The impact of communications on the self-regulation of health beliefs, decisions, and behavior.

The models used in the study of communication and health behavior have changed from those describing how to impose health actions on relatively passive respondents to models describing how respondents regulate their own health practices. We have traced the change from the fear-drive model, which described how fear induced change, to the parallel response model, which described how subjects processed information and generated coping responses to solve the problem posed by both the objective health threat and by their subjective fear. The data supporting this change showed that increasing fear led to more favorable attitudes but that fear alone was insufficient to create action: Specific action instructions had to be added to both high and low fear and both combinations produced the same level of health action. Neither the data nor the parallel model specified what subjects learned about the threat that made exposure to a high or low fear message necessary for behavior change. The parallel response model has been elaborated into a more complete systems model and new studies show how health threats are represented. They have found attributes such as IDENTITY (label and symptoms), CAUSES, TIME LINES or duration, and CONSEQUENCES, that set goals and criteria to generate and evaluate problem solving (coping) behavior. Suggestions are made for applying this more complete model to public health practice.