Key Theoretical Influences in Health

Communication

Lecture Two
 › To explain the role of theories in health communication.
› To discuss some selected behavioural and social sciences
Learning theories in the context of health communication:
Objectives › Diffusion of Innovation Theory.
› Health Belief Model.
› Theory of Planned Behaviour.
› Stages of Behaviour Change Model.

Lecture Two: Please, Do Not Cite Or Reference These Notes

3/11/2022 2
 A theory is a collection of concepts/ideas about
some real world area of concern/interest which
helps explain, predict, and/or intervene with a
phenomenon.
What is a Theories facilitate explanations regarding why
theory? and how things occur as they do, what is going
to happen given the way things are, and what
actions can be taken to make things turn out in
some desired way.

Lecture Two: Please, Do Not Cite Or Reference These Notes

3/11/2022 3
 Theories according to Hambrick (2007), are very
useful tools that help us accomplish many such
important outcomes as:
1. Organize our thoughts and ideas about the world.
2. Generate and explain relationships & interrelationships
What do among individuals, groups and entities.
Theories do? 3. Improve our predictions and expectations about
people, groups and organizations.
4. Achieve better understanding of the world.

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 4

 › Provide a basis for communication planning
and evaluation.
› Inspire specific communication approaches.
Role of Theories
in Health › Help implement a specific phase of a health
communication program.
Communication
› Support a true understanding of target audiences
and groups as well as the health communication
environment.

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 5

 › If health communication is based on a theoretical
model, some of the pitfalls associated with poor
communication can be eliminated.
Role of Theories › Theories can help predict and explain behaviours,
assist in the targeting of information and predict
in Health the effect that information will have.
Communication
› They also allow practitioners to predict why the
audience may not undertake a behaviour no
matter how much assistance or encouragement
is available.

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 6

 Theories should:
› Be considered part of a tool kit and selected
on a case-by-case basis.
Guidelines for › Respond to an audience’s needs.
Using Theories in › Address the specific health situation and all
factors that play a role in determining it.
Health › Inform and guide message development as well as the
Communication identification of appropriate communication channels.
› Be revisited in the light of emerging factors and needs.

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 7

 ➢Diffusion of innovation theory?
Diffusion of
Innovation ➢Innovation?
(DOI) Theory

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 8

 The diffusion of innovation theory addresses how
new ideas, concepts, or practices can spread within
a community or society or from one society to
Diffusion of another (NCI, 2002).
Innovation
(DOI) Theory Innovation: An idea, attitude, behavior, practice
or object that is perceived as new by an individual,
members of a social system or other units of
adoption.

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 9

 ➢Relative Advantage

➢Compatibility

Factors that ➢Complexity

Influence ➢Experimental
Adoption of ➢Observability
an Innovation

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 10

 ➢Relative Advantage: The degree to which an
innovation is seen as better than the idea, program, or
product it replaces.

➢Compatibility: How consistent the innovation is with

the values, experiences, and needs of the potential
Factors that adopters.
Influence ➢Complexity: How difficult the innovation is to
Adoption of understand and/or use.
an Innovation ➢Experimental: The extent to which the innovation can
be tested or experimented with before a commitment to
adopt is made.

➢Observability: The extent to which the innovation

provides tangible results.
3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 11
 The theory identifies and defines five subgroups
on the basis of the audience’s characteristics and
propensity to accept and adopt innovation.
Innovations do not spread equally over different
DOI Theory society segments (social groups) but through 5
Subgroups stages with particular profile of reaction.
› Innovators.
› Early Adopters.
› Early Majority.
› Late Majority.
› Laggard.

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 12

 Innovators:
› Risk-taking.
› Are active seekers of information about new ideas.
› Have a high degree of mass media exposure.
DOI Theory › Interpersonal networks extend over a wide area.
Subgroups
› Can cope with higher levels of uncertainty about an
innovation than other adopter categories.

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 13

 Early Adopters:
› Are opinion leaders.
› Have more exposure to media.
› More social participation.
DOI Theory Early Majority:
Subgroups › Deliberate.
› Adopt because they perceive it as the right thing to do.
› Reached by interpersonal channel.
› Are usually swayed by the opinions of individuals in
their immediate environment.

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 14

 Late Majority
› Skeptical.
› Low social status.
› Making little use of mass media channels.
› Learn about most new ideas from peers via
DOI Theory interpersonal channels.
Subgroups Laggard
› Traditional.
› Want to maintain status quo.
› Last in a social system to adopt an innovation.
› Adopt only if all other alternative appear worse.
› Pay little attention to the opinions of others.

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 15

 DOI Theory
Subgroups

Source: Beal and Rogers (1960)

3/11/2022 16
 Attribute of the Environmental
Audience Constraints/
Literacy Facilitators
Education Access to Education
Attribute of the Degree of social
Innovation Access to
What Predicts Relative Advantage
Participation information &
means of
Attitude toward
Rate of Compatibility
Complexity
change communication

Diffusion? Trialability Tolerance for

ambiguity and risk
Access to
innovation
Observability
Exposure to media Normative
& interpersonal pressure
channels Disposable
Information seeking income & ability
behavior to absorb loss

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 17

 › Identify how audiences think of the
innovation.
› Identify
members.
people who are key network
Putting DOI › Use messages that address concerns about
the innovation.
Theory to › Demonstrate the benefits.
Work › Show how the new behaviour fits or
grows out of current practice.
› Offer opportunities for trial.
› Encourage discussions.
3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 18
 The theory helps in early audience segmentation.
The individuals’ stage model offers a viewpoint on the
time and the external circumstance needed to achieve
Contributions of behavioural or social change.
DOI to Health
Communication It is also a valid reminder that continuing to engage
innovators and early adopters or their representatives in
program planning and evaluation is essential to program
sustainability as well as to the involvement of larger
segments of the intended population in accepting and
adopting innovative behaviours or social practices.

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 19

 HBM is one of the first theories developed to explain
the process of change in relation to health behavior.
The HBM was developed in the 1950s to explain why
medical screening programs offered by the U.S. Public
Health Service to help people diagnose and prevent
diseases failed (NCI, 2003).
Health Belief The underlying assumptions of the HBM are that to
Model (HBM) engage in healthy behaviours, intended audiences should
be aware of their risks for severe or fatal diseases and
recognize that the benefits of behavior change outweigh
probable barriers or other negative aspects of the
recommended actions. NB: An individual weighs
between the perceived consequences of failure to
adopt a behaviour change (perceived risk) and the
perceived benefits associated with adopting a
behaviour change.

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 20

 ➢Perceived Susceptibility.
➢Perceived Severity.
Key ➢Perceived Benefits.
Components ➢Perceived Barriers.
of HBM
➢Cues to Action.
➢Self Efficacy.

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 21

 Perceived Susceptibility:
An individual’s perception on whether he/she is at risk
for contracting a specific illness or health problem.
Personal risk is one of the most powerful perceptions in
Key stimulating individuals to adopt healthier behaviours. The
greater the risk, the greater the likelihood to engage in
Components behaviours to decrease the risk. The opposite is also true –
of HBM less risk results in unhealthy behaviours.

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 22

 Perceived Severity:
The subjective feeling on whether the specific
illness or health problem can be severe or life
threatening and therefore worthy of one’s
attention.
Key
Components Though the perception of seriousness is mostly
based on medical information, it may also come
of HBM from beliefs an individual holds about the
difficulties a disease would create or the effects it
would have on his/her life in general.
E.g. Asthma and flu or cattarrh

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 23

 Perceived Benefits
A Person’s perceptions of the gains of adopting
recommended actions that would in due course
reduce the risk for disease severity, morbidity, and
mortality.
Key
The perceived benefits construct holds the view that
Components people tend to adopt healthier behaviours when they
of HBM believe the new behavior will decrease their chances
of developing a disease.
E.g. Colonoscopy (Colon cancer screening)
Breast self exam – BSE (Breast cancer detection)

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 24

 Perceived Barriers
A Person’s perceptions of the costs (economic
cost & lifestyle sacrifices) of and obstacles to
adopting recommended actions.
Perceived barriers signify an individual’s own
Key evaluation of the hurdles impeding the adoption of
Components a new behaviour. It is the most significant of all
the constructs in determining behaviour change.
of HBM
For a new behaviour to be adopted, a person needs
to believe its benefits outweigh the consequences
of continuing the old behaviour so as to overcome
the barriers.
E.g. Cervical cancer screening
Regular visit to the gynecologist.

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 25

 Cues to Action
Public or social events that can signal the importance
of taking action. Alternatively, cues to action are
events, people or things that move people to change
Key their behavior. For example, diagnosis of a family
member, a mass media campaign or media report,
Components and health warning labels on products etc.
of HBM E.g. Signposts on University campuses of fatal car
accidents from drunk driving = Don’t drink and drive.

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 26

 Self Efficacy:
It is the belief in one’s own ability to do something.
Self efficacy represents an individual’s confidence in
his/her ability to perform and sustain the
recommended behaviour with little or no help from
Key others.
Components If an individual believes a new behaviour is useful,
but does not think he/she is capable of doing it, the
of HBM odds are that it may not be tried.

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 27

 ➢ The HBM does not pre-suppose or imply a strategy
for change. The overarching premise of the HBM is
that knowledge may bring change.
➢ Knowledge is considered a necessary but not
sufficient step toward change hence the main
Contributions of contribution of the HBM to the health
HBM to Health communication field is its emphasis on the
significance of knowledge.
Communication
➢ Knowledge is brought to target audiences through an
educational approach that predominantly focuses on
messages, channels, and spokespeople.
➢ HBM is also useful in audience-related research since
it provides a suitable framework to organize one’s
thoughts in developing an audience profile.

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 28

 This theory is a modified version of the Theory of
Reasoned Action (TRA). The main theme in TPB is that
the best way to predict and explain a person’s behaviors is
Theory of through that person’s behavioral intentions (Miles, 2012).
Planned The Theory assumes that:
Behaviour 1. People tend to behave rationally and to systematically
make use of information that is available to them when
(TPB) deciding to act or not to act.
2. People’s actions are guided by conscious motives and
not by unconscious motives.
3. People consider the implications of their actions before
they decide to act or not to act.

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 29

 Theory of
Planned
Behaviour

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 30

 Attitude:
In the context of TPB refers to a person’s
favourable or unfavorable appraisal of a behaviour.
E.g. I hate contraceptive use
Key
Components Attitudes toward a specific behavior are a function
of the person’s beliefs about the consequences of
of TPB such behavior. These are called behavioral beliefs.
E.g. Using contraceptives may affect my reproductive health

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 31

 Subjective norms:
Refer to the perceived social pressure from other
individuals to perform or not perform the behaviour.

Key In other words, subjective norms are the positive or

negative opinion or judgement that friends, family,
Components colleagues, professional organizations or other key
influential people may have about a potential
of TPB behaviour. E.g. My husband insists I use contraceptives.
Subjective norms are influenced by normative beliefs,
which refer to whether a person may think significant
others will approve or not of his/her behaviour.
E.g. I think my husband may be thrilled if I begin using
contraceptives.

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 32

 Perceived behavioural control:
According to the TPB, a behavioral intention can be
expressed as a behavior only if that behavior is under
the perceived control of the individual, meaning that
Key the person perceives himself as having complete
Components control over deciding to perform that behavior or not.
of TPB For instance, a person may wish to perform a
behavior, but may not have the necessary
opportunities or resources such as, knowledge, skills,
abilities, information, time, money, equipment, and
cooperation of others to actually perform it.

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 33

 Intentions:
Refer to the motivational factors that influence a
Key person’s behavior.
Components Intentions indicate how willing a person is to
attempt a behavior, and how much effort he/she
of TPB is likely to exert toward that behavior.
In general, the stronger the intention to perform
a behavior, the more likely a person is to perform
that behavior (Ajzen, 1991).

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 34

 ➢TPB is mainly useful in analyzing and identifying
reasons for action and messages that can change
people’s attitudes.
➢It is a good tool in profiling primary audiences (the
people whom the program seeks to influence more
Contributions directly and who would primarily benefit from change)
and secondary audiences (individuals and groups who
of TPB to can have an influence on the primary audience).
Health Caution: Though, TPB is presently one of the most
Communication influential theories in health communication (Coffman,
2002), it is vital to exercise some caution in concluding
that the intention of adopting a certain behaviour always
translates in actual behavioral performance.

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 35

 The stages of behaviour change model (also known as
transtheoretical model) defines behavioural change as
a process that goes through different phases or steps.

Stages of
Behaviour
Change Model

Each stage describes different levels of motivation or

readiness to change and the model identifies five stages.

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 36

 Precontemplation. At this stage individuals have no
intention of adopting a recommended health behaviour
but are learning about it.
Contemplation. Individuals at this stage are
Stages of considering adopting the recommended behaviour.
Behaviour
Change Model Determination /Decision. This is the stage at which
people decide to adopt the recommended behaviour.

Action. At this stage people try to adopt the recommended

behaviour for a short period of time.
Maintenance. At this stage people try to adopt the
recommended behaviour for a longer period of time.

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 37

 In the health communication context these stages can be
vital in the segmentation phase of intended audiences:
Stages of › To identify groups that, among other related
characteristics, will also have similar levels of motivation
Behaviour and readiness for behavioural change.
Change Model › Thus, instrumental in designing communication
objectives, messages and strategies for each of these
groups.

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 38

 In your opinion, what is the main benefit of using
theoretical frameworks and planning models in health
communication?
Assignment Select a theory addressed in this session, and use a
Two practical example on a health issue of your choice to
show how changes in health behaviors may occur
according to the key tenets of the theory you selected.

3/11/2022 Lecture Two: Please, Do Not Cite Or Reference These Notes 39