Age - On the surface, age seems easy enough to measure, and it is for many research projects. However, the concept of age can vary depending on a variety of factors, including the purpose of the research, the target respondents, policy implications, and such. For example, a research project that measures demographics of a broad population may measure age in one-year increments. Another project may group age based on some predefined ordinal scale. Yet another project may be interested in a particular age group that may be tied to other foci of the research, such as at risk populations, adolescents, elderly, developmental and lifestyle issues, etc. (Chaffee, 1991).
Typically, age is conceptualized as the length of time, most often in completed years, that a given person has been alive, measured at the beginning of birth.
Behavioral intention (BI) is defined as a person's perceived likelihood or "subjective probability that he or she will engage in a given behavior" (Committee on Communication for Behavior Change in the 21st Century, 2002, p. 31).
BI is behavior-specific and operationalized by direct questions such as "I intend to [behavior]," with Likert scale response choices to measure relative strength of intention. Intention has been represented in measurement by other synonyms (e.g., "I plan to [behavior]") and is distinct from similar concepts such as desire and self-prediction (Armitage & Conner, 2001). Ajzen (1991) argued that BI reflects how hard a person is willing to try, and how motivated he or she is, to perform the behavior.
In theory in which is it included, BI is the most proximate predictor of behavior (Ajzen, 1991), and behavior is ultimately the variable that most health communication interventions aim to influence.
Exposure in mass communication has been defined conceptually as "the extent to which audience members have encountered specific messages or classes of messages/media content" (Slater, 2004, p. 168); and "the degree to which audience members have access to, recall or recognize the intervention" (Valente, 2001, p. 117). McGuire's (2001) conceptual, sequential Communication-Persuasion Matrix has as its initial two steps exposure followed by attention.
That exposure is a fundamental and important variable in health communication is self-evident: Researchers cannot validly test the impact of communications or messages unless they establish that subjects or respondents have been exposed to them.
Habits are response dispositions that are activated automatically by the context cues that co-occurred with responses during past performance" (Neal, Wood, & Quinn, 2006, p. 198). The three components of habits recognized in conceptual descriptions are: past behavior or performance, degree of automatic response, and contextual cues.
Health information seeking represents the intentional, active efforts to obtain specific information above and beyond the normal patterns of media exposure and use of interpersonal sources (Atkin, 1973; Griffin, Dunwoody, & Neuwirth, 1999). It includes "any non-routine media use or interpersonal conversation about a specific health topic and thus includes behaviors such as viewing a special program about a health-related treatment, using a search engine to find information about a particular health topic on the Internet, and/or posing specific health-related questions to a friend, family member, or medical practitioner outside the normal flow of conversation" (Niederdeppe, Hornik, Kelly, et al., 2007, p. 155).
Health information seeking can be distinguished from information scanning (e.g., Morris, Rooney, Wray, & Kreuter, 2009; Niederdeppe, et al., 2007), which is information acquisition from routine or habitual media use and interpersonal communication. Information scanning is less active and less goal-directed than information seeking.
Health literacy The Institute of Medicine definition of health literacy is: (Ratzan & Parker, 2000; Selden et al, 2000; US Dept of H&HS, 2000;), is:
...the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions (Ratzan & Parker, 2000; US Dept of H&HS, 2000).
The WHO defined health literacy as:
... the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health (Nutbeam, 1998).
Health literacy important concept because research has linked it to health knowledge, health behaviors, and health outcomes. Limited health literacy is associated with a variety of barriers to improving health such as higher rates of hospitalization and less frequent use of preventive services and has been shown to have significant patient costs (Baker et al., 2002; Howard, Gazmararian, & Parker, 2005; IOM, 2004). For example, patients with limited health literacy and illness have less knowledge of illness management than those with higher health literacy (Kalichman et al., 2000; Schillinger et al., 2002; Williams, et al., 1998a, b). The Institute of Medicine (IOM) reported in Health Literacy: A Prescription to End Confusion (IOM, 2004, p. 6) that 90 million US adults "have difficulty locating, matching, and integrating information in written texts with accuracy and consistency." The IOM (p. 8) also reported that adults with limited health literacy skills have "less knowledge of disease management and of health-promoting behaviors, report poorer health status, and are less likely to use preventive services."
Health orientation is an individual-differences concept defined as an individual's motivation to engage in healthy attitudes, beliefs, and behaviors (Dutta, Bodie, & Basu, 2008). Essentially, health orientation represents individuals' inclinations toward their own health, and is important in understanding the extent to which individuals are willing to take responsibility for their own health (Moorman & Matulich, 1993). A person that is highly oriented toward their health is motivated to search, attend, and comprehend health information as well as perform health behaviors. Health orientation is conceptualized "as an intrinsic interest rather than an interest that is prompted by situational factors in the environment" (Dutta-Bergman, 2005a, p. 4). Thus, the greater an individual's interest in health-related issues, the stronger the likelihood of the individual engaging in health-related behaviors.
Research on individuals' motivations about their health attitudes and behaviors has shown that health motivations vary within and across populations, and that this variance can explain significant variance in health behaviors (MacInnis, Moorman, & Jaworski, 1991; Moorman & Matulich, 1993; Park & Mittal, 1985).
Information sufficiency is a concept defined as "an individual's assessment of the amount of information he or she needs to cope with...risk" (Griffin, Neuwirth, Dunwoody, & Giese, 2004, p. 24) and is central to the risk information seeking and processing model (RISP, Griffin, Dunwoody, & Neuwirth, 1999). The concept is linked to the idea of sufficiency threshold in the Heuristic-Systematic Model (HSM, Eagly & Chaiken, 1993). Specifically, information sufficiency is "the amount of information people say they need to deal adequately with a given risk in their own lives" (Griffin, et al., 2004, p. 26).
The sufficiency principle in the HSM argues that people attempt to balance exerting cognitive effort and maximizing confidence in a given judgment (Chaiken, Giner-Sorolla, & Chen, 1996; Chaiken, Liberman, & Eagly, 1989). The sufficiency threshold is an individual's desired confidence level, or the point at which individuals feel confident that a judgment satisfies their current motives. Typically, individuals will exert sufficient cognitive effort until their level of confidence reaches their sufficiency threshold. Thus, the sufficiency principle is based on two levels of confidence: the level of confidence an individual has in a judgment and the level of confidence an individual desires in a judgment.
Perceived message cognition value is a message counterpart to the need for cognition individual difference concept, just as perceived message sensation value is a message counterpart to need for sensation (Zuckerman, 1988, 1991). Recent research has attempted to characterize messages based on perceived message cognition value in order to inform message design on message attributes that would appeal to individuals high on need for cognition (Cacioppo & Petty, 1982; Cacioppo, Petty, Feinstein, & Jarvis, 1996). Need for cognition is an individual's tendency to engage in and enjoy effortful cognitive activity (Cacioppo & Petty, 1982; Cacioppo, Petty, Feinstein, & Jarvis, 1996). As message sensation value targets individuals with high need for sensation, message cognition value is designed to target individuals with high need for cognition.
Message cognition value (MCV) is a characteristic of a message regarding its complexity and implicitness (Harrington et al., 2003). Messages with high cognition value are more complex and implicit whereas low cognition value messages are more simple and explicit. Message cognition value, however, should not be understood as the content or quality of the message. Messages designed to vary in their cognition value should contain the same arguments with similar argument strength (Harrington et al., 2003).
Perceived severity refers to how serious people believe a particular disease or condition is. It involves the negative consequences an individual associates with a health event or outcome, such as a diagnosis of cancer. Witte et al. (1992, p. 10) defines perceived severity as a person's beliefs about the significance or magnitude of a health threat (e.g., "skin cancer leads to death").
Perceived severity is a central concept in several fear appeal health information processing models, including the Health Belief Model (Becker, 1974; Rosenstock, 1974; Rosenstock, Strecher, & Becker, 1994), parallel response model (Leventhal, 1970), Protection Motivation Theory (Rogers, 1975, 1983) and the Extended Parallel Process Model (Witte, 1992, 1998). Perceived severity combined with perceived susceptibility form perceived threat (Witte, 1992), which may influence how people process health information and how motivated they will be to engage in a particular behavior. The perceived severity of consequences may relate to an anticipated event that may occur in the future, or to a current state such as a pre-existing health problem. In other words, perceived severity is the perception of how serious a health problem or disease is if one were to contract it.
Perceived susceptibility, also called perceived vulnerability, refers to one's perception of the risk or the chances of contracting a health disease or condition (Witte, 1992). It can also include estimates of resusceptibility and susceptibility to illness in general (Rosenstock, Strecher, & Becker, 1994).
Perceived susceptibility is a central concept in several fear appeal health information processing models, including the Health Belief Model (Becker, 1974; Rosenstock, 1974; Rosenstock, Strecher, & Becker, 1994), parallel response model (Leventhal, 1970), Protection Motivation Theory (Rogers, 1975, 1983) and the Extended Parallel Process Model (Witte, 1992, 1998). Perceived susceptibility combined with perceived severity form perceived threat (Witte, 1992), which may influence how people process health information and how motivated they will be to engage in a particular behavior. Susceptibility information can be included as a message feature (e.g., Ronis, 1992) usually in the form of percentages or odds of contracting some illness or condition. Most often susceptibility is measured as a person's perception of the likelihood of getting an illness.
Scholars (e.g., Harris, 2000; Hirschman, et al., 2000; Perez & Hirschman, 2009; Saenz & Morales, 2005) and federal agencies, including the Census Bureau, view both race and ethnicity as social constructs. Federal agencies must measure and report race and ethnicity in accordance with standards in a 1997 revision of the Office of Management and Budget's (OMB) Directive 15. These standards "reflect a social definition of race recognized in this country... and do not conform to any biological, anthropological or genetic criteria" (Office of Information and Regulatory Affairs, 1997b). (The minimum racial categories required by the OMB are listed under Suggested Measure, below.)
The Census Bureau defines ethnicity or origin as "the heritage, nationality group, lineage, or country of birth of the person or the person's parents or ancestors before their arrival in the United States" (U.S. Census Bureau, 2001).
Reactance restoration is a concept grounded in Psychological Reactance Theory (PRT; Brehm, 1966). Brehm was interested in how people respond to a threat or a challenge to a personal freedom. PRT assumes that people value their freedoms, specifically, their freedom to choose among alternatives in a given situation. Individuals may become "reactant" to messages that communicate a threat to those freedoms. That is, when personal freedoms are threatened or challenged, a person may experience pressure or motivation to alleviate those threats. One possible outcome to such a threat is for the individual to engage in the threatened (or related) behavior or adopt an attitude consistent with maintaining the personal freedom. When a person adopts the behavior counter to the one proscribed, say, in a persuasive health message, a "boomerang" effect is said to occur (Worchel & Brehm, 1970). The person attempts to restore the threatened freedom in order to retain control over one's freedoms. Reactance will often show several boomerang effects, such as anger and negative thoughts (e.g., message derogation, counterarguing), in order to restore the eliminated freedom.
Direct measurement of psychological reactance, however, has occurred only recently (Dillard & Shen, 2005; Donnell, Thomas, & Buboltz, 2001; Hong & Faedda, 1996; Miller, Lane, Deatrick, Young, & Potts, 2007). Quick and Stephenson (2007) argue that these studies only partially measure Brehm's (1966) conceptualization of reactance. Specifically, they note that "individuals can restore their threatened or eliminated freedom by expressing in a manner opposite the threat, performing a related behavior to the threat, or vicariously performing the threat by observing others behave in a freedom-restoring manner (Brehm & Brehm, 1981)" (Quick & Stephenson, 2007b, p. 132).
Response efficacy is defined as the extent to which people believe that a recommended response is effective at deterring or alleviating a health threat (Witte, 1992, 1994).
Response efficacy is a central concept in several health information processing models, including the Health Belief Model (Becker, 1974; Rosenstock, 1974) and Protection Motivation Theory (Rogers, 1975, 1983). As is the case with self-efficacy, response efficacy is sometimes conceptualized as a property of a message, such as when a message has response-efficacy information (e.g., Lapinski, 2006; Rimal & Real, 2003). Most often it is conceptualized as beliefs in the ability of a recommended behavior to alleviate a health threat (e.g., "I think condoms prevent AIDS," Witte & Morrison, 2000).
Response efficacy is a construct similar to the benefits-of-change component of the health belief model (Hochbaum, 1958; Janz & Becker, 1984). It is also has common conceptual components with outcome expectations found in expectancy value theories, such as Theory of Reasoned Action and Theory of Planned Behavior (Ajzen, 1988; Schifter & Ajzen, 1985).
Self-efficacy is the extent to which people believe they are capable of performing specific behaviors in order to attain certain goals.
The concept of self-efficacy is the focal point of Bandura's (1997, 2001) Social Cognitive Theory. Self-efficacy is sometimes conceptualized as a property of a message, such as when a message has self-efficacy information (e.g., Turner, Rimal, Morrison, & Kim, 2008). Most often it is conceptualized as beliefs in ones' ability to perform a specific behavior, and is often referred to as perceived self-efficacy. Bandura (1994): "Perceived self-efficacy is defined as people's beliefs about their capabilities to produce designated levels of performance that exercise influence over events that affect their lives." The importance of perceived self-efficacy is that it can determine how people feel and behave. The more a person believes that a particular behavior can result in a desirable health outcome, the greater the likelihood that increased perceived self-efficacy for that behavior will result in the adoption and adherence to that behavior (Maiback, Flora, & Nass, 1991).
According to Bandura, perceived self-efficacy is "best conceptualized as perceived operative capability. It focuses on the belief in what one can do with whatever resources one can muster rather than with what one has.
Sensation seeking is a personality trait with a biological basis defined by the "seeking of varied, novel, complex, and intense sensations and experiences, and the willingness to take physical, social, legal, and financials risks for the sake of such experience" (Zuckerman, 1994, p. 27).
Sensation seeking is conceptualized as a trait with underlying biological mechanisms (Zuckerman, 1979a, 1984). Individual differences in one's biological composition explain why some individuals prefer more stimulation than others do. Zuckerman (1994), for example, argued that ‘‘the appetite for arousing stimulation and experience, whether direct or vicarious, is based in significant part on biological mechanisms, and individual differences in this appetite are based on variations in the underlying biological mechanisms as well as the outcomes of experience associated with such stimuli'' (p. 174).
Sensation seeking is a central concept in the Activation Model of Information Exposure (Donohew, Lorch, & Palmgreen, 1998; Donohew, Palmgreen, & Duncan, 1980). The Activation Model theorizes about the relationship between a person's need for stimulation and attention to media messages, based in part on a person's optimal level of arousal.
Source credibility has been defined within the persuasion literature as "judgments made by a perceiver concerning the believability of a communicator" (O'Keefe, 1990, p. 130-131).
In health communication, source credibility or believability can increase the effect of the message delivered, including ultimately on behavior but also on antecedents such as beliefs and attitudes (Pornpitakpan, 2004). In the dual processing Elaboration Likelihood Model, perceived source or communicator credibility may serve as a peripheral cue or heuristic by which receivers make quick judgments about a message (Petty & Cacioppo, 1986). They may do this without centrally processing the strength of the arguments in the message. Of course, other variables being equal, messages perceived to include both credible sources and strong arguments are most likely to affect audiences. Furthermore, although message argument strength and source credibility are separate variables, each may interact with and affect perception of the other (Slater & Rouner, 1996).
Spiritual health locus of control (SHLOC) is a concept recently developed by Holt and her colleagues (Holt, Clark, & Klem, 2007; Holt, Clark, Kreuter, & Rubio, 2003a; Holt, Lukwago, & Kreuter, 2003b). Based on research that shows complex relationships between a person's religious beliefs, spirituality, and health, spiritual health locus of control was developed to link religious and spiritual beliefs to how health outcomes are controlled. Specifically, this measure is built on the Health Locus of Control (HLC) Scale (Wallston, Wallston, Kaplan, & Maides, 1976) and the Multidimensional Health Locus of Control (MHLC) Scale (Wallston, Wallston, & DeVellis, 1978).
The underlying structure of this concept is that individuals vary on how much they believe they have control over their own health outcomes. Individuals with an internal locus of control believe that they have control, whereas individuals with an external locus of control believe that their outcomes are controlled by outside forces.
State reactance is a situation-specific psychological state resulting from a motivation to reject advocacy within a persuasive communication. State reactance is a central concept in Psychological Reactance Theory (PRT), which specifically addresses a process that predicts individuals' resistance to persuasive messages.
PRT (Brehm, 1966; Brehm & Brehm, 1981) predicts that when a perceived sense of autonomy is threatened, the individual will be motivated to reestablish that freedom. According to reactance theory, individuals perceive a set of free behaviors (Wicklund, 1974), "such as whether or not they can smoke a cigarette or their ability to choose what they will eat for dinner. Challenges to these expectancies prompt an aversive motivational state, reactance" (Gardner, 2010, p. 14).
Subjective Norm - A broad definition of perceived or subjective norm is "the perceived social pressure to perform or not to perform the behavior" in question (Ajzen, 1991, p. 188). But subjective norm is usually defined more precisely, as an individual's perception or "opinion about what important others [italics added] believe the individual should do" (Finlay, Trafimow, & Moroi, 1999, p. 2015) – i.e., perform or not perform the behavior in a specific situation. This perception or opinion has been labeled as that individual's normative belief, which is often then multiplied by motivation to comply (with this belief), as represented in the equation (NB×Mc) (Ajzen & Fishbein, 1972). When multiple, specified important others are included, the normative beliefs and motivation to comply for each would be summed, ?(NBiMci). If the researcher is interested in relative influences of each specified other, regression weights can be calculated.
Subjective norms as represented by normative beliefs are located within, but not identical to, the broader construct of social norms. "While a social norm is usually meant to refer to a rather broad range of permissible, but not necessarily required behaviors, NB refers to a specific behavioral act the performance of which is expected or desired under the given circumstances" (Ajzen & Fishbein, 1972, p. 2).
The theory of reasoned action (TRA) (Fishbein & Ajzen, 1975) includes subjective norms and attitude toward the behavior as both influencing behavioral intention, which then directly influences behavior. The theory of planned behavior (TPB) (Ajzen, 1991) adds to these the variable of perceived behavioral control, which, when lacking, can help to explain failure to perform the behavior even when attitude and subjective norms are positive.
Trait reactance, sometimes called reactance proneness, is an individual difference variable that conceptually taps an individual proneness to psychological reactance. Psychological Reactance Theory (PRT, Brehm, 1966; Brehm & Brehm, 1981) predicts that when a perceived sense of autonomy is threatened, the individual will be motivated to reestablish that freedom. Whereas state reactance functions as an outcome variable, generally itself a precursor to message outcomes in its mediating role, trait reactance is conceptualized as an antecedent variable that guides message processing and reactions (Dillard & Shen, 2005).
Transportation is a multidimensional concept defined as "the extent that individuals are absorbed into a story" (Green & Brock, 2000, p. 701). The concept is based on the metaphor of a traveler being transported from one place to another Gerrig (1993). Transportation refers to the degree to which an individual is immersed in a narrative. The primary relevance of transportation to health communication research is that it is the primary mechanism that underlies the effect of narrative messages and is hypothesized to mediate the relationship between message exposure and persuasion, particularly in a health context (Green & Brock, 2000, 2002). Transportation into a story can impact an individual's beliefs and attitudes. The degree to which a person is transported into a narrative world can create and change attitudes. Such outcomes may be useful when trying to improve individuals' beliefs, attitudes, and behaviors about a particular health issue through narrative messages (Green, 2006; Kreuter, et al., 2007; Slater, 2002; Slater & Rouner, 1996).
Transportation as it is currently conceptualized and measured integrates several processes, such as attention, imagery, and emotion. Specifically, transportive stories can focus attention on story attributes and away from real-world awareness while increasing emotional identification and responding to characters in the narrative (Green, 2006; Green & Brock, 2000). In doing so, transportive stories can reduce message scrutiny, reduce counterarguments to healthy behaviors portrayed in the story, encourage mental simulation of behaviors, and provide models for behavior change.