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School-based body mass index (BMI) screenings seek can improve parents' recall about their child's weight, increase concern about excess weight, and correct parents' misperceptions to help them make informed decisions about their child's health. However, schools have questioned parents' understanding of and attitudes about BMI, and have expressed concern about parents' reactions to BMI reports. Using a sample of school nurses (n=7) and parents/guardians (n=125) from the School District of Philadelphia (SDP), this research addressed these concerns by clarifying: 1) parents'/guardians' perceptions and knowledge about BMI; 2) the challenges schools face in communicating with parents/guardians; and 3) the messages that can be communicated to parents/guardians to help them understand their child's BMI-for-age category and why their child's BMI is measured in his/her school. The research used framing theory and perceptual mapping methods to study and improve communication about BMI to parents/guardians in the School District. The four-phase study design incorporated qualitative (focus groups and semi-structured in-depth interviews) and quantitative (cross-sectional survey) methods to assist in the development of an evidence-informed BMI report card template for the SDP. Messages were constructed to meet the needs of four distinct groups of parents/guardians that emerged from the factor and cluster analyses - "Passive Parents," "Neutral Parents," "Confident Advocates" and "Active Worriers." Although each cluster of parents/guardians had their own unique perceptions and varying degrees of assuredness and confidence related to BMI concepts, the majority of parents/guardians in this study shared common favorable perceptions about BMI measures, school-based screening programs and BMI report cards. / Public Health

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Yes / Background: A Personal Health Record (PHR) is an electronic record that individuals use to manage and share their health information, e.g. data from their medical records and data collected by apps. However, engagement with their record can be low if people do not find it beneficial to their health, wellbeing or interactions with health and other services. We have explored the beliefs potential users have about a PHR, how it could be made personally relevant, and barriers to its use. Methods: A qualitative design comprising eight focus groups, each with 6–8 participants. Groups included adults with long-term health conditions, young people, physically active adults, data experts, and members of the voluntary sector. Each group lasted 60–90 min, was audio recorded and transcribed verbatim. We analysed the data using thematic analysis to address the question “What are people’s beliefs about making a Personal Health Record have relevance and impact?” Results: We found four themes. Making it work for me is about how to encourage individuals to actively engage with their PHR. I control my information is about individuals deciding what to share and who to share it with. My concerns is about individuals’ concerns about information security and if and how their information will be acted upon. Potential impact shows the potential benefits of a PHR such as increasing self-efficacy, uptake of health-protective behaviours, and professionals taking a more holistic approach to providing care and facilitating behaviour change. Conclusions: Our research shows the functionality that a PHR requires in order for people to engage with it. Interactive functions and integration with lifestyle and health apps are particularly important. A PHR could increase the effectiveness of behaviour change apps by specifying evidence-based behaviour change techniques that apps should incorporate. A PHR has the potential to increase health-protective behaviours and facilitate a more person-driven health and social care system. It could support patients to take responsibility for self-managing their health and treatment regimens, as well as helping patients to play a more active role when care transfers across boundaries of responsibility. / Leeds Informatics Board

Master of Science / Department of Journalism and Mass Communications / Joye C. Gordon / This experimental research adopts a typology of frames by Levin, Gaeth, and Schneider (1998) and seeks to a) determine what combination of attribute and goal frames produces the strongest effect on vaccination behavior; b) ascertain to what extent personal relevance of vaccination moderates this framing effect; and c) explore how individual pre-existing characteristics, such as recent vaccination history, vaccine risk perception, vaccine dread, and general attitude toward vaccination influence the persuasive power of framed messages. The study, designed as field experiment 2 (+/- attribute frame) x 2 (+/- goal frame) x 2(involvement), recruited 476 adult female participants that were exposed online to four experimental framing manipulations and a control condition. The main effect is consistent with the typology of frames — the combination of the positive attribute and the negative goal frame was the only condition that was significantly more persuasive than the control condition. Participants who had children or were pregnant, for whom vaccination was more relevant and meaningful, have not reacted to message framing differently. However, general pre-existing attitudes towards vaccines, perception of vaccine safety, perception of vaccine efficacy, vaccine dread, and vicarious experience with vaccine side effects, appear to be associated with antecedents of vaccination behavior. Overall, this study has focused on ecological validity,aiming at the applicability of framing theory in the context of health communication.

During a public health crisis, officials need to communicate with the public quickly and accurately. Social networking sites (SNS) have been identified as an appropriate channel for this type of communication; however, few studies have examined what makes SNS messages effective. Further limiting research in this area is a lack of attention to theoretical constructs that may explain message effectiveness in SNS. In this dissertation, I propose that diffusion of innovations (DOI) be used to understand SNS and message success on SNS. In doing so, I compare traditional message success (persuasion) to message success on SNS platforms (amplification) and provide a brief overview of relevant message design constructs. I then conduct a study to analyze Twitter messages from state and local health departments and federal government agencies charged with communicating to the public during a public health crisis to test these theoretical claims and identify message elements that increase SNS message amplification. The context of the study is the fall 2014 Ebola crisis in the United States. The messages are first classified using content analysis methods to identify message design elements related to content, structure, and style. The success of those elements, in terms of the influence they have on messages amplification, is then evaluated using negative binomial regression. The results suggest that specific content (hazard information, response instruction, and official action), effective structure (word and image graphics), and key style choices (using figurative language, one hashtag or a keyword hashtag, and the first person) improve the amplification value of a message. Other choices, like mentioning another user, reduce the amplification value. These findings add to the evidence that suggests that DOI enhances scholars’ understanding of communication on SNS. In addition, the results demonstrate that messages can be conceptualized as innovations, and, as such, their characteristics influence the likelihood that they will be diffused through SNS platforms. The results suggest that those charged with communicating during a public health crisis use specific message strategies for SNS messages. These strategies include recommendations related to message content, message structure, and message style. Finally, the results suggest that scholars should continue research to understand the relationship between message design and message amplification in order to improve our knowledge of communication on SNS and help practitioners identify effective communication practices on this new and important channel. Research should also examine the relationship between persuasion and amplification in order to understand how amplification influences attitudes, behavioral intentions, and behavior in both those who amplify the message and in those who receive the message as a result of that amplification.

A few scholars have argued that the Internet is a valuable channel for social marketing, and that practitioners need to rethink how they engage with target audiences online. However, there is little evidence that online social marketing interventions can significantly influence behaviours, while there are few evidence-based guidelines to aid online intervention design. This thesis assesses the efficacy of online interventions suitable for social marketing applications, presents a model to integrate behavioural change research, and examines psychological principles that may aid the design of online behavioural change interventions.The primary research project used meta-analytical techniques to assess the impact of interventions targeting voluntary behaviours, and examined psychological design and adherence correlations. The study found that many online interventions demonstrated the capacity to help people achieve voluntary lifestyle changes. Compared to waitlist control conditions, the interventions demonstrated advantages, while compared to print materials they offered similar impacts, but with the advantages of lower costs and broader reach. A secondary research project surveyed users across an international public mobilization campaign and used structural equation modelling to assess the relationships between website credibility, active trust, and behavioural impacts. This study found that website credibility and active trust were factors in behavioural influence, while active trust mediated the effects of website credibility on behaviour. The two research projects demonstrated that online interventions can influence an individual’s offline behaviours. Effective interventions were primarily goal-orientated: they informed people about the consequences of their behaviour, encouraged them to set goals, offered skills-building support, and tracked their progress. People who received more exposure to interventions generally achieved greater behavioural outcomes. Many of these interventions could be incorporated into social marketing campaigns, and offer individually tailored support capable of scaling to massive public audiences. Communication theory was used to harmonize influence taxonomies and techniques; this proved to be an effective way to organize a diversity of persuasion, therapy, and behavioural change research. Additionally, website credibility and users’ active trust could offer a way to mitigate the negative impacts of online risks and competition.