Communication Studies 394-0: Undergraduate Research Seminar

Section 24: Persuasion in Health Contexts

Spring 2021






4. Risk perception and risk communication


4.1  Risk appraisal/perception

4.2  The relationship of risk perception and behavior

4.3  Interventions to alter risk perceptions

4.4  Risk communication: Some loose ends



4.1  Risk appraisal/perception


            Rothman, A. J., Klein, W. M., & Weinstein, N. D. (1996). Absolute and relative biases in estimations of personal risk. Journal of Applied Social Psychology, 26, 1213-1236. doi:10.1111/j.1559-1816.1996.tb01778.x

            Viscusi, W. K. (1990). Do smokers underestimate risks? Journal of Political Economy, 98, 1253-1269.



For further reading:

            Helweg-Larsen, M., & Shepperd, J. A. (2001). Do moderators of the optimistic bias affect personal or target risk estimates? A review of the literature. Personality and Social Psychology Review, 5, 74-95.

            Klein, C. T. F., & Helweg-Larsen, M. (2002). Perceived control and the optimistic bias: A meta-analytic review. Psychology and Health, 17, 437–446. doi:10.1080/0887044022000004920

            Dillard, A. J., McCaul, K. D., & Klein, W. M. P. (2006). Unrealistic optimism in smokers: Implications for smoking myth endorsement and self-protective motivation. Journal of Health Communication, 11(Suppl. 1), 93-102.

            Viscusi, W. K., & Hakes, J. H. (2008). Risk beliefs and smoking behavior. Economic Inquiry, 46, 45-59.

            Harris, P. R., Griffin, D. W., & Murray, S. (2008). Testing the limits of optimistic bias: Event and person moderators in a multilevel framework. Journal of Personality and Social Psychology, 95, 1225-1237. doi:10.1037/a0013315

            Hevey, D., French, D. P. Marteau, T. M., & Sutton, S. (2009). Assessing unrealistic optimism:  Impact of different approaches to measuring susceptibility to diabetes. Journal of Health Psychology, 14, 372-377.

            Gold, R. S., & Brown, M. G. (2009). Explaining the effect of event valence on unrealistic optimism. Psychology, Health & Medicine, 14, 262-272. doi:10.1080/13548500802241910

            Rose, J. P. (2010). Are direct or indirect measures of comparative risk better predictors of concern and behavioural intentions? Psychology and Health, 25, 149-165.

            Kim, H. K., & Niederdeppe, J. (2013). Exploring optimistic bias and the integrative model of behavioral prediction in the context of a campus influenza outbreak. Journal of Health Communication, 18, 206-222. doi:10.1080/10810730.2012.688247

            El-Toukhy, S. (2015). Parsing susceptibility and severity dimensions of health risk perceptions. Journal of Health Communication, 20, 499-511. doi:10.1080/10810730.2014.989342

            Taber, J. M., & Klein, W. M. P. (2016). The role of conviction in personal disease risk perceptions: What can we learn from research on attitude strength? Social and Personality Psychology Compass, 10, 202-218.  doi:10.1111/spc3.12244

            Alsaleh, M., Alomar, N., & Alarifi, A. (2017). Smartphone users: Understanding how security mechanisms are perceived and new persuasive methods. PLoS One, 12, e0173284. doi:10.1371/journal.pone.0173284

4.2  The relationship of risk perception and behavior


            Eiser, J. R., & Cole, N. (2002). Participation in cervical screening as a function of perceived risk, barriers and need for cognitive closure. Journal of Health Psychology, 7, 99-105. 

            McCaul, K. D., Branstetter, A. D., Schroeder, D. M., & Glasgow, R. E. (1996). What is the relationship between breast cancer risk and mammography screening? A meta-analytic review. Health Psychology, 15, 423-429.



For further reading:

            Weinstein, N. D., & Nicolich, M. M. (1993). Correct and incorrect interpretations of correlations between risk perceptions and risk behaviors. Health Psychology, 12, 235-245.

            Bengel, J., Belz-Merk, M., & Farin, E. (1996). The role of risk perception and efficacy cognitions in the prediction of HIV-related preventive behavior and condom use. Psychology and Health, 11, 505-525.

            Gerrard, M., Gibbons, F. X., & Bushman, B. J. (1996). Relation between perceived vulnerability to HIV and precautionary sexual behavior. Psychological Bulletin, 119, 390-409.

            van der Pligt, J. (1998). Perceived risk and vulnerability as predictors of precautionary behaviour. British Journal of Health Psychology, 3, 1-14.

            Diefenbach, M. A., Miller, S. M., & Daly, M. B. (1999). Specific worry about breast cancer predicts mammography use in women at risk for breast and ovarian cancer. Health Psychology, 18, 532-536.

            Thornton, B., Gibbons, F. X., & Gerrard, M. (2002). Risk perception and prototype perception: Independent processes predicting risk behavior. Personality and Social Psychology Bulletin, 28, 986-999.

            Brewer, N. T., Weinstein, N. D., Cuite, C. L., & Herrington, J. E. (2004). Risk perceptions and their relation to risk behavior. Annals of Behavioral Medicine, 27, 125-130.

            Brewer, N. T., Chapman, G. B., Gibbons, F. X., Gerrard, M., McCaul, K. D., & Weinstein, N. D. (2007). Meta-analysis of the relationship between risk perception and health behavior: The example of vaccination. Health Psychology, 26, 136-145.

            Gerrard, M., Gibbons, F. X., Houlihan, A. E., Stock, M. L., & Pomery, E. A. (2008). A dual-process approach to health risk decision making:  The prototype willingness model. Developmental Review, 28, 29-78.

            Aiken, L. S., Gerend, M. A., Jackson, K. M., & Ranby, K. W. (2011). Subjective risk and health-protective behavior: Prevention and early detection. In A. Baum, T. A. Revenson, & J. Singer (Eds.), Handbook of health psychology (pp. 113-145). New York: Routledge. doi:10.4324/9780203804100.ch6

            Taylor, W. D., & Snyder, L. A. (2017). The influence of risk perception on safety: A laboratory study. Safety Science, 95, 116-124. doi:10.1016/j.ssci.2017.02.011

4.3  Interventions to alter risk perceptions


            Weinstein, N. D., & Klein, W. M. (1995). Resistance of personal risk perceptions to debiasing interventions. Health Psychology, 14, 132-140.

            Kreuter, M. W., & Strecher, V. J. (1995). Changing inaccurate perceptions of health risk: Results from a randomized trial. Health Psychology, 14, 56-63.



For further reading:

            McBride, C. M., Halabi, S., Bepler, G., Lyna, P., McIntyre, L., Lipkus, I., Albright, J., & O’Briant, K. (2000). Maximizing the motivational impact of feedback of lung cancer susceptibility on smokers’ desire to quit. Journal of Health Communication, 5, 229-241.

            Thompson, S. C., Kyle, D., Swan, J., Thomas, C., & Vrungos, S. (2002). Increasing condom use by undermining perceived invulnerability to HIV. AIDS Education and Prevention, 14, 505-514.

            Menon, G., Block, L. G., & Ramanathan, S. (2002). We’re at as much risk as we are led to believe: Effects of message cues on judgments of health risk. Journal of Consumer Research, 28, 533-549.

            Weinstein, N. D., Atwood, K., Puleo, E., Fletcher, R., Colditz, G., & Emmons, K. M. (2004). Colon cancer: Risk perceptions and risk communication. Journal of Health Communication, 9, 53-65.

            Emmons, K. M., Wong, M., Puleo, E., Weinstein, N., Fletcher, R., & Colditz, G. (2004). Tailored computer-based cancer risk communication: Correcting colorectal cancer risk perception. Journal of Health Communication, 9, 127-142.

            Robb, K. A., Campbell, J., Evans, P., Miles, A., & Wardle, J. (2008). Impact of risk information on perceived colorectal cancer risk: A randomized trial. Journal of Health Psychology, 13, 744-753.

            Mevissen, F. E. F., Meerteens, R. M., Ruiter, R. A. C., Feenstra, H., & Schaalma, H. P. (2009). HIV/STI risk communication: The effects of scenario-based risk information and frequency-based risk information on perceived susceptibility to Chlamydia and HIV. Journal of Health Psychology, 14, 78-87. doi:10.1177/1359105308097948

            Portnoy, D. B., Ferrer, R. A., Bergman, H. E., & Klein, W. M. P. (2014). Changing deliberative and affective responses to health risk: A meta-analysis. Health Psychology Review, 3, 296-318. doi:10.1080/17437199.2013.798829

            Sheeran, P., Harris, P. R., & Epton, T. (2014). Does heightening risk appraisals change people’s intentions and behavior? A meta-analysis of experimental studies. Psychological Bulletin, 140, 511-543. doi:10.1037/a0033065

            Sweeny, K., & Dillard, A. (2014). The effects of expectation disconfirmation on appraisal, affect, and behavioral intentions. Risk Analysis, 34, 711-720. doi:10.1111/risa.12129

            Kim, H. K., & Niederdeppe, J. (2016). Effects of self-affirmation, narratives, and informational messages in reducing unrealistic optimism about alcohol-related problems among college students. Human Communication Research, 42, 246–268. doi:10.1111/hcre.12073

            Ahn, S. J. (2018). Virtual exemplars in health promotion campaigns: Heightening perceived risk and involvement to reduce soft drink consumption in young adults. Journal of Media Psychology, 30, 91-103. doi:10.1027/1864-1105/a000184

            Huang, G., Li, K., & Li, H. (2019). Show, not tell: The contingency role of infographics versus text in the differential effects of message strategies on optimistic bias. Science Communication, 41(6), 732-760.


4.4  Risk communication: some loose ends


4.4.1  Alternative expressions of risk


For further reading:

            Brase, G. L. (2002). Which statistical formats facilitate what decisions? The perception and influence of different statistical information formats. Journal of Behavioral Decision Making, 15, 381-401.

            Gigerenzer, G. (2002). Reckoning with risk: Learning to live with uncertainty. London, UK: Penguin Press.  [see esp. pp. 39-86: chapter 4 (“Insight”) and chapter 5 (“Breast cancer screening”)]

            Raghubir, P. (2008). Is 1/10>10/100? The effect of denominator salience on perceptions of base rates of health risk. International Journal of Research in Marketing, 25, 327-334.

            Timmermans, D. R. M., Ockhuysen-Vermey, C. F., & Henneman, L. (2008). Presenting health risk information in different formats: The effect on participants’ cognitive and emotional evaluation and decisions. Patient Education and Counseling, 73, 443-447.

            Young, S., & Oppenheimer, D. M. (2009). Effect of communication strategy on personal risk perception and treatment adherence intentions. Psychology, Health & Medicine, 14, 430-442.

            Visschers, V. H. M., Meertens, R. M., Passchier, W. W. F., & de Vries, N. N. K. (2009). Probability information in risk communication: A review of the research literature. Risk Analysis, 29, 267-287. doi:10.1111/j.1539-6924.2008.01137.x 

            Skubisz, C., Reimer, T., & Hoffrage, U. (2009). Communicating quantitative risk information. Communication Yearbook, 33, 174-211.

            Waldron, C.-A., van der Weijden, T., Ludt, S., Gallacher, J., & Elwyn, G. (2011). What are effective strategies to communicate cardiovascular risk information to patients? A systematic review. Patient Education and Counseling, 82, 169–181. doi:10.1016/j.pec.2010.04.014

            Akl, E. A., Oxman, A. D., Herrin, J., Vist, G. E., Terrenato, I., Sperati, F., Costiniuk, C., Blank, D., & Schünemann, H. (2011). Using alternative statistical formats for presenting risks and risk reductions. Cochrane Database of Systematic Reviews, 10, 1-87. doi:10.1002/14651858.CD006776.pub2

            Büchter, R. B., Fechtelpeter, D., Knelangen, M., Ehrlich, M., & Waltering, A. (2014). Words or numbers? Communicating risk of adverse effects in written consumer health information: A systematic review and meta-analysis. BMC Medical Informatics And Decision Making, 14, article no. 76. doi:10.1186/1472-6947-14-76

            Zipkin, D. A., Umscheid, C. A., Keating, N. L., Allen, E., Aung, K., Beyth, R., Kaatz, S., Mann, D. M., Sussman, J. B., Korenstein, D., Schardt, C., Nagi, A., Sloane, R., & Feldstein, D. A. (2014). Evidence-based risk communication: A systematic review. Annals of Internal Medicine, 161, 270-280. doi:10.7326/M14-0295

            Pighin, S., Gonzalez, M., Savadori, L., & Girotto, V. (2016). Natural frequencies do not foster public understanding of medical test results. Medical Decision Making, 36, 686-691. doi:10.1177/0272989X16640785

            Barnes, A. J., Hanoch, Y., Miron-Shatz, T., & Ozanne, E. M. (2016). Tailoring risk communication to improve comprehension: Do patient preferences help or hurt? Health Psychology, 35, 1007-1016. doi:10.1037/hea0000367

            Moyer, A., Siess, S., & Bhinder, S. (2017). How are non-numerical prognostic statements interpreted and are they subject to positive bias? BMJ Supportive & Palliative Care, 7, 415-418. doi:10.1136/bmjspcare-2017-001331

            Koo, K., Brackett, C. D., Eisenberg, E. H., Kieffer, K. A., & Hyams, E. S. (2017). Impact of numeracy on understanding of prostate cancer risk reduction in PSA screening. PLOS ONE, 12, e0190357. doi:10.1371/journal.pone.0190357

            Damman, O. C., Vonk, S. I., van den Haak, M. J., van Hooijdonk, C. M. J., & Timmermans, D. R. M. (2018). The effects of infographics and several quantitative versus qualitative formats for cardiovascular disease risk, including heart age, on people's risk understanding. Patient Education and Counseling, 101, 1410-1418. doi:10.1016/j.pec.2018.03.015

            Janssen, E., Ruiter, R. A. C., & Waters, E. A. (2018). Combining risk communication strategies to simultaneously convey the risks of four diseases associated with physical inactivity to socio-demographically diverse populations. Journal of Behavioral Medicine, 41, 318-332. doi:10.1007/s10865-017-9894-3

        Lee, B., Liu, J., Choung, H., & McLeod, D. M. (in press). Exploring numerical framing effects: The interaction effects of gain/loss frames and numerical presentation formats on message comprehension, emotion, and perceived issue seriousness. Journalism & Mass Communication Quarterly.  doi:10.1177/1077699020934195

            Liu, J., & Niederdeppe, J. (in press). Effects of communicating prevalence information about two common health conditions. Health Communication. doi:10.1080/10410236.2021.1895417





4.4.2  General risk communication items


For further reading:

               Leiss, W. (1996). Three phases in the evolution of risk communication practice. Annals of the American Academy of Political and Social Science, 545, 85-94.

               Menon, G., Raghubir, P., & Agrawal, N. (2008). Health risk perceptions and consumer psychology. In C. P. Haugtvedt, P. M. Herr, & F. R. Kardes (Eds.), Handbook of consumer psychology (pp. 981-1010). New York: Lawrence Erlbaum.

               Fischhoff, B., Brewer, N. T., & Downs, J. T. (Eds.). (2011). Communicating risks and benefits: An evidence-based user’s guide. Washington, DC: Food and Drug Administration (FDA), US Department of Health and Human Services. available on the FDA’s Web site at: default.htm

               Turner, M. M., Skubisz, C., & Rimal, R. N. (2011). Theory and practice in risk communication: A review of the literature and visions for the future. In T. L. Thompson, R. Parrott, & J. F. Nussbaum (Eds.), Routledge handbook of health communication (2nd ed., pp. 146-164). New York: Routledge.

               Cho, H., Reimer, T., & McComas, K. A. (Eds.). (2015). The Sage handbook of risk communication. Los Angeles, CA: Sage.

               Frewer, L. J., Fischer, A. R. H., Brennan, M., Bánáti, D., Lion, R., Meertens, R. M., Rowe, G., Siegrist, M., Verbeke, W., & Vereijken, C. M. J. L. (2016). Risk/benefit communication about food: A systematic review of the literature. Critical Reviews in Food Science and Nutrition, 56, 1728-1745. doi:10.1080/10408398.2013.801337

               Balog-Way, D., McComas, K., & Besley, J. (2020). The evolving field of risk communication. Risk Analysis, 40(51), 2240-2262.  





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