Cultural influences on the effects of social norm appeals.

This study reports on an experimental test of the effects of descriptive and injunctive norm appeals on intentions to prevent food waste in China and the United States (N = 1449), testing the role of cultural context and group orientation in this process. Results showed that the main effects of descriptive and injunctive norm messages on behavioural intentions were mediated by normative perceptions, and cultural context moderated both paths of this mediation. Specifically, with the same message exposure, Chinese participants perceived food waste prevention as more prevalent and socially approved compared to US participants. Normative perceptions interacted with cultural context to influence behavioural intentions, such that both descriptive and injunctive norm perceptions predicted stronger intentions to prevent food waste among Chinese participants compared to Americans. Group orientation yielded a main effect on behavioural intentions, instead of the moderation effects as expected. Findings suggest the need for culturally grounded and contextualized approaches to communication of social norms, as well as building cultural concepts into theories of social norms. This article is part of the theme issue 'Social norm change: drivers and consequences'.

The Role of Collective Group Orientation and Social Norms on Physical Distancing Behaviors for Disease Prevention.

To reduce the impact of communicable diseases like COVID-19, collective action is required and likely to be susceptible to normative influence as well as whether people are more or less collectively oriented. We extend the theory of normative social behavior (TNSB) to account for group orientation and predict the relationships between social norms and physical distancing behaviors. Using a rolling cross-sectional design during 17 weeks of the pandemic, a national sample of US residents from 20 states (N = 8,778) participated in the study. The findings show that perceived descriptive norms, injunctive norms, and group orientation are significantly associated with physical distancing. The descriptive norm-behavior relationship and injunctive norm-behavior relationship are moderated by group orientation and the other predicted moderators in the TNSB. The findings extend the TNSB and highlight the need to understand social norms and group orientation in formative research for health communication campaigns designed to promote prevention behaviors.

Predicting Breastfeeding Intentions: A Test and Extension of the Theory of Normative Social Behavior with African American Social Identity.

Breastfeeding is a health promoting social behavior but statistics suggest a persistent disparity of lower rates among African American mothers. The Theory of Normative Social Behavior (TNSB) explains when and how norms influence behaviors, but has produced inconsistent results with respect to proposed moderators group identity and injunctive norms (IN), limiting its predictive value in diverse cultural groups. Cultural norms are one of many influences on breastfeeding behaviors, yet little is known about their mechanisms of influence. The TNSB has not been tested in the breastfeeding context or within an exclusively African American cultural group. Given this knowledge gap, a survey of 528 African American mothers in the Washington, D.C. area was conducted to test the moderating effects of IN and subjective norms (SN) and social identity on the descriptive norms (DN) to intentions relationship as predicted by the TNSB. Structural equation modeling was used to show that when controlling for education and breastfeeding history, norms significantly predicted 26.4% of the variance in breastfeeding intentions. SN and DN interacted negatively to enhance breastfeeding intentions. Latent profile analysis using ethnic pride, collectivism, and religiosity scales detected four profiles of African American social identity. Social identity profile membership was a significant moderator on the DN to intentions pathway in the structural equation model. Profiles with the highest ethnic pride were significantly influenced by DN to intend to breastfeed. Implications from this study for public health intervention and communication messaging are discussed.

A Framework for Introducing Global Health Innovations to the US.

Background: Across the globe, there are successful health innovations that could help improve public health in US communities at lower cost and with higher effectiveness than standard practice. However, which factors should be considered to heighten the likelihood of successful transfer of global health ideas to the US still warrants more empirical investigation. Objective: This study aimed to develop a conceptual framework delineating important factors to be considered for successful introduction of global health innovations to US communities, based on diffusion of innovations literature and case studies of global health innovations that have been adopted in US communities. Methods: Five global health innovations adopted in US communities were selected based on expert panel recommendations and a review of academic and gray literatures. These innovations had diverse origins (Columbia, Mexico, South Africa, Sweden, and Wales) and exhibited various means of achieving desired health outcomes. We conducted archival research and 27 interviews (42 interviewees) with leaders and stakeholders of the five innovations to identify important factors for the transfer of global health innovations to the US. Findings: Six factors were determined to be important for global health innovation adoption in the US: (1) innovation attributes, (2) linking agents, (3) inter-organizational partnerships, (4) scale up strategies, (5) implementation processes and outcomes in US communities, and (6) policy and social context. These factors correspond well to factors emphasized in the diffusion of innovation literature, although the importance of some sub-factors (e.g., stigma regarding the origin of innovations) diverged from the literature. Conclusions: Based on our findings, we developed the Designing for Diffusion Framework for Global Health Innovations. The framework provides a comprehensive picture of factors that can be facilitators or hindrances for moving a global health innovation to the US to help smooth the diffusion process for better adoption and implementation in US communities.

Measuring social norms related to handwashing: development and psychometric testing of measurement scales in a low-income urban setting in Abidjan, Côte d'Ivoire.

OBJECTIVES: To design and test the psychometric properties of four context-specific norm-related scales around handwashing with soap after toilet use: (1) perceived handwashing descriptive norms (HWDN); (2) perceived handwashing injunctive norms (HWIN); (3) perceived handwashing behaviour publicness (HWP); and (4) perceived handwashing outcome expectations (HWOE). DESIGN: Scale items were developed based on previous work and pilot tested in an iterative process. Content experts and members of the study team assessed the face validity of the items. The psychometric properties of the scales were assessed in a cross-sectional study. SETTING: The study was conducted in communal housing compounds in Abidjan, Côte d'Ivoire. PARTICIPANTS: A convenience sample of 201 adult residents (≥16 years old) from 60 housing compounds completed the final questionnaire. OUTCOME MEASURE: Confirmatory factor analysis was used to assess the goodness of fit of the global model. We assessed the internal consistency of each scale using Cronbach's alpha (α) and the Spearman-Brown coefficient (ρ). RESULTS: The results of the psychometric tests supported the construct validity of three of the four scales, with no factor identified for the HWOE (α=0.15). The HWDN and HWP scales were internally consistent with correlations of ρ=0.74 and ρ=0.63, respectively. The HWIN scale appeared reliable (α=0.83). CONCLUSION: We were able to design three reliable context-specific handwashing norm-related scales, specific to economically disadvantaged community settings in Abidjan, Côte d'Ivoire, but failed to construct a reliable scale to measure outcome expectations around handwashing. The social desirability of handwashing and the narrow content area of social norms constructs relating to handwashing present significant challenges when designing items to measure such constructs. Future studies attempting to measure handwashing norm-related constructs will need to take this into account when developing such scales, and take care to adapt their scales to their study context.

Speaking of Values: Value-Expressive Communication and Exercise Intentions.

This study introduces the concept of value-expressive communication and examines its relationship with behavioral intent. Value-expressive communication is conceptualized as the verbal output of a value-expressive attitude. Value-expressive communication about exercise is examined in relationship to strength of religious faith, exercise attitudes, communication frequency, and intentions to exercise among a sample of self-identified Christians. The data indicate a significant interaction between value-expressive communication and communication frequency explains significant variance in exercise intentions. Interact to and exercise attitudes is significantly associated with intentions to exercise. Suggestions for using value-expressive communication in health communication research and practice are discussed.

Attribute-centred theorizing to address behavioural changes.

Despite the importance of behaviours in promoting health and wellness, persuading people to adopt and sustain healthy behaviours remains a significant public health challenge. Considerable progress has been made in developing and testing theories about the personal, social, environmental and structural drivers of behaviours. However, theorizing about behaviours themselves has remained elusive, as evidenced by the absence of a widely accepted taxonomy of behaviours. By carefully examining the nature of behaviours, practitioners and researchers can identify the most effective ways to promote behavioural change. We propose attribute-centred theorizing as an approach for defining behaviours based on their relevant properties, which can then assist in developing a taxonomy of behaviours and theorizing about them. Behaviours differ because of their underlying properties; for example, some behaviours are addictive, others are publicly observable and others are expensive. Addictiveness, privacy and cost are therefore three (of the many) attributes relevant for theorizing about behaviours. We describe a framework for operationalizing attribute-centred theorizing, which includes generating behavioural attributes, verifying and testing those attributes, and constructing a behavioural matrix to inform campaigns or interventions. We illustrate this framework using the examples of Guinea-worm disease and cardiovascular diseases. The benefits of our approach include the ability to inform intervention development and the ability to generalize across different behaviours; however, more research on converting the behavioural matrix into actual policy is needed.

Malgré l'importance des comportements dans la promotion de la santé et du bien-être, persuader les gens d'adopter et de conserver un mode de vie sain représente toujours un défi de santé publique non négligeable. Des progrès considérables ont été accomplis en ce qui concerne le développement et l'évaluation des théories sur les motivations personnelles, sociales, environnementales et structurelles exerçant une influence sur les comportements. Cependant, formuler des théories à ce propos demeure complexe, comme en atteste l'absence de taxinomie largement admise en la matière. En examinant attentivement la nature des comportements, les chercheurs et praticiens peuvent identifier les moyens les plus efficaces pour les faire évoluer. Nous proposons d'opter pour une théorisation axée sur les attributs afin de définir les comportements en fonction de leurs propriétés utiles, ce qui permettrait ensuite d'instaurer une taxinomie des comportements et d'énoncer les hypothèses qui en découlent. Les comportements varient en raison de leurs propriétés sous-jacentes; certains par exemple sont liés à une dépendance, d'autres sont clairement visibles et d'autres encore sont onéreux. La dépendance, l'intimité et le coût constituent donc trois (des nombreux) attributs utiles à l'élaboration d'hypothèses sur les comportements. Dans le présent document, nous traçons un cadre servant à concrétiser cette théorisation axée sur les attributs; il prévoit notamment de générer des attributs comportementaux, de vérifier et de tester ces attributs, et d'imaginer une matrice qui fournirait des orientations pour diverses campagnes ou interventions. Nous illustrons également ce cadre en prenant pour exemples la dracunculose et les maladies cardiovasculaires. Parmi les avantages de notre approche figurent la possibilité de guider le développement des interventions et celle d'intégrer différents comportements; néanmoins, une étude approfondie est nécessaire pour définir comment convertir la matrice comportementale en réelle politique.

A pesar de la importancia de los comportamientos en la promoción de la salud y el bienestar, persuadir a las personas para que adopten y mantengan comportamientos saludables sigue siendo un importante reto para la salud pública. Se ha avanzado considerablemente en el desarrollo y la comprobación de teorías sobre los factores personales, sociales, ambientales y estructurales que impulsan los comportamientos. Sin embargo, teorizar sobre los comportamientos en sí sigue siendo difícil, como demuestra la ausencia de una taxonomía de comportamientos ampliamente aceptada. Al examinar cuidadosamente la naturaleza de los comportamientos, los profesionales e investigadores pueden identificar las formas más eficaces de promover el cambio de comportamiento. Proponemos una teoría centrada en los atributos como enfoque para definir los comportamientos en función de sus propiedades relevantes, lo que puede ayudar a desarrollar una taxonomía de comportamientos y a teorizar sobre ellos. Los comportamientos difieren por sus propiedades subyacentes; por ejemplo, algunos comportamientos son adictivos, otros son observables públicamente y otros son costosos. La adicción, la privacidad y el coste son, por tanto, tres (de los muchos) atributos relevantes para teorizar sobre los comportamientos. Describimos un marco para hacer operativa la teoría centrada en los atributos, que incluye la generación de atributos de comportamiento, la verificación y comprobación de dichos atributos y la construcción de una matriz de comportamiento para informar sobre campañas o intervenciones. Ilustramos este marco con los ejemplos de la enfermedad del gusano de Guinea y las enfermedades cardiovasculares. Las ventajas de nuestro enfoque son la capacidad de informar sobre el desarrollo de intervenciones y la capacidad de generalizar entre diferentes comportamientos; sin embargo, es necesario investigar más sobre la conversión de la matriz de comportamiento en una política real.

Too stringent or too Lenient: Antecedents and consequences of perceived stringency of COVID-19 policies in the United States.

In the United States, federal and local governments have attempted to contain the spread of Coronavirus Disease 2019 (COVID-19) by implementing a variety of policies such as stay-at-home orders and mask mandates. Perceptions can influence behaviors; therefore, it is important to understand how people perceive the stringency of COVID-19 policies, what factors shape perceived policy stringency, and whether and how policy perceptions impact the practice of prevention behaviors. With rolling-cross sectional survey data collected in the US from June to October 2020 and other external sources of data, the study examines the impact of objective risk of the pandemic, information seeking, and political ideology at the individual and the state levels on perceived policy stringency, and the impact of perceived policy stringency on prevention behaviors such as mask wearing and social distancing. The findings reveal that objective risk and political ideology are significantly associated with perceived policy stringency. The perceived policy stringency has negative associations with prevention behaviors. The findings provide important implications for the development process of compulsory public health policies during the pandemic.

Breastfeeding in Context: African American Women's Normative Referents, Salient Identities, and Perceived Social Norms.

The purpose of this study was to describe social norms and salient social identities related to breastfeeding intentions among African American mothers in Washington, D.C. Five focus groups were held with 30 mothers who gave birth to a child between 2016 and 2019. Two coders conducted pragmatic thematic analysis. This study demonstrated that women hold different identities relevant to making infant feeding decisions, with mother being primary and race/ethnicity, age, and relationship status factoring into how they define themselves. Mothers drew their perceptions of what is common and accepted from family, friends, the "Black community," and what they perceived visually in their geographic area and heard from their health care providers. Mothers believed breastfeeding to be increasing in popularity and acceptability in African American communities in Washington, D.C., but not yet the most common or accepted mode of feeding, with some variability by socioeconomic status group. Implications for public health communication and social marketing are discussed.

Racism and Resistance: A Qualitative Study of Bias As a Barrier to Breastfeeding.

Background: Nearly 75% of Black non-Hispanic babies born in 2016 ever breastfed. However, Black mothers still experience barriers to breastfeeding, perpetuating disparities in exclusivity and duration. Subjects and Methods: Using data collected from five focus groups with Black mothers (N = 30) in Washington, District of Columbia during summer 2019, we critically examine the influence of institutionalized and personally mediated racism on breastfeeding. We also explore the counter-narratives Black women use to resist oppression and deal with these barriers. Results: Themes surrounding institutionalized racism included historic exploitation, institutions pushing formula, and lack of economic and employment supports. Themes regarding how personally mediated racism manifested included health care interactions and shaming/stigma while feeding in public. At each level examined, themes of resistance were also identified. Themes of resistance to institutionalized racism were economic empowerment and institutions protecting breastfeeding. Themes of resistance to personally mediated biases were rejecting health provider bias and building community. Conclusions: There are opportunities for health providers and systems to break down barriers to breastfeeding for Black women. These include changes in clinical training and practice as well as clinicians leveraging their position and lending their voices in advocacy efforts.

Extending the Theory of Normative Social Behavior to Predict Hand-Washing among Koreans.

The current study tests the predictions of the theory of normative social behavior (TNSB) in a hand-washing context in a Korean sample and extends the theory to examine the role of perceived publicness, a variable believed to activate face concerns, as a moderator of the norm-behavior relationship. The findings show substantial main effects for all of the study variables on behavior. In addition, the descriptive norm-behavior relationship is moderated by perceived publicness and outcome expectations, but the nature of the interactions is not consistent with that evidenced in previous literature on US samples. Implications for normative theory and communication campaigns are discussed.

Social networks and the communication of norms about prenatal care in rural Mexico.

Many normative beliefs are shared and learned through interpersonal communication, yet research on norms typically focuses on their effects rather than the communication that shapes them. This study focused on interpersonal communication during pregnancy to uncover (a) the nature of pregnancy-related communication and (b) normative information transmitted through such communication. Results from interviews with pregnant women living in rural Mexico revealed limited social networks; often, only a woman's mother or the baby's father were consulted about prenatal care decisions. However, women also indicated that communication with others during pregnancy provided important normative information regarding prenatal care. First, most referents believed that women should receive prenatal care (injunctive norm), which was conceptualized by participants as biomedical, nonmedical, or a blend of both. Second, family members often received prenatal care, whereas friends did not (descriptive norms). These findings highlight the key role of personal and social networks in shaping personal pregnancy-related beliefs and behaviors.

Recommendations for the role of social science research in One Health.

The social environment has changed rapidly as technology has facilitated communication among individuals and groups in ways not imagined 20 years ago. Communication technology increasingly plays a role in decision-making about health and environmental behaviors and is being leveraged to influence that process. But at its root is the fundamental need to understand human cognition, communication, and behavior. The concept of 'One Health' has emerged as a framework for interdisciplinary work that cuts across human, animal, and ecosystem health in recognition of their interdependence and the value of an integrated perspective. Yet, the science of communication, information studies, social psychology, and other social sciences have remained marginalized in this emergence. Based on an interdisciplinary collaboration, this paper reports on a nascent conceptual framework for the role of social science in 'One Health' issues and identifies a series of recommendations for research directions that bear additional scrutiny and development.

Social influence in child care centers: a test of the theory of normative social behavior.

Child care centers are a unique context for studying communication about the social and personal expectations about health behaviors. The theory of normative social behavior (TNSB; Rimal & Real, 2005 ) provides a framework for testing the role of social and psychological influences on handwashing behaviors among child care workers. A cross-sectional survey of child care workers in 21 centers indicates that outcome expectations and group identity increase the strength of the relationship between descriptive norms and handwashing behavior. Injunctive norms also moderate the effect of descriptive norms on handwashing behavior such that when strong injunctive norms are reported, descriptive norms are positively related to handwashing, but when weak injunctive norms are reported, descriptive norms are negatively related to handwashing. The findings suggest that communication interventions in child care centers can focus on strengthening injunctive norms in order to increase handwashing behaviors in child care centers. The findings also suggest that the theory of normative social behavior can be useful in organizational contexts.

The down low, social stigma, and risky sexual behaviors: insights from African-American men who have sex with men.

The "down low" is purported to contribute to social stigma associated with being homosexual and may influence risk behaviors. This article examines communication patterns among stigmatized groups and reports the findings from 32 structured interviews and five focus groups with African-American men who have sex with men. Results indicate negative emotions associated with labels based on sexual practices, the influential role of organized religion in social stigma, and barriers to reaching stigmatized groups. These findings can be used to build culturally appropriate sexual risk interventions for this population.

Prevention options for positives: the effects of a health communication intervention for men who have sex with men living with HIV/AIDS.

This article reports the results of a small-scale quasi-experiment that tested the efficacy of the Prevention Options for Positives intervention. The experiment tested for the outcomes of group sessions combined with individual-level counseling (ILC) versus ILC-only for men who have sex with men who are HIV positive. Both arms of the intervention were based on behavior change theory and dealt specifically with communication outcomes. The results indicate that the group- and individual-level interventions combined have a greater impact on risk communication behaviors with main partners than did the ILC-only sessions. group-session/ILC participants were more likely to decide not to have sex if they were drunk or high, and more likely to tell their partner and ask their partner about HIV status than were participants in the ILC groups. Knowledge about HIV was relatively high, and there was little change across groups. The Prevention Options for Positives intervention influenced the relative importance of various referent groups, but normative beliefs were not affected. The implications of these findings for communication practice and research with HIV-positive men who have sex with men are addressed.

Risk perceptions of people living with HIV/AIDS: how similarity affects optimistic bias.

Little as known about how people living with HIV/AIDS (PLWH/A) assess their vulnerability to non-HIV related risk factors, and how this judgement is affected by perceived similarity with others. This study indicates not only that PLWH/A are optimistically biased in their risk pereceptions, but also that they do not use others' HIV status to assess similarity. Perceived similarity with others, however, affects risk judgements: greater the perceived similarity with others, greater the tendency to judge others' vulnerability relative to one's own. Findings point to the importance of considering similarity as a key variable in understanding how risk assessments are made by persons with chronic health conditions.

Can a short film impact HIV-related risk and stigma perceptions? Results from an experiment in Abuja, Nigeria.

HIV/AIDS-related stigma is believed to result in negative social consequences for people with the disease and to be a deterrent to HIV serostatus testing. The ability of communicators to change people's stigma perceptions and subsequently impact decisions to test, however, is not well understood. Based on the entertainment-education approach, this article presents the results of a field experiment conducted in Abuja, Nigeria, testing a mediated intervention designed to reduce HIV-related stigma and risk perceptions. The results indicate that the intervention was effective relative to a control in impacting perceptions of the severity of HIV and some stigma-related attitudes, particularly for male participants; and that for this sample, risk and stigma perceptions significantly impact intentions to test for HIV. It also showed that severity perceptions mediated the relationship between viewing the film and testing intent.

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.