Health communication, across the nation!

Patients understand and retain about ___ percent of the information discussed by their physicians

50

dose-response

Does a correlation exist between exposure and effect?

what is NOT a part of perceived social norms?

Does not include your motivation to comply with the norm (e.g. you could be super anti-establishment but be aware that the establishment still wants you to do something)

Why was the CDC's "zombie apocalypse" disaster prep campaign so effective?

Essentially because it got people's attention and engaged them. Getting attention is crucial in health comm.

Diffusion of innovations theory

Explains how, why, and at what rate new ideas and technology spread through cultures. Divides population into groups (on bell curve) based on when they adopt new inventions - innovators, early adopters, early majority, late majority, laggards. What percentage of the population is each? What percent of the market share does each group make up? This helps companies figure out who to go after at what time when marketing a product, and how to release a product.

T/F: health comm is primarily about preventing medical catastrophes, not so much events like terror attacks or death during natural disasters.

F

T/F: pretty much all research done on the TTM supports the model

F

T/F: Those with limited literacy are more likely to ask questions during the medical encounter and seek health info

F - afraid of revealing their ignorance

T/F: There aren't that many disparities across literacy levels. Literacy levels are adequate, for the most part.

F!! Many disparities, largely inadequate

T/F: A good SOCO needs supplementary info.

F. A good SOCO can stand on its own.

T/F: people's perceptions of what their social network is doing are pretty much always accurate.

F. For example, we think everyone is binge drinking at duke but not that many people binge drink

T/F: The general population has a strong interest in topics related to health.

F. Health is of only low to moderate interest in the population and requires extra effort to gain their attention

T/F: There's generally only one good possible SOCO to shape your presentation around when reporting on a given piece of research

F. Many different SOCOs are possible - it's about the angle you put on it

T/F: There's usually one good theory per issue.

F. Multiple theories may explain one issue.

T/F: Adding in details that are only nice to know breaks up the presentation of info and makes it more pleasant and fascinating.

FALSE!! Leave 'em out!

Name a test used to assess health literacy.

Four most widely used instruments -Rapid Estimate of Adult Literacy in Medicine (REALM) -Test of Functional Health Literacy in Adults (TOFHLA) -Newest Vital Sign (NVS) -One- or two-question tests (multiple question usually more effective)

Who invented balance theory?

Fritz Heider (o hei der, I'm Fritz Heider, let me tell you about balance theory. you HIDE your disagreements for the sake of harmony. actually you change your attitudes so it's not really hiding so that's not really accurate)

Randomized controlled trial (experimental studies)

Group of subjects "exposed" to intervention and compared to unexposed similar subjects

Health contexts are unusual compared to other contexts because of...

Health contexts are unusual compared to othercontexts because of an *underlying stress or fear factor.* • Healthcare contexts may involve unique conditions such as physical or mental *impairment* due to illness. • Health situations are often *new, unfamiliar, and intimidating.*

Health communication is dependent on the communication skills of who?

Health literacy is dependent on the communication skills of lay people and health professionals. Joint effort!

Which people's intentions will be affected more by perceived norms?

If you care about people, your intentions are affected more

Transtheoretical model is also known as

SOC (stages of change) model

How is balance theory put into practice?

It is the basis of endorsements. E.g. "I like Oprah, Oprah likes Obama, so in order to maintain psychological balance, I too should like Obama"

Is it good to have more or less messages when communicating with patients? What should your focus be on?

Limit the number of messages. Focus on what your audience needs to know and do

Is the TTM model linear/rigid stage timing?

Model is not linear and stage timing is arbitrary (can jump around the stages)

Socioeconomic factors alone don't seem to sufficiently explain infant mortality rates. Why might the US be higher in infant mortality than less developed countries?

More C-sections in the US, average age of mothers much higher

What is the scope of testing for most behavior change theories (what types of populations have most been tested on)?

Most have not been tested in sociodemographically-diverse populations and outside the U.S. (in the prochaska article I think only 5 trials with diverse populations were mentioned for the TTM)

Where should the most important info go when communicating with patients?

Most important info FIRST. Tell what actions to take and why these actions are important

The "pop quiz" we did with the nutrition label in class was this test used to assess health literacy:

Newest Vital Sign (NVS)

Is it generally easy to tell what stage of the TTM people are in?

No, figuring that out is the hardest part

macro plan

analyzes everything - the setting, problem, strategy

What is considered the biggest hindrance to all theories?

assumption of rationality

Balance theory is about influencing ______ towards things

attitudes

Appropriate for what literacy level?: explain why it is hard for people to know that they have a chronic disease, based on a pamphlet; name 2 reasons a person with no symptoms of disease should be tested, based on a pamphlet

basic

Precaution Adoption Process model (PAPM)

basically the same thing as the TTM - also stage-based. Has a unique "deciding not to act" stage

Appropriate for what literacy level?: identify what one can drink before medical test; circle the date of the medical appointment on an appointment slip; identify how often a person should have a test based on the pamphlet

below basic

A good SOCO is (brief, lengthy).

brief

What is the appeal of the integrative model when it comes to health message design ?

can help identify the beliefs a message should address - then uses the messages to change those beliefs and reinforce them

media advocacy

change decisions that affect health by influencing the mass media's selection of topics and by shaping the debate about those topics (e.g Media advocacy to support regulatory or policy changes to limit access to tobacco) (using media to get people talking/debating about an issue, pushing for change, getting community support)

What are the "stages of change"? (general, not TTM)

circle model (move through stages in a cycle): - thinking about change - ready to change - making changes - maintaining change - relapsing

case-control studies

compare a case where something WAS present to a case where that thing WASN'T present

time-series studies

compare data before and after an intervention

ecologic studies

compare/correlate 2 types of population data

change theory (give example)

Which strategies promote change? How should the program work? (more outcome-oriented than explanatory theory) E.g. "people will only change when they think something really matters"

explanatory theory (give example)

Why does it happen? What can be changed? E.g. "Obesity happens in urban environments because parents keep their kids indoors"

gain-framed appeal

emphasizes advantages of doing something (as opposed to loss-framed)

"The greater challenge in working with persons with low health literacy is NOT their inability to read, but the lack of a ___________ or ________, to use as a starting place for explanation of a complex health topic."

explanatory framework, schema

What are the 2 general categories of behavioral theories? Which are we most focused on as health communicators?

explanatory theory, change theory. We are most focused on change theories.

Information processing theory suggests...

limited ability to process large quantities of information (thus, we turn to strategies like confirmation bias to process info)

Individuals with low health literacy are more likely to be... (demographic)

male, older, low income, non native english speakers, minority race

Is education alone enough to help most people achieve a health goal?

no - for example, people know how to lose weight in theory (burn more calories than you eat), but will never do it, because of personal beliefs/worldview/myths holding them back

The beliefs that influence perceived norms are...

normative beliefs and motivation

health disparity

one part of the population (e.g. a certain ethnicity) is more healthy than another

health literacy

our ability to understand/use complex health information

The beliefs that influence attitude are...

outcome beliefs

secondary vs tertiary audience

secondary influences primary, tertiary is kind of even more fringe

Education entertainment

seeks to embed health promoting messages and storylines into entertainment and news programs or to eliminate messages that counter health messages; can also include seeking entertainment industry support for a health issue (very calculated)

Which PoCs are useful at the contemplation level?

self-reevaluation

Systematic review is conducted to answer a (broad, specific) question.

specific. Narrative overviews are the broad ones.

Stage sensitivity in the TTM is (determined, undetermined)

undetermined

What does the "Simply Put" guide mean by "choose your words carefully"?

use one or two syllable words, communicate as though you were talking to a friend, limit jargon, don't use abstract math language (what does a millimeter look like, anyway? what is a "risk"?), use analogies your audience is familiar with ("the size of a pea")

How widely used is the TTM?

very very widely used

Example of the upstream/downstream model of public health

water situation in Flint, MI - the government's decision not to purify the water led to terrible health outcomes for individuals

Confirmation bias

we tend to interpret messages such that they confirm what we already believe

Rothschild model

when an individual is asked to adopt a new behavior, that individual will analyze the costs and benefits

Where DOESN'T the TTM work very well?

with kids, specifically preventing substance abuse in kids

partner-based segmentation

working through groups who are partnered with the target group

channel segmentation

working with personal media/channels that are popular with the target group

Does the teach-back method work well?

yes, one of the top 11 methods

3 components of balance theory (the three things in play in every triangle)

you, another person, and an object

What are the 2 components of perceived norms?

• *Injunctive* norm: is social network supportive of the behavior? • *Descriptive* norm: does network do the behavior?

Health communication WITH other strategies can... (2)

• Cause *sustained* health behavior/policy *change* • *Overcome* barriers/*systemic problems*, such as insufficient access to care

Health communication ALONE CANNOT...

• Compensate for inadequate health care • Produce sustained change in complex health behaviors without the support of a larger program for change • Be equally effective in relaying all messages

What does it mean that self-efficacy deals with "confidence not competence"?

• Competence: actual skills • Confidence: your perceived capability Self-efficacy is all about what you THINK you can do, not what you can actually do.

Theory helps us do what 3 things?

• Identify the determinants of behavior (the determinants are what we want to target with our health communication efforts) • Choose specific intervention strategies • Evaluate, monitor & measure program effectiveness

Stage theories... • Include ____________ • Promise people will respond better when interventions are _______________

• Include an ordered time dimension (you can go at your own pace, but you still have to move through certain stages) • Promise people will respond better when interventions are matched to a person's stage in the cycle of change (are they thinking about change? are they relapsing? someone a bit motivated to change might be encouraged by a program that encourages small steps towards progress, because that seems manageable)

What is usually the best type of visual? When are simple line drawings good? Cartoons?

• Photographs usually work best • Simple illustrations or line drawings may work best in some instances. • showing a procedure (drawing blood) • depicting socially sensitive issues (drug addiction) • explaining an invisible or hard-to-see event (airborne transmission of tuberculosis). • Cartoons may be good to convey humor or set a more casual tone. Use cartoons with caution (these are emotional times in people's lives)

Universal precautions approach

• Taking specific actions that minimize risk for everyone when it is unclear which patients may be affected (Zika, ebola)

4 points to touch on when communicating research to the public (DEIA)

• What did you find (description)? • *Why* did it happen (explanation)? • What does it mean (interpretation)? • What needs to be done about it (action)? (last one is important to touch on in order to avoid fear, denial, blame)

What are some reasons that health comm alone may not be equally effective in relaying all messages? (3)

• the topic may be *complex* • the intended audience may have *preconceptions* • the topic may be *controversial*

- Theory applies to a (broad, narrow) variety of populations and situations. - Theory is (concrete, abstract) and (does, doesn't) have a specified content or topic area (differentiating it from a hypothesis)

•Applies to a broad variety of populations and situations •Abstract and don't have a specified content or topic area

Among laypeople, those who are most interested in health are...

•Are older, female, and have generally better health •Have experienced health problems

The CDC provides health info and PARTNERS with the public to prevent disease. What is the CDC sequence of health communication?

•Collect and analyze *data* •Develop communication *strategies* •Evaluate *effectiveness* •*Recollect* and analyze data to measure health outcomes •*Repeat* steps 2-4, if necessary

Name some impacts of health comm alone. (like, 3)

•Increase *knowledge and awareness* •Influence *perceptions, beliefs, and attitudes* that change *social norms* •Prompt *action* •*Advocate a position* on a health issue or policy •Increase *demand* or support for health services •Refute *myths* and misconceptions

It is important to place scientific findings in the *context* of...

•Prior research and recommendations •Target community

Two dimensions of source credibility

•Reporting scientists and their respective institutions •Publication or publisher of the reports

Say you want to change an existing societal problem like infant mortality. This issue is complex and certainly cannot be explained by just one factor, thus requiring you to change... (name 3)

•Societal conditions •Environmental conditions •Healthcare service delivery •Ancillary care support •Individual behavior

systematic review

Authors attempt to find all research on a topic

what is decisional balance?

Awareness that the advantages of changing outweigh the disadvantages.

PoC: counter-conditioning (experiential or behavioral?)

"Doing things with my hands is a good substitute for smoking" (behavioral)

PoC: Helping Relationship (experiential or behavioral?)

"I have someone to listen when I talk about smoking" (behavioral)

PoC: Self-Liberation (experiential or behavioral?)

"I made a commitment not to smoke" Re-defining the self as a non-smoker (experiential)

PoC: Dramatic Relief (experiential or behavioral?)

"I react emotionally to warnings about smoking cigarettes" (experiential)

Processes of change: Consciousness Raising (experiential or behavioral?)

"I recall information about how to (e.g.) stop smoking" (experiential)

PoC: Stimulus Control (experiential or behavioral?)

"I remove things from my house that remind me of smoking" (behavioral)

PoC: Reinforcement Management (experiential or behavioral?)

"I reward myself when I don't smoke" (behavioral)

PoC: Environmental Reevaluation (experiential or behavioral?)

"I think smoking can be harmful to the environment" (experiential)

PoC: Self-Reevaluation (experiential or behavioral?)

"My tobacco use makes me disappointed in myself" (experiential) Be careful - this is not the same as shaming people.

What is theory? Does any single theory dominate?

"Set of interrelated concepts and constructs that present a systematic view that shows relationships between variables *in order to explain or predict situations or outcomes*" No single theory dominates.

PoC: Social Liberation (experiential or behavioral?)

"Society has made it easier to be a non-smoker" Re-defining one's SOCIAL self (the self in relation to others) as a non-smoker (behavioral)

"powerful" vs "powerless" language

"powerful" language is decisive ("eating 5 fruits and veggies a day prevents cancer")

What's the question that needs to be answered when communicating with patients about a treatment?

"what's in it for me?" - i.e. - what will the patient gain?

As a health communicator, what is the role of scientific research in your work?

- Assess audience's state of scientific knowledge - Communicate scientific findings to laypersons

What do these adult literacy levels mean in terms of what people are able to do?

- Below Basic - no more than the *most* simple and concrete literacy skills •Basic can perform simple everyday literacy activities •Intermediate - can perform moderately challenging literacy activities •Proficient - can perform complex and challenging literacy activities

Disadvantages of cross-sectional study (3)

- Collection of data on potential exposures and outcomes at the same time - Lack of sequential data (kind of ties into first point) - Difficult to determine causality

Pro strategies when using the teach-back method

- DON'T ask yes or no questions - "Chunk and Check" - Teach the 2-3 main points for the first concept & check for understanding using teach-back...

HOW DO PEOPLE CHANGE STAGES?

- Decisional balance: Awareness that the advantages of changing outweigh the disadvantages. - Self-efficacy: Confidence in the ability to make change - Processes of change: strategies that can help to make and maintain change

Experimental studies are useful for these particular types of problems: where relevant conditions can be...

- Where relevant conditions can be manipulated or changed - Where relevant conditions naturally vary but cannot be changed

What are the 3 main considerations when evaluating research?

- study design (strong vs weak?) - Population in question and representativeness of sample - how much can we infer causality? are the factors simply strongly associated because of a third variable?

Here are some research designs. Put them in order from most to least effective: - Case studies/reports - Case-control studies - cohort studies - editorials/expert option - Randomized, controlled trials - systematic reviews (meta-analyses)

- systematic reviews - randomized, controlled trials - cohort studies - case-control studies - case series, case reports - editorials/expert opinion

Which PoCs are useful at the maintenance level?

- Reinforcement management - Helping relationships - stimulus control

Who are the health communicators? Give examples of people who are health communicators (3)

- Surgeon general Murthy - CDC - TV doctors - Dr. Oz, Dr. Drew, Dr, Phil, Sanjay Gupta - Reality TV stars like Snooki (people still listen, even if someone isn't an "acceptable authority") - Jenny McCarthy - "Hospital dramas" like Grey's Anatomy, House (raises awareness of medical conditions, people ask their doctors about them)

People with limited or inaccurate knowledge about the body and the causes of disease may not understand the relationship between ______ and ________, recognize when they need to __________, and feel _______ by health info.

- Understand the relationship between lifestyle factors (such as diet and exercise) and health outcomes - seek care - overwhelmed

Intentions are shaped by what 3 things?

- attitudes - subjective norm - self-efficacy

Which PoCs are useful at the precontemplation level?

- consciousness raising - dramatic relief - environmental re-evaluation

3 advantages of experimental studies

- control (isolate effects of treatment, eliminate alternative explanations) - manipulation (isolate how a specific change leads to the outcome) - random assignment (Everyone has an equal chance of being in each group - another way of eliminating alternative explanations)

Say you are treating a patient with prostate cancer. He has several options for treatment (watchful waiting, surgery, hormone therapy...). Surgery has the highest chance of survival but will likely impact his quality of life. How do you help him choose what option to go with?

- don't give him ALL the info - just stuff you select as the most important - is staying alive no matter what (e.g. for his family's sake) his top priority? Or is living the highest quality of life he can, even if it's shorter, his top priority? - choose treatments based on what activities are the most important in people's lives - consider emotional impact - "so you're just going to leave this cancer in my body?" - often there are no good answers

Give an example of an effect that impacts the success of the TTM.

- effort effects (those who try more get more out of it) - severity effect (those w/ less severe behaviors have more success) - stage effect (those who start in preparation do better than those starting in contemplation) - treatment effect (not sure what this one was about, like I should hope the people in treatment do better than the controls??)

4 different broad "ecological levels"

- environmental - societal - organizational - individual

Across eras, what has been the shift in identified leading causes of death in the US?

- environmental disease (from poor sanitation, hazardous locations), to disease that could be prevented with expanding health care (ca 1950, when health care really expanded), to lifestyle/unhealthy behaviors, to social and economic causes. These areas all still ought to be communicated about!!

_______ (behavioral, experiential) processes of change should be used in early stages. __________ processes of change should be used in late stages.

- experiential in early ("I think/feel x to reinforce the behavior") - behavioral in late ("I do x to reinforce the behavior")

Examples of worldviews/cultures that can complicate health comm. Why do worldviews have the potential to complicate things?

- fatalism, individualism, egalitarianism, or respect and trust for authority - Worldview impacts one's perceived level of control over life

Low health literacy rates can lead to these unfortunate outcomes (name 3):

- higher mortality - more unnecessary hospitalizations - medication error - inability to comprehend insurance info - higher healthcare costs - lower quality of life

Name some components of good health communication. (4)

- increasing health literacy skills - helping people make informed decisions - enabling quick/informed action - building social support networks - facilitating information exchange (e.g. by increasing internet and mobile access) - connecting with hard-to-reach populations - delivering accurate info - Providing personalized self management tools and resources.

Why do we need health communication more than ever nowadays (w/ the huge influence of media)?

- people, especially kids, are statistically exposed to way much more programming advocating an unhealthy lifestyle (e.g. candy and mcdonalds commercials) than to things like PSAs encouraging healthy behavior - need more media coverage of health, and existing coverage must be effective and memorable

subjective/percieved norms

- perceived social pressure to change/not change behavior - Your opinion about what others believe you should do

5 stages of transtheoretical model

- precontemplation - NOT MOTIVATED to change ("I don't need to lose weight") - contemplation - thinking about change, weigh pros and cons (within 6 months) ("I should lose weight, the pros outweigh the cons") - preparation - how will I change? gathering info (within 30 days) ("I will lose weight by doing x") - action - making the change, can be one time or long term (actually doing x) - maintenance (keeping up with the behavior you did during action) (I guess relapse isn't specified as a stage but it is implied in the cycle)

You are trying to get a friend to stop smoking. What is your focus at the... - precontemplation level? - contemplation level? - action level?

- precontemplation: Encourage person to think about quitting - contemplation: trigger the decision to quit (create a supportive environment for them, get them a health check) - action: encourage the first step (praise them, reinforce behavior, advise them)

5 different ecological model levels

- state/national/global - living and working conditions - social/community/family - individual behavior - individual biology

Give 4 important considerations for assessing causality.

- strength of association - dose-response - response consistency - temporal correctness - specificity of association - biological plausibility - coherence - experimental evidence - analogy (do structurally similar chemicals cause similar effects?)

Many health-related documents are written at a _____ level, but most Americans read at a ___ grade level

-college - 8th

dimensions of marketing - 4 Ps

-price -placement -product attributes -promotion (communication)

3 steps of changing behavior through the theory of planned behavior

1. Define the behavior (have to be very *specific* about it - action directed at a target, in a given context, at a given time) 2. Identify the beliefs (ask the population. Focus on outcome, norm, and self efficacy beliefs) 3. Choose which beliefs to address (focus on one area or 2, choose things most relevant to intentions and to the behavior itself)

How effective is the TPB in practice/what is the evidence? After many studies, theory of planned behavior shown to explain about ____% (pick one: 10, 20, 50, 70, 90) of the variance in prospective measures of behavior

20

schema

A cognitive framework that helps organize and interpret information. Schemas allow us to take shortcuts in interpreting the vast amount of information that is available in our environment. However, these also cause us to exclude pertinent information in favor of things that confirm our preexisting beliefs and ideas.

Upstream/downstream model of public health (in a nutshell)

A lot of what determines our health is not individual - determined by factors "upstream" of us, like government, neighborhoods, social relationships, genetic factors

What is better - an active or passive voice? Concrete or abstract nouns?

Active voice, concrete nouns

Teach-back method

Asking patients to repeat in their own words what they need to know or do, in a non-shaming way. ● NOT a test of the patient, but of how well you explained a concept. ● A chance to check for understanding and, if necessary, re-teach the information.

Ecological models of health comm assume what?

Assumes multiple elements such as biology and environment affect wellbeing of individuals, families and communities over their life course

The integrative model assumes what?

Assumes rationality and that intentions drive behavior

Why is theory controversial?

Because of its relationship to practice - is theory just useless compared to practice? "The best theory is informed by practice; the best practice should be grounded in theory"

The integrative model says that behavior is not only driven by _______, but also _______ and _________

Behavior isn't only driven by personal attitudes, but by social influence and a sense of control

Theories exist at multiple levels. Give examples of some of these levels.

Behavioral, organizational, community, social movement, political/policy

cross-sectional study

Collects data at a single point in time (e.g. survey) (DESCRIPTIVE, aim to provide data on whole population)

Communication skills include...

Communication skills include literacy skills (e.g., reading, writing, numeracy - what you learn in school), oral communication skills, and comprehension.

How is health a "culturally constructed phenomenon"?

Culture impacts... •How to define health and illness, whom to seek for care, symptoms, causes •Willingness to use treatments and technologies

Data in cohort studies are collected (prospectively, retrospectively)

Data are collected prospectively or retrospectively

cohort studies

Data are examined for *changes over time*, comparing an *exposed subgroup* (to the phenomenon in question) to an *unexposed subgroup*

Should you directly tell patients what to do, or is that approach too harsh? What's more effective - positive (do's) or negative (dont's) language?

Definitely tell them exactly what to do!!! Spell it out for them clearly. Use positive language as much as possible

Why is literacy especially potent in a healthcare context?

Individuals have to fill out many forms to receive treatment; need to know about the various types of health professionals and services as well as how to access care

Intentions are...

Intentions are our explicit plans or motivations to do something

Healthy eating is often discussed in terms of nutrients. Why is this not effective? But why is it hard to change this?

Not effective because people think in terms of foods, not nutrients. But it's hard to change because you want to be able to outright say things like "eat less meat" (as opposed to "eat less saturated fat"), but then the interests of your supporters (ie, the meat industry) prevent you from doing so. So you often just end up being vague and meaningless

How does the example of hormone replacement therapy demonstrate the importance of reporting the science accurately?

Originally, reported faulty evidence that HRT reduced risk of heart disease. Several women went on HRT. but then it was re-evaluated, found to actually increase risk of stroke, CHD, etc. Have to get the science right because people base their health decisions on it, and their lives are at stake

What is the idea behind the trans-theoretical model?

People move through specific stages when changing behavior. Accounts for the fact that people tend to relapse, but acknowledges that they can and will "get back with the program" again. Behavior moves in a very prescribed way.

Satisficing

People search for information quickly. When they find it, they stop searching. Never want to search again. People *don't like* the idea that recommendations can change based on further research.

Basic idea behind balance theory

People will attempt to maintain a psychological balance and form relationships that balance out their likes and dislikes. •In other words, if we feel we are 'out of balance', then we are motivated to restore a position of balance.

Why use universal precautions approach?

Providers don't always know which patients have limited health literacy. Also, "dumbing down" info doesn't have negative impact on higher literacy patients

SOCO stands for...

Single Overriding Communications Objective

T/F: A person can be literate and still have limited health literacy.

T

T/F: If your SOCO is good, the audience should be able to uniformly tell you what your SOCO was.

T

T/F: Perceived behavioral control (like, how much control you think you have over your behavior?) independently predicts intentions.

T

T/F: changing one behavior with the TTM has the potential to impact multiple health behaviors, unintentionally

T

T/F: experimental studies provide a strong test of causality

T

T/F: health literacy is related to cognitive ability, in part

T (correlates w/scores on cognitive aptitude tests)

T/F: Intentions do not equal behavior. People can be oblivious to factors that inhibit their intentions to act.

T - factors like environmental constraints or your actual skill level can inhibit you

T/F: what violates a norm for one group may not violate a norm for another group. Give an example to support your answer.

T. example: women's soccer team who wore flip flops to meet the president. Older generation doesn't see flip flops as real shoes, but younger generation does

TTM allows for what kind of population treatment?

TTM allows for tailoring/population segmentation

__________ is the biggest predictor of obesity.

TV watching

Map out the theory of planned behavior.

The basic model is that attitude, self-efficacy, and perceived norm all influence intention, which leads to behavior change. But although intention may be present, skills and environmental constraints also ultimately influence whether or not there will be behavior change. Background variables like culture, media, socioeconomic stat influence perceived norms. Specific sets of beliefs also influence attitude, perceived norm, and self-efficacy (a different set of beliefs for each).

The integrative model is derived from what 2 previous theories?

Theory of planned behavior & theory of reasoned action (rationality?)

What is a bad thing that news reports on scientific studies often do?

They don't report the standard/quality of evidence backing their claims. Was it a strong study or a weak study? We don't know!!

What you can reasonably recommend to people in terms of health is constrained by existing norms. Give an example.

You'll never get people in China, or in really urban areas, to exercise by running outside. It simply violates too many cultural norms (looks like you're running away from someone). Try recommending another form of exercise.

literacy

ability to make sense of information in any form in which it is presented

self-efficacy

confidence in ability to change behavior

Acceptance or disbelief of health information is strongly influenced by two psychological principles. Name them.

confirmation bias and selective exposure

Communication skills are ______ specific

context (for example, "over the counter" means different things in different contexts)

Perceived importance varies by ______

context (what you think Duke students should do matters while at Duke, not so much at home)

Theory helps us avoid...

cookbook approaches (lists of abstract "ingredients" needed to solve a problem, like "education" - ignores specifics of how people interact with those "ingredients"), and potentially saves costs by narrowing down strategies/focus

attitudes

degree to which the behavior in question is positively or negatively valued (does this matter to me? is it something I value?)

people and places model of social change

divides up environment/assessment in terms of "what are the needs of people in order to be healthy? what has to happen in certain places in order to promote health?" these 2 things are inextricably linked

peripheral cues

do not deal directly with the subject matter, but tell the audience "hey, I'm speaking to YOU" (remember the elaboration likelihood model?)

Outcomes of TTM with diverse groups suggest what - that these groups are fundamentally less able to change, or that they just don't have access to good behavior change programs?

don't have access to good programs

The beliefs that influence self-efficacy are...

efficacy beliefs

How can automation help low-literacy patients?

give them as much time as they need to understand something, reduce embarassment

How does the CDC primarily define health comm?

health comm is about the use of communication strategy in influencing people AND communities to *make informed decisions about their health*

doer vs non-doer analysis

how do you find out what consumers want, what makes them use a product? ask the people who are doing it/using it (doers) and the people who aren't (non-doers)

evaluation plan

how will we check up on how the intervention is coming along?

expansion/continuation plan

how will we keep the intervention going?

positive deviance

identifying healthy individuals, and finding out what they are doing RIGHT - uncommon in a successful way

audience segmentation

identifying smaller groups of the audience who share characteristics

social epidemiology

identifying social gradients in health

Most behavior change theories exist at the (individual, community) level

individual

social cognitive theory

individual behavior is the result of constant interaction between the external environment and internal psychosocial characteristics, involves observational learning

for Facebook, who were the innovators? Who were the early adopters? The early majority? Late majority? Laggards?

innovators - Zuckerberg et al. early adopters - Harvard and Stanford early majority - other elite schools late majority - rest of schools laggards- grandma

Behavior change theories focus on changing _________, but ________ aren't everything. It's only an assumption of theories that changing _________ will lead to behavior change. (all 3 blanks are the same word)

intentions

The greatest percentage of adults are in what literacy level?

intermediate (except for 65+, who are more basic/below basic)

the model for population health is split into health _________ and health _________, and then considers effective __________

outcomes (mortality, general health status), determinants (things that fall under the "causes of death" categories discussed above), programs/policies

If advice is not definitive, people have what kind of reaction?

people become fearful, angry, and tune out

Selective exposure

people obtain information from sources with which they tend to agree

Advertising as a health comm strategy

places paid or public service messages in the media or in public spaces to increase awareness of and support for a product, service, or behavior

Attitudes are either positive or negative. In balance theory, attitudes are in balance if the sum of the 3 valences is a ________ result.

positive (for example, I like technology (positive). My friend Kate likes me (positive), so in order to maintain psych balance, Kate should feel motivated to like technology (positive)). Think of a triangle.

Health Belief model

pre-existing beliefs about health either motivate or discourage people to take on certain health behaviors

PRECEDE-PROCEED model

precede = assess the situation proceed = carry out implementation

To help low literacy patients, should we increase or decrease word variation?

probably decrease. Repetition is good!

Public relations promotes..

promotes the inclusion of messages about a health issue or behavior in the mass media

You are creating a sexual risk awareness campaign for a specific group of people. Where is a good place to start?

survey them: what behaviors do they engage in? What do they know? What do they THINK they're at risk for? What has and hasn't worked for this group? How do they for in a social context? Who do they respect- who has influence? It's good to be empirically oriented. Once you have this info, you need a theory to know what to do with it/how to apply it

media literacy

teaches audiences (often youth) to deconstruct media messages so they can identify the sponsor's motives

Theories lead to the derivation of...

testable hypotheses

What is a criticism of tendency to focus on theory in behavior change?

the focus on theory may drive the status quo (too much theorizing not enough action towards change?)

reciprocal determinism

the same thing as the social cognitive theory

role of "knowledge hierarchies" in health comm

to understand C, you must first understand A and B. We need to give people the requisite foundational knowledge to understand health messages

which behavior change theory is the most popular?

trans-theoretical model