A practitioner’s guide to persuasion: An overview of 15 selected persuasion theories, models and frameworks
Introduction
At an interest group session on the theoretical bases of communication in healthcare at the International Conference in Communication in Healthcare (ICCH) in 2007, a practitioner noted that he was aware that the use of theory in health communication, whether in clinical practice or research, was touted as desirable. However, he countered, what references were available for a busy practitioner to obtain a concise overview of theories and models that may be of use in understanding patient behavior, behavior change, or lack of behavior change? This question became the foundation of this manuscript.
Theory in health communication research is used to understand, explain and predict health beliefs, attitudes, intentions, and behaviors of individuals, groups, and mass audiences. Persuasive theories are one subset of theories applicable to health communication; they can be applied at many levels including intrapersonal, interpersonal, organizational, and mass communication. Knowledge of this subset of available theories can assist practitioners in better understanding their interactions with patients as well as patient behavior. Entire textbooks are written, and courses taught on the topic of persuasion and persuasive theory, but practitioners seldom have the opportunity to engage in such deep study and reflection. This article serves to fill that lacuna by providing a selective overview of persuasion theories and concepts, and referring interested readers to other sources for more extensive explanation and commentaries of these and other theories [1], [2], [3], [4], [5].
There are almost as many different definitions of persuasion or persuasive communication as there are persuasion scholars. A common theme throughout these definitions is that “persuasion involves a conscious effort at influencing the thoughts or actions of a receiver” [6]. One definition of persuasive communication attractive in its inclusiveness is Miller’s [7]: “any message that is intended to shape, reinforce, or change the responses of another, or others.” Persuasive communication, then, can be viewed as comprising three processes: response shaping, response reinforcing, and response changing.
Response shaping relates to the creation of responses to a new stimulus: prior to exposure to a new stimulus, an attitude toward the stimulus cannot yet exist. Information provision about a new product or an unfamiliar event can constitute response shaping. Practitioners may provide information about a disease, condition, or test unknown to the patient. Patients may be aware of the existence of specific screening tests, but unaware of associated risks and benefits. Response reinforcing occurs when an individual already holds an attitude or is enacting a behavior advocated by the persuader. Support groups, such as Alcoholics Anonymous, fill the function of being response reinforcing: they exist to reinforce a decision (e.g., sobriety) [8]. Encouraging medication adherence can be response reinforcing: a provider may reinforce accurate and consistent patient behavior. Response changing is the most recognized aspect of persuasion: that of value, belief, attitude, intention or behavior change. A critical factor across all three processes is that persuasion is constrained to intentional behavior. This manuscript provides a necessarily brief overview of 15 theories or perspectives oft identified by their development or scholarly description as persuasive theories: those identifying constructs and variables intended to shape, reinforce, or change the response of others. Table 1 presents the theories discussed in this manuscript.
Section snippets
Persuasion theories applicable to the patient–provider context
Although the response shaping, reinforcing, and changing processes are elucidative when explaining persuasion, individual theories may apply to more than one process. For example, a theory may be useful both for a practitioner encouraging a patient to continue performing a desired health behavior (response reinforcing) and also for a practitioner attempting to change a patient’s health behavior (response changing). Therefore, the theories discussed are not delineated based on the three
Discussion
As it is often the intent of a practitioner to shape, reinforce, or change a patient’s behavior, familiarity with theories of persuasion may lead to the development of novel communication approaches with patients. An understanding of fear appeals recognizes that if a patient does not believe that a health risk affects her, or has serious consequences, then she is unlikely to consider or exhibit behavior change. Further, if she perceives a high level of threat, but is unconvinced of the efficacy
Acknowledgements
I gratefully acknowledge the insights and suggestions provided by Michael E. Roloff, Franklin J. Boster, Shelly Campo, Michael S. Wolf and the reviewers. The author has indicated no potential conflict of interest.
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