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Summary for HEP4211

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Vak
Changing Health Behaviour (HEP4211)

Instelling
Maastricht University (UM)

I made a summary of all the summary lectures + I added information from the mini lectures in case I felt like it was needed. The course has changed from last year so this is the most up to date summary!

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summary for hep4211

Instelling
Maastricht University (UM)
Studie
Master Health education and promotion
Vak
Changing Health Behaviour (HEP4211)

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SUMMARY LECTURE
LC1. RISK COMMUNICATION METHODS

Risk perception is incorporated in many (health) behavior change theories, such as: ;
• Protection Motivation Theory
• Health Belief Model
• I-Change Model
• Extended Parallel Process Model
• Health Action Process Approach, etc.
It is seen as a precondition for motivation and informed decision making. People are more motivated to
behave healthy if they perceive themselves to be at risk. You need adequate knowledge of the risk to be
able to make an informed decision.

Risk perception = severity (Am I at risk? How high is my risk?) + susceptibility (How bad are the consequences
of me performing the behavior).

Risk communication = Conveying or transmitting information between parties about a range of areas including:
- Levels of health or environmental risks
- The significance or meaning of health or environmental risks
- Decisions, actions or policies aimed at managing or controlling health or environmental risks
Risk communication goals:
- Behavior change (people do not seem to perceive the risk)
- Provide reassurance when people are outraged/far more concerned than expected based on a
scientific point of view
- To inform people so that they can make informed decisions (informed decision making)
→ Goal: to reach accurate risk perceptions of risk (not necessarily ‘higher perceived risk’) and enable
people to make an informed decision.

In real (working) life, you have to study the specific literature of (tailoring it as much as possible to
your group is the best way to go):
- The risk issue
- The risk context
- The target group
- And take into account the goal of the risk communication

The perception of risk likelihood can guide (health-protective) behavior. People are often unrealistically
optimistic (=optimistic bias) about their vulnerability and underestimate their likelihood, especially when the
risk is partly controllable. Therefore, risk information is often included in health interventions to influence
individuals’ risk perception.
→ Not a one-size-fits-all way.

Probability estimates are affected by:
- Cognitive capacities and characteristics of the person who is receiving the message (e.g. numeracy,
graph literacy, educated).
- Context (e.g. the place where the message is given). → are people able (time) and motivated/have the
ability to process the information? (When watching television, people may have more time to process
info then when driving by a bus stop poster)
- Risk perception methods (e.g. formats, framing).

,→ Affect motivation and ability of people to process information: central/systematic route vs.
peripheral/heuristic route →the more central (deliberately) the processing of the message, the higher the
likelihood that people accept the message and will take action.

The dual-process theory:
- Systematic: extensive processing, for which motivation and time and cognitive capability are needed
- Heuristic: quicker, more superficial information processing. Presentation formats are especially
important in heuristic processing of information.

1. PRESENTATION OF RISK INFORMATION

The communication of risk information is a fundamental aspect of nearly all health
promotion interventions. However, no consensus exists regarding the most effective way to
provide people with risk information. Two approaches to risk communication:

1. Numerical probability-based approach = presentation of numerical information regarding the
probability of a risk/health problem occurring
- Percentages (2% risk)
- Rates (2 in 100)
- Proportion (1 in 50)
- Number needed to treat, relative and absolute risk reduction, etc.

→ What is the higher risk?
- 1286 of 10.000 or 24.14 of 100. Most people choose option 1, but the probability of option
2 is (much) higher. People tend to remember higher numbers more and perceive the risk to
be higher. They usually focus on the first number, so 1286 and 24.14.
→ When people must compare different risks, the misunderstanding among rates is lower
than in proportions.

-

Numeric risk information:
- Provides precise information regarding probabilities.
- People have problems understanding numerical information and ascribe meaning to a given
probability.
- Combining risk presentation to optimize understanding?
o Numerical for precision
o Verbal for helping people understand the number’s evaluative meaning (e.g. good/bad)
o Support with visual/graphical to increase comprehension and satisfaction.

Verbal risk information
- Difficult to use only verbal risk information
- Numerical information is perceived as more accurate than verbal information
- Verbal risk information can be useful
o Particularly in combination with numerical and/or visual info
o When exact numerical information is not available
- Whenever possible: prevent the use of verbal information alone

,Visual/graphical risk information
- Generally considered more attractive than numerical info
- Beneficial for facilitating risk comprehension, recall and satisfaction
o Particularly for persons with low numeracy OR high graph literacy

Conditions for effect
In order to optimize involvement/motivation and ability to process risk info:
- Adjust format and content to age, gender, specific subgroups
o Optimize relevance of info to increase involvement in the message (Increases
chance of centra processing)
- Take into account the cognitive capacities of the message receiver (e.g. numeracy and
graph literacy; Gaissmaier et al., 2012; Keller & Siegrist, 2009)
- Optimize the situation/context in which info is provided (environment, time, pressure,
mood, headspace for it at that moment etc.)
- Beware of information bias: people welcome favorable info about health
o Information that is inconsistent with important beliefs is likely to elicit a defensive
response (low involvement – no central/systematic processing) → use more
contextualized approach (e.g. narratives)
o People who really see the benefits of smoking → risk information does not help
them as much, narrative approaches would be better.

(Combining is wise when you do not know the characteristics of numeracy etc. of your audience to
address the needs of all of them)

Risk is more than probability
- Perceived risk = perceived susceptibility/probability + perceived severity
- People are more inclined to focus on the outcomes than on the probabilities
- People experience emotions in connection to these outcomes

2. NARRATIVE TECHNIQUES

Narrative = Any cohesive and coherent story with an identifiable beginning, middle and end that provides
information about the scene (scenario), characters, and conflict; raises unanswered question or unresolved
conflict and provides a solution to the problem.

- Correspond to basic mode of human interaction
- Logical and vivid description of the antecedents (often provided in the beginning, so what leads up to
the risk) and consequences of a health risk (= core elements)
o Important to have clear antecedents and consequences of a risk!
- Includes real-life emotionally interesting information
- Where statistical evidence appeals to logic and reason, narrative approaches tend to appeal to feelings

, - Often narratives are thought to be more persuasive than numbers BUT evidence not congruent.
o Narrative are more easily processed and better to comprehend?
o They evoke more affective responses/emotions, therefore they may be less counteracting
with counterarguments?
- The vividness of the information influences the effect of narratives: role of imaginability/ease of
imagination (availability heuristic) → more vivid the more easy it is to image the situation, the more
available in peoples mind
- People will judge the occurrence of a particular risk as more likely if it is easier to imagine (simulation
heuristic)

➔ Vividness and identifiability lead to more imaginability

Theoretical background
- Studies using ELM or HSM to explain narrative effects: mixed results/effects
- We should focus on Transportation Imagery Model instead!
o Transportation = ‘an integrative melding of attention, imagery, and feelings, focused on story
events’
o Persuasion due to transportation of individual into narrative world
▪ Transportation makes story seem like actual experience
▪ Individuals may identify with or develop emotions for the character(s) in the
narrative
▪ Individuals are absorbed in story; less likely to counter-argue

Conditions for effect
- Vividness of information on antecedents and consequences.
- Identifiability with main character.
→ Goal = increase ease of imagination.

- Perceived congruence with own values and beliefs.
o Congruent: statistical evidence is more persuasive.
o Incongruent: narrative evidence is more persuasive (less counterarguing).
- Combining statistical and narrative information is more effective than when using either one
- Align risk communication with characteristics of target population and goal/desired outcome of the
messages.

- There are 4 basic components that can affect the effectiveness of narrative communication in health
behavior change:
o Source
o Message
o Channel (written, verbal, radio, TV)

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