The Role of Theory in Developing Effective Health Communications

This article mentions that theories of behavioral prediction and behavioral change are useful because they give a framework to help identify the determinants of any given behavior, which is a start essential to developing a successful way to change a behavior. Knowing more about the determinants of a behavior will allow one to better develop an effective communication to reinforce or change behaviors. The article serves as a guide for communicators to understand the variables to developing an effective message.

Fishbein Integrative Model

The authors utilized the Fishbein Integrative Model, which brings together a number of theoretical views. It is mentioned in the model that any given behavior will most likely occur if one has a strong intention to perform the behavior, has the skill and abilities to perform the behavior and there are no environmental or constraints to prevent the performance. Also mentioned are three important determinants of intention, attitude towards performing the behavior, perceived norms concerning performance and self-efficacy with respect to performing the behavior. The importance of these variables as determinants of intention depends on the behavior as well as the population being considered.

The three factors are all affected by underlying beliefs about the outcomes of performing the behavior, the norms which the person is exposed to in his/her group and specific barriers or facilitators of behavioral performance. For example, if one believes that quitting smoking is good for his health and prevent health issues, the more favorable one’s attitude towards performing that behavior. Another is if peer pressure or a specific important person in that individual’s life performs the behavior or feels that he/her should not perform the behavior, the more the individual will comply. Lastly, the more one perceives that he/her has the skills and abilities to perform the behavior in the face of barriers, the stronger one’s self efficacy to perform the behavior. Thus, communication professionals should go to people in the particular population to identify the salient outcome, normative and efficacy beliefs.

The model also shows the role played by demographic, personality, attitudinal and other individual difference factors like perceived risk and sensation seeking characteristics. The model is both population and behavior specific where the variables are all different in different populations and cultures.

Applying the model

The first step to using the model is to identify the behavior that a communicator wishes to understand, reinforce and change. Second, one must understand that the definition of a behavior involves the action, the target, the context and the time. Any change in one of these elements changes the behavior under consideration. Once one or more behaviors are identified, the model can help to understand why some members of a target population are performing the behavior and others are not. Specific beliefs can then be identified and addressed in a theory-based communication. If properly implemented, behavioral theory can identify the critical beliefs underlying the performance of any behavior and the beliefs can be targets of a persuasive communication or intervention.

Role of Communication Theory

Although the theories of behavior prediction and change can help identify the critical beliefs underlying a given behavior, theories of communication are needed to craft messages that will increase belief change, which unfortunately as mentioned are not as advanced as theories of behavior prediction and change. Several theories are given by the authors including if a message is to be effective, it must be attended to, comprehended, accepted and yielded to. Others include how messages are framed; loss-framed messages are more effective when promoting illness-detecting behaviors and gain-framed messages are more effective for promoting health-affirming behaviors. Although research on perceived effectiveness and framing are mentioned to be the right way, there is still a lack of strong studies on valid and comprehensive theories of message effectiveness. It is hard to tell what factors can influence acceptance, yielding and impact. It is thus hard to tell how best to design a message so that it is attended to, accepted and yielded to.

My View

The authors mentioned that if a receiver already holds the beliefs advocated in a message, he/she may accept the message, but such acceptance will not lead to belief change. However, in my opinion, taking an example in smoking, a person may have changed their beliefs moving to a position that he or she feels that it harms his/her health and wants to quit. However, due to peer pressure he/she is unable to quit.

Do you agree with the model and what do you think are factors or ways that can best enhance message effectiveness?


Fishbein Martin and Cappella Joseph N (2006) ‘The Role of Theory in Developing Effective Health Communications’, Journal of Communication pp.S1-S17 Available from:


3 comments so far

  1. fireprism on

    There are many factors to consider when it comes to motivation. One must understand that there is extrinsic and intrinsic motivating factors. Extrinsic motivation are tangible rewards that appeal to the individual. For example, in the case of smoking, the tangible reward would be monetary savings if the individual would choose to quit.

    Intrinsic motivation, on the other hand, involves deeper meaning without any focus on tangible benefits. With smoking as the example, an intrinsic motivator would be the belief that kicking the habit would make your body healthier and prevent smoking related diseases. There is still focus on benefits but these benefit are not immediately noticeable or tangible.

    Thus the challenge that one would face is how can one motivate an individual in both an extrinsic and intrinsic way?

  2. durianshells on

    I agree with you fireprism that ultimately one must have the intrinsic motivation to quit smoking out of their own account, in the mindset that they do want to become healthier themselves and not affect their family members as well. Extrinsically as well, the importance of families and friends’ influences cannot be dismissed as well, as support is often needed as a form of motivation to help one kick the habit by engaging them in other activities in times of urge, encouraging them or not smoking around them when the individual is around. However, bad influence or peer pressure can often cause an individual to quickly get back into the habit.

  3. janisuhoshi on

    Hi durianshells, you have summarised the reading very well and it is easy to understand.

    You mentioned that the 3 important determinants of intention are:
    – Attitude towards performing the behavior
    – Perceived norms concerning performance
    – Self-efficacy with respect to performing the behavior.

    I remember Cialdini (2003)’s study on injunctive and descriptive norms, and also how perceived norms can encourage people to adopt a certain behaviour by seeing many people doing it (descriptive norm) and/or knowing that most people approve such behaviour (injunctive norm).

    You gave a good example of how the Fishbein Integrative model can be applied to smoking and in response to your question, I agree with the model.

    For communicators seeking to discourage smoking, they have to understand what has motivated people to smoke. In order to alter this behaviour, the smoker’s attitude must change and communicators can do so through health education. Apart from this, communicators can emphasize norms (both descriptive and injunctive) that disapprove smoking or negate the popularity of smoking in their communication. They can also make smoking appear costly and wasteful so smokers would quit if they feel they cannot afford this behaviour.

    So, what other factors or ways can enhance message effectiveness?

    The Fishbein Integrative Model focuses on inner motivations. How about the external motivations? I concur with fireprism that focussing on monetary savings is one way to encourage people to quit smoking.

    fireprism went on to ask this question in his reply: “How can one motivate an individual in both an extrinsic and intrinsic way?”

    Let’s take smoking as an example again. One good way is to emphasize, in a communication, that smoking is expensive and wasteful so those who find that they cannot afford to continue smoking will quit (self-efficacy). By doing so, it is also highlighting the monetary savings from not smoking (extrinsic motivation).

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