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Integrating Application of Media Effects, Persuasion, and Behavior Change Theories to Communication Campaigns: A Stages-of-Change Framework
Health Communication
Abstract
A central problem in the planning of communication campaigns to change health behaviors is how to identify and apply appropriate communication, persuasion, and behavior change theories to overcome obstacles to behavior change. The stages-of-change model (Prochaska, DiClemente, & Norcross, 1992) provides a framework for integrating theories of media effects, such as agenda setting and multistep flow; theories of persuasion, such as the elaboration likelihood model and protection motivation theory; and theories of behavior change, such as the theory of reasoned action, social cognitive theory, and attitude accessibility, for communication campaign purposes. Implications for audience segmentation, selection of objectives, campaign strategy, and message design are discussed.
... Continuous, frequent exposure to media campaign advertisements is recommended to produce campaign effects (Hornik, 2002b;Wakefield et al., 2010), as even the most convincing messages are subject to null effects if insufficient exposure occurs (Hornik, 2002a). Frequent exposure increases the likelihood that messages are top of mind (Slater, 1999) and facilitates greater opportunities for audiences to encode and learn specific messages and to engage in social interaction due to campaign exposure (Hornik, 2002a); in turn, campaign-generated interpersonal communication have been shown to impact campaign-targeted health outcomes (Jeong & Bae, 2018). Heavy-up approaches to campaign advertising offer opportunities for repeated exposure in select audiences. ...
... Results from this study align with our expectation of greater Campaign impact in markets that received heavy-up advertising compared to those that did not. We anticipated that heavy-up Campaign dose would correspond with an increased likelihood of COVID-19 vaccine uptake because frequent exposure increases the likelihood that messages are top of mind (Slater, 1999) and facilitates greater opportunities for message recall and encoding (Hornik, 2002a), precursors to belief, intention, and behavior change (Depue et al., 2015;Farrelly et al., 2017;Kranzler et al., 2017Kranzler et al., , 2023. These results offer evidence consistent with the notion that campaign exposure is fundamental to eliciting campaign effects (Hornik, 2002a(Hornik, , 2002b. ...
To address vaccine hesitancy, the U.S. Department of Health and Human Services (HHS) launched the “We Can Do This” COVID-19 public education campaign (the Campaign) in 2021 to promote vaccine confidence and increase vaccine uptake. The Campaign introduced a heavy-up media strategy to enhance its reach and engagement with its vaccine hesitant audience. This approach complemented the Campaign’s national media strategy while delivering an additional advertising dose to select priority designated market areas (DMAs) – that is, media markets – each month. We examine the relationship between the Campaign’s heavy-up strategy and initial COVID-19 vaccine uptake from August to December 2021. A stacked difference-in-differences (DID) analysis com-pared initial COVID-19 vaccine uptake between DMAs that received heavy-up (treatment) and DMAs that did not (control). The Campaign’s short-term heavy-up advertising strategy was associated with increased initial vaccine uptake in treatment DMAs. These results provide valuable insights for public health campaign strategy and evaluation, highlighting the effectiveness of increasing campaign dose in select markets to address vaccine hesitancy and improve public health outcomes.
... Las estrategias de comunicación deben ir adecuadamente dirigidas al tipo de público al cual se quiere hacer llegar el mensaje. Como explica Slater (1999), cada grupo y subgrupo de población objetivo tiene unas características preexistentes. Estas características pasan por aspectos como el conocimiento, creencias, motivaciones, limitaciones percibidas, etcétera. ...
Urban air pollution is currently the greatest environmental risk to the health of Europe's population. Traffic calming measures are increasingly seen as a solution to improve air quality and promote people's well-being in urban areas. As public opposition is considered one of the main obstacles to the introduction of such policies, this Thesis investigates public acceptance and attitudes towards a specific urban intervention to reduce air pollution: The Barcelona¿s Superilles (Superblocks). The research proposal is structured through a mixed methodological approach. For the qualitative data, an exploratory analysis was carried out using interviews and focus groups. The aim of the interviews was to explore personal characteristics, previous attitudes, problem perception, institutional trust, the legitimacy of the process and the specific beliefs and emotions of the Superilles. The sample (n=15) consisted of experts and/or policy makers responsible for designing, implementing and/or evaluating the Superilles in the city of Barcelona, shopkeepers, residents, associations and interest groups in favour and against this policy. The aim of the focus groups was to obtain exhaustive information on citizens' beliefs regarding aspects such as air pollution and traffic in the city of Barcelona and the implementation of the Superilles. Eight focus groups (n=32) were carried out, half of which were made up of residents and half of which were non-residents of the Superilles. For quantitative data, a survey of residents in Barcelona was conducted using deliberate sampling (n=501), with the aim of estimating public acceptance of the Superilles and examining the personal, attitudinal and socio-demographic factors associated with acceptance and general attitude towards this policy. The results have led to the conclusion, firstly, that the acceptance of the Superilles is not determined by a single factor, but by a combination of several factors. Secondly, it is worth noting the significant polarisation in acceptance between those who consider themselves supporters and those who consider themselves opponents of the Superilles. Emotions have been found to show the highest explanatory effect, followed by perceived impacts on environmental quality and perceived legitimacy. Antecedent variables also have an explanatory effect, mediated through the aforementioned variables. In addition, supporters tend to be younger, more likely to be female, more likely to live near a Superilla, more likely to be non-car owners and more likely to be on the left side of the ideological spectrum. Moreover, it has been found that perceiving the benefits of the measure is insufficient to accept it, due to the important role played by emotions, which can manifest themselves positively or negatively and range from anger, joy or concern, to perceptions of freedom, interest or fairness. Therefore, if the Superilles¿ scheme aims to be applied with optimal public acceptance, it is essential for authorities and policymakers to take a number of factors into account. Firstly, the emotions of the public, due to their strong influence on the public acceptance of the Superilles and, consequently, the necessity of trying to convince the public through targeted persuasion. Other aspects to be considered are how the public perceives the impacts on environmental quality and whether they perceive that the implementation of this policy is being carried out in a democratic way.
... The main objective of this paper is to provide a comprehensive conceptual model to explain how game design considerations can contribute to pro-environmental attitudes while examining the persuasive potential of a case study (Plasticity). Exploring persuasive game studies shows that even though game-based interventions have been exposed to specific theories, such as stages of change [135], identification [148], and perspective-taking [67], the existing literature on persuasive games lacks endorsement from theoretical and psychological processes that target specific design factors. Investigating the literature on climate-focused game design shows that the limited frameworks/guidelines in this field (e.g., in [40,44,49,54,114]) are rarely supported by any empirical evidence, and in some cases even lack a comprehensive inclusion or categorisation of game design factors. ...
... If not persuasion, then what are we seeing here? In the context of a pro-attitudinal but potentially anxiety-provoking topic, we believe that it makes more sense to think in terms of the ability of a message to motivate behavior among those who already agree the behavior would be desirable, rather than to alter attitudes (see stages of change models, Weinstein, 1988;Slater, 1999). This interpretation is underscored by the similar impact of the testimonial on those who had as opposed to those who had not had substantive prior conversations. ...
Persuasive testimonials are common in commercial, nonprofit, and public health contexts. They pose challenges to existing theories of narrative persuasion because they are typically both narrative and overtly persuasive. Prior research has suggested testimonials may be effective with counter-attitudinal recipients by decreasing negative affective responses and increasing meaningful affect. Often, however, testimonials may address behaviors that are anxiety provoking rather than counter-attitudinal; prior research provides little theoretical or empirical guidance concerning message influence in the face of such anxiety. An experiment comparing a testimonial versus a non-narrative message advocating end-of-life conversations found that the testimonial message increased behavioral intentions via meaningful affect and self-efficacy. The testimonial did not decrease anxiety, and there was no differential impact on high versus low anxiety recipients. The authors conclude that a eudaimonic testimonial may serve as a motivator of behavior regardless of anxiety concerning the message topic, as well as a means of increasing self-efficacy.
... For example, recognizing that many people struggle to understand risks, particularly rare risks, we highlighted portions of crowds in football stadiums of different sizes to visually depict and compare the risks of disease and the risks and benefits of vaccination. We expanded our use of behavior theories to include Narrative Theory Anecdotes (27)(28)(29)(30). Timing Inoculation Theory (31), and the Transtheoretical Model for Behavioral Change (32), as described in Table 1. ...
Introduction
Vaccine hesitancy is a global health threat undermining control of many vaccine-preventable diseases. Patient-level education has largely been ineffective in reducing vaccine concerns and increasing vaccine uptake. We built and evaluated a personalized vaccine risk communication website called LetsTalkShots in English, Spanish and French (Canadian) for vaccines across the lifespan. LetsTalkShots tailors lived experiences, credible sources and informational animations to disseminate the right message from the right messenger to the right person, applying a broad range of behavioral theories.
Methods
We used mixed-methods research to test our animation and some aspects of credible sources and personal narratives. We conducted 67 discussion groups (n = 325 persons), stratified by race/ethnicity (African American, Hispanic, and White people) and population (e.g., parents, pregnant women, adolescents, younger adults, and older adults). Using a large Ipsos survey among English-speaking respondents (n = 2,272), we tested animations aligned with vaccine concerns and specific to population (e.g., parents of children, parents of adolescents, younger adults, older adults).
Results
Discussion groups provided robust feedback specific to each animation as well as areas for improvements across animations. Most respondents indicated that the information presented was interesting (85.5%), clear (96.0%), helpful (87.0%), and trustworthy (82.2%).
Discussion
Tailored vaccine risk communication can assist decision makers as they consider vaccination for themselves, their families, and their communities. LetsTalkShots presents a model for personalized communication in other areas of medicine and public health.
... The theory argues that an individual's belief and confidence in their ability to reproduce a certain behavior is a major factor in determining if they will actually do it. Additionally, self-efficacy appears to be partially responsible for how social influences shape behavior [6]. ...
According to the White Paper on China’s Pet Industry 2021, the population of raising cats and dogs in China has reached 68.44 million. However, many acquire these pets without giving it much thought, only to later realize that caring for a pet requires significant effort, time, money, and patience. As a result, pet abandonment has become a serious issue. The World Health Organization predicts that around the world, there are about 200 million stray dogs, with China accounting for 40 million or one-fifth of the total. Rapid modernization and urbanization have turned Shanghai into a hub of homeless pets. To address this issue, this paper focuses on changing the attitudes of Shanghai high school students toward animal protection. The study focuses on this particular group since their attitudes represent the future generation, yet there is a lack of research on this topic. The paper aims to fill this gap by exploring the most effective way to raise awareness among Shanghai high school students about the issue of homeless animal protection. To this end, the researcher has devised three types of persuasion methods in a lab setting to compare and contrast the results among Shanghai high school students.
... By designing communication for homogenous groups that share certain characteristics-whether knowledge, attitudes, or behaviors-programs arguably can be both more effective and efficient (Slater, 1996). Audience segmentation research also can contribute to theory by further elucidating behavior change pathways (Slater, 1999). The transtheoretical model proposed by Prochaska and colleagues (1992) identifies a progression in stages of behavioral changeprecontemplation, contemplation, preparation, action, and maintenance-that aligns with general models of communication and risk information processing (Bostrom et al., 2018). ...
This audience segmentation of visitors at coastal parks in Hawaii and North Carolina addresses an emergent natural resource management concern and risk to aquatic ecosystems: sunscreen chemical pollution. Four audiences were identified that correspond to different behavioral profiles: sunscreen protection tourists, multimodal sun protection tourists, in‐state frequent park visitors, and frequent beachgoers who skip sunscreen. The second‐largest audience, sunscreen protection tourists, represents 29% of visitors at Cape Lookout National Seashore and 25% at Kaloko‐Honokōhau National Historical Park. This group ranks of most concern for chemical pollution because they use sunscreen, but not typically mineral formulations or other methods such as protective clothing, and they have lower levels of sunscreen chemical issue awareness. The identification of similar audience segments across regions with differing cultural characteristics and sunscreen regulation status suggests the robustness of the model and its indicator variables, with implications for both environmental protection and public health. Further, coastal visitors’ interest in enacting pro‐environmental sun protection behaviors during their next park or beach visit indicates the potential for natural resource managers to holistically address risks in both domains through targeted interventions with audiences of most concern.
Background: Restrictions on televised tobacco ads do not apply to vaping and oral nicotine products. Several campaigns are currently active on U.S. national television. This research examines the extent to which objective ad features are associated with ad, brand, and product appeal and use intentions among 18-24-year-olds. Methods: We identified seven unique campaigns for Vuse, Velo, and JUUL from the Mintel Comperemedia database, coded for youth-appealing content, and then randomly assigned among N = 1450 18-24-year-olds. Following exposure to one 15-second ad, participants completed a survey assessing their subjective responses. Results: Youth-appealing content was prevalent across these ads to varying degrees. Mixed effects regression analyses showed a positive association between features from the Content Appealing to Youth (CAY) index and pro-social brand perceptions, positive attitudes, reactions, and perceived effectiveness of the ad, and positive use perceptions. Moreover, themes related to customization of the device and environmental sustainability were associated with similar positive perceptions, including that using the product would be cool, as well as behavioral intentions to try, use occasionally, and use daily. Conclusions: Regulators need to update tobacco advertising restrictions to accurately reflect the current tobacco product landscape. This study contributes to the research on tobacco promotion strategies by examining the current marketing landscape for newer tobacco products and their appeal to youth. Findings from this study inform comprehensive tobacco marketing regulations, recommending the FDA update its guidelines and apply current marketing restrictions to e-cigarettes and oral nicotine products.
This aerial review concentrates on the development of the South African television industry as chronicled and analysed by scholarship. Academic reflections on the evolution of television are categorised into three main periods: First, the advent of South African television, second, the transitional period, and third, a period of stocktaking. The overview aims to provide readers with key academic discussions during these periods and the historical context within which they took shape. Looking at issues ranging from censorship, nation-building, restructuring and globalisation, to event television, edutainment programming and community TV, the South African television environment is shown to be in constant transition.
This is a classic textbook in public relations, which emphasizes a theoretical, managerial approach to public relations.
Research dealing with various aspects of* the theory of planned behavior (Ajzen, 1985,
1987) is reviewed, and some unresolved issues are discussed. In broad terms, the theory is
found to be well supported by empirical evidence. Intentions to perform behaviors of different
kinds can be predicted with high accuracy from attitudes toward the behavior, subjective
norms, and perceived behavioral control; and these intentions, together with perceptions of
behavioral control, account for considerable variance in actual behavior. Attitudes, subjective
norms, and perceived behavioral control are shown to be related to appropriate sets of salient
behavioral, normative, and control beliefs about the behavior, but the exact nature of these
relations is still uncertain. Expectancy value formulations are found to be only partly
successful in dealing with these relations. Optimal rescaling of expectancy and value
measures is offered as a means of dealing with measurement limitations. Finally, inclusion of
past behavior in the prediction equation is shown to provide a means of testing the theory*s
sufficiency, another issue that remains unresolved. The limited available evidence concerning
this question shows that the theory is predicting behavior quite well in comparison to the
ceiling imposed by behavioral reliability.
The research described in this article tested the social cognitive hypotheses that self-efficacy can be enhanced more effectively by symbolically modeling risk reduction information and by encouraging its cognitive rehearsal than by the presentation of risk reduction information alone. Young unmarried women (N = 138) viewed one of three videos: AIDS information only, information plus modeling, or information plus modeling with cognitive rehearsal. The hypotheses were confirmed at both posttest and one month follow-up: AIDS prevention self-efficacy was most improved among participants who watched the information plus modeling with rehearsal video, while participants viewing the information plus modeling video exhibited an intermediate level of improvement. Certain AIDS preventive behaviors, including condom purchases and conversations with friends about safe sex, also exhibited significant treatment-related changes at follow-up. These results indicate that symbolic modeling and cognitive rehearsal of modeled information are effective strategies for enhancing perceptions of self-efficacy through televised media.
No consensus exists on how to develop effective risk messages that motivate appropriate action yet do not unduly frighten people. A useful framework for developing risk messages is the extended parallel process model (EPPM). The EPPM suggests that when people are faced with health or environmental risks, they are motivated to either control the danger or control their fear. This chapter offers a description of how the EPPM can explain public responses to risk messages, and then reports on two pilot studies that illustrate how existing audience perceptions can be used in the design and generation of effective risk management messages.
An injury prevention research program supported by funding from the U.S. Bureau of Mines (USBM) and the National Institute for Occupational Safety and Health (NIOSH) resulted in the development, evaluation, and dissemination of approximately 70 narrative-based simulation exercises for mining industry workers in the United States (Catalog of training products, 1993). More than 400,000 copies of the mining exercises have been used in the United States, and additional copies are used in four other countries (Cole, 1993; Cole et al., 1993). Additional funding from the National Institute for Environmental Health Sciences (NIEHS), the Office of Surface Mining, the Agency for Toxic Substances Disease Registry, and NIOSH produced interactive-narrative exercises for firefighters, mine reclamation inspectors, hazardous-waste workers, health care providers, and farm family adult and youth workers.