The importance of theories and models in literature
Any effective health communication campaign has to be anchored on a relevant health
communication theory. A relevant theory will help a health communicator to
understand behavior that causes a health problem and the factors that influence it. The
theory will also offer the health communicator a framework upon which an effective
health communication campaign which will lead to behavior change among the target
audience will be based. Atkin (2001) observes that the first step of any communication
campaign is to analyse the behavioural aspects of the health problem. Naidoo and
Wills (2000) also observe that being able to predict behavior makes it easier to plan
an intervention. Similarly, Tones and Tilford (1994) argue that understanding
factors that influence behavior will help us to devise strategies and formulate
methods that will achieve our health education goals.
Corcoran (2007) explains that theory enables the practitioner to predict the
outcomes of interventions and the relationships between internal and external
variables. She continues explaining that theories generate a series of ideas for a
theory-led intervention to adopt. She adds that the purpose of theory is to enable the
successful exchange of information between the health promoter and the target
audience. In addition, Corcoran (2007) says, theory can help predict and explain
behaviours, assist in the targeting of information and predict the effect that
information will have and allow practitioners to predict why the audience may not
undertake a behavior no matter how much assistance or encouragement is available.
She also explains that models are derived from a simplified version of theory and
can be used to guide the development of health promotion programmes.
The importance of theories and models is emphasized by Trifiletti et al. (2005)
when they say that theories and models are useful in planning, implementing and
evaluating interventions. However, literature indicates that many health
communication interventions are not based on theory at all or use theory to guide
certain stages of health communication interventions and not others. Kobetz et al.
(2005) argue that theory is often used to inform the groundwork for health
promotion, but is usually given less attention during the implementation of
programmes. Jones and Donovan (2004) state that practitioners frequently ignore
theory, failing to use and implement theory-based interventions. They argue that
practitioners lack the skills and knowledge to operationalize the generic theories
and models available. Other reasons why practitioners fail to use theories are lack
of time, resources, expertise or evidence base to implement their knowledge
(Corcoran, 2007).
Although theory is central to the success of health communication programmes, it
has some limitations. Tones and Green (2004) highlight the concern that theory
objectifies human experience and through this process deviates from the main
health promotion ethos of holism and empowerment. This means that a person is
seen as someone who can be measured, analysed, adjusted or directed.
Airhihenbuwa and Obregon (2000) suggest that theoretical frameworks should not
be rigid but flexible and therefore applicable to different contexts. They suggest
that theory should be used as a means to guide the understanding of complex
behavior. Parker et al. (2004) suggest that designing interventions that attempt to
focus on all aspects of a model may be both daunting and unrealistic.
In addition, Corcoran (2007) says that the other criticism of the theory-based
approach is that structural, political and environmental factors are excluded in
many theoretical models. Behaviour and influences on behavior are altered by the
wider societal context and theory often focuses on individuals only. This approach
alone will not be effective without other enabling factors present to assist the
facilitation of a behavior change. Corcoran (2007) adds that when designing
communication campaigns, supportive environments are available to facilitate
change. She argues that wider societal influences are sometimes difficult to control.
There are a number of theories that can and have been used in the communication
of health. These include the theory of planned behavior, the health belief model, the
extended parallel process model, the trans theoretical model, the process of
behavior change, the symbolic interactionism theory and the social marketing
theory.
Conceptual framework
The knowledge, attitudes and beliefs that people have regarding mental illnesses
and the mentally ill are as a result of the meanings they have assigned them. These
meanings are expressed in the language that people use which reflects their level of
knowledge, attitudes and beliefs. The knowledge, attitudes and beliefs of a
community influence individual thoughts. They are also shaped by one’s
understanding of self. One’s portrait of oneself in relation with knowledge, attitudes
and beliefs on mental illnesses and the mentally ill are closely related to one’s
community’s portrait.
If knowledge levels are low, stigma is high. Consequently, the meanings people
have assigned mental illnesses and the mentally ill are discriminatory. They will not
perceive their susceptibility to mental illnesses, the severity of those illnesses and
the benefits of obtaining knowledge of mental illnesses or even seeking treatment.
They will see barriers such as mental illnesses not being treatable in hospitals.
Failure to take appropriate action such as seeing a psychiatrist will be as a result of
lack of confidence due to lack of knowledge. And if all this happens even after
communication campaigns for mental health have taken place, then the
communication campaigns are ineffective and people either reject, do not
comprehend or are unaware of the messages of those communication campaigns.
Factors that can lead to rejection, lack of comprehension or awareness of health
messages include low reach, lack of repetition of the message, the message not
being timely, cultural inappropriateness, the language used being too technical, age,
gender, peer pressure and prior contact with the disease (Corcoran, 2007).
However, if effective communication campaigns are conducted, knowledge levels will
increase and positive attitudes and beliefs about mental illnesses and the mentally ill
will be embraced. This study therefore had three variables: communication campaigns,
modifying factors and communication outcomes. Communication campaigns were the
independent variable; knowledge levels were the dependent variables while modifying
factors included age, gender and socioeconomic status.
Independent Variables
Mental Health
Knowledge Levels
High
Low
Components of Mental
Health Messages
Perceived
susceptibility
Perceived
severity
Benefits
Barriers
Cues to action
Effectiveness of
communication
campaigns
Accuracy
Availability
Repetition
Theory-based
Link media
strategies with
community
Dependent Variable
Mental Health Behaviour
Change
Positive
Negative
Demographic factors
Age
Gender
Socioeconomic factors
Modifying variables
Figure 2.1: The conceptual framework
Source: Researcher 2022
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