A practitioner’s guide to persuasion: An overview of 15 selected persuasion theories, models and frameworks

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Abstract

Objective

To provide a brief overview of 15 selected persuasion theories and models, and to present examples of their use in health communication research.

Results

The theories are categorized as message effects models, attitude–behavior approaches, cognitive processing theories and models, consistency theories, inoculation theory, and functional approaches.

Conclusions

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 existing patients.

Practice Implications

This article serves as an introductory primer to theories of persuasion with applications to health communication research. Understanding key constructs and general formulations of persuasive theories may allow practitioners to employ useful theoretical frameworks when interacting with patients.

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.

References (161)

  • R.E. Petty et al.

    Attitudes and persuasion: classic and contemporary approaches

    (1981)
  • A.H. Eagly et al.

    The psychology of attitudes

    (1993)
  • E.P. Bettinghaus et al.

    Persuasive communication

    (1994)
  • G.R. Miller

    On being persuaded: some basic distinctions

  • J. Stiff

    Persuasive communication

    (1994)
  • D.J. O’Keefe

    Persuasion: theory and research

    (1990)
  • J.N. Cappella

    Integrating message effects and behavior change theories: organizing comments and unanswered questions

    J Commun

    (2006)
  • P. Cleary

    Why people take precautions against health risks

  • K.A. Cameron et al.

    The persuasive functions of warnings: theory and models

  • N.K. Janz et al.

    The health belief model

  • C.I. Hovland et al.

    Communication and persuasion

    (1953)
  • W. Benoit et al.

    Persuasive messages: the process of influence

    (2008)
  • R.B. Cialdini
    (2001)
  • R.H. Gass et al.

    Persuasion, social influence, and compliance gaining

    (2006)
  • I.L. Janis et al.

    Effects of fear-arousing communications

    J Abnorm Soc Psychol

    (1953)
  • J.P. Dillard

    Rethinking the study of fear appeals: an emotional perspective

    Commun Theory

    (1994)
  • G.R. Miller

    Studies on the use of fear appeals: a summary and analysis

    Cent States Speech J

    (1963)
  • F.J. Boster et al.

    Fear-arousing persuasive messages

  • P.A. Mongeau

    Another look at fear arousing messages

  • J.P. Dillard et al.

    The role of fear in persuasion

    Psychol Mark

    (2004)
  • J.L. Hale et al.

    Fear appeals in health promotion campaigns: too much, too little, or just right?

  • H. Leventhal

    Fear appeals and persuasion: the differentiation of a motivational construct

    Am J Public Health

    (1971)
  • K. Witte

    Putting the fear back into fear appeals: the extended parallel process model

    Commun Monogr

    (1992)
  • K. Witte

    Fear control and danger control: a test of the extended parallel process model

    Commun Monogr

    (1994)
  • R.W. Rogers

    A protection motivation theory of fear appeals and attitude change

    J Psychol

    (1975)
  • R.W. Rogers

    Cognitive and physiological processes in fear appeals and attitude change: a revised theory of protection motivation

  • K.H. Beck et al.

    A conceptualization of threat communications and protective health behaviour

    Soc Psych Q

    (1981)
  • D.L. Floyd et al.

    A meta-analysis of research on protection motivation theory

    J Appl Soc Psychol

    (2000)
  • S. Milne et al.

    Combining motivational and volitional interventions to promote exercise participation: protection motivation theory and implementation intentions

    Br J Health Psychol

    (2002)
  • S. Milne et al.

    Prediction and intervention in health-related behavior: a meta-analytic review of protection motivation theory

    J Appl Soc Psychol

    (2000)
  • H. Leventhal et al.

    Findings and theory in the study of fear communications. Advances in experimental social psychology

    (1970)
  • K. Witte et al.

    Testing the health belief model in a field study to promote bicycle safety helmets

    Commun Res

    (1993)
  • K.N. Kline et al.

    Breast self-examination pamphlets: a content analysis grounded in fear appeal research

    Health Commun

    (2000)
  • K.A. Cameron et al.

    Preventing HIV transmission along the Trans-Africa highway in Kenya: using persuasive message theory in formative education

    Int Q Community Health Educ

    (1999)
  • K. Witte et al.

    A theoretically based evaluation of HIV/AIDS prevention campaigns along the Trans-Africa highway in Kenya

    J Health Commun

    (1998)
  • Cameron KA, Rintamaki LS, Kamanda-Kosseh M, Noskin GA, Baker DW, Makoul G. Using theoretical constructs to identify key...
  • K. Witte et al.

    Radon awareness and reduction campaigns for African Americans: a theoretically based evaluation

    Health Educ Behav

    (1998)
  • A.J. Roberto et al.

    Using the Extended parallel process model to prevent firearm injury and death: field experiment results of a video-based intervention

    J Commun

    (2000)
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