Practice safe sex, be alert to suspicious activities, immunize your children against measles, mumps and rubella--these are just a few of the many imperatives government agencies broadcast to the public. And behavioral scientists have long researched ways to make these messages persuasive and effective. However, a new breed of researchers is working to change the tenor of public communications--arming people with the knowledge to make informed choices instead of trying to persuade them to do the "right" thing.
The weakness of persuasive messages is they tend to give incomplete information, explains Baruch Fischhoff, PhD, a psychology professor who studies risk communication at Pittsburgh's Carnegie Mellon University (CMU) and a member of the National Academy of Sciences' Institute of Medicine.
For example, a sexual education course may emphasize that having sex just once can lead to pregnancy without noting the chances of that happening are small. Then, when people realize the facts have been tweaked, they may end up distrusting all the information provided during that class, he says.
To avoid this problem, Fischhoff and others are exploring more informational approaches to risk communication and studying whether they lead to healthy choices.
"Our work focuses on seeing how far you can get with nonpersuasive communication," says Fischhoff. "The research shows that...people are capable of understanding risks and making decisions in their best interest."
Indeed, a number of threads of research in areas ranging from public health and safety to terrorism suggest more knowledge leads to better decisions. With this in mind, Fischhoff and other psychologists in risk communication have a battle plan: Assess the risks, determine what information the public lacks, then fill those critical gaps.
These psychologists hope to expand this strategy to the area of terrorist threats--though it won't be easy to keep the public well-informed without the government tipping its hand to potential attackers, says Wändi Bruine de Bruin, PhD, a CMU postdoctoral research associate in risk communication. Moreover, even the officials themselves may not know the risks of events that have never happened before, she notes.
While the risks of terrorist threats are tricky to pinpoint, government officials and scientists have a much stronger sense of the risks of unprotected sex, from pregnancy to sexually transmitted infection (STI). In her own STI research with teenagers, Bruine de Bruin begins with a thorough assessment of what they already know. In one study, for example, she and her colleagues interviewed 48 sexually active 14- to 18-year-old girls, asking open-ended questions such as "What kinds of things can happen as a result of having sex?"
The researchers found that while the girls used terms such as "safe sex," they frequently could not provide a definition or examples. More troubling, the participants did not seem to understand that repeatedly engaging in a sexual behavior leads to a net increased risk--potentially contributing to an "all-or-nothing" attitude, in which once they have had unsafe sex, they feel they might as well continue to do so since they've already been exposed to the risk.
To fill these gaps, the psychologists created an interactive DVD that shows a couple progressing through different kinds of sexual encounters. The DVD allows students to intervene at "decisions points" and determine what steps the female actor can take to minimize her risk of pregnancy or STI. The program then provides feedback about these choices and ranks various sexual behaviors according to the likelihood of contracting an infection through them.
Three months after working through the interactive DVD, participants were almost three times more likely to become abstinent than teens who participated in standard sexual education programs. Moreover, those who had completed the DVD program contracted 10 percent fewer STIs.
In addition to carefully tailoring information to the audience's knowledge gaps, the method by which the DVD presented data--through charts and graphs--may have contributed to its success, says J. Frank Yates, PhD, a University of Michigan psychology professor who studies how people respond to representations of risk.
"You could just give people the numbers, or what you might do is use stick figures representing the number of people who are going to contract the disease," says Yates. "Graphical displays tend to result in more risk avoidance than numerical displays."
Charts and graphs can be good tools for conveying behavioral risks, but telling a coherent story may be even more important, says Julie Downs, PhD, a CMU psychologist and director of the university's Center for Risk Perception and Communication.
Downs and her colleagues are finding that storytelling plays a central role in parents' understanding of vaccination risks, such as the chances that a child will develop a fever or other medical symptoms after receiving an immunization. And, she says, some antivaccination activists are doing a better job putting information into a narrative framework than the Centers for Disease Control and Prevention (CDC), which is funding her research.
"The CDC's communications, which report the results of studies, convince someone who trusts science and understands how vaccines work," says Downs. "The antivaccination Web sites are telling a much more compelling story."
For example, a typical antivaccination Web site might include an anecdote about a child who had a life-threatening reaction to a measles shot. Such a vivid tale provides easily digestible information about a high-risk, low-probability situation--which studies have shown people remember more readily than more common, less dramatic outcomes. To balance this information, Downs and her colleagues are suggesting that the CDC tell alternative stories, perhaps of communities where all of the children get vaccinated and avoid a dangerous outbreak of measles.
In addition to investigating Web site content, the psychologists interviewed 30 parents of young children and found many of them lacked understanding of vaccination concepts. To fill the gap and gain parents' trust, Downs suggests that the CDC provide easily understandable discussions of the benefits of these shots as well as the risks.
The CDC is evaluating the psychologists' recommendations, though they do not know yet how the findings will be applied, says CDC spokesperson Alex Janssen.
Federal legislation and available funding will limit how the CDC can use the Downs team's risk-communication suggestions, notes Fischhoff, who contributed to the project. But those constraints are small compared with the difficulties communicating terrorist threats, he says.
For example, after the Sept. 11 attacks, no one knew how safe it was to fly, but many public officials urged people to return to the airways anyway, saying flying was safer than driving, says Fischhoff. In such cases, government spokespeople should admit that they simply do not know what the risk is, he notes.
However, in the case of the anthrax mail attacks, postal service spokespeople could have done a better job communicating the risk of infection, Fischhoff believes. During that attack, health officials were flooded with questions about the pathogen--questions that could have been easily answered had government announcements given the full picture of the difficulty of being infected, says Fischhoff.
"The simple message regarding what it takes to be exposed got lost in the clutter," he notes.
Research shows that the public is unlikely to panic, unless they lose faith in their own authorities, adds Fischhoff. Government officials should trust that if they give people as much information as possible on a threat such as anthrax, keep in mind potential knowledge gaps and use devices such as graphs and charts, the public can be trusted to respond reasonably, he says.
"Everyone must decide for themselves how much risk they can tolerate," he says. "Just making that decision can make risks more tolerable."
Adds Bruine de Bruin, "We haven't stumbled upon a domain where educating people, in terms they understand, didn't work."
Dittmann, M. (2004, April). Sex: Worth the risk? Monitor on Psychology, 34(4), 58-59.
Downs, J.S., Murray, P.J., Bruine de Bruin, W., Penrose, J., Palmgre, C., & Fischhoff, B. (in press). Interactive video behavioral intervention to reduce adolescent females' STD risk: A randomized controlled trial. Social Science & Medicine.
Fischhoff, B.(2002). Assessing and communicating the risks of terrorism. In A.H. Teich, S.D. Nelson & S.J. Lita (Eds.), Science and technology in a vulnerable world (pp. 51-64). Washington, DC: American Association for the Advancement of Science.
Yates, J.F. (1990). Judgment and decision making. Englewood Cliffs, NJ: Prentice Hall.
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