The potency of health promotion versus disease prevention messages in a college population

American Journal of Health Studies, Winter, 2002 by Craig M. Becker, Shari McMahan, Jennifer Etnier, J. Ron Nelson

Abstract: The objective of this study was to determine the effects of health promotion and disease prevention messages on college students' cognition and behavior. One hundred-sixty undergraduates read different health messages and answered questions to assess their intentions and reasons for engaging in health behaviors. Results indicated that there was a preference for cognition and behaviors that promote health rather than those designed to prevent disease. Positive reinforcement was also a significant factor related to behavioral intentions. This has important implications for health educators who develop health programs designed to affect the cognition and behaviors of college populations.

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Recent research in health education has suggested that traditional approaches to health education, including fear approaches, are not successful at promoting behavior change. One possible explanation is that people are not only searching for how to relieve their fear but also how to develop behavior that enhances feelings of health and well being (Monahan, 1995). Current efforts by health professionals to help people reach these desired outcomes have begun to move toward efforts that emphasize desirable consequences. New approaches have evolved because findings regarding the effectiveness of fear- or vulnerability-programs designed to change cognition and behaviors have been inconsistent (Rothman and Salovey; 1997). New approaches use reinforcement, specifically, positive reinforcement and positive affect messages because they may have a persuasive influence on health behavior changes (Monahan, 1995).

Reinforcement plays an important role in both health promotion and disease prevention behavior change efforts. Sidman (1989, 1993) suggests that all cognition and behaviors are developed as a result of reinforcement. Reinforcement, either positive or negative, is any consequence that tends to increase the probability of the behavior that preceded it. Positive reinforcement is defined as the process of adding or applying something to increase the probability of the behavior that preceded it. An example of positive reinforcement could be the feeling of competence, self-efficacy, or an award earned after completing a difficult task. Negative reinforcement is a process that involves the removal of something aversive to increase the probability of the behavior that preceded it. An example of negative reinforcement would be taking an aspirin to relieve a headache. If the aspirin eliminates the headache, the removal of the aversive headache would reinforce the behavior of taking the aspirin (Nemeroff and Karoly, 1997; Sarafino, 2002). Although reinforcement works, a difficulty associated with this process is that stimuli or cues that are specifically reinforcing or aversive for one person may not be for another. Sidman has demonstrated in the patients he works with that they will not repeatedly engage in a desired behavior unless they receive an immediate benefit (Sidman, 1989).

In studies regarding reinforcement, researchers have manipulated participants to have either a promotion or prevention focus. A participant with a promotion focus is one that aspires to create a sense of accomplishment or achievement and has therefore been associated with positive reinforcement. The strategic inclination with promotion is to make progress by approaching gains and advancement toward what they believe will ultimately help them attain a desired end state. On the other hand, a prevention focus is one that creates a responsibility to maintain security. The prevention focus has been associated with negative reinforcement because these individuals are in a state of vigilance to assure safety from aversive stimuli in attempts to reach their desired end state. Either positive or negative reinforcement results in a desirable state of affairs from the person's point of view (Higgins, 1998; Roney and Sorrentino, 1995; Shah and Higgins, 1997).

Other efforts by health professionals to affect cognition and behaviors have focused on health message design. Many difficulties are associated with health messages including problems associated with the technical and complex nature of health and disease. Other times, health messages are confusing because they may be based upon and reflect inconclusive findings. Other problems surface with health messages because often these health messages ask people to give things up, to change comfortable habits, or to refrain from pleasurable experiences (Levanthal, Safer, and Panagis, 1983).

Recently an effort is being made to change health messages from traditional fear- or vulnerability based messages designed to evoke behavior changes toward persuasive positive affect messages (Rothman and Salovey, 1997; Monahan, 1995). Affect refers to the whole range of feelings and emotions. Positive affect messages are designed to evoke a positive, personal emotional appeal. These messages usually have the benefit of overcoming any personal filtering devices that may cloud or block out a message because they can support and justify positive feelings and generate personal interest (Monahan).