Contents

Too Smart To Start SmartSTATS: a Data Book

Theories and Models for Health Communications

Using Theories and Models

According to the National Institutes of Health (NIH) National Cancer Institute’s (NCI) Making Health Communications Work (2002), “sound health communication development should draw upon theories(1) and models that offer different perspectives on the intended audiences and on the steps that can influence their change. No single theory dominates health communication because health problems, populations, cultures, and contexts vary. Many programs achieve the greatest impact by combining theories to address a problem.” In planning, developing, implementing, and evaluating the Too Smart To Start Initiative, the Substance Abuse and Mental Health Services Administration is using a comprehensive health communications approach that is guided by various behavioral theories and models.

Making Health Communications Work, further states, “Although theories cannot substitute for effective planning and research, they offer many benefits for the design of health communication programs. At each stage of the health communication process, theories and models can help answer key questions, such as:

• Why a problem exists
• Whom to select
• What you need to know about the population/intended audience before taking action
• How to reach people and make an impact
• Which strategies are most likely to cause change

Reviewing theories and models can suggest factors to consider as you formulate your objectives and approach, and can help you determine whether specific ideas are likely to work. Theories and models can guide message and materials development, and are also useful when you decide what to evaluate and how to design evaluation tools.” For a more in depth discussion of health communication programming, refer to the National Institutes of Health National Cancer Institute’s Making Health Communication Programs Work (2002).

Theories and Models for Heath Communications Planning

The following are examples of theories and models that you can use while working through a health communication process.

Cognitive Theories and Models(2)

• Developmental Concept (Erickson, 1963). As 9- to 13-year-old children age, they continue to develop physically, emotionally, and mentally. All of these changes are happening at once, but not necessarily at the same rate. Understanding child development will help you design projects and messages that a child is emotionally ready to handle. This information will help you recognize how differently people at different ages respond to motivators, process information, and interact with their environment.

• Health Belief Model (Hochbaum, Kegels, and Rosenstock, 1952). This theory focuses on the relationships between health behaviors and individual perceptions. It says that individual risk perception affects the likelihood of taking preventive measures. Further, an individual’s tendency to take action is influenced by his or her perception of the personal threat as well as the benefits and barriers to taking action. This model is especially appropriate for preventive health campaigns—you persuade people to avoid developing habits that are bad for their health by showing them the consequences looming ahead.

• Social Cognitive (Learning) Theory (Bandura, 1977, 1986). Behavioral change is influenced through the interplay of knowledge, behavior, and social context applied at individual, community, or institutional levels. This theory suggests that information transmitted through both formal and informal networks within the community is most influential, and that a person’s unique behavior is determined by reciprocal interactions among personal factors, behavior, and environment.

• Theory of Reasoned Action (Fishbein and Ajzen, 1975). This theory addresses relationships among beliefs, attitudes, intentions, and behaviors. According to this theory, to change behavior it is necessary to understand whether the behavior is determined by an attitude or a social norm. People pay attention to what others think about their behaviors, and their actions reflect the importance this opinion has to them.

• Uncertainty Reduction Theory (Berger, 1975). According to this theory, uncertainty reduction is the main goal of interpersonal communication. Further, the degree of uncertainty (concerning perceived similarity, intimacy, reciprocity, and liking increases) has a profound effect on the way people communicate, both verbally and nonverbally.

Social Process Theories and Models(3)

• Attribution Theory (Heider, Jones, and Kelley, 1958–67). This theory posits that people act on the basis of their beliefs, regardless of the validity of those beliefs. Further, people’s beliefs profoundly affect their explanation and understanding of events around them, including their own actions and the actions of others.

• Cultivation Theory (Gerbner, Gross, Morgan, and Signorielli, 1980, 1986). According to this theory, repeated, intense exposure to deviant definitions of “reality” in the mass media leads to perception of the deviant reality as normal. The result is a social legitimization of the reality as depicted in the mass media, which can influence behavior.

• Cultural Competence and Intercultural Communication.(4) Everything you do should respect the diversity of your community, recognizing ethnic, gender, age, and other characteristics. Only when prevention programs are culturally tailored to the specific target audience, and when cultural diversity is respected and addressed, will relevance to and impact on the target population increase. For example, if a particular group considers it inappropriate to voice criticism publicly, do not expect too much feedback in a focus group evaluating your activities. Give these individuals an alternative way to express themselves such as written questionnaires or a suggestion box, keeping an eye toward what instruments are appropriate for the people in your community.

• Diffusion Theory (Rogers, 1983, 1995). According to this theory, individuals in social systems are most likely to adopt new behavior that is based on favorable evaluation of the intervention and that is conveyed to them within their social networks. Telling people how to change their behavior works best when you tap a community’s formal and informal communication networks.

• Multimedia Approaches (Hornik, 1989; Rogers, 1995). Health communication has three broad, basic channels: interpersonal communication aimed to families, friends, and health providers; group communication, including mobilization of community organizations; and mass media, including print and broadcast. A lead channel that reaches the intended audience needs to be identified based on analysis of the target population. What works best and what is most effective in health communication are multimedia approaches that use more than one medium or channel, that combine media to repeat and reinforce key messages.

• Resiliency (Rutter, 1993). This theory concerns the ability to develop or strengthen certain traits in individuals through positive influences in their own environment. These traits are social competence (communication skills), problem solving (critical and creative thinking), autonomy (self-awareness, identity), and aspirational levels.

• Social Identification Model (Turner and Taifel). This model says that people identify with the groups that they actually belong to, as well as groups they admire and groups they perceive as having traits in common with themselves.

• Social Marketing (Kotler, 1989). This model emphasizes the need to target and carefully select segments of the target audience, with the audience segmentation or targeting based on selected variables (such as geography, sex, age, values, or lifestyle). This kind of targeting allows for the selection of appropriate channels, messages, and sources for given audience segments.

• Social Norm. Social norms reflect peoples’ belief about the behavior expected of them in a particular social context. People’s perceptions of social norms are often good predictors of what they will say and do. Most people prefer to fall within normative ranges of behavior, however, perceptions of certain populations about nonnormative behavior often differ significantly from the facts. Further, members of a community may adapt their behavior to fall within perceived rather than actual norms.

• Transtheoretical Model/Stages of Change Theory. (Prochaska and DiClemente, 1983, 1985; Prochaska and DiClemente and Norcross, 1992). According to this model/theory, sustainable behavioral change in individuals moves through the following stages: precontemplation (unaware of or refuse to acknowledge their own risk); contemplation (begin to consider the need to change, evaluate cost and benefits); preparation (decision making and planning for change); action (begin to perform their new behavior consistently); and maintenance (solidify and routinize the behavioral practice).

Health Communication Process

NCI’s four-stage health communications process offers a practical approach for planning, implementing, and evaluating health communication efforts. The four stages constitute a circular method in which the last step feeds back into the first as you work through a continuous loop of planning, implementation, and improvement. In each of the stages, it is important to learn about the intended audience’s needs and perceptions. These needs and perceptions may change as the project progresses, so be prepared to make changes to the program as you proceed.

Stage One: Planning and Strategy Development

In Stage One, you create the plan that will provide the foundation for your program. By the end, you will have identified how your organization can use communication effectively, identified the target audience, crafted a communication strategy, and drafted communication plans, including activities, partnerships, and baseline surveys for outcome evaluation.

Stage Two: Developing and Pretesting Concepts, Messages, and Materials.

In Stage Two, you develop message concepts and explore them with the intended audience using qualitative research methods. By the end, you will have developed messages, planned activities and drafted materials, and pretested the messages and materials with your intended audience.

Stage Three: Implementing the Program

During Stage Three, you introduce the fully developed program to the intended audience. By the end of the stage, you will have begun program implementation, tracked intended audience exposure and reaction, and made revisions and adjustments when needed.

Stage Four: Assessing Effectiveness and Making Refinements

In Stage Four, you assess the program using the outcome evaluation methods you planned in Stage One. By the end, you will have assessed your program and identified refinements to increase the effectiveness of future program iterations.

Lastly, because program planning is a recurring process, you will likely conduct the planning, management, and evaluation activities described in the above stages throughout the life of the program.

(1) A theory is an explanation of how two or more variables work together to produce a certain outcome(s). (Witte, Meyer, and Martell, 2001)
(2) CSAP, Identity matters, Resource Manual, June 2001.
(3) CSAP, Identity matters, Resource Manual, June 2001.
(4) CSAP, Technical Assistance Bulletin, September 1994.