeking and communication to be explored with people aged 60 and older. Analysis of the impact of multilevel factors is facilitated by an ecological approach, increasing its value for the task of designing the content of health and risk messages. The “how” of designing health messaging is not addressed specifically by this approach.
Following the study of older adults, the ecological model was broadened, modified, and applied to the study of the information and communication behavior of different community groups, involving a range of topics. The flexibility of the approach is a key strength. A study of information seeking, by women with breast cancer, indicated that several “ecological” elements, such as age, ethnicity, and stage of disease, played a part in the type of information sought and in preferences for how information was communicated. Health and risk avoidance implications emerged from a study of information seeking for online investment, providing another good example of the ways in which the model can be adapted. A range of ecological factors were shown to influence investing behavior, including level of risk taking. A study of people in the Fourth Age (the last stage of life) resulted in a further refined and extended model, as well as making a contribution to the already substantial body of accumulated gerontological knowledge.
Social influence processes play an important role in the recovery process for alcoholics who affiliate with Alcoholics Anonymous (AA). Group norms at AA emphasize the sharing of stories about past difficulties with alcohol, the circumstances that led a person to join AA, and how life has changed since achieving sobriety. These narratives serve to increase collective identity among AA members via shared experiences and to reinforce AA ideology. In discussions and interpersonal interactions at AA meetings, AA ideology is also communicated and reinforced through AA literature and the discussion of central tenets, such as the Twelve Steps and Twelve Traditions, the idea that alcoholism is a progressive disease, and the need to be active in one’s sobriety. Moreover, AA meetings provide an opportunity for recovering alcoholics to find others who share similar experiences, an opportunity for greater social comparisons to other alcoholics than are typically available in primary social networks, and group-suggested role obligations that influence commitment to AA and long-term sobriety. These social influence processes have been linked to important health outcomes, including longer abstinence from alcohol use than with other treatment options, reduced stigma associated with alcoholism, reduced stress/depression, increased self-efficacy, and the acquisition of coping skills that are important to the recovery process.
Kristin Hocevar, Miriam Metzger, and Andrew J. Flanagin
Our understanding and perceptions of source credibility significantly drive how we process health and risk messages, and may also influence relevant behaviors. Source credibility is believed to be impacted by both perceptions of source trustworthiness and expertise, and the effect of credibility on changes in attitudes and behavior has been studied for decades in the persuasion literature. However, how we understand and define source credibility—particularly the dimension of expertise—has changed dramatically as social media and other online platforms are increasingly used to design and disseminate health messages. While earlier definitions of source credibility relied heavily on the source’s credentials as indicators of expertise on a given topic, more recent conceptualizations must also account for expertise held by laypeople who have experience with a health concern. This shifting conceptualization of source credibility may then impact both why and when people select, as well as how they perceive, process, and judge, health messaging across both novel and more traditional communication contexts.
Persuasive messages use statistical evidence in order to convince an audience to accept a conclusion. Statistical evidence represents a compilation of experiences structured and collected in a manner that permits expression in mathematical form. Research demonstrates that the use of statistical evidence increases the persuasiveness of a message, and a message that uses both statistical and narrative evidence generates the greatest persuasiveness.
Statistical evidence can take the form of summarizing the collective opinion of experts on a topic or an expression of the collective set of experiences. The challenge becomes gaining acceptance of statistical expressions of experience versus what is perceived as the narrative or lived experience of the single person. Statistical evidence is often presented using a mathematical expression to indicate the size or force of the evidence.
The accumulation of statistical evidence often involves the use of meta-analysis to reduce Type I (false positive) and Type II (false negative) error. The use of evidence is strategic and can target specific elements of belief by understanding the structure of beliefs and the connectivity among elements. The use of the Subjective Probability Model provides a means to capitalize on the use of evidence by changing probabilities in beliefs to increase the effectiveness of a message campaign.
Statistical evidence, however, may be ineffective under circumstances referred to as the “base-rate fallacy.” The base-rate fallacy occurs when the presentation of statistical information is accepted, but examples are used that contradict the base-rate. The impact of the use of the example is to create a shift in the belief in the typicality of the example, despite knowledge of the base-rate.
Fear appeals provide a particularly useful and important application of statistical evidence in the pursuit of public health campaigns. The tenets of the Extended Parallel Processing Model indicate that message effectiveness relies on a combination of: (a) perceived severity of the threat, (b) perceived vulnerability to the threat, (c) perceived efficacy of the solution, and (d) perceived personal efficacy of the solution. Each element is largely impacted by the application and use of statistical information to make claims. The use of statistics generally outlines the argument and supports the conclusion offered in support of a conclusion offered to the message recipient.
Statistical evidence when used in a message often offers data or information that becomes the justification for a conclusion. A large part of a message becomes gaining acceptance of information by an audience, then explaining (reasoning) to the audience how those facts support a conclusion, often involving some type of recommendation for behavior. Understanding statistical evidence requires understanding how the material functions within the context of the belief system of the individual.
Rachel A. Smith, Xun Zhu, and Madisen Quesnell
Stigmas are profoundly negative stereotypes of a social group and its members that have diffused and normalized throughout a community. Being marked as a member of a stigmatized group does more than designate someone as different: stigmas denote people as discredited, devalued, and disgraced. Stigmas shape health and risk communication and are considered the leading—but least understood—barrier to health promotion.
Communication and stigmas are dynamically connected. Communication is critical to a stigma’s existence, spread, expression, coping, and elimination. Using mediated and interpersonal communication, community members are socialized to recognize and react to stigmatized people. People use communication to enact the devaluation and ostracism of stigmatized people, and stigmatized people use communication to cope with stigmatization. Stigmas also shape communication: stigmas compel non-marked persons to engage in stigmatization and ostracism of marked persons, reduce marked people’s disclosure and encourage secrecy, and shape the characteristics of personal and community networks. Last, campaigns have used communication to attempt to eliminate existing stigmas. The accumulating research, conducted from diverse assumptions about human behavior (cultural determinism, evolutionary, socio-functional), shows how easily and effectively stigmas may be socialized; how challenging they are to manage; how many facets of health and wellbeing are devastated by their existence; and how difficult it is to attenuate them.
While much has been uncovered about stigma, health, and risk, many questions remain. Among these include: How can one design messages that effectively alert the general public about imminent health threats and that successfully promote desirable behavioral changes without evoking stigma processes? How do different reactions to stigmatization influence targets and their social networks? What factors increase resistance or vulnerability to messages containing stigma-inducing content? How can one create an effective, reliable means to eliminate existing stigmas?
Substance Abuse Prevention Message Generation: Engaging Adolescents in Health Message Planning and/or Production of Health Promotion Messages
Smita C. Banerjee and Kathryn Greene
Adolescent substance use remains a significant public health challenge, with recent approaches to address these problems including actively engaging adolescents in message planning and/or production as a prevention strategy. There are two benefits of this active involvement strategy. First, engaging adolescents in message planning or producing substance prevention messages is a form of participatory research that results in participant-generated messages for use in future intervention efforts. This participatory form of research is increasingly common in a wide range of topics and populations, particularly disenfranchised or stigmatized groups. It is important to focus on the second benefit of engaging adolescents in message planning and prevention: the effect of engaging in planning or producing substance prevention messages on the adolescents themselves. If done properly, the process of engaging adolescents in planning (or producing) anti-substance messages can provide longer-term benefits of delaying onset of substance use (strengthening resistance) as well as changing patterns for those already using. Some examples of this strategy exist with media literacy, although applied with a great deal of variability. The increased popularity of these planning/production approaches requires greater explication of how, when, and why they produce effects for participants. Two different theoretical perspectives address this active involvement intervention approach: narrative engagement theory and the theory of active involvement. Beyond these theories, sensation seeking is positioned as a moderator to explore for active involvement intervention effects.
This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of Communication. Please check back later for the full article.
The design of health messages involves a large number of decisions with respect to the messages’ format, delivery, and content, among others. Because many of these decisions involve creative translations of message content, determining what a message needs to convey is a first step in health message design. Message content should correspond to those factors that most importantly guide people’s decision to engage or not engage in a particular health behavior, as improvement in these factors should result in maximal improvement in the behavior. Clearly, then, the better we can explain which factors determine a particular health behavior, the better able we are to design effective health messages. Reasoned action theory is a useful tool both for explaining any given health behavior and for selecting message content. Reasoned action theory comprises the theory of reasoned action, the theory of planned behavior, and the integrative model of behavioral prediction, which together can best be seen as a sequence of reformulations that build on one another in a developmental fashion. The current formulation of the theory is called the reasoned action approach to explaining and changing behavior. The theory proposes that health behavior follows from intention when one has the necessary skills for performing the behavior and when no environmental barriers exist that obstruct behavioral performance. Intention follows from one’s attitude, perceived normative pressure, and perceived behavioral control with respect to performing the behavior. Because the extent varies to which attitude, perceived normative pressure, and perceived behavioral control shape intentions across behaviors and populations, each health message design project should begin with research to establish the relative importance of attitude, perceived normative pressure, and perceived behavioral control. Underlying these variables are beliefs about consequences, influence from normative referents, and control with respect to performing the behavior. Whereas people may hold a great many beliefs about a particular health behavior, only some of these beliefs will guide people’s decisions about performing or not performing the behavior. Reasoned action theory focuses on changing or reinforcing this subset of beliefs. The appeal for health message design is that reasoned action theory provides guidelines for the identification of beliefs to target in a health message.
M. Jeffrey Farrar, Yao Guan, and Kaitlyn Erhardt
Humans live not only in a physical world but also in a mental world. Theory of mind reflects the understanding that the mind is comprised of different mental states, such as intentions, desires, and beliefs. This conception of the mind is a critical achievement in human development because it directly impacts effective communication and social interaction. It allows for the understanding of others’ behaviors by inferring their mental states. The formation of a theory of mind has been a central topic in psychology, neuroscience, cognitive science, and philosophy. It impacts related processes, such as communication skills, perspective-taking ability, and social cognition.
Across the life span, the understanding of the mind becomes increasingly complex. Early in development, infants and toddlers can discern the intentions of others. Later, more sophisticated reasoning about the mental states of others becomes possible. For instance, the ability to follow and understand the recursive thought that “Sam believes, that Mary said, that Jose wanted . . .” develops. Additionally, within distinctive developmental time periods, people differ in their ability to take into account mental states. Once people’s beliefs, including their misconceptions, are identified, it is possible to generate effective communication strategies designed to teach, learn, and even reduce risk-taking behaviors.