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Community intervention. Creating opportunities and support for cancer control behaviors.

Much of the potential for reducing cancer mortality is dependent on the adoption of new behavioral patterns. Such changes demand application of the behavioral-social sciences. A shift from univariate reductionist models of causation toward multivariate systems models is needed. Decisions (and behavior) are the focus of much of the behavioral-social sciences. Determinants of decisions are delimited by controlling systems. Health care is only one of many possible influences on controlling systems, and its influence is only marginal for the behavior of the general public. Thus, community interventions that address multiple determinants within controlling systems are needed to influence most behaviors. Belief saliency hierarchies appear to psychologically mediate controlling systems. Changes in these saliency hierarchies lead to changes in behaviors. Person-valued beliefs, social-valued beliefs, and feasibility beliefs serve as the informational basis for the hierarchies. Needs activation is a primary means by which hierarchies shift. Changing environmental cues and signals also impart such shifts. Experience, persuasive communication, and value extracted from the environment also change hierarchies. Needs activation, community presence, persuasive communication, facilitation, inhibition, and experience-based interventions are discussed for tobacco use control, dietary change, and breast and cervical cancer screening behavior. Emphasis is given to how the health care system can become a part of the controlling system that influences community behavior. Issues concerning successful implementation of community education programs are raised.

Community Health Services↗

Analysis of adolescents' beliefs about the outcome of using dental floss and drinking non-sugared mineral water.

Using an expectancy value approach, personal and normative beliefs about the outcome of using dental floss and drinking non-sugared mineral water were studied in a sample of 970 15-year-old adolescents in the county of Hordaland in Norway. The data stem from a survey performed in October 1992. A detailed analysis of these beliefs provides information about which of them should be targeted in a persuasive communication directed at changing behavior. The adolescents evaluated six outcomes of each behavior in terms of how much they wanted or feared them, and rated the probability of each outcomes happening. The adolescents also rated the probability that four significant referents would approve the performance of each behavior and how much they valued the approval of each referent. Subjects with relatively strong and relatively weak intentions to use dental floss and to drink non-sugared mineral water (intenders and non-intenders) were compared with respect to their scores on each measure. A one-way analysis of variance showed consistent differences between intenders and non-intenders. Intenders were more likely to believe that the specified behaviors would result in positive outcomes and they evaluated these outcomes as more desirable than non-intenders. Intenders believed their referens, in particular dentists and parents, to be more concerned about whether or not to perform the specified behaviors than non-intenders. The most promising candidates for persuasive communication among behavioral beliefs with respect to the specified behaviors appeared to be reduced tooth decay and several non, health beliefs in terms of immediate social and sensory concerns.

Adolescent↗

Promoting parental management of teen driving.

OBJECTIVE: Parenting may be an important protective factor against teen driving risk; however, parents do not limit teen driving as much as might be expected. The Checkpoint Program was designed to promote parental management of teen driving through the use of staged persuasive communications. METHODS: Parent-teen dyads (n = 452) were recruited when teens received learner's permits and interviewed over the telephone at baseline, licensure, and three months post-licensure. After baseline, families were randomized to either the intervention group that received persuasive communications or to the comparison group that received general information about driving safety. RESULTS: Both parents and teens in the intervention group reported significantly greater limits on teen driving at licensure and three months post-licensure. In multivariate analyses, intervention and baseline driving expectations had significant effects on driving limits at licensure. Intervention and driving limits established at licensure were associated with three month driving limits. CONCLUSION: The findings indicate that exposure to the Checkpoints Program increased parental limits on teen driving.

Accidents, Traffic↗

The effects of the checkpoints program on parent-imposed driving limits and crash outcomes among Connecticut novice teen drivers at 6-months post-licensure.

INTRODUCTION: Because crash rates are highly elevated during the first months of licensure, it is advisable for parents to limit teen driving so that teens can gain independent driving experience under less dangerous driving conditions. This report describes the effect of the Checkpoints Program on parent limits on novice teen driving through six months post-licensure. METHODS: Nearly one-quarter of all Connecticut teens who obtained a learner's permit over a 9-month period were recruited, providing a final sample of 3,743 who obtained licenses within the next 16 months. Families were randomized to the intervention or comparison condition. Intervention families received by mail a series of persuasive communications related to high-risk teen driving and a parent-teen driving agreement, while on the same schedule comparison families received standard information on driver safety. RESULTS: Families who participated in the Checkpoints Program reported significantly greater limits on teen driving at licensure, 3-months, and 6-months post-licensure. However, there were no differences in reported risky driving behavior, violations, or crashes. CONCLUSION: This is the first statewide study testing the efficacy of the Checkpoints Program. The results indicate that it is possible to foster modest increases in parental restrictions on teen driving limits during the first six months of licensure using passive persuasive communications, but that the levels of restriction obtained were not sufficient to protect against violations and crashes.

Adolescent↗

Health communication on the Internet: an effective channel for health behavior change?

This article presents a theoretical rationale for using the Internet to conduct persuasive public health interventions. Through an examination of the conceptual bases of persuasion, it is posited that the World Wide Web and other Internet-based resources have many of the characteristics necessary for persuasive communication and may, in fact, constitute a hybrid channel that combines the positive attributes of interpersonal and mass communication. The notion that the Internet features many of the persuasive qualities of interpersonal communication makes it a prime candidate for the application of key behavioral science theories and principles to promote healthier behaviors. The broad reach that the Internet shares with many mass communication channels indicates an economy to Internet-based efforts to communicate with large audiences. It is concluded that if the Internet can be used for persuasive health communication and its reach continues to expand, it is time for public health professionals to explore the design and evaluation of Internet-based interventions directed at health behavior change.

Health Behavior↗

Talking nets: a multiagent connectionist approach to communication and trust between individuals.

A multiagent connectionist model is proposed that consists of a collection of individual recurrent networks that communicate with each other and, as such, is a network of networks. The individual recurrent networks simulate the process of information uptake, integration, and memorization within individual agents, and the communication of beliefs and opinions between agents is propagated along connections between the individual networks. A crucial aspect in belief updating based on information from other agents is the trust in the information provided. In the model, trust is determined by the consistency with the receiving agents' existing beliefs and results in changes of the connections between individual networks, called trust weights. These weights lead to a selective propagation and thus to the filtering out of less reliable information, and they implement H. P. Grice's (1975) maxims of quality and quantity in communication. The unique contribution of communicative mechanisms beyond intrapersonal processing of individual networks was explored in simulations of key phenomena involving persuasive communication and polarization, lexical acquisition, spreading of stereotypes and rumors, and a lack of sharing unique information in group decisions.

Communication↗

The reinforcing effects of the recommendation in the threatening communication.

An instrumental escape conditioning paradigm was used to test the drive reducing effects of the recommendation in a threatening communication. Analogies were drawn between threatening communications and conditioning. Instrumental response speed was a monotonic decreasing function of delay of reinforcement: 0, 2, 6 sec (p less than .001). Each of the three delay groups acquired the instrumental response (p less than .001). Speed = 1/latency, automatically measured to .01 sec by a Lafayette digital stop clock. The Ss were 54 undergraduate males. A procedure was introduced to allow the separation and analysis of the drive inducing and reinforcing components of a threatening communication. Significant differences were detected between the reinforcing effects of communications (p less than .008). The results were interpreted in terms of the fear reduction model of persuasive communication.

Anxiety↗

Persuasion as a strategy for managing up.

Managing up and the effective use of persuasion are described. Managing up involves the use of relationships built on respect, understanding, and effective communication. Persuasion is an important strategy for managing up; its elements include establishing credibility, framing goals on common ground, vividly reinforcing your position, and connecting emotionally. Persuasive strategies that should be avoided include using hard-sell tactics, refusing to compromise, relying on strong arguments alone, surprising the boss in front of others, and assuming that persuasion is a one-shot effort. The use of supporting data helps establish credibility. Anticipating important data elements and locating published outcome data and experience at peer institutions that support a proposed plan of action increase the likelihood of the plan's acceptance. The plan and supporting data should be presented clearly and concisely. Once a proposal is approved, delivering what has been promised and following through with measurements of effectiveness are critical for enhancing credibility and increasing the likelihood of future successes. Persuasion is one key to working synergistically with an organization's upper-level management.

Group Processes↗

Guilt, fear, stigma and knowledge gaps: ethical issues in public health communication interventions.

Public health communication campaigns have been credited with helping raise awareness of risk from chronic illness and new infectious diseases and with helping promote the adoption of recommended treatment regimens. Yet many aspects of public health communication interventions have escaped the scrutiny of ethical discussions. With the transference of successful commercial marketing communication tactics to the realm of public health, consideration of ethical issues becomes an essential component in the development and application of public health strategies. Ethical issues in public health communication are explored as they relate to eight topics: 'targeting' and 'tailoring' public health messages to particular population segments; obtaining the equivalence of informed consent; the use of persuasive communication tactics; messages on responsibility and culpability; messages that apply to harm reduction; and three types of unintended adverse effects associated with public health communication activities that may label and stigmatise, expand social gaps, and promote health as a value. We suggest that an ethical analysis should be applied to each phase of the public health communication process in order to identify ethical dilemmas that may appear subtle, yet reflect important concerns regarding potential effects of public health communication interventions on individuals and society as a whole.

Community-Institutional Relations↗

False physiological feedback and persuasion: effect of fear arousal vs. fear reduction on attitude change.

Two experiments tested the hypothesis that increases in false physiological feedback of fear arousal will enhance persuasion and that reduction in the arousal feedback is unnecessary for increased persuasion to occur. Prior research has usually found a positive relation between level of arousal and persuasion, but support for the drive reduction hypothesis is tenuous. However, Harris and Jellison (1971) claimed support for such a hypothesis. They manipulated subjects' fear arousal cognitively via false physiological feedback while the subjects listened to a persuasive communication. The present experiments used a similar procedure in an attempt to test an "arousal only" against an "arousal reduction" hypothesis. Subjects listened to a persuasive speech while receiving false feedback via a meter concerning their fear arousal. In Experiment I half of the subjects received high arousal and half received moderate arousal information. Within each of these conditions half of the subjects had their arousal reduced, and the other half did not. In Experiment II subjects received either low arousal, high arousal, or high then low arousal feedback while listening. The results of the two studies generally provided support for the "arousal only" hypothesis. An interpretation in terms of Bem's attribution theory was tentatively suggested.

Arousal↗

Understanding the effects of printed health education materials: which features lead to which outcomes?

Printed health education materials (HEMs) are widely used to increase awareness and knowledge, change attitudes and beliefs, and help individuals adopt and maintain healthy lifestyle behaviors. While much of the contemporary research and development of persuasive communication is based on McGuire's input/output model, to date few studies have compared the impact of a large set of inputs across a comprehensive set of the 12 outputs. We examined the effects of printed HEMs on weight loss on the cognitive, affective, and behavioral responses of 198 overweight adults. Participants were recruited via a newspaper advertisement and were randomly assigned to review one of three HEMs. Participants were interviewed and asked to complete a series of questionnaires both before and after viewing the HEMs. Regression analyses were conducted to identify the input characteristics associated with success at each of the output steps. The results revealed attractiveness, encouragement, level of information, and application to one's life were significantly associated with early steps (attention, liking, and understanding) as well as some of the mediating steps (recalling, keeping, and rereading HEMs). Later steps, such as intention to change behavior and show others, were associated with readiness to change, self-efficacy, and perceived application to one's life. Behavior change was more likely for those who received tailored materials and those who had higher self-efficacy. These results provide useful direction for the use of computers in tailoring the content of HEMs and the development of effective communication of health information on weight loss.

Body Mass Index↗

Influence of a persuasive strategy on nursing students' beliefs and attitudes toward provision of care to people living with HIV/AIDS.

Based on the theory of planned behavior and the elaboration likelihood model, the aim of this study was to verify the effect of persuasive messages on nursing students' beliefs and attitudes regarding provision of care to people living with HIV/AIDS. The assumption was that a persuasive communication strategy induces a constructive change in beliefs and attitudes regarding provision of care. Baseline data collection was performed among a group of 74 nursing students (experimental group = 27; control group = 47). The questionnaire assessed the variables of the theory of planned behavior (i.e., beliefs, attitudes, perceived behavioral control). The results confirmed that persuasive messages generated a change in beliefs and attitudes of the nursing students concerning providing care to people living with HIV/AIDS. It appears that this strategy of modifying behavioral predispositions is effective and generates cognitive and affective changes. Therefore, educational programs should take these observations into consideration to ensure that future nurses are better prepared to provide appropriate care to people living with HIV/AIDS.

Adult↗

Young adolescents' intention to use seat belts: the role of attitudinal and normative beliefs.

In this study, the Theory of Reasoned Action was applied for two different purposes: (i) to explain and predict seat-belt usage among young adolescents, and (ii) to investigate the specific cognitions underlying the decision to use seat belts. A detailed analysis of these cognitions may provide clues as to which beliefs one should try to change in order to improve seat-belt usage among young adolescents. The decision to wear seat belts was under attitudinal control in the front seat, while it was under both attitudinal and normative control in the back seat. However, prior use of seat belts was the single most powerful predictor of intention. There was a striking consistency in the difference between high intenders and low intenders with regard to the specific underlying cognitions. The most promising 'messages' for persuasive communication appears to be that use of seat belts has an injury reducing effect and makes one feel safe when driving.

Adolescent↗

[The effect of unpleasant mood and involvement on information processing in persuasion].

This study investigated the effect of unpleasant mood and involvement on the processing of persuasive communication. It was hypothesized that unpleasant mood would facilitate the processing of a message on a highly self-involving topic but inhibit that on a low self-involving topic. Mood-inducing films were used to induce unpleasant or neutral mood. Results indicated that unpleasant mood facilitated cognitive processing of the message in both the conditions of high and low involvement. Moreover, subjects in unpleasant mood evaluated plausibility of the message and communicator's credibility and likability more carefully than subjects in neutral mood. Consistent with the findings of Schwarz, Bless, and Bohner (1991), the present results indicate that unpleasant mood facilitates elaborated processing.

Adult↗

[Behavior change from defection to cooperation in a social dilemma: a field study of attitude-behavior consistency in campus parking behavior by motorcyclists].

Behavior change by persuasive communications in a social dilemma, in which a university tried to persuade students to park their motorcycles in a designated lot in order to resolve noise problems, was studied by a questionnaire. Hayashi's quantification theory III was applied to variables such as subjective norms, beliefs in the effectiveness of one's cooperation, the perception of campus traffic conditions and attitudes toward one's parking behavior. Factor scores obtained were subjected to a cluster analysis, which, within 105 defectors, yielded three subgroups. Contrary to prediction, subgroups were not different in their cooperation ratio examined 10 months later, but tended to be different in their readiness for acceptance of persuasion and in their intention to cooperate in a social dilemma other than parking. Two mechanisms underlying cooperation were revealed: internalization of prosocial norm, and compliance in which cooperation was unaccompanied by correspondent changes in normative beliefs. The Fishbein model was applicable only to change through internalization. A linear assumption in the Fishbein model between evaluative attitude and behavior should be reexamined in its application to a social dilemma.

Adult↗

Stigmatized sources and persuasion: prejudice as a determinant of argument scrutiny.

Two experiments examined the viability of several explanations for why majority group individuals process persuasive messages from stigmatized sources more than those from nonstigmatized sources. In each study, majority group participants who either were high or low in prejudice or were high or low in ambivalence toward a stigmatized source's group were exposed to a persuasive communication attributed to a stigmatized (Black, Experiment 1; homosexual, Experiment 2) or nonstigmatized (White, Experiment 1; heterosexual, Experiment 2) source. In both studies, source stigmatization increased message scrutiny only among those who were low in prejudice toward the stigmatized group. This finding is most consistent with the view that people scrutinize messages from stigmatized sources in order to guard against possibly unfair reactions by themselves or others.

Black or African American↗

Effects of persuasion and autotelic inquiry methods on attitude change.

Attitude change of nursing students following two group-therapy treatments, involving persuasive communication (n = 6) and autotelic inquiry (n = 7), was measured by the Attitude Toward Old People and Opinions About Mental Illness scales. Rotter's Locus of Control scale was used to measure internal vs external orientation. A significant difference from controls (n = 14) for Interpersonal Etiology on the Opinions About Mental Illness scale was found for the Autotelic Inquiry group (n = 7) which provided role-induced simulations, but no difference was found for Atttitudes Toward Old People or Locus of Control.

Adult↗

The effects of mailed reminders and tailored messages on mammography screening.

A mail campaign to promote mammography screening was tested with 3,887 Medicare recipients in North Dakota who had not had a mammogram in 2 1/2 years. Three types of mailings were compared: (1) a simple reminder message, (2) a reminder accompanied by a persuasive communication emphasizing personal risk, and (3) a reminder accompanied by a message tailored to the participants' chief barrier to having a mammogram. Overall, subsequent mammography rates for women in these conditions did not differ from the rate observed among women who did not receive any mailing. However, post-hoc analyses suggested that women who reported a barrier to having a mammogram were more likely to have a mammogram. Population-wide mail campaigns of the kinds tested here may be generally ineffective for Medicare recipients who are obtaining screenings infrequently. Tailoring messages may be one potentially effective intervention, if investigators can develop ways to increase responses to inquiries about barriers.

Aged↗