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DOI: 10.1177/109019818000700203 1980; 7; 127 Health Educ Behav

Brian R. Flay, Don DiTecco and Ronald P. Schlegel Information-Processing Model

Mass Media in Health Promotion: An Analysis Using an Extended

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127

Mass Media in Health Promotion:An Analysis Using an ExtendedInformation-Processing Model

Brian R. Flay, D. Phil.Don DiTecco, M.A.Ronald P. Schlegel, Ph.D

University of Waterloo

Preparation of this paper was partially supported by a University of Waterloo Research Grantto the first author. We would like to thank Thomas D. Cook for helpful comments on anearlier version, and Carolyn Edison and Janice Dick for their extensive assistance in libraryresearch.Address reprint requests to the first author, Health Studies Department, University of

Waterloo, Waterloo, Ontario, Canada, N2L 3G1.

ABSTRACT: The information-processing model of the attitude andbehavior change process was critically examined and extended from six to12 levels for a better analysis of change due to mass media campaigns.Findings from social psychology and communications research, and fromevaluations of mass media health promotion programs, were reviewed todetermine how source, message, channel, receiver, and destinationvariables affect each of the levels of change of major interest (knowledge,beliefs, attitudes, intentions and behavior). Factors found to most likelyinduce permanent attitude and behavior change (most important in healthpromotion) were: presentation and repetition over long time periods, viamultiple sources, at different times (including "prime" or high-exposuretimes), by multiple sources, in novel and involving ways, with appeals tomultiple motives, development of social support, and provisions ofappropriate behavioral skills, alternatives, and reinforcement (preferablyin ways that get the active participation of the audience). Suggestions forevaluation of mass media programs that take account of this complexitywere advanced.

We are increasingly learning about how lifestyles affecthealth.’-3 Accordingly, there is a growing consensus regarding theneed to promote positive health behaviors on a large scale basis.The rising costs of traditional health care increases the need to findthe most effective method of modifying health behaviors. Oneapproach which has generated much enthusiasm is the use of massmedia campaigns. The last decade has seen an increasing numberof attempts to use mass media campaigns to influence the public




128

for their own good in the areas of disease prevention, health

promotion, and public safety. Some of the substantive areas

addressed, together with selected illustrative references andreviews of them are as follows.

1. General Health, of which the Stanford Three CommunityHeart Disease Prevention Project,4-6 the North Karelia Pro-ject/-9 and the &dquo;Feeling Good&dquo; television series produced bythe producers of &dquo;Sesame Street,&dquo; but with a health

promotion focus and targeted to adu Its, 10 are probably themost well known;

2. Safety, especially driving,11-14 seat belt use,’ 1.16 and lawn-mower safety;&dquo;

3. Smoking;,&2Z4. Alcohol and Drug Abuse;23.255. Family Planning,21-286. Programs in Third World countries;29-337. Miscellaneous areas such as cancer control,34 immuniza-

tion,35 screening,36 compliance,37 mental health,38 and lungdisease.39

Unfortunately, assessing the effectiveness of many of theseprograms is difficult. Of the numerous mass media healthpromotion campaigns that have been mounted, only some havebeen reported in public outlets. Most have been described only ininternal reports not generally available to the public and somehave not been documented at all. Few media campaigns have beenformally evaluated and, of those evaluations undertaken, manyhave turned out to be uninterpretable or invalid because ofunresolved methodological, technical, administrative, and/orpolitical issues .11.40.41 This happens not for want of adequatemethodology. The tools of evaluation research in general are wellestablished.42-59 The problem seems to be lack of an adequateappreciation of either a) these tools and methodologies, or b) thecomplexity of the attitude/behavior change process. As a result,the interpretation of most of those evaluations of mass mediaprograms which have been carried out has been ambiguous orimpossible.

It has proven unusually difficult to develop methods of

influencing the public to change their attitudes, and especiallytheir behaviors, to improve their health status. Of those mediacampaigns successfully evaluated, only a few demonstratedsuccessful behavior change.4-6.13,18.22 Most have been found to beunsuccessful in influencing attitudes and behavior for any length




129

of time. cf. review i5.2i.27.6M5 Bvp suggest that part of the reason for thislack of success is the absence of systematic application of knowncommunication principles in the design and evaluation of massmedia programs.This paper presents a model of the attitude/behavior change

process which can serve as a guide for assessing the substantiveadequacy of mass media programs as well as having relevance toevaluation strategies. Initially McGuire’s information processingmodel of attitude change is described and then examined in termsof knowledge from social psychology and communicationresearch and its potential relevance to health promotion. Finally amore detailed, extended model of the communication/changeprocess is suggested.

THE INFORMATION PROCESSING MODEL

The most well developed and researched model of thecommunication process is the classic information-processingmodel of general attitude and behavior change first developed atYale by Hovland66.67 and hence often known as the Yale or Hovlandmodel. It has been elaborated upon and extensively advocated byMcGuire ’68-71 who has suggested a &dquo;persuasion matrix&dquo; as a way of

conceptualizing the change process and understanding the

complexities of the relationships between outcomes (changes in

knowledge, attitudes, and behavior), and inputs (the persuasivecommunication and its properties).

Communication Factors

The columns of McGuire’s persuasion matrix are factors whichlocate, alone or in combination, the independent variables (orinputs) of most general attitude change studies. These include:

1. Source factors-the attributes of the perceived source of themessage;

2. Message factors-the content, structure and style of the

message;3. Channel factors-the medium used, and how it is used;4. Receiver factors-the characteristics of the audience receiv-

ing the message;5. Destination factors-the target issue, the target component

of general attitude, and whether the change is long-term orshort-term, etc.




130

It is suggested here that any review or evaluation of thepotential effectiveness of mass media programs needs to considereach of the above elements of the communication process. Acomprehensive review of how source, message, channel, receiverand destination variables affect general attitude change in

laboratory studies has been provided by McGuire,69 andsummarized by Roberts’4 and Zimbardo, Ebbesen, and Maslach. 7S

The Stochastic Change Process

The rows of McGuire’s persuasion matrix represent commondependent variables (outcomes) in general attitude change studiesand, according to McGuire,69.71 also constitute six steps in thestochastic process of general attitude change. The six stepssuggested by McGuire are:

1. Being presented with the persuasive message (exposure);2. Attending to the message (awareness);3. Comprehending its content (knowledge);4. Yielding to its appeal (beliefs/attitudes);5. Retaining this new position (persistence of attitude change;

and6. Acting on the basis of it (behavior).

The complete information-processing model may, therefore, berepresented as in Figure 1.

FIGURE 1. McGuire’s persuasion matrix.




131

It is generally assumed that belief (cognitive) changes will auto-matically lead to attitude (affective) and behavior (conative)changes,&dquo; apparently because of a need for psychologicalconsistency. This is not the only possible order of change however.

Ray’6 has provided a systematic analysis of the different ordersof change and suggests three basic &dquo;hierarchy of effects&dquo; modelsof communication response in terms of cognitive, affective andconative elements. The appropriateness of each model for a

particular situation is most dependent upon the factors ofinvolvement, differentiation of alternatives, and communicationsource. The three hierarchies are:

The low-involvement hierarchy in which learning new informationleads directly to behavior change which subsequently producesattitude change (i.e., cognitive-conative-affective). The lowinvolvement hierarchy would be likely to occur when, as its nameimplies, there is a low involvement on the part of the target aud-ience and minimal differences between alternative behaviors. Thiswould be a typical situation for many consumer choices. For ex-ample, an individual is not tremendously concerned about whatbrand of soap he buys and if costs are close he should choose thatbrand with which he is most familiar (has been exposed to or hashad favourable experiences with). This behavior will then befollowed by positive attitudes if the soap is found satisfactory.

The dissonance-attribution hierarchy in which behavior occurs first(the consumer is forced to make a choice on the basis of some non-media source) leading to attitude change as a function ofdissonance or self-attribution, and then selective learningconsistent with the original behavior (i.e., conative-affective-cognitive). This situation should most likely occur when the targetaudience is involved but there is little difference amongalternatives.

The learning hierarchy in which cognitions are altered which leadsto a change of attitude which then determines the appropriatebehavior (i.e., cognitive-affective-conative). According to Ray,this hierarchical ordering should most likely occur when the targetaudience is involved and there are clear differences betweenalternatives.

Although there are no doubt exceptions, and thecommunication itself can be structured to affect involvement anddifferentiation of alternatives, the learning model (i.e.,cognitive-affective-conative hierarchy) would seem most




132

appropriate to health promotion campaigns. Changing healthrelevant behaviors typically involves important adjustments byindividuals and so the alternatives (e.g., quitting vs. continuingsmoking) are highly differentiable. Further, involvement should behigh where the potential importance of the behavior for personalwelfare is known. For these reasons it is suggested that typicallythe information-processing model is appropriate for mass mediahealth promotion programs.The following briefly presents findings from social psychology

and communications research as they relate to each stage of thestochastic change process and compares these with findings fromhealth promotion campaigns. In view of these considerations the

adequacy of McGuire’s model is assessed and an extended versionof the information-processing model is proposed.

KNOWLEDGE FROM SOCIAL PSYCHOLOGYAND COMMUNICATION RESEARCH

Presentation of the Message

It should be relatively easy to change people’s awareness ofcertain issues as long as they can be exposed to information.Although few evaluations have bothered to measure exposure orawareness, many health promotion programs have probably failedbecause they did not reach their target audience.&dquo; A majorproblem here is the potential for selective exposure, that is thetendency for persuasive appeals not to reach those to whom theyare directed. For example, a program aimed at increasingawareness of nutritional requirements may only be watched bythose already interested in nutrition who probably have a

reasonable knowledge of the subject, while those who are

relatively uninformed, and thus uninterested, watch somethingelse. In the presentation of the message then, although a popularmedia (channel) is selected, pre-existing audience (receiver)factors may preclude exposure. For this reason, one of the basictechniques of advertising is to insert a message which is novel,shocking, and/or entertaining (to ensure attention) into a specificprogram which is already determined to have a large audience (toensure exposure).

Attention and ComprehensionIn order to change people’s knowledge they have to be

motivated to attend to and to comprehend the information being




133

presented or else the information has to be repeated so many timesthat it becomes &dquo;lore.&dquo;

Theories of learning (attention and comprehension in the

present context) and research on instructional media are wellestablished and have already been thoroughly reviewedelsewhere.78-86 Although many of the hundreds of studies done withinstructional media are methodologically so poor as to beuninterpretable,4~ it appears that any media can lead to

improvements in knowledge just as well as face-to-faceinstruction, but not necessarily any better, and that no one form ofmedia is consistently better than another. An importantimplication, however, is that media, especially radio, are muchcheaper, and therefore more cost-effective than face-to-faceinstruction.86-8’The above findings are macro-level ones. Micro-level findings

are few: a) programs must be directed at a felt need (to ensureattention); and b) hearing a program in groups and discussing itafterwards leads to better understanding.

Yielding and Retention

There are vast literatures on belief and attitude change withinboth the areas of social psychology and communications research.A confusing, and sometimes contradictory, array of findings andtheories has been generated.88-95 This confusion was somewhatreduced when McGuire69 provided a thorough conceptual reviewof the area.

For changes due to a health promotion campaign to bemeaningful, they must persist over long periods of time. It hasbeen suggested that many of the changes in belief and attitudereported in the literature might have been no more than responsesto immediate situational demands and did not representmeaningful change at a11.9~98This fundamental issue was addressedrecently when Cook and Flay96 provided a review of the conditionsunder which attitude change persisted over time.The findings from the Cook and Flay96 and McGuire69 reviews,

together with summaries by Roberts’4 and Zimbardo et al. 75 pro-vide the clearest picture of the conditions most conducive tomeaningful and persistent changes in attitude that can be derivedfrom the social psychological and communications researchliteratures. These conditions may be summarized as follows.A persuasive message has most impact if it:

1. comes from multiple sources of high credibility (i.e., trust-

worthiness and expertise) and similarity (a property of thesource);




134

2. is repeated often and consistently (message);3. is sent via multiple media at accessible times and locations

(channel);4. arouses or is accompanied by a high level of a) personal in-

volvement in the issue and b) consistency with related at-

titude and value structures (receiver);Finally, two other factors which appear to fall outside ofMcGuire’s communication variables but which have been found tobe important are:

5. a high level of social support or acceptance in the receiver’senvironment; and

6. opportunities to give expression to the newly formed at-

titudes, and ongoing reinforcement for doing so.

There are other conditions that appear to be conducive to mean-

ingful and persistent attitude change. Many of these involve in-

teractions between the components of the communication process(e.g., between message and receiver factors, such as higher feararousal being more effective for less anxious receivers, or an ex-plicit conclusion being more effective with a less intelligent, unin-formed audience). They are reviewed best by McGuire.69

A cting

Some researchers have relied on expressions of intention as in-dicators of behavior, while others have assessed only behavior. Forthis reason both concepts are treated together here.The available information on meaningful and long-term

behavior change is much more sparse and scattered than that on

knowledge, belief, and attitude change. Within psychology, resear-chers have only recently begun to investigate the conditions

necessary for the long-term maintenance of changed behaviors.96Examples of recent statements regarding health-related behaviorsare Wilson99 for the treatment of obesity, Best18.100 for smokingcessation, and Marlatt & Gordon101 for various addictive behaviors,including alcoholism and smoking.The consensus about the factors that contribute to long-term

change may be summarized as:

1. specific target behaviors to be changed - a non-specific pro-gram cannot effect specific changes;

2. a desire to change, which most clients in behavior changeprograms already have96-for mass media programs to besuccessful they must be either targeted at people whoalready have this desire or else they must motivate the desire;




135

3. the provision of multiple alternative behaviors as coping re-sponses in those situations where the undesired behaviorwould normally be practiced;18.102

4. a concern with making the social environment suppor-tive;18.103.1o4 and possibly

5. an emphasis on self-management of the behavior change.

It is apparent that the above factors do not readily fall intoMcGuire’s communication categories. Recall that the assumptionunderlying the model was that changing attitude automaticallyshould produce behavior change. This point shall be consideredfurther when an extension of the information-processing model is

proposed.

FINDINGS FROM EVALUATED MASS MEDIA PROGRAMS

Despite the limitations of past evaluations, preliminary reviewsof those mass media programs that have been evaluated suggestsome conditions that seem to affect the likelihood of mediacampaigns being effective .11.13.1 <;.20-23.60-63.65

Conditions conducive to effective belief or attitude changeappear to be:

1. arousing involvement in the issue and/or motivation to

change;2. much repetition by several sources, via multi-media, over

long periods of time (i.e., years, not weeks or months);3. novelty in the way the message is presented (in order to main-

tain attention and increase the chance of arousinginvolvement);

4. targeting very specific issues and providing consistent alter-native attitudinal structures; and

5. high quality production of materials (equal to that of com-mercial mass media production) to ensure attention.

It is encouraging to note that the above factors are very similar tothose derived from the social-psychological and communicationsresearch theories and findings.Mass media campaigns have been even less successful at

changing behaviors than at changing beliefs or attitudes. At leastthis is so for specific target behaviors-there is some questionabout the influence of the media on behavior in a more generalway.86 Few of the mass media health promotion campaigns listed




136

earlier that have been evaluated have demonstrated 5’successfulbehavior change, especially over the long term. Those which havehad success however,4-7.18.101 usually included additional elements intheir overall program which involved identifying alternative

(healthy) behaviors and/or specifying the development of personalskills necessary to performing these behaviors. These objectiveswere pursued in various ways including combinations of thefollowing:

1. incorporation of information pertaining to behavioral alter-natives and skills development within the communication

message itself;2. promotion of interaction with the audience (e.g., via

telephone or written materials);3. supplementation with face-to-face clinics; and4. mobilization or restructuring of community resources (e.g.,

cooperation with the dairy industry to develop low-fat dairyproducts in the North Karelia project).

IMPLICATIONS: EXTENSION OF THEINFORMATION PROCESSING MODEL

Generally McGuire’s model offers a good paradigm for the plan-ning and assessment of mass-communication/health-promotioncampaigns. However, certain deficiencies can be demonstratedconcerning the validity of the assumption that changes in know-

ledge and beliefs will automatically lead to changes in attitudeand ultimately behavior. This is directly relevant to the appropri-ateness and comprehensiveness of the model for assessing andplanning health promotion strategies based on mass communica-tion approaches.

Differentiating Concepts z

We agree with McGuire that the general attitude change processis a stochastic one involving several steps. However, work in socialpsychology on the attitude-behavior consistency problem89wouldsuggest that the steps involved in changing knowledge and/orbeliefs ought to be differentiated from those involving attitudes,intentions, and behaviors.Although the distinction between knowledge and belief is not

definitive we may generally discriminate these concepts in thefollowing way. Knowledge can be defined as factual information,whereas belief pertains to the degree to which one subjectively




137

accepts an association between some object or behavior (e.g.,smoking) and an attribute or consequence (e.g., lung cancer).Knowledge is taken as a given or universal truism; belief is a

personal estimate of subjective probability that reflects varyingdegrees of certainty. This is not to say that a change in knowledgewill not lead to a change in beliefs. It clearly sometimes will,89 andthis is what McGuire69 calls acceptance or yielding (changing onesbeliefs on the basis of new knowledge).

According to Fishbein’s89formulation an attitude is conceived ofas an evaluative (affective) response toward some object or act,and this response is based upon an underlying set of beliefs whereeach is weighted by the value placed upon the associated attribute(viz. an object) or expected outcome (viz. an action). Thus anattitude reflects the net value (or affect) that is associated with thisunderlying set of beliefs. This value-expectancy formulationunderscores the potential complexity of the belief-attitudeconnection. For example, an apparently highly relevant belief

change (smoking is carcinogenic) may not lead to the expectedattitude change (smoking is bad for me) if an individual’s personalexpectation for the negative outcome (cancer) is low, of if

expected positive outcomes (smoking relaxes me) are numerous.Behavioral intentions may be defined as one’s personal estimate

of the subjective probability of performing a certain behavior (orclass of behaviors). According to Fishbein, attitude is only one oftwo major factors which will affect an individual’s intention toengage in a behavior. Beliefs concerning what important others(e.g., peers, relatives) want us to do will also determine our inten-tions.

Finally, it is recognized that behavior, the specific act or set ofacts which are the focus of concern, will be directly related to in-tention only in so far as extraneous factors which may interferewith the behavior are not present.101 Thus, other considerationssuch as situational constraints, social support systems, skills, alter-native behaviors, etc. may affect the intention-behavior connec-tion.How does McGuire’s model (Figure 1) match up with the con-

cepts of knowledge, beliefs, attitudes, intentions, and behavior(KBAIB) identified above? Clearly, attention and comprehensionhave to do with knowledge, and action has to do with behavior.But are yielding and retention concerned with beliefs or attitudes(affective) or both? From McGuire’s writings it is not altogetherclear. In places it seems as if he would agree with Cartwright77 whoclassified beliefs together with knowledge as part of the cognitivestructure, attitudes and values under a motivational structure, and




138

intentions, behaviors, and supportive environments as part of thebehavioral structure. In other places, however, he suggests thatyielding leads to attitude change. However, when it comes to

operationalizing measurement of each step, McGuire seems tothink of attitude change as being cognitive as measured by an&dquo;opinionnaire.&dquo;70,72 What is clear, is that the information-process-ing model is most appropriately concerned with changes in Cart-wright’s&dquo; cognitive structure, especially beliefs. Once changes inknowledge and beliefs have been brought about, it is assumed thatchanges in attitudes, intentions, and behavior will automaticallyfollow,75 apparently because of a need for consistency. ThusMcGuire’s model does not directly address issues of attitude andbehavior change.

Similarly, although McGuire considers as important the reten-tion of memory of message content or (depending on which sourceyou read) the new belief, he does not consider the maintenance ofnew behavior. 11,96,99.100.102,101, Since maintaining a certain behavior isoften the basic goal of health promotion attempts, it must be an in-tegral aspect of any model in this area.The above differentiation reveals a hierarchy of potential

change areas. It is generally assumed that changes in beliefs are

usually more difficult to obtain than changes in knowledge,changes in attitude are probably more difficult to obtain thanchanges in belief, and long-term behavior change is usually moredifficult to obtain than attitude and intention change. For exam-ple, practically all smokers now know of the association betweensmoking and certain diseases (knowledge); most of them, but notall, accept that smoking causes cancer (belief); fewer, though still alarge proportion, agree that smoking is bad for them personally (at-titude) and desire (have intentions) to stop; but a large proportionof these people still do not stop smoking (behavior).

Extending the Model

Considering the above points we suggest the adaptation of theinformation-processing model as shown in Figure 2.The arrows from one dependent variable to another in Figure 2suggest a casual chain where:

exposure will lead to awareness, but only when the message isattended to;awareness will lead to changes in knowledge, but only when themessage is comprehended;changes in knowledge will lead to changes in beliefs, but only if thearguments or conclusions of the message are accepted or yielded to;and




139

changes in beliefs might (hence the dashed arrows) lead to changesin attitude, intentions, and ultimately behavior.

This makes it clear that other factors play a major role in

determining the particular behavior engaged in.As we have seen from the above reviews, factors relating to the

receiver’s environment, such as social support, opportunity to

express attitudes, and reinforcement for behavior, are important intranslating attitudes or intentions into action. Until now thesefactors have been given little attention in mass communications,although it is feasible that they could be addressed. For example, apersuasive message regarding &dquo;quitting smoking&dquo; could be

targeted towards families or other relevant social groups ratherthan individuals; or messages could be aimed at convincing peopleto support those who are trying to quit. Furthermore, it is necessaryfor the target individual to be given the skills necessary to change aparticular health behavior if his or her intention is to be translated

successfully into action. Although these skills can be thought of asreceiver characteristics, they are typically absent in those to whomthe communication is addressed. However the inclusion of skill

training within the context of a persuasive message has been

attempted infrequently at the mass communication level. Thusother approaches, such as value-expectancy formulations,107.108the

FIGURE 2. A reconceptualization of the information processing model ofthe general attitude change process.




140

health belief model9 value self-confrontation procedures,11o.111Fishbein’s behavior prediction model,89 Cartwright’s motivationaland behavioral structures,&dquo; and social learning theories112.113 thattake into account other factors affecting change (e.g., values,social support structures, and behavioral skills and alternatives)appear to be necessary for a comprehensive model of the attitudeand behavior chance process. 114

In considering his model for attitude change, and the empiricalevidence relevant to it, McGuire69 was not certain whether alllevels of change had to occur for meaningful and persistentattitude change to occur. Consideration of the model in respect ofthe five KBAIB concepts, suggests that change is not necessary atall levels in order for meaningful change to occur in any one ofKBAIB. For example, changes in beliefs or attitudes can occurwithout changes in knowledge or behavior. Sometimes changes inbehavior can even occur without accompanying changes in beliefsor attitude. However, in real-life situations (as opposed to thelaboratory) it seems clear that meaningful and long-term change inany one element of KBAIB is more likely if there is alsocorresponding change in the other four elements. For example, aswould be predicted from the many consistency theories in social

psychology,&dquo;5 changes in beliefs or attitude are more likely topersist if they are accompanied by corresponding changes in

knowledge and behavior.96 Changes in behavior are more likely tobe maintained if the underlying cognitive and motivationalstructures are consistent with the new behavior. Even changes inknowledge are probably more likely to be retained if otherexperiences, as represented by the corresponding beliefs,attitudes, and behavior, are consistent with it.

Implications for Evaluation

The complexity of the extended information-processing modelimplies that a comprehensive mass media program should meet allthe conditions suggested above to maximize effectiveness.Similarly, a comprehensive evaluation of a mass media programshould measure outcomes, and their antecedent variables, at alllevels of the 12 stage change process. In past evaluations,interpretation has been especially difficult in those cases when theprogram apparently failed. If the major outcome measured washealth status or behavior, then failure could be located at any oneof the other steps in the change process. Did it fail because peoplewere not exposed to it, did not attend to it, did not understand it,did not accept or yield to it, etc.? Assessments of behavior andhealth status may answer questions of impact, but without answers




141

to questions of implementation and process, questions about whya program was or was not effective cannot be answered.48 Inaddition to the types of questions above, questions of treatment(the source, the message, and the channel), the receiver (audience),and the context should also be asked in a comprehensiveevaluation. Finally, it should be emphasized that there needs to bea correspondence between the mass media content and the

particular outcome measures assessed. In some programs, very

general interventions have been planned and then were evaluatedby very specific outcome criteria. General interventions (e.g., goodnutrition) should be assessed by multiple-act criteria since peoplemay respond in any number of &dquo;correct&dquo; ways. On the other hand,if very specific outcomes are desired (e.g., checkups for high bloodpressure), then the intervention content must be appropriatelyspecific and the corresponding single-act criterion assessed.&dquo;6 Aswe have seen, the failure to do methodologically adequateevaluations means that the findings from mass media campaignsto date, as opposed to the &dquo;field-wisdom&dquo;, are scarce.

SUMMARY: A PROFILE FOR SUCCESSFULMASS MEDIA PROGRAMS

The ultimate, long-term objective of any health promotion massmedia program must be to change people’s lifestyles (behavior), orto prevent negative lifestyles, and consequently improve theirlong-term health status. Although there is still some questionabout whether or not all 12 steps of the persuasion process arenecessary to lead to behavior changes we suspect that they arenecessary if permanent behavior change, and therefore changes inhealth status, are to be effected. Thus, any change attempt, massmediated or not, should aim to end up with consistency bothwithin and between cognitive, motivational and behavioralstructures. That is, consistency across knowledge, beliefs,attitudes, intentions, and behavior must be sought. In addition,more general values and social norms may also need to beconsidered.

For some issues, some of the steps in the persuasion process mayalready be consistent with the behavior desired by the healthpromoter. In such cases, the consistent knowledge and/or beliefs,for instance, need only be reinforced and the message canconcentrate on attitudes and behavior. A good example is thatmost smokers already know of the association between smokingand lung cancer, accept (believe) that it is probably a casual link,




142

and feel that smoking is bad for their own health and desire to

stop. In that case any (health promotion) change strategy needonly reinforce the consistent knowledge, opinions, attitudes, andbehavioral intentions, and concentrate on changing behavior.

However, in all cases the first requirement is to reach the targetaudience. Many programs have probably proved ineffectivebecause not enough people were exposed to it. Airing spots onpublic television or at non-peak hours on commercial televisiondoes not ensure good exposure.&dquo;’ Presentations via multi-media,at different times, over long periods are necessary simply to getexposure.Once exposure is achieved, it is no use reaching people’s living

rooms if they do not attend to the message. Appeals to multiplemotives (e.g., to improve health, to improve social and/or self

esteem, to decrease cost of living, to improve quality of life); in

novel ways; with repetition across sources, channels, and times;will help get attention. An expert (who is perceived as credible andtrustworthy), yet similar, source who presents a clearly targeted,concise, easily understood message will also increase attention, aswell as ensure comprehension.

Acceptance of, or yielding to, the message is also more likely ifthe source is credible and similar and presents the message in anarousing and involving (i.e., motivating) way. Changes in attitudesand intentions are more likely if that source also offers social

support, and asks for (and gets) active participation (answer aquestionnaire, keep a diary, etc.). Repetition in many ways,involvement, active participation, and social support, all together,also increase the likelihood of persistent changes in attitudes andintentions. This has been found to be true for the laboratory,96 aswell as in the real world with the long-term effects of smokingcampaigns.22Many of the factors mentioned above will increase the chance

of behavior change consistent with all the other changes. However,the chances of behavior change are maximized only when explicitways to change are provided. This means providing theappropriate behavioral control and behavioral skills, as well asappropriate alternative behaviors for those situations where theold behavior took place. New behaviors will only be maintainedover time if an appropriate social support structure (e.g., spousalsupport for persons losing weight) is available and the newbehaviors are positively reinforced at least on a decreasingrandom interval basis.

In conclusion, this review has demonstrated that the earlierpessimism about the effectiveness of mass media in health




143

promotion’ 1,11,61-61should now give way to a cautious optimism andmore sophisticated development. Our analysis suggests that theuse of mass media may sometimes be as successful as

face-to-face interventions if the appropriate components (e.g.,skill training) are included in the communication. However, anoptimally effective campaign may need to incorporate yet otherapproaches to behavior change.

REFERENCES

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