The information-processing model of the attitude and behavior change process was critically examined and extended from six to 12 levels for a better analysis of change due to mass media campaigns. Findings from social psychology and communications research, and from evaluations of mass media health promotion programs, were reviewed to determine how source, message, channel, receiver, and destination variables affect each of the levels of change of major interest (knowledge, beliefs, attitudes, intentions and behavior). Factors found to most likely induce permanent attitude and behavior change (most important in health promotion) were: presentation and repetition over long time periods, via multiple sources, at different times (including "prime" or high-exposure times), by multiple sources, in novel and involving ways, with appeals to multiple motives, development of social support, and provisions of appropriate behavioral skills, alternatives, and reinforcement (preferably in ways that get the active participation of the audience). Suggestions for evaluation of mass media programs that take account of this complexity were advanced.
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References
1.
Belloc NB, and Breslow L.: Relationship of physical health status and health practices. Prev Med1: 409-421, 1972.
2.
Lalonde M.: A new perspective on the health of Canadians: A working document. Ottawa: National Health and Welfare, 1974.
3.
McKeown T.: Determinants of health. Hum Nature: April, 60-67, 1978.
4.
Farguhar JW, Maccoby N., Wood PD, Alexander JK, Breitrose H., Brown BW, Jr, Haskell WL, McAlister AL, Meyer AJ, Nash JD, and Stern MP: Community education for cardiovascular health. Lancet, June: 1192-1195, 1977 .
5.
Maccoby N., and Alexander J.: Use of media in lifestyle programs. In Davidson P (Ed): Behavioral Medicine: Changing Health Lifestyles . New York: Brunner/Mazel, 1979.
6.
Maccoby N., and Farquhar JW: Communication for health: Unselling heart disease. J Communication25: 114-126, 1975.
7.
Koskela K., Puska P., and Tuomilehto J.: The North Karelia project: A first evaluation. Int J Health Educ19: 59-66, 1976.
8.
McAlister A. , Puska P., Koskela K., Pallonen U., and Maccoby N.: Psychology in action: Mass communication and community organization for public health. Am Psychol35:4, 375-379, 1980.
9.
Tuomilehto J. , Koskela K., Puska P., Biorkqvist S., and Salonen J.: A community anti-smoking programme: Interim evaluation of the North Karelia project. Inter J Health Educ , supplement to vol. 21: 4, 1-15, 1978.
10.
Mielke KW, and Swinehart JW: Evaluation of the "Feeling Good" television series. New York: Children's Television Workshop, 1976.
11.
Haskins JB: Evaluative research on the effects of mass communication safety campaigns: A methodological critique. J Safety Res2: 86-96, 1978.
12.
Mendelsohn H. : Mass communication for safety: A critical review and a proposed theory. Chicago: National Safety Council, 1963.
13.
Mendelsohn H.: Some reasons why information campaigns can succeed. Public Opinion Q37: 50-61, 1973.
14.
Williams RA , Cousins LS, and Wilde, Gjs: Communications, media, and audience effects upon attitude change with regard to automobile safety responsibility. Behav Res Highway Safety1:3, 155-171, 1970.
15.
Robertson LS : The great seat belt campaign flop. J Communication26: 4, 41-45, 1976.
16.
Robertson LS , Kelley AB, O'Neill B., Wixom, CW, Eisworth RS, and Haddon W., Jr: A controlled study of the effect of television messages on safety belt use. Am J Public Heal64: 1071-1080, 1974 .
17.
Kerpelman LC , Fax GE, and Nunes D.: Evaluation of the effectiveness of outdoor power equipment information and education programs. Contract report, U.S. Consumer Product Safety Commission . Cambridge, Mass: Abt Associates, Inc., 1978.
18.
Best JA: Mass media, self-management, and smoking modification. In PO Davidson and SM Davidson (Eds.) Behavioral Medicine: Changing Health Life Styles . New York: Brunner/Mazel, 1980.
19.
Dubren R.: Evaluation of a televised stop smoking clinic. Public Heal Rep92: 81-84, 1977.
20.
Green P.: The mass media anti-smoking campaign around the world. Proceedings of 3rd World Conference on Smoking and Health (Vol. II), 245-253, 1975.
21.
O'Keefe MT:The anti-smoking commercials: A study of television's impact on behavior. Public Opinion Q35: 2, 242-248, 1971.
22.
Warner KE: The effects of the anti-smoking campaign on cigarette consumption . Am J Public Heal67: 645-650, 1977.
23.
Blane HT, and Hewitt LC: Mass media, public education and alcohol: A state-of-art review. Prepared for the National Institute on Alcohol Abuse and Alcoholism, Alcohol, Drug Abuse and Mental Health Administration, 1977
24.
Kline FG: Evaluation of a multimedia drug education program. J Drug Educ2: 3, 229-239, 1972.
25.
Plant MA, Pirie F., and Kreitman N.: Evaluation of the Scottish Health Education Units 1976 Campaign on Alcoholism . J Soc Psychiat14:1, 11-24, 1979.
26.
Planned Parenthood Federation of Canada.An assessment of the mass media campaign for family planning, 1973.
27.
Udry JR, Clark LJ, Chase CL, and Levy M.: Can mass media advertising increase contraceptive use? Fam Plann Perspect4: 3, 37-44, 1972.
28.
Young MC: Review of research and studies on the health education and related aspects of family planning (1967-1971): Communication, program planning, and evaluation . Health Educ Monogr35: whole issue, 1973.
29.
Barrett H.: MTU NI AFYA - Health Education by radio in Tanzania. Combread ( London), 21: 37-38, 1973.
30.
Cooke TM, and Ronweber ST: Radio, advertising techniques, and nutrition education: A summary of a field experiment in the Phillipines and Nicaragua. Washington, D.C.: AID, 1977.
31.
Hall B., and Zikambona C.: An evaluation of the 1973 mass health education campaign in Tanzania (Studies in Adult Education, No. 12). Dar es Salaam: Institute of Adult Education, 1974.
32.
Ramadasmurthy V., Hanumantha RD, Clarence ID, and Balasubramanian SC: Nutrition education and SITE telecasts. Int J Health Educ21: 3, 168-173, 1978.
33.
Zaltman G., Hingson R., and Allwood J.: The impact of education and of mass media exposure on child feeding in Costa Rica. Int J Health Educ13: 3, 103-112, 1970.
34.
Butler M., and Paisley W.: Communicating cancer control to the public. Health Educ Monogr5: 5-24, 1977.
35.
Hingson R.: Obtaining optimal attendance at mass immunization programs. Health Serv Rep89: 53-64, 1974.
36.
Salzer JE, Marshall CL, and Glazer ER: The use of cable television as a tool in health education of the elderly: Screening. Health Educ Monogr5: 363-378, 1977.
37.
SerVass B., and Weinberger MH: Use of multi-media motivation in enhancing compliance of hypertensives discovered at a screening operation. Am J Public Health69: 382-388, 1979.
38.
Sundal M., and Schanie CF: Community mental health and mass media preventive education: The alternatives project. Soc Serv Rev June: 297-306, 1978.
39.
Worden JK, Sweeney RR, and Waller JA: Audience interest in mass media messages about lung disease in Vermont . Am J Public Health68: 378-382, 1978.
40.
Flay BR, Edison CN, and Dick J.: Mass media in health safety and promotion: An annotated bibliography . Canada: University of Waterloo, 1980 .
41.
Stickell DW: A critical review of the methodology and results of research comparing televised and face-to-face instruction. Doctoral dissertation, Pennsylvania State University, 1963.
42.
Abt CC (Ed.): The evaluation of social programs. Beverly Hills: Sage, 1976.
43.
Campbell DT : Reforms as experiments. Am Psychol24: 409-429, 1969.
44.
Also in F.G. Caro (Ed.) Readings in Evaluation Research . New York: Russell Sage Foundation , 233-261, 1971.
45.
Campbell DT, and Stanley JC: Experimental and quasi-experimental designs for research. Chicago: Rand-McNally, 1966.
46.
Cook TD, Del Rosario ML, Hennigan KM, Mark M, and Trachim WMK (Eds): Evaluation Studies Review Annual (Vol. 3). Beverly Hills: Sage, 1978.
47.
Cook TD, and Campbell DT: The design and conduct of true experiments and quasi-experiments in field settings. In M.D. Dunnette (Ed.) Handbook of Industrial and Organizational Psychology. Chicago: Rand-McNally, 1976.
48.
Cook TD, and Campbell DT: Quasi-Experimentation: Design and Analysis Issues. Chicago : Rand-McNally, 1979.
49.
Flay BR, and Best JA: Design problems in the evaluation of health behavior change programs . Preprint, Canada: University of Waterloo, 1980 .
Guttentag M., and Struening EL: Handbook of Evaluation Research (Vol. 2). Beverly Hills: Sage, 1975.
53.
Hennigan KM, Flay BR, and Haag RA: Clarification of terms and concepts commonly used in evaluative research . In RE Klein, MS Read, HW Riecken, JA Brown, A Peradelli, and CH Daza (Eds.): Evaluating the Impact of Nutrition and Health Programs. New York: Plenum, 1979.
54.
Klein RE, Read MS, Riecken, HW, Brown JA, Peradelli A, and Daza CH (Eds): Evaluating the Impact of Nutrition and Health Programs . New York: Plenum, 1979.
55.
Riecken HW, and Boruch RF, et al. Social Experimentation: A Method For Planning and Evaluating Social Interventions. New York: Academic Press, 1974.
56.
Rutman L (Ed): Evaluation Research Methods: A Basic Guide. Beverly Hills: Sage, 1977.
57.
Shortell SM, and Richardson WC: Health Program Evaluation. St. Louis: C.V. Mosby, 1978.
58.
Streuning EL , and Guttentag M.: Handbook of Evaluation Research (Vol. 1). Beverly Hills: Sage, 1975.
59.
Suchman EA: Evaluative research: principles and practice in public service and social action programs. New York: Russell Sage Foundation, 1967.
60.
Weiss CH: Evaluation Research: Methods of Assessing Program Effectiveness. Englewood Cliffs, N.J.: Prentice-Hall, 1972.
61.
Atkin CK: Research evidence on mass mediated health communication campaigns. Communication Yearbook 3, New Brunswick, New Jersey: Transaction, 1979.
62.
Bauer R.: The obstinate audience: The influence process from the point of view of social communications. Am Psychol19: 319, 1964.
63.
Griffiths W. , and Knutson AL: The role of mass media in public health. Am J Public Health50: 515-523, 1960.
64.
Hymann H., and Sheatsley P.: Some reasons why information campaigns fail. Public Opinion Q11: 412-423, 1947.
65.
Katz E., and Lazarsfeld PF: Personal Influence. New York: Free Press, 1955.
66.
Klapper JL: The Effects of Mass Communication. Glencoe, III. : Free Press, 1960.
67.
Hovland CI, Janis IL, and Kelley HH: Communication and Persuasion. New Haven: Yale Press, 1953.
68.
Hovland CI, Lumsdaine AA, and Sheffield FD: Experiments on Mass Communication. Princeton, N.J. : Princeton University Press, 1949 .
69.
McGuire WJ:Personality and susceptibility to social influence . In EF Borgatta, WW Lambert (Eds.), Handbook of Personality Theory and Research . Chicago: Rand-Mc-Nally, 1968.
70.
McGuire WJ:The nature of attitudes and attitude change . In G Lindzey and E Aronson (Eds): The Handbook of Social Psychology (2nd ed.) (Vol. 3). Reading, Mass.: Addison-Wesley, 1969.
71.
McGuire WJ: Attitude change: The information processing paradigm. In CG McClintock (Ed): Experimental Social Psychology . New York: Holt, Rinehart, & Winston, 1972.
72.
McGuire WJ:Persuasion, resistance, and attitude change . In I deSola Pool, W Schramm, et al., (Eds,): Handbook of Communication . Chicago: Rand-McNally, 1973.
73.
McGuire WJ:The concepts of attitude and their relations to behaviors. In SH Wallace and LA Broedling (Eds): Perspectives on Attitude Assessment. Washington, D.C.: Smithsonian Institute, 1975.
74.
McGuire WJ:An information-processing model of advertising effectiveness. In HL Davis and AJ Silk (Eds): Behavioral and Management Science in Marketing. New York: Wiley, 1978.
75.
Roberts DF: Attitude change and the motivation of health practices. In AJ Enelow and JB Henderson , Applying behavioral science to cardiovascular risk: Proceedings of a conference (Seattle, Washington , June 1976). American Heart Association, Inc., 1975.
76.
Zimbardo PG, Ebbesen EB, and Maslach C.: Influencing Attitudes and Changing Behavior (Second Edition). Reading, Mass.: Addison-Wesley, 1977.
77.
Ray ML: Marketing communication and the hierarchy-of-effects. In IP Clarke (Ed): New Models for Mass Communication Research. Beverly Hills: Sage, 1973.
78.
Cartwright D. : Some principles of mass persuasion: Selected findings of research on the sale of United States War Bonds. Hum Relat11: 253-267, 1949.
79.
Allen, WH:Media stimulus and types of learningAudio-Visual Instr12: 27-31, 1967.
80.
79. Bloom BS, Engelhart MD, Furst EJ, Will WH, and Krathwohl DR: Taxonomy of Education Objectives. Handbook I: Cognitive Domain. New York: McKay, 1956 .
81.
Briggs LJ: Handbook of Procedures for the Design of Instruction. Pittsburgh, Pa.: American Institutes for Research, 1970.
82.
Briggs LJ, Campeau, PL, Gagne RM, and May MA: Instructional Media. Pittsburgh, Pa.: American Institutes for Research, 1967.
83.
Campeau PL: Selective review of the results of research on the use of audio-visual media to teach adults. AV Commun Rev22: 5-40, 1974.
84.
Gagne RM, and Briggs LJ: Principles of Instructional Design. New York: Holt, Rinehart, & Winston, 1974.
85.
Jamison DT, and McAnany EG: Radio for Education and Development. Beverly Hills : Sage, 1978.
86.
Salomon G., and Clark RE: Reexamining the methodology of research on media and technology in education . Re Educ Res47: 99-120, 1977
87.
Schramm W.: Big Media Little Media: Tools and Technologies for Instruction. Beverly Hills: Sage, 1977.
88.
Jamison DT, Kleas, SJ, and Wells SJ: The Costs of Educational Media: Guidelines for Planning and Evaluation . Beverly Hills: Sage, 1978.
89.
Fishbein M (Ed): Readings in Attitude Theory and Measurement. New York: Wiley, 1967.
90.
Fishbein M., and Ajzen I.: Belief, Attitude, Intention, and Behavior. Reading, Mass. : Addison-Wesley, 1975.
91.
Flay BR: Catastrophe theory in psychology: Some applications to attitudes and social behavior. Beha Sci23. 335-350, 1978.
92.
Greenwald AG, Brock TC, and Ostrom TM (Eds): Psychological Foundations of Attitudes. New York : Academic Press, 1968.
93.
Hovland CI, and Rosenberg M (Eds): Attitude Organization and Change. New Haven: Yale University Press, 1960.
94.
Kiesler CA, Collins BE, and Miller N.: Attitude Change. New York: Wiley , 1969.
95.
Oskamp S.: Attitudes and Opinions. Englewood Cliffs, N.J.: Prentice-Hall, 1977.
96.
Triandis HC: Attitudes and Attitude Change. New York: Wiley, 1971.
97.
Cook TD, and Flay BR: The persistence of experimentally induced attitude change. In L Berkowitz (Ed): Advances in Experimental Social Psychology (Vol. 11). New York: Academic Press, 1978.
98.
Hass RG, and Mann RW: Anticipatory belief change: Persuasion or impression management? J Per Soc Psycho34: 105-111, 1976
99.
Nuttin JM, Jr.: The Illusion of Attitude Change: Toward A Response Contagion Theory of Persuasion. New York: Academic Press, 1975.
100.
Wilson GT: Behavioral treatment of obesity: Maintenance strategies and long-term efficacy . Preprint, Graduate School of Applied and Professional Psychology, New Brunswick, New Jersey, 1978.
101.
Best JA, and Bloch M.: Compliance in the control of cigarette smoking. In RB Haynes, DW Tayler, and DL Sackett (Eds): Compliance with Therapeutic and Preventive Regimens. Baltimore: Johns Hopkins University, 1979.
102.
McAlister A. : Television as a medium for delivering behavior therapy: A pilot study of a televised smoking cessation program. Paper presented at the Association for the Advancement of Behavior Therapy, 10th Annual Convention , New York, 1976.
103.
Best JA, and Flay BR: Evaluating behaviour modification programmes for health lifestyles intervention . In RJ Lauzon (Ed): Seminar on the Evaluation of Health Education and Behaviour Modification Programs . Ottawa: Canadian Health Education Society, 1978.
104.
Brownell KD, Herckerman CL, Westlake RJ, Hayes SC, and Monti PM: The effect of couples training and partner cooperativeness in the behavioral treatment of obesity. Behav Res Ther16: 323-333, 1978.
105.
Lichtenstein E., Antonuccio DO, and Rainwater G.: Unkicking the habit: The resumption of cigarette smoking. Paper presented at the annual meeting of theWestern Psychological Association , Seattle, 1977.
106.
Wicker AW: An examination of the "other variables" explanation of attitude-behavior inconsistency . J Per Soc Psychol19: 18-30, 1971.
107.
Marlatt GA, and Gordon JR: Determinants of relapse: Implications for the maintenance of behavior change . In PO Davidson (Ed): Behavioral Medicine: Changing Health Lifestyles. New York : Brunner/Mazel, 1979.
108.
Feather NT: Subjective probability and decision under uncertainty. Psychol Rev66: 150-164, 1959.
109.
Maiman LA, and Becker MH: The health belief model: Origins and correlates in psychological theory . In MH Becker (Ed): The Health Belief Model and Personal Health Behavior. Thorofare, N.J.: C.B. Slack, 1974.
110.
Becker MH (Ed): The Health Belief Model and Personal Health Behavior. Thorofare, N.J .: C.B. Slack, Inc., 1974.
111.
Rokeach M.: Beliefs, Attitudes, and Values: A Theory of Organization and Change . San Francisco: Jossey-Bass, 1968 .
112.
Rokeach M.: The Nature of Human Values. New York: Free Press, 1973.
113.
Bandura A.: Social Learning Theory. Morristown, N.J.: General Learning Press, 1971.
114.
Bandura A. : The self system in reciprocal determinism . Am Psychol33: 344-358, 1978.
115.
Flay BR: An integrative model of the attitude and behavior change process in health promotion. Preprint, Canada: University of Waterloo , 1980.
116.
Abelson RP, Aronson E, McGuire WJ, Newcomb TM, Rosenberg MJ , and Tannenbaum PH (Eds): Theories of Cognitive Consistency: A Sourcebook. Chicago : Rand-McNally, 1969.
117.
Fishbein M. , Ajzen I.: Attitudes toward objects as predictors of single and multiple behavioral criteria. Psychol Rev81: 59-74, 1974.
118.
Hanneman G. , McEwen W., and Coyne S.: Public service advertising on television . J Broadcasting17: 387-404, 1973.
