Walid A. Afifi
The turn of the 21st century has seen an explosion of frameworks that account for individuals’ decisions to seek or avoid information related to health risks. The four dominant frameworks are Risk Perception Attitude Framework, the Risk Information Seeking and Process model, the Planned Risk Information Seeking Model, and the Theory of Motivated Information Management. A comparison of the constructs within each and an examination of the related empirical tests reveal important insights into (a) factors that have consistently been shown to shape these decisions across these approaches and (b) constructs in need of additional theorizing and empirical testing. Specifically, the analysis suggests that uncertainty, efficacy, affect, risk perceptions, and subjective norms all play crucial roles in accounting for decisions to seek or avoid risk-related information. However, inconsistencies in the direction of influence for uncertainty or information discrepancy, risk perceptions, and negative affect argue for the need for considerably more theoretical clarity and empirical rigor in investigations of the ways in which these experiences shape decision making in these contexts.
Michael L. Hecht and Michelle Miller-Day
Adolescent substance use and abuse has long been the target of public health prevention messages. These messages have adopted a variety of communication strategies, including fear appeals, information campaigns, and social marketing/branding strategies. A case history of keepin’ it REAL, a narrative-based substance abuse prevention intervention that exemplifies a translational research approach, involves theory development testing, formative and evaluation research, dissemination, and assessment of how the intervention is being used in the field by practitioners. The project, which started as an attempt to test the notion that the performance of personal narratives was an effective intervention strategy, has since produced two theories, an approach to implementation science that focused on communication processes, and, of course, a school-based curriculum that is now the most widely disseminated drug prevention program in the world.
At the core of the keepin’ it REAL program are the narratives that tell the story of how young people manage their health successfully through core skills or competencies, such as decision-making, risk assessment, communication, and relationship skills. Narrative forms not only the content of curriculum (e.g., what is taught) but also the pedagogy (e.g., how it is taught). This has enabled the developers to step inside the social worlds of youth from early childhood through young adulthood to describe how young people manage problematic health situations, such as drug offers. This knowledge was motivated by the need to create curricula that recount stories rather than preaching or scaring, that re-story health decisions and behaviors by providing skills that enable people to live healthy, safe, and responsible lives. Spin-offs from the main study have led to investigations of other problematic health situations, such as vaccination decisions and sexual pressure, in order to address crucial public health issues, such as cancer prevention and sex education, through community partnerships with organizations like D.A.R.E. America, 4-H clubs, and Planned Parenthood.
V. Santiago Arias and Narissra Maria Punyanunt-Carter
Through the years, the concept of family has been studied by family therapists, psychology scholars, and sociologists with a diverse theoretical framework, such as family communication patterns (FCP) theory, dyadic power theory, conflict, and family systems theory. Among these theories, there are two main commonalities throughout its findings: the interparental relationship is the core interaction in the familial system because the quality of their communication or coparenting significantly affects the enactment of the caregiver role while managing conflicts, which are not the exception in the familial setting. Coparenting is understood in its broader sense to avoid an extensive discussion of all type of families in our society. Second, while including the main goal of parenting, which is the socialization of values, this process intrinsically suggests cultural assimilation as the main cultural approach rather than intergroup theory, because intercultural marriages need to decide which values are considered the best to be socialized. In order to do so, examples from the Thai culture and Hispanic and Latino cultures served to show cultural assimilation as an important mediator of coparenting communication patterns, which subsequently affect other subsystems that influence individuals’ identity and self-esteem development in the long run. Finally, future directions suggest that the need for incorporating a nonhegemonic one-way definition of cultural assimilation allows immigration status to be brought into the discussion of family communication issues in the context of one of the most diverse countries in the world.
Monique Mitchell Turner
In social marketing, the use of guilt appeals can be effective for influencing healthy behaviors. Guilt, being a moral, other-based emotion, can spur people to think of others, act honestly, and be empathetic. Likewise, collective guilt, the feeling that arises when people believe their in-group caused illegitimate harm to others, can lead people to feel positively toward the victimized others and desire policies that will help them. We can see then, that guilt, though often considered “negative” can lead to an array of prosocial, constructive, behaviors. In that vein, a number of researchers have assessed the possibility that guilt based persuasive appeals can induce such positive behaviors.
Clearly, guilt-appeals can be an effective tool for reducing risk (STI testing), increasing prevention practices (encouraging mammograms), and effecting altruistic health-related behaviors (donating blood). In the correct conditions, guilt appeals can induce guilty feelings, lead people to want to “right the wrong,” generate positive attitudes about the message’s advocacy, and intend to engage in a behavior.
Kaite Yang and Emily Pronin
Social psychological research on thinking has generally focused on the attitudes, emotions, motivations, and biases that affect thinking and consequent behavior. What has received less attention is the speed of thinking: how quickly thinking occurs and whether thoughts accelerate or slow down. Communication design and processing may take for granted that the structure and reception of messages occur at a certain speed. Recent findings from the psychological study of thought speed shed light on ways that this research may be applied to health communication. Fast and slow rates of thinking are correlated with distinct patterns of affective, cognitive, physiological, and behavioral events. Fast thinking is associated with positive mood, energy, approach motivation, arousal, creativity, and risk-taking. Slow thinking is associated with negative mood and depression, low energy, and cognitive impairment. Potential theories exist for why psychological and physiological experiences are associated with thought speed.
Recent experimental research demonstrates that thought speed can be successfully manipulated to elicit psychological effects, and it can be manipulated independent of thought content. Researchers, healthcare practitioners, and communicators should be aware of the psychological correlates and consequences of thought speed and consider harnessing the effects of thought speed to augment communication. Thought acceleration and deceleration can be integrated into the design and processing of health communication.
Kristin L. Farris and Maureen P. Keeley
Social support in the context of chronic illness management is important, as individuals diagnosed with these conditions and their loved ones often experience increased distress, reduced relational quality, and diminished physical health as a result of coping with these long-term symptoms. Therefore, diagnosed individuals and their close relational partners rely on others to provide support in their time of need. The communication of social support is characterized by “verbal and nonverbal behavior produced with the intention of providing assistance to others perceived of needing that aid” (MacGeorge, Feng, & Burleson, 2011, p. 317). Individuals living with these chronic illnesses and their loved ones often turn to a variety of interpersonal others, including friends, family, health care providers, and support groups to manage the difficulties that accompany their physical symptoms. Although some researchers suggest that diagnosed individuals seek support most frequently from close relational partners, other scholars assert that chronic care support groups (whether meeting face to face or via computer-mediated channels) offer support recipients an opportunity to discuss their challenges and receive help from experientially similar others.
On the one hand, regardless of the support provider, individuals who have been diagnosed with chronic conditions generally perceive effective supportive communication to be messages in which their support providers enact competent tangible assistance in managing the illness, provide an opportunity for them to vent their feelings, and express messages of empathy and affection, among others. Ineffective messages, on the other hand, are those in which diagnosed individuals feel their partners are overly involved in helping them make decisions about their care or portraying negative attitudes or discomfort around them. Overall, research in this area suggests that support recipients and their relational partners have improved emotional, relational, and physical outcomes when they perceive support to be available or receive effective support from these resources.
Andrea Kloss and Anne Bartsch
Emotions are an important part of how audiences connect with health and risk messages. Feelings such as fear, anger, joy, or empathy are not just byproducts of information processing, but they can interact with an individual’s perception and processing of the message. For example, emotions can attract attention to the message, they can motivate careful processing of the message, and they can foster changes in attitudes and behavior. Sometimes emotions can also have counterproductive effects, such as when message recipients feel pressured and react with anger, counterarguments, or defiance. Thus, emotion and cognition are closely intertwined in individuals’ responses to health messages. Recent research has begun to explore the flow and interaction of different types of emotions in health communication. In particular, positive feelings such as joy and hope have been found to counteract avoidant and defensive responses associated with negative emotions such as fear and anger. In this context, research on health communication has begun to explore complex emotions, such as a combination of fear and hope, which can highlight both the severity of the threat, and individuals’ self-efficacy in addressing it. Empathy, which is characterized by a combination of affection and sadness for the suffering of others, is another example of a complex emotion that can mitigate defensive responses, such as anger and reactance, and can encourage insight and prosocial responses.
Erin M. Hill
Narcissism is a personality trait characterized by perceptions of grandiosity, superiority, and the need for attention and admiration. There has been an increase in focus on examining the development of narcissism and how the trait influences a range of social and health behaviors. A key feature of narcissism is that it is characterized by high self-esteem with a simultaneously fragile ego that requires continual monitoring and manipulation. Therefore, much of the behaviors narcissists engage in are linked to the drive to maintain perceptions of superiority and grandiosity. In the area of health and well-being, narcissism has been positively correlated with psychological health, a relationship that may be accounted for by self-esteem. However, there has been less research on the relationship between narcissism and physical health and well-being. There is some evidence that narcissism is linked to a variety of physical appearance-oriented health behaviors (i.e., behaviors that could affect body weight or other aspects of physical appearance, including eating and exercise). Narcissism has also been positively linked to risk-taking behaviors, including use of substances, as well as risks that could significantly impact others, including sexual behaviors and risky driving. The relationship between narcissism and health is therefore complex, with some positive correlates (e.g., physical activity), but also various health risk behaviors.
In considering how narcissism might interact with health messages, communicators have to keep in mind that narcissists seem to have some deficits in judgment and decision-making, such as overconfidence and a narrow focus on rewards associated with behaviors. Their behaviors tend to be driven by managing their own ego and by drawing attention and admiration from others to maintain perceptions of superiority and grandiosity. In turn, health communicators may need to rely on creative strategies that tap into these domains of narcissism in order to effectively modify health behaviors among narcissistic individuals. Further research on the influence of narcissism in healthcare seeking and related preventive behaviors would also help to provide a more detailed understanding for how the trait influences health decisions, information that would be useful for both health researchers and practitioners.
Spring Chenoa Cooper and P. Christopher Palmedo
Embarrassment, according to Fischer and Tangney, is an “aversive state of mortification, abashment, and chagrin that follows public social predicaments.” It is usually related to our perceptions of how others perceive us as well as their judgments of us, and it is associated with a loss of self-esteem when we perceive that others have judged us as inadequate or incompetent. However, even mere exposure or attention publicly placed on someone can elicit embarrassment (think of someone pointing at you and laughing).
Embarrassment is considered a self-conscious emotion. Self-conscious emotions include those that are evoked by self-reflection and self-evaluation: embarrassment, shame, guilt, and pride. Shame, an intense form of embarrassment, also has structural and larger social contexts, while embarrassment is more individually experienced. Self-conscious emotions play an important role in regulating behavior; they assist us in behaving according to social standards and guide us in responding when those rules are broken. While these emotions provide feedback in social situations, they also provide feedback for anticipated outcomes.
Embarrassment can play an important role in health, both in communication and behavior, and occurs through different forms. Primary embarrassment is the first rush of blood to the face and increased heart rate that usually lasts a few moments. Secondary embarrassment is the after-effect that shapes future behavior. Anticipatory embarrassment is the emotion surrounding the potential for embarrassment in an upcoming situation. Solitary embarrassment is the one that no one actually observes.
Three stigmatized areas of health—mental health, healthcare, and sexual health—may be assessed as case studies through which to understand the literature around embarrassment, as both an affect and an emotion.
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.