Background. Self-categorisation theory and the identity-based motivation perspective suggest that people’s motivation to engage in a particular behaviour is stronger when that behaviour is congruent with their salient social identity. In situations where a certain social identity is made salient, or where people identify strongly with a particular group, the social norm associated with that group may have a strong effect on individual behaviour. This perspective can be used to enhance the understanding of health-related intentions and behaviour. The aim of this thesis is to investigate the usefulness of adding concepts related to social identity to existing social cognitive models of healthy eating. The prediction being made is that members of groups that value healthy eating might be more likely to engage in healthy eating when their membership in that particular group is made salient. Five experimental studies tested the effect of social identity salience and group identification on healthy eating intentions and behaviour. Both intentions and behaviour were measured in each of the five studies, to allow for investigating the existence and potential causes of the intention-behaviour gap for healthy eating. Methods and Results. All five studies included random assignment of participants to conditions, and an experimental manipulation of social identity salience or social image healthiness. In Study 1 (n = 149), conducted among female university students, participants’ female, family, or personal identity was made salient. The results showed that increasing the salience of female or family identity led to stronger healthy eating intentions, but did not increase the likelihood of picking a healthy snack over an unhealthy one. Study 2 (n = 115) did not include a successful manipulation of salient social identity, but it showed a positive association between female identification, measured as a trait, and healthy eating intentions, even after controlling for attitude, subjective norm and perceived behavioural control. Study 3 (n = 156) included a manipulation of social identity salience (female or student) and a manipulation of social image healthiness (images presenting in-group members engaging in either healthy or unhealthy behaviour). The results corroborated the earlier finding that female identification is positively correlated with healthy eating intentions. Also, the results indicated that when participants were shown social images of their in-group members engaging in healthy or unhealthy behaviour, they expressed intentions in line with the social images only if they did not express strong identification with the in-group. Study 4 (n = 87) was conducted in the context of Australian identity and included a manipulation of social images healthiness. The findings provided evidence for the existence of a vicarious licensing effect for healthy eating. Namely, for participants who highly identified with their social group, exposure to pictures of other in-group members engaging in healthy behaviour resulted in choosing less healthy food items from a restaurant menu. Study 5 (n = 117) demonstrated the existence of a vicarious licensing effect in the context of female identity, where participants’ food intake during a taste test was predicted by the interaction of the social image healthiness and their group identification. Conclusions. By examining the predictors of both healthy eating intention and behaviour, the research presented in this thesis sheds light on some of the phenomena potentially underlying the intention-behaviour gap for healthy eating, particularly among women. It appears that the healthy eating norm is internalised by women and translated into healthy eating intentions, to the extent that women who identify more highly with their gender group, and those whose female identity is made temporarily salient, also express stronger healthy eating intentions. The association between female identification and healthy eating behaviour, however, appears to be much less consistent, and in most studies the correlation between healthy eating intentions and eating behaviour was poor, even though a variety of measures of behaviour was used. These findings suggest that actual eating is often not predicted by intentions, but depends on contextual factors, such as being given an opportunity to reinforce the healthy eating goal, or the availability of information about in-group members’ eating behaviour. The results also have implications for health-psychological interventions, in suggesting that people’s response to health-related content (such as social images that may be used in health promotion interventions) may be different depending on their level of group identification. In line with the vicarious licensing effect, individuals who report high levels of group identification might be less likely to respond to interventions aimed at their specific social groups.

This thesis is concerned with the health-related effects of perspective-taking in response to a narrative health campaign. To begin, the thesis outlines the health promotion strategies currently in use (i.e., statistical vs. narrative), presents research discussing their relative effectiveness, and considers the potential for perspective-taking to influence the impact of narrative health campaigns (Chapter 1). The thesis then defines two types of perspective-taking, cognitive and emotional, and explores the processes underlying these (Chapter 2). Each type of perspective-taking is then considered in the context of the health promotion literature (Chapter 3). It was proposed that, whereas cognitive perspective-taking should have a relatively straightforward and positive effect on the impact of narrative health campaigns, the effects of emotional perspective-taking should be more variable. Seven studies were conducted to test this basic premise and identify mediators and moderators of the observed effects. In Chapter 4, two studies are presented that aim to establish the effects of perspective-taking on health-related outcomes (Studies 1 & 2). A broadly consistent pattern was observed across these studies: encouraging cognitive perspective-taking led to more positive health-related outcomes than did encouraging emotional perspective-taking. Having established the basic effect, two studies are presented in Chapter 5 that explore a potential mediator: perspective-takers’ self-efficacy concerning a health promoting behaviour (chlamydia testing: Studies 3 & 4). These studies found a consistent indirect effect of perspective-taking on intentions to get tested for chlamydia through self-efficacy: encouraging cognitive perspective-taking increased participants’ perceived self-efficacy relative to encouraging emotional perspective-taking, which in turn positively predicted intentions to get tested in the future. The three studies presented in Chapter 6 explore potential moderators of the effects of perspective-taking (Studies 5-7). Specifically, these studies test whether the relative effects of perspective-taking are moderated by features of the relationship between the perspective-taker and a target presented in a narrative health campaign. The broad pattern observed across these studies suggests that the perception of a shared categorisation (or social identity) between the perspective-taker and target moderates the effect of perspective-taking on health-related outcomes. Specifically, the final study, Study 7, demonstrated that encouraging cognitive perspective-taking in response to a narrative health campaign leads to more positive health-related effects than encouraging emotional perspective-taking when perspective-takers’ personal (unshared) identity is made salient; however, these effects are attenuated (and potentially even reversed) when a social (or shared) identity is made salient. Considered as a whole, the research presented in this thesis represents the first empirical examination of the relative health-related effects of different types of perspective-taking in response to a narrative health campaign. The research demonstrates that perspective-taking is an important factor in determining whether or not narrative health promotion campaigns are likely to be effective. However, it also makes clear that the processes through, and conditions under, which cognitive and emotional perspective-taking can help to ensure the effectiveness of narrative health campaigns are not yet fully understood. Nevertheless, the studies presented herein successfully identify several such conditions and mechanisms ready for further study. Theoretical and practical implications, alongside limitations and more specific suggestions for further research are discussed.

O Agente Comunitário da Saúde (ACS) compõe a equipe mínima da Estratégia Saúde da Família e teve sua profissão reconhecida recentemente. Tem como especificidades o fato de atuar na mesma comunidade em que vive e não ter como exigência para o ingresso na profissão a conclusão prévia de curso técnico na área da saúde. O presente estudo teve como objetivo analisar as concepções de usuários e profissionais da equipe mínima da Estratégia Saúde da Família a respeito do trabalho do ACS. Trata-se de um estudo descritivo que utilizou o método qualitativo em pesquisa. Foram realizadas no contexto de duas Unidades de Saúde da Família: 1) entrevistas semiestruturadas com dezoito usuários e com sete profissionais (dois médicos, duas enfermeiras, duas auxiliares de enfermagem e uma dentista); 2) observações participantes, ao longo de seis meses, do trabalho do ACS especialmente das visitas domiciliares e das reuniões de equipe. O material da pesquisa, composto pelas transcrições das entrevistas e pelos registros das observações participantes, foi analisado através dos princípios da Análise de Conteúdo Temática, que possibilitou a descrição de dois temas: \"Processo de trabalho do Agente Comunitário de Saúde\" e \"Identidade do Agente Comunitário de Saúde: origem e formação de um trabalhador em suas especificidades\". A análise apontou que o \"processo de trabalho\" do ACS, segundo as concepções de profissionais e usuários, encontra-se centrado na realização das visitas domiciliares, que tem como finalidades: levar informações aos usuários, entregar produtos e/ou serviços a domicílio, escutar o usuário e fiscalizar o cumprimento de prescrições. Destacamos o predomínio, na perspectiva dos participantes, de uma concepção das visitas domiciliares centrada em uma prática individual, que focaliza os aspectos técnicos do trabalho em saúde e, portanto, reducionista. Além disso, a inserção do ACS em outras atividades laborais, como grupos com a comunidade e participações em reuniões de equipe, dá-se com o intuito de que o mesmo aprenda conteúdos e práticas do trabalho em saúde, ou seja, o \"saber/fazer\", apontando para uma desvalorização deste profissional em suas especificidades. Apesar dos participantes referirem à origem comunitária do ACS como forma de compartilhar vivências com os usuários da ESF, valoriza-se o conhecimento biomédico como viabilizador de práticas do ACS e como meio de diferenciá-lo de um \"leigo\". Deste modo, o estudo permitiu descrever e refletir acerca das contradições que perpassam o processo de trabalho do ACS e a construção de sua identidade profissional, bem como a captura do trabalho do ACS pela lógica reducionista/biomédica e a consequente desvalorização de tal profissional em suas especificidades. Apontamos a importância do resgate dos fundamentos filosóficos que possibilitaram a inserção do ACS enquanto um profissional da saúde no intuito de ressaltar suas especificidades e valorizá-las no seu fazer cotidiano, recuperando, assim, sua atuação comunitária/política e reconfigurando o lugar/papel do ACS na equipe e na comunidade em que atua. / The Community Health Agent (CHA) is a member of the minimal composition of the Family Health Team, whose profession has been recently acknowledged. The specificities of CHAs are that they must work in the same community in which they live, and that it is not necessary for them to complete any technical health course. The objective of the present study was to analyze the conceptions of workers and clients of the Family Health Team, in its minimal composition, regarding the work of the CHA. This descriptive study was performed using a qualitative research method. The following activities were performed within the environment of two Family Health Units: 1) semi-structured interviews with eighteen clients and seven workers (two physicians, two nurses, two nursing aides and one dentist); 2) participant observation of the CHA\'s work for six months, particularly of home visits and team meetings. The research material, comprised of the transcribed interviews and the records from the participant observations, was analyzed according to the principles of Thematic Content Analysis, which enabled the description of two themes: \"The Working Process of the Community Health Agent\" and \"The Identity of the Community Health Agent: the origin and development of a worker considering particular specificities\". The analysis revealed that the \"working process\" of the CHA, according to the conceptions of workers and clients, currently focuses on performing home visits, which aim at: bringing information to clients, delivering products and/or services at home, listening to the client, and supervising the clients\' compliance to drug treatments. We highlight the predominance, from the participants\' perspective, of a conception of home visits centered on an individual practice, focused on the technical aspects of health work; hence, reductionist. Furthermore, the inclusion of the CHA in other work activities, such as community groups and their participation in team meetings, occurs with the purpose of offering the CHA the chance to learn contents and practices of health work; i.e., the \"know/do\", which reveals an undervaluing of this profession and its particular specificities. Although the participants referred to the CHA being from the community originally as a way to share the experiences of the FHT clients, biomedical knowledge is valued as the foundation of the work of the CHA, and as the factor that differentiates a CHA from ordinary \"laymen\". Therefore, the present study permitted to describe and reflect upon the contradictions that permeate the working process of the CHA, and the construction of the professional identity of the CHA. Furthermore, this study allowed understanding the work of the CHA from the reductionist/biomedical rationale and the consequent undervaluation of this profession and its specificities. We highlight it is important to recover the philosophical foundations that allowed including the CHA as a health professional with the purpose to outline the specificities of this profession and value them in everyday practice, thus rescuing their community/political participation and reestablishing the position/role of the CHA in the team and community in which they work.

O Agente Comunitário da Saúde (ACS) compõe a equipe mínima da Estratégia Saúde da Família e teve sua profissão reconhecida recentemente. Tem como especificidades o fato de atuar na mesma comunidade em que vive e não ter como exigência para o ingresso na profissão a conclusão prévia de curso técnico na área da saúde. O presente estudo teve como objetivo analisar as concepções de usuários e profissionais da equipe mínima da Estratégia Saúde da Família a respeito do trabalho do ACS. Trata-se de um estudo descritivo que utilizou o método qualitativo em pesquisa. Foram realizadas no contexto de duas Unidades de Saúde da Família: 1) entrevistas semiestruturadas com dezoito usuários e com sete profissionais (dois médicos, duas enfermeiras, duas auxiliares de enfermagem e uma dentista); 2) observações participantes, ao longo de seis meses, do trabalho do ACS especialmente das visitas domiciliares e das reuniões de equipe. O material da pesquisa, composto pelas transcrições das entrevistas e pelos registros das observações participantes, foi analisado através dos princípios da Análise de Conteúdo Temática, que possibilitou a descrição de dois temas: \"Processo de trabalho do Agente Comunitário de Saúde\" e \"Identidade do Agente Comunitário de Saúde: origem e formação de um trabalhador em suas especificidades\". A análise apontou que o \"processo de trabalho\" do ACS, segundo as concepções de profissionais e usuários, encontra-se centrado na realização das visitas domiciliares, que tem como finalidades: levar informações aos usuários, entregar produtos e/ou serviços a domicílio, escutar o usuário e fiscalizar o cumprimento de prescrições. Destacamos o predomínio, na perspectiva dos participantes, de uma concepção das visitas domiciliares centrada em uma prática individual, que focaliza os aspectos técnicos do trabalho em saúde e, portanto, reducionista. Além disso, a inserção do ACS em outras atividades laborais, como grupos com a comunidade e participações em reuniões de equipe, dá-se com o intuito de que o mesmo aprenda conteúdos e práticas do trabalho em saúde, ou seja, o \"saber/fazer\", apontando para uma desvalorização deste profissional em suas especificidades. Apesar dos participantes referirem à origem comunitária do ACS como forma de compartilhar vivências com os usuários da ESF, valoriza-se o conhecimento biomédico como viabilizador de práticas do ACS e como meio de diferenciá-lo de um \"leigo\". Deste modo, o estudo permitiu descrever e refletir acerca das contradições que perpassam o processo de trabalho do ACS e a construção de sua identidade profissional, bem como a captura do trabalho do ACS pela lógica reducionista/biomédica e a consequente desvalorização de tal profissional em suas especificidades. Apontamos a importância do resgate dos fundamentos filosóficos que possibilitaram a inserção do ACS enquanto um profissional da saúde no intuito de ressaltar suas especificidades e valorizá-las no seu fazer cotidiano, recuperando, assim, sua atuação comunitária/política e reconfigurando o lugar/papel do ACS na equipe e na comunidade em que atua. / The Community Health Agent (CHA) is a member of the minimal composition of the Family Health Team, whose profession has been recently acknowledged. The specificities of CHAs are that they must work in the same community in which they live, and that it is not necessary for them to complete any technical health course. The objective of the present study was to analyze the conceptions of workers and clients of the Family Health Team, in its minimal composition, regarding the work of the CHA. This descriptive study was performed using a qualitative research method. The following activities were performed within the environment of two Family Health Units: 1) semi-structured interviews with eighteen clients and seven workers (two physicians, two nurses, two nursing aides and one dentist); 2) participant observation of the CHA\'s work for six months, particularly of home visits and team meetings. The research material, comprised of the transcribed interviews and the records from the participant observations, was analyzed according to the principles of Thematic Content Analysis, which enabled the description of two themes: \"The Working Process of the Community Health Agent\" and \"The Identity of the Community Health Agent: the origin and development of a worker considering particular specificities\". The analysis revealed that the \"working process\" of the CHA, according to the conceptions of workers and clients, currently focuses on performing home visits, which aim at: bringing information to clients, delivering products and/or services at home, listening to the client, and supervising the clients\' compliance to drug treatments. We highlight the predominance, from the participants\' perspective, of a conception of home visits centered on an individual practice, focused on the technical aspects of health work; hence, reductionist. Furthermore, the inclusion of the CHA in other work activities, such as community groups and their participation in team meetings, occurs with the purpose of offering the CHA the chance to learn contents and practices of health work; i.e., the \"know/do\", which reveals an undervaluing of this profession and its particular specificities. Although the participants referred to the CHA being from the community originally as a way to share the experiences of the FHT clients, biomedical knowledge is valued as the foundation of the work of the CHA, and as the factor that differentiates a CHA from ordinary \"laymen\". Therefore, the present study permitted to describe and reflect upon the contradictions that permeate the working process of the CHA, and the construction of the professional identity of the CHA. Furthermore, this study allowed understanding the work of the CHA from the reductionist/biomedical rationale and the consequent undervaluation of this profession and its specificities. We highlight it is important to recover the philosophical foundations that allowed including the CHA as a health professional with the purpose to outline the specificities of this profession and value them in everyday practice, thus rescuing their community/political participation and reestablishing the position/role of the CHA in the team and community in which they work.