Vanessa Boudewyns

The Health Literacy Skills Framework

Although there are a variety of models and frameworks that describe factors that are associated with health literacy skills, few illustrate the full pathway from development and moderators of health literacy skills, their application, and the outcomes that result all in one framework or model. This article introduces the Health Literacy Skills conceptual framework that does encompass this full continuum. To develop the framework, the authors reviewed and built upon existing health literacy frameworks. The Health Literacy Skills framework hypothesizes the relations between health literacy and health-related outcomes and depicts how health literacy functions at the level of the individual. The framework also reflects how factors external to the individual (e.g., family, setting, community, culture, and media) influence the constructs and relations represented in the framework. The framework is organized into 4 primary components: (a) factors that influence the development and use of health literacy skills; (b) health-related stimuli; (c) health literacy skills needed to comprehend the stimulus and perform the task; and (d) mediators between health literacy and health outcomes. Previous theoretical frameworks lend support to the proposed causal pathways it illustrates. The authors hope this conceptual framework can serve as a springboard for further discussion and advancement in operationalizing this complex construct. The Health Literacy Skills framework could also be used to guide the development of interventions to improve health literacy. Future research should be conducted to fully test the relations in the framework.

Communicating quantitative risks and benefits in promotional prescription drug labeling or print advertising

Under the Food, Drug, and Cosmetic Act, all promotional materials for prescription drugs must strike a fair balance in presentation of risks and benefits. How to best present this information is not clear. We sought to determine if the presentation of quantitative risk and benefit information in drug advertising and labeling influences consumers’, patients’, and clinicians’ information processing, knowledge, and behavior by assessing available empirical evidence.

Intentions and Beliefs About Getting Tested for STDs: Implications for Communication Interventions

Although sexually transmitted diseases (STDs) are common among college students, there have been few studies that examine the psychological determinants of STD testing. To help address this gap in the literature, we drew on the reasoned action framework to gain insight into the cognitive processes underlying STD-testing intentions for two samples of college students (n = 181 and n = 160). More generally, we demonstrate how behavioral theory can be applied in formative research to generate recommendations for developing communication interventions. Our findings suggest that attitudes toward getting tested for STDs were the strongest determinant of intentions for the college students in our samples. Further, results of a belief analysis indicate that students who did not intend to get tested for STDs might change their mind if they could be persuaded that getting tested would show that they respect their sexual partner or that getting tested would prevent them from spreading an STD to someone else.

Stigma's Effect on Social Interaction and Social Media Activity

Stigmatized topics, such as HIV/STD, likely constrain related information sharing in ways that should be apparent in social interactions both on and off the Internet. Specifically, the authors predicted that the more people perceive an issue as stigmatized, the less likely they are to talk about the issue both privately (with sexual partners and peers) and publicly (on Twitter). Study 1 tested the effect of stigma on conversations at the individual level: The authors asked a group of participants (N = 138) about perceived STD-testing stigma, interactions with a sexual partner, and conversations with peers about STD testing. Study 2 assessed whether health conditions, in the aggregate, were less likely to generate social media activity as a function of current stigmatization. Using 259,758 archived Twitter posts mentioning 13 medical conditions, the authors tested whether level of stigma predicted the volume of relevant social media conversation, controlling for each conditions amount of advocacy and Google search popularity from a users perspective. Findings supported our hypotheses. Individuals who reported perceiving a given health conditions in more stigmatic ways also reported interacting less with others about that topic; Twitter results showed a similar pattern. Results also suggest a more complex story of influence, as funding from the National Institutes of Health (i.e., each conditions amount of advocacy) associated with the examined health conditions also predicted Twitter activity. Overall, these results indicated that stigma had a similar, dampening effect on face-to-face and Twitter interactions. Findings hold theoretical and practical implications, which are discussed.

CDC'S Testing Makes Us Stronger (TMUS) Campaign: Was Campaign Exposure Associated With HIV Testing Behavior Among Black Gay and Bisexual Men?

This study assessed exposure among Black gay, bisexual, and other men who have sex with men (BMSM) to a communication campaign, Testing Makes Us Stronger (TMUS), and its association with HIV testing to determine campaign effectiveness. Data from an online survey (N = 3,105) were analyzed using propensity score weight-adjusted logistic regression to examine the effect of exposure on HIV testing. Among BMSM aged 18-44 (n = 702), 43.2% reported TMUS exposure. The majority of those exposed were aged 25-34 (54%), HIV-negative (65%), and had some college education (87%). TMUS exposure was associated with reported increased HIV testing behaviors at 6- and 12-month frequencies. Communication campaigns with clear implementation strategies, focused objectives, and online and event presence can be associated with longer-term outcomes such as HIV testing.

Understanding Women’s Preconception Health Goals: Audience Segmentation Strategies for a Preconception Health Campaign

This article discusses the social marketing planning process and strategies used to design a preconception health campaign, Show Your Love, launched in February 2013. Developing a social marketing strategy for preconception health is a challenging endeavor, in part because preconception health represents a set of diverse behaviors and the audience for the campaign is quite large, encompassing all women of childbearing age whether they intend to become pregnant or not. The network of organizations implementing the campaign, the National Preconception Health Consumer Workgroup, required a broad audience segmentation strategy; therefore, two large audiences were selected. This commentary describes the two primary audiences selected for the campaign based on the Transtheoretical Model—intenders (those in contemplation, preparation, and action) and nonintenders (precontemplators)—and explores how levels of knowledge, motivations, the campaign product, and the campaign goals are distinct for each audience. Additionally, the authors describe potential extensions to the segmentation strategy that could offer finer grained approaches for social marketers who may be building on the Show Your Love campaign or designing other programs in this area.

The Effects of Guilt-Appeal Intensity on Persuasive and Emotional Outcomes: The Moderating Role of Sponsor Motive

ABSTRACT Studies examining the persuasive effects of guilt appeals have yielded mixed results. The current study hypothesizes that source motive (profit versus not for profit) is a key moderating variable underlying these inconsistences. A controlled experiment tested the moderating role of sponsor motive on the relationship between guilt-appeal intensity and persuasiveness of the appeal and ad liking. Findings confirmed the notion that sponsor motive moderates the effects of guilt appeals: When guilt appeals are commercially oriented there is a relative failure of high-intensity guilt appeals compared to moderate-intensity guilt appeals. Moderate-intensity guilt appeals cause more-positive brand attitudes than high-intensity appeals. Yet, when guilt appeals are nonprofit, increases in intensity of guilt communicated lead to positive results. As the guilt-intensity increased, ad liking and persuasiveness increased. It appears that guilt-appeal intensity did not have an effect on brand attitudes when the message was nonprofit.

Attention to and Distraction from Risk Information in Prescription Drug Advertising: An Eye-Tracking Study

Direct-to-consumer (DTC) television ads must disclose a drugs most important risks. Currently, the risks must be presented in audio at a minimum. Studies have shown that presenting information with both audio and superimposed risk text (dual modality) improves recall beyond what is achieved using audio alone. However, distracting elements in DTC ads may draw attention away from the superimposed risk text. This study combines eye-tracking data with questionnaire data to examine whether distracting elements decrease attention to the risk text in DTC ads, in turn affecting risk retention and risk perceptions. The authors randomly assign 300 U.S. opt-in panel members to view either a low-distraction or a high-distraction DTC television ad. The authors find that distracting elements during risk presentation drew attention away from the risk text and, in turn, reduced retention of drug risk information. Risk perceptions were not affected. These results suggest that even if dual modality is used to increase consumers’ comprehension of drug risk information, distracting visuals should still be avoided to help consumers focus on key information in the ad.

Professional online community membership and participation among healthcare providers: An extension to nurse practitioners and physician assistants

BACKGROUND AND PURPOSE Professional online communities allow healthcare providers to exchange ideas with their colleagues about best practices for patient care. Research on this topic has focused almost exclusively on primary care physicians and specialists, to the exclusion of advanced practice providers such as nurse practitioners and physician assistants. We expand this literature by examining membership and participation on these websites among each of these provider groups. METHODS Participants (N = 2008; approximately 500 per provider group) responded to an Internet-based survey in which they were asked if they use professional online communities to dialogue with colleagues and if so, what their motivation is for doing so. CONCLUSIONS Nearly half of the participants in our sample reported utilizing professional online communities. Select differences were observed between provider groups, but overall, similar patterns emerged in their membership and participation on these websites. IMPLICATIONS FOR PRACTICE Nurse practitioners and physician assistants utilize professional online communities in similar proportion to primary care physicians and specialists. Providers should be cognizant of the impact this use may have for both themselves and their patients. Researchers are urged to take into account the various professional roles within the healthcare community while developing research on this topic.

Relationships Between Theoretically Derived Short-Term Outcomes and Support for Policy Among the Public and Decision-Makers

Purpose and Objectives Policy change is a lengthy and complex process. Thus, it is important to articulate hypothesized causal pathways between advocacy activities and policy change outcomes and to identify and monitor early indicators of progress toward policy change. Intervention Approach The Kansas Health Foundation supports grantee efforts to address the public health effects of obesity through evidence-based policy, systems, and environmental change interventions. To build support for policy, systems, and environmental changes in schools, workplaces, and health care and retail settings, grantees mobilize communities, educate government policy makers, and advocate with organizational decision makers. Evaluation Methods To understand whether early outcomes from obesity-prevention advocacy efforts predict interim outcomes related to eventual policy change, we conducted surveys of the general public and of opinion leaders in Kansas, which were designed to measure components of Kansas Health Foundation’s theory of change. We then used structural equation modeling to test the theory of change’s underlying relationships by using support for obesity prevention policies as the outcome. Results Our findings supported the hypothesized model: perceptions of obesity as a serious community problem influence beliefs about causes of the problem. Beliefs about causes predict beliefs about who is responsible for the solution to the problem, which in turn predicts support for obesity prevention policies. Implications for Public Health Evaluators of advocacy for policy change interventions can use this approach to monitor proximal changes in public and opinion leader beliefs related to eventual policy change and to determine whether efforts are likely to be successful or need to be adapted or abandoned.