Process of behavior change
An alternative to the trans theoretical model is the process of behaviour change or
perceived behavioral control model (Corcoran, 2007). It was developed by the
Population Communication Services/ Centre for Communication Programs (2003)
in the US. Corcoran (2007) explains that this model recognizes communication as a
process where people can move between the stages of the process of behaviour
change framework. Different messages are sought depending on where the person
is on the process of behaviour change framework. The main difference between the
process of behaviour change and the trans theoretical model is that the process of
behaviour change is not seen as circular, but as a series of ‘steps’ where a person
moves upwards towards the final goal. Corcoran (2007) explains that in the process
of behaviour change people move through the following steps:
i. Pre-knowledge. When a person is unaware of any risks or problems
associated with their behaviour.
ii. Knowledgeable. When a person is aware of the problem and of the risks
attached to their behaviour.
iii. Approving. When a person is in favour of changing their behaviour.
iv. Intending. When a person is intending to take action to change their
behaviour.
v. Practicing. When the intended behaviour is being practiced.
vi. Advocating. When the new behaviour is being implemented and when a
person then advocates that behaviour to another.
This model was not used because of several reasons. First, just like the trans
theoretical model, it explains behaviour change in terms of stages which might not
be easily or accurately identified by members of the target audience. For instance, it
might not be easy to distinguish between those who are at the stages of approving
and intending. The second reason why this model was not used is that whereas it is
applicable to small target audiences that can be easily described, it will be difficult
to apply to large target audiences for mental health communication campaigns.
Thirdly, the model does not acknowledge the possibility of those who have had
knowledge of mental health not moving to the stages of approving, intending and
practicing. The fourth reason is that the model does not explain the factors that lead
to approving, intending, practicing and advocating. Finally, it is only in mental
health problems caused by drug abuse where these steps of behaviour change may
be followed. In mental illnesses caused by other factors such as major illnesses, the
steps may not be useful.
The extended parallel process model
The extended parallel process model (EPPM) was developed by Witte (1992).
Witte used Leventhal’s parallel process model (1970) as the overall framework of
the EPPM to differentiate between two processes, danger control and fear control.
The theory adopts the original explanation of the protection motivation theory
(PMT) that explains danger control processes that lead to message acceptance
(Rogers, 1975, 1983) and defines and expands the fear control processes which lead
to message rejection. These are the two sides of the parallel process model.
The theory posits that when a person is presented with a fear appeal depicting the
components of threat (severity and susceptibility) and the components of efficacy
(response efficacy and self-efficacy) the fear appeal initiates two appraisals in the
cognitive encoder (individual) (Witte, 1992). First, persons appraise the perceived
threat of the hazard. If the appraisal of threat results in moderate to high perceived
threat, then fear is elicited (Easterling & Leventhal, 1989; Lang, 1984) and people
are motivated to begin the second appraisal, which is an evaluation of the efficacy
of the second response. When the threat is perceived as low, there is no motivation
to process the message further; efficacy is not evaluated and there is no response to
the fear appeal (Witte, 1992).
Witte (1992) argues that when both perceived threat and perceived efficacy are
high, danger control processes are initiated. He says that when people fear an
applicable and significant threat, and when they perceive a response that would
feasibly and effectively avert the threat, they are motivated to control the danger
(protection motivation) by thinking of strategies to avert the threat (adaptive
outcomes). When danger control processes are dominating, individuals respond to
the danger, not to their fear. Conversely, when perceived threat is high, but
perceived efficacy is low, fear control processes are initiated. The fear originally
evoked by the personally relevant and significant threat becomes intensified when
individuals believe they are unable to effectively deter the threat. Thus, they
become motivated to cope with their fear (defensive motivation) by engaging in
maladaptive responses such as denial. When fear control processes are dominating,
individuals respond to their fear, not to the danger (Witte, 1992). Perceived threat
determines the degree or intensity of the reaction to the message, while perceived
efficacy determines the nature of the reaction.
Individual differences influence the appraisal of threat and efficacy. Each person
evaluates the components of a message in relation to his or her prior experiences,
culture and personality characteristics. Thus, the same fear appeal may produce
different perceptions in different people, thereby influencing subsequent outcomes
(Witte, 1992).
The study did not use this theory because of two reasons. The first reason is that the
theory appears to suggest that people can only respond to messages if they feel
individually threatened and they have the ability to respond effectively to avert the
threat. The messages conveyed during communication campaigns for mental health
do not only target those who are highly susceptible so that they can respond to the
fear based on their individual susceptibility and their response efficacy and self-
efficacy. Young members of society might be targeted with messages of mental
health problems affecting the elderly so that as care-givers they have knowledge of,
among others, seeking treatment and managing these mental health problems.
Similarly, adults might be targeted with messages of mental health problems
affecting children and young people with the aim of improving their knowledge and
ability as care-givers.
The second reason why the extended parallel process model was not used in this
study is because it does not explain other factors that can lead to either danger
control or fear control. It is not just prior experiences, culture and personality
characteristics that can influence danger control or fear control as suggested by the
model. For mental health problems, other factors would include availability or
unavailability of the following: psychiatrists, psychiatric facilities, affordable
medicine and medicine that do not have side effects. Another important factor will
be the chances of one healing completely once they have received medication. In
the health belief model such factors will be classified under the perceived benefits
and perceived barriers.
REFERENCES
Alzheimer’s Disease International (2012). World Alzheimer Report 2012:
Overcoming the stigma of dementia. London: Alzheimer’s Disease
International.
Albrecht, T. L. (1996). Advances in segmentation modeling for health
communication and social marketing campaigns. Journal of Health
Communication. 1(1), 65–80.
Airhinhenbuwa, C. O., & Obregon, R. (2000). A critical assessment of theories/
models used in health communication for HIV/AIDS. Journal of Health
Communication, 5, 5-15.
Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social
behaviour. New Jersey: Prentice-Hall.
Ajzen, I. (1991). The theory of planned behaviour. Organisational Behaviour and
Human Decision Processes. 50, 179-211, Retrieved from
www.unix.oit.umass.edu/~aizen/index.html.
Andreasen, A. (1997). Investing in social marketing. Journal of Health
Communication. 2(4), 315–316.
Ashton, C. M., Haidet, P., Paterniti, D. A., Collins, T. C., Gordon, H.S., O’Malley, K.,
Petersen, L. A., ... & Street R. L., (2003). Racial and ethnic disparities in the use
of health services. Journal of General Internal Medicine. 18, 146–152.
Atkin, C. K. (2001). Theory and principles of media health campaigns. In R. E. Rice
& C. K. Atkin (Eds.), Public communication campaigns (2nd ed., pp.49-68).
Thousand Oaks, CA: Sage.
Atwoli, L. (2012, June 17). IDPs still suffering poor mental health. Sunday Nation,
31.
Atwoli, L. (2011, August 21). Time to finally address stigma in mental health.
Sunday Nation, 35. th
Babbie, E. (2001). The Practice of Social Research (9 ed.). Belmont, CA:
Baker, T. L. (1994). Doing social research (2nd ed.). New York: McGraw-Hill Inc.
Bandura, A. (1997). Self-efficacy: The exercise of control. New York: Freeman.
Baran, S. J., & Davis, D. K. (2009). Mass communication theory: foundations, th
Barker, C., Pistrang, N., Shapiro, D.A., Davies, S., & Shaw, I. (1993). ‘You in Mind’
: A preventive mental health television series. British Journal of Clinical
Psychology, 32, 281-293.
Barry, M. M. (2007). Generic principles of effective mental health promotion.
International Journal of Mental Health Promotion, 9(2), 4-16.
Barry, M., & Jenkins, R. (2007). Implementing mental health promotion. Oxford:
Elsevier.
Barry, M. M., & McQueen, D. (2005). The nature of evidence and its use in mental
health promotion. In: H. Herrman, S. Saxena, & R. Moodie, (Eds.).
Promoting Mental Health: Concepts, emerging evidence, practice. A WHO
Report in collaboration the Victorian Health Promotion Foundation and the
University of Melbourne. Geneva: World Health Organization. Retrieved
from www.who. int/mental_health/evidence/MH_Promotion_Book. Pdf.
Baxter, L. A., & Babbie, E. (2003). The basics of communication research. Boston,
MA: Wadsworth, Cengage Learning.
Beaudoin, C. E. (2009). Evaluating a media campaign that targeted PTSD after
Hurricane Katrina. Health Communication, 24 (6), 515-523.
Becker, M. H. (1974). The health belief model and personal health behavior. Health
Education Monographs 2 (4), 324-473.
Belle, D., & Doucet, J. (2003). Poverty, inequality and discrimination as sources of
depression among U. S. women. Psychology of Women Quarterly, 27, 101-113.
Berg, L. B., & Lune, H. (2012). Qualitative Research Methods for the Social
Sciences (8th ed.). New Jersey: Pearson Education, Inc.
Bhugra, D. (2004). Migration and mental health. Acta psychiatrica scandinavica,
109, 243-258. Retrieved from [CrossRef][Web of Science ®][CSA] .
Bocha, G. (2012, March 9). “Witchcraft hinders war on epilepsy,” says medic.
Daily Nation, 34.
Boruch, R. (1996). Randomized experiments for planning and change. Thousand
Oaks, CA: Sage.
Bryman, A. L. (2012). Social Research Methods (4th ed.). Oxford: Oxford
University Press.
Brown, S. J., Lieberman, D. A., Gemeny, B. A., Fan, Y. C., Wilson, D. M., &
Pasta, D. J. (1997). Educational video game for juvenile diabetes: Results of a
controlled trial. Medical Informatics, 22 (1), 77-89.
Brug, J., Conner, M., Harre, N., Kremers, S., McKeller, S., & Whitelaw, S. (2005).
The transtheoretical model of change: a critique. Health Education Research,
20 (2) 244-258.
Brundtland, (2001) World Health Organization. The World Health Report: mental
disorders affect one in four people-message from the Director General.
Geneva: WHO. Retrieved from http://www.who.int/whr/2001/media
centre/press release/en/index.html
Burak, L. J., & Meyer, M. (1997). Using the health belief model to examine and
predict college women’s cervical cancer screening beliefs and behavior.
Health Care for Women International, 18 (3), 251-262.
Burns, J., Ellis, L., Mackenzie, A., & Nicholas, J. (2009). Reach Out! Innovation in
Mental Health Service Delivery for Young People. Counselling,
Psychotherapy, and Health, 5 (1), 171-190.
Chang, B. L., Bakken, S., Brown, S. S., Houston, T. K., Kreps, G. L., Kukafka, R.,
Safran, C., & Stavri. P. Z. (2004). Bridging the digital divide: Reaching
vulnerable populations. Journal of the American Medical Informatics
Association, 11(6), 448–457.
Chew, L. D., Bradley, K. A., & Boyko. E. J. (2004). Brief questions to identify
patients with inadequate health literacy. Family Medicine, 36, 588–594.
Commonwealth Department of Health & Aged Care (2000). Promotion, Prevention
and Early Intervention for Mental Health- A Monograph. Canberra: Mental
Health & Special Programs Branch, Commonwealth Department of Health &
Aged Care.
