Alexander J. Rothman

Shaping Perceptions to Motivate Healthy Behavior: The Role of Message Framing

Health-relevant communications can be framed in terms of the benefits (gains) or costs (losses) associated with a particular behavior, and the framing of such persuasive messages influences health decision making. Although to ask people to consider a health issue in terms of associated costs is considered an effective way to motivate behavior, empirical findings are inconsistent. In evaluating the effectiveness of framed health messages, investigators must appreciate the context in which health-related decisions are made. The influence of framed information on decision making is contingent on people, first, internalizing the advocated frame and, then, on the degree to which performing a health behavior is perceived as risky. The relative effectiveness of gain-framed or loss-framed appeals depends, in part, on whether a behavior serves an illness-detecting or a health-affirming function. Finally, the authors discuss the cognitive and affective processes that may mediate the influence of framed information on judgment and behavior.

Stage theories of health behavior: Conceptual and methodological issues

Despite growing interest in stage theories of health behavior, there is considerable confusion in the literature concerning the essential characteristics of stage theories and the manner in which such theories should be tested. In this article, the 4 key characteristics of a stage theory-a category system, an ordering of categories, similar barriers to change within categories, and different barriers to change between categories--are discussed in detail. Examples of stage models of health behavior also are described. Four major types of research designs that might be used for testing stage theories are examined, including examples from the empirical literature. The most commonly used design, which involves cross-sectional comparisons of people believed to be in different stages, is shown to have only limited value for testing whether behavior change follows a stage process.

The Systematic Influence of Gain-and Loss-Framed Messages on Interest in and Use of Different Types of Health Behavior

Framing health messages systematically in terms of either gains or losses influences the behaviors that people adopt. Rothman and Salovey proposed that the relative influence of gain-and loss-framed messages is contingent on people’s perception of the risk or uncertainty associated with adopting the recommended behavior. Specifically, loss-framed messages are more effective when promoting illness-detecting (screening) behaviors, but gain-framed messages are more effective when promoting health-affirming (prevention) behaviors. Two experiments provide a direct test of this conceptual framework. In Experiment 1, participants’ willingness to act after reading about a new disease was a function of how the information was framed and the type of behavior promoted. Experiment 2 replicated and extended these findings with a real health concern—gum disease. Gain-framed pamphlets heightened interest in a plaque-fighting mouth rinse, whereas loss-framed pamphlets heightened interest in a plaque-detecting disclosing rinse. Research on message framing provides a theoretically based guide for the development of effective health messages.

Evolution of the Biopsychosocial Model: Prospects and Challenges for Health Psychology

Although advances have been made in specifying connections between biological, psychological, and social processes, the full potential of the biopsychosocial model for health psychology remains untapped. In this article, 4 areas that need to be addressed to ensure the continued evolution of the biopsychosocial model are identified and a series of recommendations concerning initiatives directed at research, training, practice and intervention, and policy are delineated. These recommendations emphasize the need to better understand and utilize linkages among biological, psychological, social, and macrocultural variables. Activities that facilitate the adoption of a multisystem, multilevel, and multivariate orientation among scientists, practitioners, and policymakers will most effectively lead to the kinds of transdisciplinary contributions envisioned by the biopsychosocial perspective.

Is there nothing more practical than a good theory?: Why innovations and advances in health behavior change will arise if interventions are used to test and refine theory

Theoretical and practical innovations are needed if we are to advance efforts to persuade and enable people to make healthy changes in their behavior. In this paper, I propose that progress in our understanding of and ability to promote health behavior change depends upon greater interdependence in the research activities undertaken by basic and applied behavioral scientists. In particular, both theorists and interventionists need to treat a theory as a dynamic entity whose form and value rests upon it being rigorously applied, tested and refined in both the laboratory and the field. To this end, greater advantage needs to be taken of the opportunities that interventions afford for theory-testing and, moreover, the data generated by these activities need to stimulate and inform efforts to revise, refine, or reject theoretical principles.

The Effects of Message Framing and Ethnic Targeting on Mammography Use Among Low-Income Women

The authors examined the effects that differently framed and targeted health messages have on persuading low-income women to obtain screening mammograms. The authors recruited 752 women over 40 years of age from community health clinics and public housing developments and assigned the women randomly to view videos that were either gain or loss framed and either targeted specifically to their ethnic groups or multicultural. Loss-framed, multicultural messages were most persuasive. The advantage of loss-framed, multicultural messages was especially apparent for Anglo women and Latinas but not for African American women. These effects were stronger after 6 months than after 12 months.

Reflective and automatic processes in the initiation and maintenance of dietary change.

Purpose and MethodsThis paper examines the social cognitive processes that regulate peoples eating behavior. Specifically, we examine how eating behavior can be regulated by reflective, deliberative processes as well as automatic and habitual processes. Moreover, we consider how these processes operate when people are not only initiating a change in behavior but also maintaining the behavior over time.Results and DiscussionDecomposing action control and behavior change into a 2 (reflective, automatic) × 2 (initiation, maintenance) matrix offers a useful way of conceptualizing the various determinants of eating behavior and suggests that different intervention strategies will be needed to target particular processes during respective phases of behavior change. The matrix also helps to identify key areas of intervention development that deserve attention.

The impact of self-efficacy on behavior change and weight change among overweight participants in a weight loss trial.

Despite considerable clinical interest, attempts to link perceived self-efficacy with successful weight control have had mixed success. Definitive data on prospective associations between self-efficacy and weight loss are particularly sparse. This study examined relationships between self-efficacy beliefs, weight control behaviors, and weight change among individuals participating in a weight loss trial (N = 349, 87% women). Cross-sectionally, eating and exercise self-efficacy beliefs were strongly associated with corresponding weight loss behaviors. Self-efficacy beliefs prospectively predicted weight control behavior and weight change during active treatment but not during follow-up. Mediational models indicate that peoples weight control behaviors mediate the impact of self-efficacy on weight change.

NIH working group report: Innovative research to improve maintenance of weight loss.

The National Institutes of Health, led by the National Heart, Lung, and Blood Institute, organized a working group of experts to discuss the problem of weight regain after weight loss. A number of experts in integrative physiology and behavioral psychology were convened with the goal of merging their perspectives regarding the barriers to scientific progress and the development of novel ways to improve long‐term outcomes in obesity therapeutics. The specific objectives of this working group were to: (1) identify the challenges that make maintaining a reduced weight so difficult; (2) review strategies that have been used to improve success in previous studies; and (3) recommend novel solutions that could be examined in future studies of long‐term weight control.

Specifying the determinants of the initiation and maintenance of behavior change: An examination of self-efficacy, satisfaction, and smoking cessation

Using data from smokers (N = 591) who enrolled in an 8-week smoking cessation program and were then followed for 15 months, the authors tested the thesis that self-efficacy guides the decision to initiate smoking cessation but that satisfaction with the outcomes afforded by quitting guides the decision to maintain cessation. Measures of self-efficacy and satisfaction assessed at the end of the program, 2 months, and 9 months were used to predict quit status at 2, 9, and 15 months, respectively. At each point, participants were categorized as either initiators or maintainers on the basis of their pattern of cessation behavior. Across time, self-efficacy predicted future quit status for initiators, whereas satisfaction generally predicted future quit status for maintainers. Implications for models of behavior change and behavioral interventions are discussed.