Health Communication Theories

By
Solomon A. Oyeleye, Ph.D.
Aondover, Eric Msughter, Ph.D
Health Communication Class,
Dept of Mass Communications,
Caleb University, Imota, Lagos, Nigeria
October, 2023
 Uses of Health Communication theories
• It’s a useful framework for planning.
• It provides inspiration for specific communication
approaches.
• Provides support to phased health campaigns.
• Theories help us understand the various target group
characteristics, and the environment in which they
live.
• It also helps us to understand the communication
environment in which the communication team
operates.

2 21/10/2023
 Points to note:
• Health communication theories are multi -
disciplinary.
• There is intersection among many different
disciplines, between behavioral and social
sciences, social marketing and health education,
and between the social sciences and the
humanities.
• Health communication theories impact heavily on
program design and evaluation.

3 21/10/2023
 APPLICATION OF THEORIES SHOULD:
Be considered as part of a tool kit and applied on case by case
basis.
Respond to all targeted audience needs,
Address all specific health situation and causative or
influencing factors.
Inform and guide message design, channel selection,
Be revisited in the light of emerging trends and new realities
after program evaluations.

4 21/10/2023
 Behavioral and social science theories
These theories explain how behavior change takes
place at individual, community and social levels: they
include;
Diffusion of innovation theory,
 Health Belief model,(HBM)
 Theory of reasoned action, (TRA)
Convergence theory,
Stages of behavior change theory,
Communication for persuasion theory,

5 21/10/2023
 Diffusion of Innovation

This theory ( Rogers, 1962, 83, 95)explains how new

ideas, concepts, innovations, products, practices, etc
can spread into the community, or from one society to
the other.
The theories identifies 5 subgroups on the basis of
audience characteristics and propensity to accept the
Innovation.

6 21/10/2023
 The 5 groups are:
Innovators
Early adopters,
Early majority
Late majority,
Laggards.

7 21/10/2023
 Roger’s Stages of diffusion
Awareness
Knowledge and interest.
Decision
Trial or implementation
Confirmation or rejection of the new behavior.

8 21/10/2023
 Premises
The theory postulates that innovators usually decide
much faster, than any group on wether to accept new
ideas, concepts, or practices.

It assumes that these innovators can then diffuse the

innovative idea to other members of the group, acting
as role models.

9 21/10/2023
 Key lessons learnt from diffusion
Audience segmentation remains a relevant strategy in
health com.
Use of role models and influencers can enhance
program impact.
The theory helps explain the external factors and time
required to facilitate behavioral outcomes.

10 21/10/2023
 Critique of diffusion theory.
The trickle down approach from innovators to laggards
may not work in all cases.

Rogers himself noted this, and in he1976 modified the

information flow approach to an information sharing
approach that stresses mutual understanding.

11 21/10/2023
 Health Belief Model
This theory was borne out of a research to understand
why some people did not participate in some programs
that that could help prevent diseases. ( Becker,
Haefner, and Maiman, 1977)
The theory postulates that in order for people to adopt
preventive or recommended behaviors, they must:

12 21/10/2023
 HBM Model

People must perceive their susceptibility to the

infection, and their personal risks.

Perceive that the benefits of behavior change

outweighs the potential barriers or other negative
aspects of recommended actions.

13 21/10/2023
 HBM Influences and lessons

The HBM facilitated the emergence of health

education.

Health education refers to any planned combination of

learning experiences designed to predispose, enable,
and reinforce voluntary behavior, conducive to health
in persons, groups or communities.

14 21/10/2023
 Premises
HBM model is premised on 6 principles built around
knowledge brings change approach.
Perceived susceptibility ( am I at risk?)
Perceived severity ( is the health problem serious)
Perceived benefits ( can the recommended action
reduce the severity? Mortality, morbidity, etc)
Perceived barriers ( can I afford it)
Cues to action ( who else recommends the behavior,
media, role models?
Self efficacy. ( am I confident about maintaining the
new behavior, can I?)
15 21/10/2023
 Key lessons

The theory stresses the need to teach new information

so that knowledge can bring about change.

It however does not guarantee that knowledge will

necessarily lead to change, even though it is
considered as a priori.

16 21/10/2023
 Social Cognitive theory
This theory is also referred to as social learning
theory. Bandura, (1977, 1986, 1997) is the founding
father of this theory.
It is based on the premises that behavior is socially
learned and can be changed. That behavior is the
result of 3 reciprocal factors, behavioral factors,
personal factors and outside events.
The theory emphasizes the external environment and
how it affects behavior.

17 21/10/2023
 Premises
The theory holds that; the environment is a place where
individuals can observe an action, understand its
consequences, and as result of personal and interpersonal
influences become motivated to repeat and adopt it.
There are 6 key components to this kind of learning;
Attention, Retention, and Reproduction, motivation,
performance and self efficacy.

18 21/10/2023
 Premises of SCT
 Attention :refers to people’s awareness of the action being
modeled and observed.
 Retention: peoples ability to remember the action.
 Reproduction: peoples ability to reproduce the action.
 Motivation: refers to the internal impulses and the intention to
perform the action. Being dependent on factors such as peer
influence, parental support, school inputs, etc.
 Performance: The individual ability to perform the action on a
regular basis.
 Self efficacy: The individual’s confidence in his or her ability
to sustain the action with little or no help from others, which
plays a major role in actual performance.

19 21/10/2023
 Key Learning
The theory provides healthcom planners
and programmers a way to understand the
factors that influence retention,
reproduction and motivation on a given
behavior.
Provides a framework with which to
approach several questions in program
research and planning.
20 21/10/2023
 Theory of Reasoned Action TRA
Theory of reasoned action suggests that primary
determinant of behavior is the intention to
perform a given behavior.
Ajzen and Fishbein (1980) identified 2 factors that
contribute to such intentions. They are:
Attitude . ( a person’s own value judgment,
feelings, conception of an idea, or thing)
Subjective norms . ( the opinion or judgment of
his/her influencers)

21 21/10/2023
 Premises
TRA assumes that attitudes towards a specific behavior
are a function of the person’s beliefs, about the
consequences of such behavior. E.g. Smoking cigarettes
may affect my self image. These are called behavioral
beliefs.
Subjective norms are influenced by normative beliefs
which refers to whether a person may think significant
others will approve of his/her behavior or not.

22 21/10/2023
 Critique
It has been critiqued for assuming that intentions
will always necessarily translate into behavioral
outcomes.
But appropriate communication is often required
to support the individual to translate intentions into
actual behaviors.
The theory is very useful in audience profiling,
program evaluation and in identification of
influencers of target groups.

23 21/10/2023
 Convergence Theory

The convergence theory emphasizes the importance

of information sharing, mutual understanding and
mutual agreement on any collective action that
would bring social change.

The theory was espoused by Kincaid (1979), Rogers,

and Kincaid (1981).

24 21/10/2023
 Premises
The theory is based on the premises that an
individual’s perceptions and behavior are
influenced by the perceptions and behaviors of
members of the same group, family, profession or
social class. Such as peers, friends, family, or
professional colleagues.

It holds that information is shared in a

participatory fashion with everyone being both a
sender and a receiver on equal basis.
25 21/10/2023
 Convergence theory contd

Communication emphasizes individual perceptions

and interpretations of the information being shared,
encourages an ongoing dialogue, fosters mutual
understanding and agreement on common meanings.
Communication is horizontal, participatory, equal and
can stimulate group action
The theory has redefined the importance of social
networks, and the need to take into account people’s
feelings, emotions, fears and concerns.

26 21/10/2023
 Stages of Behavior Change Model

This theory by Prochaska and Diclemente (1983)

defines behavior change as a process that takes place
in stages.

Each stage of the behavior change describes a different

level of motivation or readiness to change.

27 21/10/2023
 The stages of BC
Precontemplation : No intention to adopt
behavior but are open to learning.
Contemplation: Individuals know about the
behavior and are weighing in.
Decision: the stage at which behavior is adopted.
Action: trial behavior.
Maintenance: sustained behavior.

28 21/10/2023
 Usefulness of stages of change

It helps program managers to segment audiences

according to their stages of change or level of
readiness to change.

It helps communication managers to design objectives,

and strategies that are targeted and tailored to suit the
group’s specific situations.

29 21/10/2023
 Communication for persuasion theory
This theory was developed by McGuire (1984) and focuses
on how people process information. A psychologist,
William McGuire identified 12 steps through which
individuals assimilate and perform a new behavior.
1. Exposure to the message.
2. Pay attention to it.
3. Become interested.
4. Understand.
5. Fit new behavior into lifestyle.
6. Accept the change.
7. Remember and validate the message.

30 21/10/2023
 McGuire's 12 steps to persuasion
8. Be able to think of the message in relevant
contexts.
9. Make decisions on the basis of retrieved
information
10. Behave in line with new decision.
11. Receive positive reinforcement/
12. Integrate new behavior into normal
lifestyle.
31 21/10/2023
 Lessons from comm. for persuasion
That message design, channel selection,
source credibility, audience characteristics,
recommended behavior etc should be
intended to fit into people’s lives.
The theory has been critiqued for shifting
the focus from engaging audiences in a
participatory manner to the issue of
persuasion.

32 21/10/2023
 Mass Communication Theories
Broadly divided into 3 themes:

Media effects
Media Power
Media effectiveness

33 21/10/2023
 Cultivation Theory
Cultivation theory of health communication
transcends the mass media and applies to all
aspects of health communication.
Nurturing the feelings of key stakeholders,
and interested audiences, through continued
exposure to key messages through various
channels including the mass media is a
practice that helps to secure their
involvement in the health issue and its
34
solutions. 21/10/2023
 Premises
The cultivation theory was developed
by George Gerbner (1969) and it
specifies that repeated exposure to
deviant definitions of reality in the
mass media leads to perceptions of that
reality as “normal”.
The result is a social legitimization of
that reality depicted in the mass media
which can influence behavior.
35 21/10/2023
 Cultivation Theory contd
The theory emphasizes that the media have
power to portray a behavior and make it
socially acceptable by shaping public
perceptions and feelings towards that behavior.
It refers to the ability of the media to produce
long term effects on the audiences by nurturing
their feelings through continuous message
exposure.
36 21/10/2023
 Marketing Based theories and models
Social marketing has been defined as
the application of commercial
marketing technologies to the analysis,
planning, execution, and evaluation
of programs designed to influence the
voluntary behavior of target audiences
in order to improve their personal and
social welfare. (Andreasen, 1995)
37 21/10/2023
 Social Marketing
In social marketing, behavior change is the
gain, and not commercial profit. The gain is
measured in social change. The improved
health conditions of target populations.
Social marketing is also planned around the 4
P’s of marketing, product, price, place and
promotion.
It is a tool used along with other health comm.
strategies.
38 21/10/2023
 The 4Ps of social marketing
Product: This refers to the behavior, service, policy or
product the organization or program seeks to see
adopted by the target audiences. It can be tangible or
intangible, e.g. net, or quitting smoking.

Price: Refers to the cost of the product or the price of

the product being promoted in terms of social
emotional physical or psychological cost. E.g. the
social cost of adopting a new behavior or policy.

39 21/10/2023
 The 4ps of social marketing
Place: The product distribution channels. E.g.
point of service, location, wholesale, or the place
in the minds of the targeted audience that is
appropriate for the product to occupy. Often, also
referred to as positioning.

Promotion: This refers to how a message is

promoted to motivate the target audiences to adopt
the new behavior, sustain an old one or try out a
new service.
40 21/10/2023
 Critique
It has been critiqued as a top-down
approach because most participants are
more of consumers than active
collaborators.
Another brand of social marketing, referred
to as integrated marketing communication
focuses on participatory, audience centered
approach to program design and
implementation.
41 21/10/2023
 Use of models In health comm.
Most health comm. programs utilize several of these
theories at a time. When these theories are combined to
develop a model of health communication, they facilitate
strategic behavioral change more effectively.
There are many models in existence today, UNICEF has
used the COMBI model, communication for behavioral
impact in its child protection and juvenile Justice program.
The first Nigerian national behavior change strategy for
HIV and AIDS used the IMB model. There is also the
precede- proceed model which emphasizes focusing on the
factors that contribute to behavior change. Etc.

42 21/10/2023
 Models
The IMB model stresses a focus on information motivation,
and provision of behavioral skills to promote healthy
behaviors.
The COMBI model stresses specific diseases by promoting
behavioral objectives that prevent such diseases. It does not
extend issues to social change.
The Communication for social change model stresses
participatory planning, implementation and evaluation. It is
a process of public and private dialogue through which
people define who they are, what they want and how they
can get it. It starts with a catalyst that stimulates action and
when effective leads to a collective action that resolves
social problem.
43 21/10/2023
 Medical Models
The medical models stress the functions of communications
within healthcare settings. Provider –patient settings, and also
in relation to how healthcare providers determine or perceive
public health interventions. There are 2 main currents.
The biomedical model assumes that poor health is physical
phenomenon that can be explained, identified, and treated
with physical means. ( Du pre’ 2000). This model does not
take into cognizance psychological factors, attitudes, social
beliefs, norms, and other factors that can influence or affect
health and illness. Communication programs based on the
biomedical models is usually strictly scientific, doctrinarian,
authoritarian, efficient and focused. It is top-down.

44 21/10/2023
 Biomedical model
Communication in this model is professional, lacks
empathy with the patient, and the target audience’s
feelings and social experiences.

The Biopsychological model is based on the premise

that poor health is not only physical but is also
influenced by people’s feelings, their ideas about
health and given events in their lives, (Du pre’ 2000).
This model has gained greater currency, and well
promoted as a patient centered approach to health care
efficiency.
45 21/10/2023
 The logical framework model
The logical framework model has been used for
program planning education and other program areas.
The logical framework is a summary of the program’s
key components, the rationale used in defining the
program strategies, the objectives and key activities,
and expected program outputs, and measurement
parameters that would be used, with relevant input and
output indicators.
The logic framework is a relevant tool for the planning
and evaluation of public health communication
campaigns.
46 21/10/2023
 Current Issues that influence the practice of
health comm.
Many of the issues that influence the practice of health
communication, other than theories, and models, are:
 Population,
 Nature of the country and its environment
 Political situation
 Development status.
 Types of health issues and common health problems.
 Demographic health statistics.
 Prevalence of chronic illnesses,
 Other health indicators, of maternal and infant/child
mortality.
47 21/10/2023
 Overarching Issues in Healthcom
• Health Disparities , social and gender inequalities, poverty,
illiteracy
• Patient empowerment
• Limits of preventive medicine and habits.
• E- Health
• Low Health literacy
• Managed care and other cost cutting issues
• Re-emerging diseases and Healthcom renaissance.
• Bioterrorism
• Capacity and infrastructure building
• Access to drugs and other services in a globalised world.
48 21/10/2023
 How can health comm. help?
Promotion of health literacy and cultural competence
Patient empowerment through education and
awareness, both about the conditions of the disease
and on rights and privileges.
Provision of culturally competent public health comm.
interventions to motivate people into accepting
preventive behaviors.
Use of interactive health comm. outlets, eg internet
websites, health care applications on iPods, iPods,
mobiles, use of call centers, etc

49 21/10/2023
 Health comm. can help through:
Increased public health campaigns aimed at increasing
health literate and competent societies.
Provision of health insurance, managed healthcare, using
advocacy and comm./social mobilization to promote cost
effectiveness in healthcare,
Promotion of vaccinations and immunizations for
communicable diseases, and for infants and children under
5.
Strategic health crisis communication plans to be put in
place before any health crisis emerges.
Capacity building and infrastructural development for health
communication at all levels.
50 21/10/2023