ICH

Health Communication &Rational Decision Making.

An OverviewRational Choice Theory in Communication Research

Lugano, May 7, 2009

Marco BardusInstitute of Communication and

HealthFaculty of Communication SciencesUniversità della Svizzera italianamarco.bardus@lu.unisi.ch

data: 7-05-2009ICH Slide:2

Table of contents

Introduction

Literature Overview Rational Choice and Decision

Making: is that Rational?

Lugano, 7-05-2009 Rational Choice Theory in Communication Research 2

data: 7-05-2009ICH 37-05-2009

data: 7-05-2009ICH 47-05-2009

data: 7-05-2009ICH

HOW DO YOU FEEL?

How are you today?

http://flickr.com/photos/ufosightings/3269808057/

Slide:5

data: 7-05-2009ICH

What is Health?

“a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”

(World Health Assembly, 1948)

“a resource for everyday life, not the objective of living.

Health is a positive concept emphasizing social and personal resources, as well as physical capacities.”

(World Health Organization, 1986)Slide:6

data: 7-05-2009ICH

What is Health Communication?

Health communication encompasses the study and use of communication strategies to

inform and influence individual and community decisions that enhance health. […]

Health communication can contribute to all aspects of disease prevention and health promotion and is relevant in a number of contexts, including

(1) health professional-patient relations,

(2) individuals’ exposure to, search for, and use of health information,

(3) individuals’ adherence to clinical recommendations and regimens,

(4) the construction of public health messages and campaigns,

(5) the dissemination of individual and population health risk information, that is, risk communication,

(6) images of health in the mass media and the culture at large,

(7) the education of consumers about how to gain access to the public health and health care systems, and

(8) the development of telehealth applications.(US Office of Disease Prevention and Health Promotion)

Slide:7

data: 7-05-2009ICH

Literature SearchDatabaseses

ISI Web of Knowledge, Jstor, ScienceDirect, SpringerLink, PsycINFO, EBSCOhost (Communication & Mass Media complete), CSA Illumina (Medline) and Scholar Google.

Keywords 1“rational choice”, “rational choice theory”, “rational decision making”, “informed decision making” + “health”, “health behavio*”, “self-management”, “medical compliance” or “medical adherence”, “treatment adherence” or “treatment compliance” = +1000 entries.

Keywords 2“rational choice theory” or “rational choice model” + “health behav*” or “health decision making” = 70 entries

Slide:8

data: 7-05-2009ICH

In a NutshellHealth topicsRisk and Sexual behavior: HIV-AIDS prevention

(Bell et al., 1998; Eifler, 2004; Eskridge & Weimer, 1994; Reyna & Farley, 2006; Takyi, 2000)

Addictive behaviors(Monterosso & Ainslie, 2007; Suranovic, Goldfarb & Leonard, 1999)

Prenatal diagnosis(Bekker, Hewison & Thornton, 2004)

Diabetes self-management (Baker, 2006)Health Care Professional’s perspective

(Freemantle, 1996; Friedman, 1965)

Slide:9

data: 7-05-2009ICH

Open Questions & Limitations

Rational Decision Making (Broadstock & Michie, 2000) => Naturalistic approach is preferable; it does not work for all health issues; HIV Epidemics does not work (Eskridge & Weimer, 1994)

TPB & TRA (Armitage, Conner & Norman, 1999) => applies to some extent and to some behaviors: mood influences performance

Habit vs. Rational Choice (Lindbladh & Lyttkens, 2002) => non-reflective and repetitive behaviors (apply to lower social positions)

Health Lifestyle Theory (Cockerham, 2005): Abandon the individualistic paradigm in favour of a agency and structure approach =>

Social Determinants of Health behaviors (Chin et al., 2000) => QoL (Ormel et al., 1997):

Slide:10

data: 7-05-2009ICH

CRITICISMS AND LIMITATIONS. WHAT DO YOU THINK?

Health behavior decision making: is that rational?

Slide:11

data: 7-05-2009ICH

THANK YOUFOR THE ATTENTION!

Marco Bardusmarco.bardus@gmail.commarco.bardus@lu.unisi.ch

Slide:12

data: 7-05-2009ICH

References - 1Glanz, K., Rimer, B. K., & Marcus Lewis, F. (2002). Health behavior and health education: Theory, research, and

practice San Francisco: Jossey-Bass.Montano, D.E., & Kasprzyk, D. (2002). The Theory of Reasoned Action and the Theory of Planned Behavior. In

Glanz, K., Rimer, B. K., & Lewis, F. M. (Eds.). Health behavior and health education: Theory, research, and practice San Francisco: Jossey-Bass.

Armitage, C. J., Conner, M., & Norman, P. (1999). Differential effects of mood on information processing: Evidence from the theories of reasoned action and planned behavior. European Journal of Social Psychology, 29, 419-433.

Baker, R. M. (2006). Economic rationality and health and lifestyle choices for people with diabetes. Social Science & Medicine, 63(9), 2341-2353.

Bekker, H. L., Hewison, J., & Thornton, J. G. (2004). Applying decision analysis to facilitate informed decision making about prenatal diagnosis for down syndrome: A randomised controlled trial. Prenatal Diagnosis, 24, 265-275.

Bell, D. C., Richard, A. J., Montoya, I. D., Elwood, W. N., Goush, S. N., & Matta, B., N. (1998). Social network utility and the economics of risk: The case of HIV. Journal of Economic Behavior & Organization, 33, 195-205.

Broadstock, M., & Michie, S. (2000). Processes of patient decision making: Theoretical and methodological issues. Psychology and Health, 15, 191-204.

Chin, N. P., Monroe, A., & Fiscella, K. (2000). Social determinants of (un)healthy behaviors. Education for Health, 13(3), 317-328.

Cockerham, W. C. (2005). Health lifestyle theory and the convergence of agency and structure. Journal of Health and Social Behavior, 46(1), 51-67.

Eifler, S. (2004). Rational choice, personality and HIV-preventive behavior in the presence of opportunities. Journal of Applied Social Psychology, 34(6), 1251-1280.

Slide:13

data: 7-05-2009ICH

References - 2

Eskridge, W. N., & Weimer, B. D. (1994). The economics epidemic in an AIDS perspective. The University of Chicago Law Review, 61(2), 733-774.

Freemantle, N. (1996). Are decisions taken by health care professionals rational? A non systematic review of experimental and quasi experimental literature. Health Policy, 38, 71-81.

Friedman, J. F. (1965). The value of free choice in health care. Medical Care, 3(2), 121-127.Lindbladh, E., & Lyttkens, C. H. (2002). Habit versus choice: The process of decision-making in health-related

behaviour. Social Science & Medicine, 55, 451-465.Monterosso, J., & Ainslie, G. (2007). The behavioral economics of will in recovery from addiction. Drug and

Alcohol Dependence, 90S, 100-111.Ormel, J., Lindenberg, S., Steverink, N., & Vonkorff, M. (1997). Quality of life and social production functions: A

framework for understanding health effects. Social Science & Medicine, 45(7), 1051-1063.Reyna, V. F., & Farley, F. (2006). Risk and rationality in adolescent decision making. implications for theory,

practice and public policy. Psychological Science in the Public Interest, 7(1), 1-44.Suranovic, S. M., Goldfarb, R. S., & Leonard, T. C. (1999). An economic theory of cigarette addiction. Journal of

Health Economics, 18, 1-29.Takyi, B. K. (2000). AIDS-related knowledge and risks and contraceptive practices in ghana: The early 1990s.

African Journal of Reproductive Health / La Revue Africane De La Santé Reproductive, 4(1), 13-27.

Slide:14