How can mask-wearing in public be effectively increased? Institutions like the World Health Organization (WHO) aim to improve global health. Through the use of effective strategies to communicate with the public, they could persuade people towards using face masks and prevent them from diseases. However, first, they need to face the difficulties of designing an effective message that can lead to such a persuasion. This includes certain operational tasks, like selecting credible sources, choosing a message strategy, and determining the optimal setting or channels through which the communication is to be delivered.
To help the WHO facing those difficulties, this paper will focus on persuasive communication strategies. To do so, the paper is structured as follows: In the first section, two different strategies to promote mask wearing in public worldwide will be provided. Then, in the second section, some basic considerations the WHO should make before adapting those strategies will be highlighted. Lastly, the paper will end with a brief summary.
By the end of 2019, an outbreak of severe pneumonia of unknown cause in Wuhan, China was reported to the World Health Organization (WHO). A few months later, the coronavirus has taken over the world and infected over 14 Million people worldwide, causing almost 600,000 people’s death. Therefore, the search for effective strategies to prevent people from getting COVID-19 is currently the primary goal of many countries’ governments. Because social distancing and a total lockdown are just short-term solutions, the need for alternative solutions is rising. According to Cheng et al. (2020), community-wide face mask wearing may help to slow down the outbreak of COVID-19. As shown by those researchers, this is due to the reduced emission of people’s respiratory droplets.
Strategies the WHO Can Use to Increase Mask Wearing in Public
By the end of 2019, an outbreak of severe pneumonia of unknown cause in Wuhan, China was reported to the World Health Organization (WHO) (Jiang et al., 2020). A few month later, the coronavirus has taken over the world and infected over 14 Million people worldwide, causing almost 600.000 people’s death (Johns Hopkins University, 2020). Therefore, the search for effective strategies to prevent people from getting COVID-19 is currently the primary goal of many countries’ governments. Because social distancing and a total lockdown are just short-term solutions, the need for alternative solutions is rising. According to Cheng et al. (2020), community-wide face mask wearing may help to slow down the outbreak of COVID-19. As shown by those researchers, this is due to the reduced emission of people’s respiratory droplets. But how can mask-wearing in public be effectively increased? Institutions like the World Health Organization (WHO) aim to improve global health. Through the use of effective strategies to communicate with the public, they could persuade people towards using face masks and prevent them from diseases. However, first, they need to face the difficulties of designing an effective message that can lead to such a persuasion. This includes certain operational tasks, like “…selecting credible sources, choosing a message strategy, and determining the optimal setting or channels through which the communication is to be delivered” (Kreuter & Wray, 2003, p. 227). To help the WHO facing those difficulties, this paper will focus on persuasive communication strategies. To do so, the paper is structured as follows: In the first section, two different strategies to promote mask wearing in public worldwide will be provided. Then, in the second section, some basic considerations the WHO should make before adapting those strategies will be highlighted. Lastly, the paper will end with a brief summary.
Strategies for the WHO to Consider: Fear Appeals and Narratives
There is a wide range of communication strategies, which can be adapted by the WHO to increase mask wearing in public. As not all of them can be shown, this paper will focus on mainly two strategies: Fear appeals and narrative communication.
Fear Appeals with Efficacy Cues
According to Witte (1992), fear appeals are persuasive messages that are designed to scare people by showing them the negative consequences that will occur when they don’t follow the communicated recommendations. In health and risk communication fear appeals are used to prevent individuals from potential noxious consequences of a specific behavior (Rogers & Deckner, 1975). In sum, the idea of fear appeals is the triggering of a cognitive impulse to avert the potential noxious consequence. This impulse then should lead to a change in attitude and behavior (Rogers & Deckner, 1975).
Although, the link between fear arousal and persuasion is widely researched, at first it seemed that there was an inconsistent or even contradictory empirical evidence of the effectiveness of fear appeals. Whilst some researchers (e.g. Beck, 1984) could confirm the positive effects of fear appeals on a person’s attitude, others claimed that they are ineffective (Kohn et al., 1982). To address this mixed evidence, Witte and Allen (2000) conducted a meta-analysis and showed that strong fear appeals combined with a low efficacy component can increase a persons perceived threat, which than leads to defensive responses and therefore to a rejection of the communicated recommendation. In contrast, if the fear appeal contains a high efficacy message, the opposite will show and a change in attitudes and behavior should occur. Consequently, fear appeals can be successfully used under the condition that they are combined with efficacy cues (Witte & Allen, 2000).
These findings are in line with a message design theory named The Extended Parallel Process Model (EPPM) (Witte, 1992). The EPPM uses people’s perception of threat and efficacy to offer predictions about their responses to fear appeal messages. A fear appeal has to increase the perceived threat to the point that it is high enough to produce fear (Witte, 1992). But once the perceived threat gets too high, it can get bigger than the perceived efficacy, which is defined as „..beliefs about the effectiveness of the recommended response in deterring the threat’’ (Gore & Bracken, 2005, p. 29). As Witte (1992) stated, this then leads to fear control process causing a defensive response. As a result, individuals will not respond as recommended by the fear appeal message and no change in behavior will occur. In Contrast, if perceived efficacy is higher than perceived threat, this will lead to a danger control process and individuals will respond as recommended by the message and change their behavior (Witte, 1992). Gore and Bracken (2005) examined the model und confirmed the EPPM’s predictions. In sum, a fear appeal should be designed to increase the perceived efficacy by highlighting the effectiveness of a recommendation in reducing the threat. Ruiter et al. (2014) added the importance of an instruction to effectively implement the recommended behavior. Moreover, Rogers (1975) also took into account the perceived probability that the noxiousness consequence will occur if no change in behavior is performed . Thus, fear appeal messages should not only emphasize the effectiveness of a recommended action in reducing the threat but also the personal relevance of the noxious consequence.
Taken together, the WHO can use fear appeals with efficacy cues by emphasizing how dangerous it would be to not wear a mask, as well as how easy and effective it is to do so. Additionally, they should highlight the personal relevance of the consequence of not wearing a mask, for example, by showing that there are coronavirus cases in the persons environment.
Although, fear appeals combined with efficacy cues can increase mask wearing in public, it is important to note that there are many effective persuasion strategies and under certain conditions fear appeals are not the best for motivating health behaviors. Muthusamy et al. (2009), for example, showed that fear appeals are not effective in high fear situations or when people have high levels of pre-existing fear about a hazard. Others showed that high sensation-seekers were less affected by fear appeals than low sensation-seekers (Witte & Morrison,1995). Moreover, the impact of fear appeals may decrease, if the recommendations are too far away from a person’s existing beliefs and practices (Cook & Berrenberg, 1981). According to Cook and Berrenberg (1981), this can reduce attention to the message and even strengthen those existing beliefs. For example, some people do not believe in the existence of the coronavirus. Also, especially according to mask wearing, some individuals may assume that their own actions will have no impact to avert a hazard unless the behavior is also performed by others. Though, this problem could be resolved by combining the fear appeal with the suggesting that others are also taking the desired action. Further, there are some cultural differences as people from an individualistic culture response different to fear appeals than people from a collectivistic culture (Murray-Johnson et al., 2001). When people are more individualistic their perceived threat is higher when the message communicates a hazard to a group to which they belong, whereas more collectivistic people are threatened by messages that address the hazard to the self (Murray-Johnson et al., 2001). Consequently, depending on the population of interest, the WHO should tailor fear appeal messages either by addressing the hazard to the self or the group a person belongs. Interestingly, Maloney et al. (2011) found that cultural orientation cannot be assumed based on ethnicity. Also, what is not yet known about fear appeals is the critical point, at which danger control process shifts into fear control process (Maloney et al., 2011). This would be important to know when designing a fear appeal message. Also, most of the studies conducted are lab experiments. Therefore, it’s questionable if and how fear appeals work in the real world. Additionally, fear appeals are not always interpreted the way they were intended. That’s why they should be pilot tested with a small sample from the population of interest. To develop an effective health message, researcher also need to measure threat and efficacy attitudes toward the message (Gore & Bracken, 2005).
Though fear appeals need some consideration before used, it is an effective strategy for the WHO to increase mask wearing in public. Nevertheless, it has its limitation and can be ineffective under certain circumstances. That’s why in the following an additional and more recently investigated strategy will be shown.
Narrative Communication
In the last decades, the use of a narrative form of persuasive health communication like entertainment education, storytelling, and testimonials is rapidly rising. Hinyard and Kreuter (2007) define narrative communication as “…any cohesive and coherent story with an identifiable beginning, middle, and end that provides information about scene, characters, and conflict; raises unanswered questions or unresolved conflict; and provides resolution” (p. 778). A narrative communication is the most basic form of human interaction and therefore is comfortable and familiar. It can include good stories, personal experience and the experience of others, gripping drama, faith and religion and historical accounts (Hinyard & Kreuter, 2007).
While traditional persuasion strategies like fear appeals try to convince the population of interests with more rationally and explicitly presented arguments, narrative communication is more entertaining with the persuasive component being more implicit (Shen et al., 2015).
According to Green (2006), what's unique to narratives is their ability to mentally involve the population of interests by transporting them into the story’s world. This can arouse emotional reactions which than can cause a change in attitudes and behavior. Green (2006) defines transportation into a narrative world as an “integrative melding of attention, imagery, and feelings” (p. 164). As a consequence, the audience focus more on the story instead of thinking about counterarguments (Green, 2006).
Van Laer et al. (2014) meta-analysis approved the important role of transportation in persuasive communication by showing that transportation increases affective responses, thoughts and other persuasion outcomes. Further, a study conducted by Slater et al. (2003), showed that identification with characters portrayed in the narrative increases the audience response according to health behavior outcomes. Also, they found that narratives were perceived as more believable than didactic evidence in the form of a newsletter article. Therefore, when designing narrative health campaigns, involvement with the story and identification with persons portrayed should be carefully pre-tested to make sure that the health intervention is effective. Some other studies in the field of health communication confirmed the effects of narratives on health behavior outcomes by showing that narrative communication lowered the audience intention to use tanning beds (Greene & Brinn, 2003) and increased the perceived importance of vaccination against the human papillomavirus (HPV) (Murphy et al., 2013) and mammography screening (Kreuter et al. 2010).
Looking at research designs, both field studies and lab experiments could proof the effectiveness of narratives (Shen et al., 2015). Since other persuasion strategies are mostly examined through lab experiments, this is another argument for the WHO to use narratives. The positive effect of narratives can be generalized to the real world, while strategies only tested through lab experiments cannot.
Further, what's important to mention is that as shown by the meta-analysis conducted by Shen et al. (2015), narratives delivered via audio and video channels are effective in changing the audience attitudes and behavior, while in contrast print-based narratives don’t seem to have that persuasive impact. As stated by the researchers, this can be due to the strength of narratives in transporting the audience mentally into the world of a story rather than convincing them with explicit and rational arguments. Health communication through audio and video messages evoke emotions and are therefore more useful in transporting people than a print medium (Shen et al., 2015). Still, the ineffectiveness of print-based narratives could be also related to the lengths of those messages, as they are mostly short and therefore may not be able to transport the audiences to the world of a narrative. That’s why Shen et al. (2015) suggest that the longer the narratives, the more persuasive they might be. Moreover, cultural differences should be taken into account when designing a narrative message, because as shown by the meta-analysis by Shen et al. (2015), field studies that did not use culturally sensitive and tailored messages were less effective in promoting health behavior.
Taken together, the WHO should aim to transport the audience into the story’s world through a culturally tailored video or audio health campaign. For example, they could embed entertainment education and use characters, who are easily to identify with while simultaneously show how they wear masks to protect themselves and others.
As with any other strategies there are some limitation of narratives used in persuasive communication and possibly, they won’t work under certain conditions. First, while narratives that emphasize disease detection and prevention behaviors are successful, those advocating the cessation of addictive behaviors are not (Shen et al. 2015). Luckily, as COVID-19 is a disease, this won’t affect the WHO. Second, what Shen et al. (2015) also found is that most studies examined the persuasion outcomes in student samples. Therefore, it’s not possible to generalize those results to a broader population. Moreover, almost all studies used a single exposure to the narrative. A real health campaign, however, will be repeatedly shown to the population of interests, what according to Pechman and Stewart (1989, as cited in Shen et al., 2015) will increase individuals engage in message processing. But through to lack of research in the field of health communication it is not known if repeatedly shown narratives are more effective or can backfire (Shen et al. 2015). Also, there are some gender differences, as females are more responsive to narratives than men are (Van Laer et al., 2014).
Mixed Strategies
Though, fear appeals and narrative communication can successfully increase health behavior outcomes, some researchers claimed that the best effects can be achieved through a more mixed strategy (e.g. Slater, 2002). Regarding narratives, Slater (2002) suggests that the inclusion of an epilogue to recap the persuasive information in the form of a nonnarrative summary may increase the effectiveness of narrative communication. Subsequently, a mixed approach of narrative and statistical evidence may be more persuasive than either type alone (Slater, 2002). According to fear appeals, as stated before it’s crucial to emphasize the personal relevance of a noxious consequence and the effectiveness of the recommendation in reducing the threat. To do so, it seems to be best to combine fear appeals with statistical evidence, that proof the effectiveness of the recommended action. For the WHO this could be a statistic that shows how mask wearing can prevent people from getting COVID-19.
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- Bettina Schneider (Autor), 2020, Communication Strategies the WHO Can Use to Increase Mask Wearing in Public, Múnich, GRIN Verlag, https://www.grin.com/document/1319389
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