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Summary - Risk and Health Communication (S_RHC)
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Complete summary of the risk and health communication course. Includes a summary of all articles and lectures.
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Risk and Health communicationFincet (2020) - Effective health communication – a key factor in fighting the COVID-19 pandemic
There are different preferences for different age/social groups on how they want to be spoken to in
terms of health communication. For example, elderly depend on classical media channels, youth on
social media, and immigrants on totally different media channels. This is difficult because it is
important that everyone gets informed clearly with the same accurate information.
In comes the difficult task to make people feel safe in times of uncertainty. Four elements are
suggested that are particular important in these times:
1. Declare openly what is known and what is unknown and stick to the facts as much as
possible
2. Information should be consistent and specific
3. It is important to demonstrate the ability in a situation characterized by uncertainty with
confidence
4. We should acknowledge emotions
Moreover, behaviour change should be promoted. But this is difficult, after all, knowing you should
do something isn’t the same as actually doing something different. This is the intention-behaviour
gap. There are four recommendations regarding behaviour change:
1. Michie and have suggested the usefulness of creating a mental model about how
contamination works and how this can be prevented. The better the inner picture is, the
greater likelihood that people will adopt the suggestion
2. Behaviour change requires not only verbal recommendations, but also real interventions in
the environment and even legislation
3. Even if citizens are more isolated than ever, in more or less self-imposed quarantines,
appeals to collective action and a spirit of we-are-in-it-together are very important to flatten
the curve and reduce the rate of infection
4. It is important to acknowledge that transition of initiation of behaviour to maintenance
requires a change in the self-regulation of the behaviour. Behaviour initiation requires
intentional behaviour planning whereas maintenance becomes more habitual and requires
less self-regulation. Self-efficacy is relevant in the motivational phase of behaviour, when
behaviour intentions are being formulated. To initiate a new health behaviour, individuals
must be confident in their ability and skills to perform that behaviour (action self-efficacy).
To maintain behaviour, individuals must be repetitive in their performance of the desired
behaviours and confident in their ability to overcome barriers in order to continue that
behaviour (maintenance self-efficacy)
Lecture 1
Most governments in most countries have outlines for their health communications. Note that the
campaigns try to address different groups in different ways. Moreover, the risk perception differs
per person and the media plays a role as well (agenda-setting theory). Namely, if it isn’t covered by
the news media, than it isn’t considered important.
Health can be seen in a trident:
- Objective
I am healthy as declared by health professionals
- Subjective:
I feel healthy
- Social:
I am accepted by society as healthy
,Primary prevention → prevention is better than the cure
Example: wash your hands to prevent Covid or wear your seatbelt to prevent harm during an
accident
Secondary prevention → early detection of a disease/issue/problem
Example: getting a scan (like a mammogram) to see if you have something (like breast cancer) or
not.
Tertiary prevention→ limiting the severity or consequences of a disease that people already have
Example: getting people to adhere to exercising problems in case that they are indeed obese to
prevent early death.
Note that the context and target group is important to define before being addressed by the
campaign. Namely, people can use exercise as a primary prevention as well as a tertiary prevention
once they are already obese.
Social marketing → how can I sell a specific behaviour
e.g., How can I sell not to smoke instead of commercial marketing, how can I sell cigarettes
Conner (2010) – Cognitive Determinants of Health Behaviour
Social-cognition models focus on what distinguishes people from performing or not performing a
certain behaviour. Because people can influence other people’s socio-demographic factors best,
health communicators tend to focus on these aspects.
Self-regulation → “... mental and behavioural processes by which people enact their self-
conceptions, revise their behaviour, or alter the environment so as to bring about outcomes in it in
line with their self-perceptions and personal goals.”
Self-regulation falls apart in two phases: motivational and volitational. During the motivational
phase, costs and benefits are weighted to choose between goals and behaviours. During the
volitational phase, planning and action for the set goal is mostly
dominant. Most SCM focus on the motivational phase, but the results
can of course play a role in the volitational phase.
The first model is the Health Believe Model (HBM) and is the oldest and
most widely used model. It rests on two cognitions: perceptions of
,illness threat and evaluation of behaviours to counteract this threat. So, the severity and the
consequences. Additionally, the costs and benefits are taken into consideration.
The main strength of HBM is the common-sense operationalization it uses including key beliefs
related to decisions about health behaviours. However, further research has pointed out other key
concepts that are stronger predictors of health behaviour than those shown in this model. A
proposal of self-efficacy and thus an extended health believe model, has improved the power of this
model significantly.
Second, protection motivation theory with its main pillar of
protection motivation (intention to perform health behaviour. There
are two appraisals: threat appraisal and coping appraisal. Note that
the threat appraisal is similar to HBM. Coping appraisal has two
components: the individual’s expectancy that carrying out a
behaviour can remove the threat (action-outcome efficacy) and a
belief in one’s capability to successfully execute the recommended
courses of action (self-efficacy). Together they for adaptive or
maladaptive behaviours.
Adaptive behaviour → individual is performing behaviour that is likely to reduce the threat. This is
more likely when the individual feels like he/she is suspectable to the proposed threat.
Third, theory of planned behaviour. The TPB proposes that
the key determinants of behaviour are intention to engage
in that behaviour and perceived behavioural control over
that behaviour. Perceived behavioural control (PBC) is a
person’s expectancy that performance of the behaviour is
within his/her control and confidence that he/she can
perform the behaviour and is similar to self-efficacy.
Intention is determined by: attitudes, subjective norms, and perceived behaviour control (PBC).
Attitudes are the overall evaluations of the behaviour by the individual as positive or negative.
Subjective norms are a person’s beliefs about whether significant others think he/she should engage
in the behaviour. PBC could influence both attitudes and subjective norms.
Fourth, Social Cognitive Theory (SCT) holds that health
behaviour is determined by: goals, outcome expectancies,
and self-efficacy. Goals are plans to act and can be
conceived of as intentions to perform the behaviour.
Outcome expectancies are similar to behavioural beliefs in
the TPB but here are split into physical, social, and self-
evaluative depending on the nature of the outcomes
considered. Self-efficacy is the belief that a behaviour is or
is not within an individual’s control and is usually assessed
as the degree of confidence the individual has that he/she
could still perform the behaviour in the face of various
obstacles (and is similar to PBC in the TPB).
Unlike a number of the other models considered above, many of the applications of SCT only assess
one or two components of the model (usually self-efficacy) rather than all components. Self-efficacy
and action-outcome expectancies along with intentions have been found to be the most important
, predictors of a range of health behaviours in a diverse range of studies. With stage models,
behaviours can change depending on which stage the participant is in. The most known stage model
is Transtheoretical model of change (TTM). It identifies 5 stages: pre-contemplation (unaware of
problem, no intention to stop), contemplation (smoker starts to think about behaviour change,
preparation (quit intention, planning to stop smoking), action (quitting smoking) and maintenance
(prevent relapse).
There have been attempts to morph the two types of models, eight variables across two groups.
First, those variables which were viewed as necessary and sufficient determinants of behaviour:
- Have a strong intention
- Have the necessary skills to perform the behaviour
- Experience an absence of environmental constraints that could prevent behaviour
Second, those variables that were seen primarily to influence intention (although a direct effect on
behaviour was noted as possible):
- Perceives the advantages (or benefits) of performing the behaviour to outweigh the
perceived disadvantages
- Perceives the social (normative) pressure to perform the behaviour to be greater than that
not to perform the behaviour
- Believes that the behaviour is consistent with his/her self-image
- Anticipates the emotional reaction to performing the behaviour to be more positive than
negative
- Has high levels of self-efficacy
The result? An integrated model:
Some misunderstandings
- Intentions are not stable
- Affect influences behaviour
- Research focuses too much on the motivational phase and not enough on the volitional
phase
Fishbein (2003) – Using theory to design effective health behaviour interventions
“This article shows the usefulness of two theories for the development of effective health
communication campaigns. The integrative model of behavioural prediction focuses on changing
beliefs about consequences, normative issues, and efficacy with respect to a particular behaviour.
Media priming theory focuses on strengthening the association between a belief and its outcomes,
such as attitude and intention toward performing the behaviour. Both the integrative model of
behavioural prediction and media priming theory provide guidance with respect to the selection of
beliefs to target in an intervention.”
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