Rajiv N. Rimal

Moving Toward a Theory of Normative Influences: How Perceived Benefits and Similarity Moderate the Impact of Descriptive Norms on Behaviors

ABSTRACT In recent years researchers have focused attention on understanding the role of normative factors in influencing behaviors. Although there is some evidence to support the idea that restructuring normative beliefs can result in behavior change, the norms literature is largely silent about how or why this influence occurs. The theory of normative social behavior describes the moderators of the descriptive norm-behavior relationship. Through a 2 (descriptive norms: high or low)×2 (perceived benefits: high or low)×2 (similarity: high or low) between-subjects experiment(N = 174), we tested whether these cognitive mechanisms moderated the norms-behavior link. Results indicated that descriptive norms do not exert a direct influence on behavior. Rather, perceived benefits moderated the relationship between descriptive norms and behavioral intention and perceived similarity moderated the relation between descriptive norms and self-efficacy.

Modeling the Relationship Between Descriptive Norms and Behaviors: A Test and Extension of the Theory of Normative Social Behavior (TNSB)∗

Informed by the theory of normative social behavior, this article sought to determine the underlying mediating and moderating factors in the relationship between descriptive norms and behavioral intentions. Furthermore, the theory was extended by asking whether and what role behavioral identity played in normative influences. Simulating the central message of norms-based interventions to reduce college students alcohol consumption, in this field experiment, descriptive norms were manipulated by informing half of the students (nu2009=u2009665) that their peers consumed less alcohol than they might believe. Others (nu2009=u2009672) were not provided any norms information. students injunctive norms, outcome expectations, group identity, behavioral identity, and behavioral intention surrounding alcohol consumption were then measured. Exposure to the low-norms information resulted in a significant drop in estimates of the prevalence of consumption. Injunctive norms and outcome expectations partially mediated and also moderated the relationship between descriptive norms and behavioral intentions. Group identity and behavioral identity also moderated the relationship between descriptive norms and behavioral intentions, but the effect size was relatively small for group identity. Implications for health campaigns are also discussed.

Friends talk to friends about drinking: exploring the role of peer communication in the theory of normative social behavior.

Peer communication represents 1 mechanism through which norms are disseminated in social groups. The theory of normative social behavior (TNSB) posits that group identity, outcome expectations, and injunctive norms moderate the relation between descriptive norms and behaviors. This article extends the purview of the TNSB by conceptualizing peer communication as another moderator in the relationship between descriptive norms and behaviors. A survey was conducted among college students (N = 675) to measure their normative perceptions, peer communication, alcohol consumption, alcohol-related consequences, and intention to drink alcohol. As hypothesized, descriptive norms, peer communication, and the interaction between these two variables were significantly associated with consumption, even after controlling for known predictors of both consumption and various mechanisms of normative influences. Controlling for prior consumption, peer communication was also a significant predictor of intention to consume alcohol in the future. This model explained approximately 63% of the variance in intention. This study found a significant relationship between peer communication and alcohol drinking behaviors and intentions after controlling for perceived norms.

Why health communication is important in public health

For the first time, health communication was allocated a chapter in the United States of America (USA)’s Healthy People 2010 objectives, illustrating its growing importance, according to Parrott.1 In these objectives, set by the United States Department of Health and Human Services, health communication is seen to have relevance for virtually every aspect of health and well-being, including disease prevention, health promotion and quality of life. This increase in the prominence of the field, externally, is happening contemporaneously with important developments taking place, internally, one of which is the focus on the study of environmental, social and psychological influences on behaviour and health. Given the global challenges posed by major threats, health communication scholars and practitioners recognize the importance of prevention and, with it, the need to understand human behaviour through the prism of theory. This has given rise to theorizing about the role of risk perceptions,2,3 social norms,4,5 emotions6,7 and uncertainty8 in health behaviours. n nCommunication is at the heart of who we are as human beings. It is our way of exchanging information; it also signifies our symbolic capability. These two functions reflect what James Carey characterized as the transmission and ritual views of communication, respectively.9 Carey recognized that communication serves an instrumental role (e.g. it helps one acquire knowledge) but it also fulfils a ritualistic function, one that reflects humans as members of a social community. Thus, communication can be defined as the symbolic exchange of shared meaning, and all communicative acts have both a transmission and a ritualistic component. n nIntervention efforts to change behaviours are communicative acts. By focusing mostly on the transmission function of information exchange, such efforts often neglect ritualistic processes that are automatically engaged through communication. In adopting the transmission view of communication, it is reasonable to think carefully about the channels through which intervention messages are disseminated, to whom the message is attributed, how audience members respond and the features of messages that have the greatest impact. These considerations reflect the essential components of the communication process: channel, source, receiver and message, respectively. In the ritual view, however, target audiences are conceptualized as members of social networks who interact with one another, engage in social ceremony and derive meaning from the enactment of habitual behaviours. n nThree important intervention considerations emerge from this dual view of communication. First is the realization that communication interventions do not fall into a social vacuum. Rather, information is received and processed through individual and social prisms that not only determine what people encounter (through processes of selective exposure), but also the meaning that they derive from the communication (known as selective perception), depending upon factors at both the individual (prior experience, efficacy beliefs, knowledge, etc.) and the macro-social (interpersonal relationships, cultural patterns, social norms) levels. n nSecond, it is reasonable to expect discrepancies between messages disseminated and received. They arise not only due to differential exposure to the intervention but also because of the differences in interpretation in decoding information. A careful study of the correspondence between messages as they are sent and received is thus of great importance to avoid unintended (and worse, counterproductive) effects.10 n nThird, communication is a dynamic process in which sources and receivers of information continuously interchange their roles. One of the central tenets of health communication interventions – the need to conduct extensive formative evaluation, audience needs assessment and message pretesting – is the direct offshoot of this understanding. n nUse of these health communication principles in public health presents challenges. First, the evaluation of communication interventions, especially those using national mass media (e.g. radio), does not usually lend itself to randomized trials. Hence, innovative methodological and statistical techniques are required for attributing observed outcomes to intervention efforts. The responsive and transactional nature of health communication interventions also means that modification in intervention content may occur, adding an additional challenge to the evaluation process. Second, the recognition among behavioural scientists – that causes of human behaviour reside at multiple levels that reinforce each other – poses difficulties in designing and testing multilevel interventions. This complexity of health behaviour determinants also requires a multidisciplinary approach for effectively promoting change, which further means that interventions need to incorporate expertise from a variety of professional backgrounds. Finally, because of the rapidly changing communication channels, health communication interventions need to make extra efforts to meet their audiences at their level of technology use. n nHealth communication has much to celebrate and contribute. The field is gaining recognition in part because of its emphasis on combining theory and practice in understanding communication processes and changing human behaviour. This approach is pertinent at a time when many of the threats to global public health (through diseases and environmental calamities) are rooted in human behaviour. By bringing together researchers and practitioners from diverse disciplines and adopting multilevel theoretical approaches, health communicators have a unique opportunity to provide meaningful input in improving and saving lives. We are optimistic. n n[Editor’s note: Read more about health communication in the upcoming special theme issue of the Bulletin in August 2009.] ■

The Role of Group Orientation and Descriptive Norms on Water Conservation Attitudes and Behaviors

Social norms have been shown to impact behaviors, but with mixed results. The theory of normative social behavior delineates factors that moderate the relationship between descriptive norms and behaviors, and it addresses the attributes of behaviors that make them susceptible to normative influence. This study tests whether group orientation moderates the impact of descriptive norms on water conservation attitudes and behavioral intentions. Findings indicate a consistent pattern of interactions for descriptive norms and group orientation on both attitudes and behavioral intent. Implications for normative theory and campaign design are addressed.

An Integrated Multi-Institutional Diabetes Prevention Program Improves Knowledge and Healthy Food Acquisition in Northwestern Ontario First Nations

This article presents the impact results of a feasibility study in Canada for prevention of risk factors for diabetes in seven northwestern Ontario First Nations. Baseline and follow-up data were collected before and after the 9-month intervention program in schools, stores, and communities that aimed to improve diet and increase physical activity among adults. Regression analyses indicate a significant change in knowledge among respondents in intervention communities (p < .019). There was also a significant increase in frequency of healthy food acquisition among respondents in the intervention communities (p < .003). There were no significant changes in physical activity or body mass index in either intervention or comparison groups. The multi-institutional approach demonstrated promising results in modifying selected risk factors for diabetes First Nations communities.

Brand‐Specific Consumption of Alcohol Among Underage Youth in the United States

BACKGROUNDnLittle is known about brand-specific alcohol consumption among underage youth, as existing information is collected at the level of alcoholic beverage type. This study identifies the alcohol brands consumed by a nationally representative sample of underage youth in the United States.nnnMETHODSnWe obtained a national sample of 1,032 underage youth, aged 13 to 20, using a pre-recruited Internet panel maintained by Knowledge Networks. Youth aged 18 to 20 were recruited directly from the panel via email invitation. Teens aged 13 to 17 were identified by asking adult panelists to identify a member of their household. The survey assessed the past 30-day consumption of 898 brands of alcohol among 16 alcoholic beverage types, including the frequency and amount of each brand consumed in the past 30 days. Market share for a given brand was calculated by dividing the total number of drinks for that brand in the past 30 days across the entire sample by the total number of drinks for all identified brands.nnnRESULTSnThe alcohol brands with highest prevalence of past 30-day consumption were Bud Light (27.9%, 95% confidence interval [CI] 23.3 to 32.4%), Smirnoff malt beverages (17.0%, 95% CI 12.9 to 21.1%), and Budweiser (14.6%, 95% CI 11.0 to 18.3%). Brand market share was concentrated in a relatively small number of brands, with the top 25 brands accounting for nearly half of all market shares.nnnCONCLUSIONSnUnderage youth alcohol consumption, although spread out over several alcoholic beverage types, is concentrated among a relatively small number of alcohol brands. This finding has important implications for alcohol research, practice, and policy.

Extending the purview of the risk perception attitude framework: findings from HIV/AIDS prevention research in Malawi.

The risk perception attitude (RPA) framework posits that efficacy beliefs moderate the relationship between risk perception and health outcomes. To extend the purview of the theory, this central hypothesis was tested in the context of HIV/AIDS-prevention behaviors. Data (N = 890) were collected from 8 districts in Malawi in southern Africa as part of a baseline research effort to obtain benchmark measures on key behavior-change indicators. Results pertaining to 2 behaviors, use of condoms and remaining monogamous, are reported in this study. Relationships between risk perception and behavioral intentions were not significant, but those between efficacy beliefs and behavioral intentions were. Furthermore, efficacy beliefs were found to moderate the relationship between risk perception and intentions to remain monogamous, but not between risk perceptions and intentions to use condoms. The model was able to explain approximately 40% of the variance in intentions to use condoms, and 19% of the variance in intentions to remain monogamous. Implications for health campaigns, particularly the need to strengthen efficacy beliefs and the need to be careful in enhancing risk perceptions without simultaneously strengthening efficacy beliefs, are also discussed.

Applying social marketing principles to understand the effects of the radio diaries program in reducing HIV/AIDS stigma in Malawi.

ABSTRACT Relatively little is known about the extent to which health campaigns can play a constructive role in reducing HIV/AIDS-related stigma. The Malawi Radio Diaries is a program in which HIV-positive men and women openly discuss day-to-day events in their lives with the goal of reducing stigma in the population. Adopting a social marketing perspective, we analyze the various components of the Radio Diaries program in terms of three of the “Four Ps”: product (stigma reduction), place (radio), and promotion (the program itself). We first investigated the important dimensions of stigma and then developed a model to test the demographic and psychosocial correlates of these dimensions. A midterm household survey was then used to determine the relationship between exposure to the Radio Diaries program and stigma. In multivariate analyses, lower education and knowledge were associated with stronger beliefs that persons living with HIV should be isolated from others. Exposure to the Radio Diaries program did not have a main-effect on stigma, but there was a significant interaction between exposure and efficacy to reduce number of partners such that there was little difference in stigma by exposure level for those with low efficacy, but a significant difference by exposure level for those with high efficacy. Findings are discussed in terms of social marketing principles.

Information Seeking About Global Climate Change Among Adolescents: The Role of Risk Perceptions, Efficacy Beliefs, and Parental Influences

Global climate change is likely to have significant impacts on public health. Effective communication is critical to informing public decision making and behavior to mitigate climate change. An effective method of audience segmentation, the risk perception attitude (RPA) framework, has been previously tested with other health behaviors and classifies people into 4 groups on the basis of their perceptions of risk and beliefs about personal efficacy. The 4 groups—indifference (low risk, weak efficacy), proactive (low risk, strong efficacy), avoidance (high risk, weak efficacy), and responsive (high risk, strong efficacy)—are hypothesized to differ in their self-protective behaviors and in their motivations to seek information. In this article, we extend the RPA framework in two ways. First, we use it at the household level to determine whether parental classifications into the 4 groups are associated with their teenage childrens classification into the same 4 groups. Second, we predict adolescent information seeking behaviors on the basis of their and their parents membership in the 4 RPA groups. Results (N = 523 parent–adolescent pairs) indicated that parental membership in the 4 RPA groups was significantly associated with childrens membership in the same 4 groups. Furthermore, the RPA framework was a significant predictor of adolescent information seeking: Those in the responsive and avoidance groups sought more information on climate change than the indifference group. Family communication on global warming was positively associated with adolescents information seeking. Implications for interventions are discussed.