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Applications of Selective Exposure and Attention to Information for Understanding Health and Health Disparities
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Applications of Selective Exposure
and Attention to Information for
Understanding Health and Health
Disparities
ALLISON EARL and CHRISTINA NISSON
Abstract
In this essay, we discuss how social psychological work on selective exposure and
attention can be used to understand information selection decisions in a health context. In particular, we begin with an overview of the selective exposure and attention
literatures, including a summary of literature suggesting that people are more likely
to seek out (selective exposure) and pay attention to (selective attention) information
they agree versus disagree with. We then discuss various motives that may influence
information selection and attention. Finally, we conclude with a summary of how the
work on selective exposure and attention can be brought to bear on health message
design and reduction of health disparities.
INTRODUCTION
Interventions designed to change health behaviors often assume that the people who could most benefit from the intervention are the ones receiving the
message. Ironically, but perhaps not surprisingly, people are less likely to
seek out and pay attention to messages that advocate changing what they
are currently doing. Interventionists may, in fact, be preaching to the choir,
rather than reaching target audiences. Unfortunately, this suggests limited
efficacy of health intervention programs that could ultimately be successful
if received by target audiences.
FOUNDATIONAL RESEARCH
What do you do if you want to persuade people to change their attitudes or
behaviors? For instance, what is the best way to convince someone that smoking is bad for them, or to engage in safer-sex behaviors such as condom use?
Emerging Trends in the Social and Behavioral Sciences. Edited by Robert Scott and Stephen Kosslyn.
© 2015 John Wiley & Sons, Inc. ISBN 978-1-118-90077-2.
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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES
One strategy that has received much attention by both persuasion researchers
and lay theorists alike has been to design an advertising campaign or intervention program directed at changing a specific set of beliefs or behaviors
(e.g., “Don’t Smoke” or “Use a Condom”). However, this strategy is only
effective up to the point that the target audience actually sees and pays attention to the message. Unfortunately, 60 years of social psychological research
suggests that exposure and attention to persuasive messages may be critical
barriers to address, as people are more likely to both seek out and pay attention to information they agree with compared to information they disagree
with (Eagly, Chen, Chaiken, & Shaw-Barnes, 1999; Festinger, 1964; Frey, 1986;
Hart et al., 2009). One consequences of this bias is that persuasive campaigns
may simply be preaching to the choir, without reaching the audiences for
whom they are intended.
Preferential selection of, and attention to, messages that are supportive
(vs challenging) of one’s attitudes or behaviors are well-established phenomena in the social psychological literature. Recent meta-analytic evidence
suggests that people show a selective exposure bias by preferring information that is supportive (vs challenging) of their own attitudes or behaviors
(d = 0.36; Hart et al., 2009). Similarly, people are more likely to store and recall
attitude-supportive versus attitude-challenging information from memory,
a phenomenon labeled selective attention (d = 0.23; Eagly et al., 1999).
Message reception by target audiences may be difficult because people
selectively attend to information. No matter how many times an intervention
program is offered or prevention messages are played in the waiting room
of a health clinic, clients can always tune out the message. For instance,
prejudiced people are less likely to attend to anti-prejudice propaganda
than nonprejudiced people (Cooper & Jahoda, 1947). Furthermore, heavy
drinkers tend to watch more advertisements for alcohol than do light
drinkers and nondrinkers (Perrissol, Boscher, Cerclé, & Somat, 2005). In
the area of human immunodeficiency virus (HIV)-prevention, participants
with higher motivation to use condoms, stronger condom use behavioral
skills, and more frequent past condom use are more likely to accept an
HIV-prevention counseling session than participants with lower scores on
these dimensions (Earl et al., 2009).
PREDICTING ATTENTION TO HEALTH INFORMATION
Several models have been proposed to conceptualize the process from
information reception to behavior change (Greenwald, 1968; McGuire, 1968;
Petty & Cacioppo, 1986). According to McGuire’s (1968) reception-yielding
model, receiving a message can be separated into three discrete steps:
exposure, attention, and comprehension. In this model, exposure involves
Applications of Selective Exposure and Attention to Information
3
initial presentation of a persuasive message, attention concerns whether or
not participants choose to attend to the information, and comprehension
entails whether or not participants understand the persuasive message.
In the case of health information, it is rarely the case that people have not
been exposed to at least some information. On the contrary, prior work
suggests that people often feel inundated with informational overload
(Bargh & Thein, 1985; Edmunds & Morris, 2000), particularly in a health
context (Cline & Haynes, 2001; Hall & Walton, 2004). Furthermore, health
clinics and hospitals frequently play educational videos in their waiting
rooms to give clients additional exposure to messages, and high school
students are often required to go through health classes that feature health
education (Centers for Disease Control and Prevention, 2012). However,
presentation of information does not necessarily ensure that participants
will pay attention to messages.
Models of attention frequently differentiate information processing as
a function of amount of attentional resources allocated to a particular
stimulus. For instance, Broadbent’s (1958) filter theory of early selection
posits that sensory stimuli are selectively filtered, with attended stimuli
being further processed and unattended stimuli being summarily ignored.
In contrast, Deutsch and Deutsch (1963) posit a late disengagement model in
which all stimuli are initially processed, at least until an object is identified,
at which point selective processing occurs. Work by Posner and Peterson
(1990) integrated these two seeming disparate viewpoints by suggesting
that three attentional systems of alerting, orienting, and executive control
may operate independently. In particular, alerting is related to achieving and
maintaining a state of alertness, orienting refers to selection of information
from sensory input, and executive control is defined as resolving conflict
among responses (Posner & Peterson, 1990).
MEASURING SELECTIVE EXPOSURE AND SELECTIVE ATTENTION
Selective exposure is frequently measured by the amount of supportive (congenial) versus challenging (uncongenial) information participants choose to
view. In a typical selective exposure paradigm, participants may be asked to
select from among arguments on both sides of an issue (e.g., the validity of
an intelligence test: Frey & Stahlberg, 1986). In this case, selective exposure
would be calculated by creating a difference score between the number of
congenial articles selected and the number of uncongenial articles selected.
Selective exposure can also be measured by recording whether or not participants enroll in an intervention program (Earl et al., 2009), or if people recall
seeing a public service announcement on television (Siska, Jason, Murdoch,
Yang, & Donovan, 1992).
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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES
Common measures of selective attention include self-reported attention to
a message (e.g., “How much attention did you pay to the message”), recall
and recognition measures of message content (e.g., “What did you read
about”), as well as behavioral measures of amount of time spent reading a
message or coders’ observation of overt attention to a message. Recently, psychophysiological measures have been used to measure eye-gaze, as well as
brain electrical response to messages [e.g., event-related potentials (ERPs) or
functional magnetic resonance imaging (fMRI); Falk, 2010; Ruiter, Kessels,
Jansma, & Brug, 2006]. These approaches have distinct advantages and
drawbacks. For instance, self-report measures are cheap and easy to administer, but are subject to biases in reporting (Nisbett & Wilson, 1977; Schroder,
Carey, & Vanable, 2003). Physiological measures (e.g., eye-tracking, ERP,
and fMRI) are expensive and open to interpretation, but are not dependent
on participant’s conscious awareness of attentional allocation.
MOTIVES UNDERLYING SELECTIVE EXPOSURE AND SELECTIVE ATTENTION
Both selective exposure and selective attention are driven by defense,
impression, and accuracy motives (Chaiken, Giner-Sorolla, & Chen, 1996;
Chaiken, Liberman, & Eagly, 1989; Hart et al., 2009). For instance, activation
of a defense motive drives people to buffer current beliefs and behaviors
from attack, and promotes avoidance of information that threatens current
views and approach to information that supports current views. Activation of an impression motive heightens concerns about how selecting or
attending to information would influence perceptions about the self, and
would facilitate the selection of information that would help convey a
desired identity or image to an audience and avoidance of information that
undermines a desired identity (Schlenker, 1980). In contrast, activation of an
accuracy motive drives people to form and maintain beliefs and behaviors
that are consistent with relevant information, and would prompt selection
of information evenhandedly, and as well as a preference for high quality
compared to low quality information regardless of its stance on an issue.
There are several factors that may spark defense motivation and subsequent avoidance of uncongenial information. For instance, defense motives
are likely to operate when participants feel committed to a decision (Brehm
& Cohen, 1962; Kiesler, 1971), when the issue is relevant to important values (Johnson & Eagly, 1989), or when participants are close minded (Adorno,
Frenkel-Brunswik, Levinson, & Sanford, 1950). In addition, dispositional perceptions of one’s inability to defend personal views from persuasive attacks
may promote avoidance of dissenting opinions (Albarracín & Mitchell, 2004;
Albarracín, Durantini, Earl, Gunnoe, & Leeper, 2008). In contrast, increasing
one’s perceived ability to defend cherished beliefs may facilitate approach
Applications of Selective Exposure and Attention to Information
5
to attitude-inconsistent information (Albarracin, Leeper, Earl, & Durantini,
2008; Albarracín & Mitchell, 2004). More generally, receiving a threat to the
self immediately before exposure to either supporting or threatening information increases avoidance of threatening information (Frey, 1986), as does
receiving a threat after recently reporting a position or belief (Festinger, 1964).
In the context of health information seeking, examining perceptions of one’s
ability to defend oneself may be particularly relevant for those with chronically low perceived power or self-efficacy, as these groups are often the target
audiences of health promotion campaigns. A second factor that may influence avoidance of dissenting opinions is commitment to the beliefs or behaviors in question. For instance, participants avoid information that challenges
their current beliefs or behaviors, but only for those beliefs that are strongly
held and thus represent a threat (Brehm & Cohen, 1962). Similarly, making participants self-aware may produce avoidance of threatening information, presumably because heightened awareness of one’s own beliefs should
lead to unwillingness to be inconsistent, even to the self (Diener & Srull,
1979). In the case of health promotion, heightened self-awareness may trigger
beliefs that threatening health messages (i.e., messages that contradict one’s
self-views) are irrelevant and thus not deserving of attention.
Furthermore, the decision to attend to health information may be based,
in part, on the impression that seeking this information might make on
others. The focus on external evaluations triggered by impression motives
is often separate from the focus on internal evaluations triggered by defense
motives. According to impression management theory, people are motivated
to control the perceptions others have of them (Schlenker, 1980) and focus
on the interpersonal outcomes of a given behavior (Chaiken, Giner-Sorolla,
et al., 1996). As a result, people are aware of the views of others and take
those views into account before they act (Chaiken, Giner-Sorolla, et al., 1996;
Schlenker, 1980). There are likely several factors that trigger impression
motives. For instance, chronic sensitivity to rejection entails heightened
awareness of others and their evaluations of one’s behavior (Downey &
Feldman, 1996). Similarly, the presence of others may also influence the
activation of impression motives by heightening norms about how to
behave (Ajzen & Fishbein, 2005; Goffman, 1963; Shah, 2003). In addition,
telling participants that they will be discussing an issue after reading
information also prompts activation of an impression motive and a focus
on self-presentational concerns (Leippe & Elkin, 1987). In contrast, heightening accuracy concerns in addition to an impression motive manipulation
mitigates bias in information search (Lundgren & Prislin, 1998).
In contract, accuracy motives may have opposing effects on information
processing compared to defense and impression motives. In particular, activation of an accuracy motive should increase seeking of high quality versus
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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES
low quality information, regardless of its congeniality (Lowin, 1967, 1969;
Lundgren & Prislin, 1998). Accuracy motives are likely to operate when the
issue is tied to an outcome or performance (e.g., you have to give a speech
later on the topic; Johnson & Eagly, 1989), and when the utility of the information is high (Canon, 1964; Freedman, 1965).
CUTTING-EDGE RESEARCH
APPLICATIONS TO HEALTH: FOCUS ON MESSAGE CHARACTERISTICS
The principles of selective exposure and attention can be applied to increase
the efficacy of public health campaigns by ensuring that target audiences
actually receive the message. One strategy to increase attention to health promotion campaigns has been to focus on features of the message that may facilitate attention. For instance, patients who were discharged from the ER with
wound-care information that contained both text and pictures were more
likely to report reading the information than patients who received the text
information alone (Delp & Jones, 1996). More broadly, a review of graphics
on attention to health information suggest that pictures linked to written or
spoken text can significantly increase attention to and recall of health information when compared to text alone (Houts, Doak, Doak, & Loscalzo, 2006).
Perhaps the most widely researched message characteristic in selective
attention to health information is the presence of threatening information.
Public health campaigns often use threatening information as a means of
conveying risk and reducing the occurrence of an unhealthy behavior (e.g.,
graphic anti-smoking ads). Unfortunately, however, numerous studies now
indicate that participants may be less likely to attend to messages containing threatening information compared to similar low threat messages
(Albarracin et al., 2005; Brown & Richardson, 2012; Earl & Albarracin, 2007;
Kessels, Ruiter, & Jansma, 2010). For example, Brown and Richardson (2012)
found that anti-alcohol persuasive messages paired with distressing images
resulted in lower message gaze time, which further resulted in lower intentions to reduce drinking in the following three months compared to the same
messages paired with less distressing images. Furthermore, meta-analytic
evidence in the area of HIV-prevention suggests that fear appeals decrease
learning about health recommendations, both immediately following the
intervention as well as longitudinally (Earl & Albarracin, 2007). Other highly
researched message characteristics in this area include the benefit of tailored
versus nontailored interventions (Kessels et al., 2010; Ruiter et al., 2006), gain
versus loss framed health messages (O’Malley & Latimer, 2012; Rothman
& Salovey, 1997), and novel versus familiar information (Fox, Krugman,
Fletcher, & Fischer, 1998; Krugman, Fox, Fletcher, Fischer, & Rojas, 1994).
Applications of Selective Exposure and Attention to Information
7
APPLICATIONS TO HEALTH: INTERACTION bETWEEN AUDIENCE AND MESSAGE
CHARACTERISTICS
Research on selective attention in public health has also focused on the
interaction between audience and message characteristics. For instance,
investigating how specific audiences (e.g., adolescents) may process messages related to specific health topics (e.g., cigarette ads; Krugman et al.,
1994). In addition, meta-analytic work suggests that the decision whether
or not to enroll in an intervention program may be based in part on if the
intervention program meets individual preferences. For example, men are
more likely to enroll in HIV-prevention intervention programs when they
provide instrumental and financial resources (e.g., payments), whereas
women are more likely to enroll when programs are run in a group format
(vs individual counseling; Durantini & Albarracin, 2009). Furthermore,
disenfranchised groups prefer interventions led by experts compared to
peers (Durantini, Albarracin, Mitchell, Earl, & Gillette, 2006). In addition,
acceptance of low investment intervention strategies (e.g., brochures) can
lead to greater acceptance of high investment intervention strategies (e.g.,
counseling sessions; Albarracin et al., 2008). This work lends support to the
notion that taking both the message and the audience into consideration
when designing an intervention program is critical to success.
Beyond demographic variables, another example of work examining the
interplay of message and audience characteristics involves the study of attention to health information as a function of health optimism. In particular,
those high versus low in health optimism are more likely to attend to threatening health information (Aspinwall & Brunhart, 1996). Furthermore, understanding that audiences may differentially react to features of health message
is a key tenant of the message-framing effects literature (e.g., Rothman &
Salovey, 1997). Although the dependent measures in these studies are often
intention change, rather than attention, this work may be brought to bear on
understanding the parameters of selective exposure and selective attention
in a health context.
APPLICATIONS TO HEALTH: HEALTH DISPARITIES
Disenfranchised groups often bear the brunt of disease burden (National
Association of Chronic Disease, 2010). For instance, African-Americans
relative to European-Americans carry a disproportionate weight of a wide
variety of conditions including heart disease, hypertension, cancer, diabetes,
stroke, and HIV (Centers for Disease Control and Prevention, 2005). These
disparities in health outcomes across groups may be triggered by myriad
causes. For instance, African-Americans compared to European-Americans
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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES
may have systemically less access to healthcare, incomplete or nonexistent
insurance coverage, or may simply not receive necessary medical procedures (Agency for Healthcare Research and Quality, 2000; Center for Health
Equity Research and Promotion, 2010). From a public health perspective, the
existence of health disparities suggests that work is needed to ensure that all
people receive needed medical care and prevention services.
Although past work has been done to address health disparities at a
system level (Agency for Healthcare Research and Quality, 2000; Center
for Health Equity Research and Promotion, 2010), comparatively little
has been done to examine how individual level factors may also perpetuate these gaps. For instance, health disparities may also be due in
part to discomfort and unwillingness to approach health information by
African-Americans. One possibility is that attention to HIV-prevention
information may be modulated by how identity-congruent attending to
information is perceived to be. Work by Oyserman, Fryberg, and Yoder
(2007) suggests that health disparities for African-American and Latino
children may be explained, in part, by the perceived discrepancy between
engaging in healthy behaviors and children’s currently accessible identity.
Other work in the realm of HIV-prevention suggests that African-American
clients of a public health clinic report that reading a brochure or watching
a video in a health-department waiting room is identity incongruent and
potentially stigmatizing, as others in the waiting room may infer that the
reader/watcher is HIV-positive and/or engages in behavior that puts them
at risk for HIV infection (e.g., uses drugs or has promiscuous sex; Albarracín,
Durantini & Earl, 2006). Taken together, this work suggests that one crucial
consideration of whether or not African-Americans will attend to health
information may be how identity-congruent health information is perceived
to be for African-Americans. For instance, if information is perceived to be
identity-congruent (i.e., reading health information is something “someone
like me” does), one might predict increased attention to the information. In
contrast, if information is perceived to be identity-incongruent (i.e., people
like me do not pay attention to health information), one might instead predict decreased attention to the information. If this is the case, one potential
intervention point to minimize heath disparities may be to begin by closing
the attention gap to health information for African-Americans compared
to European-Americans by ensuring that attention to health information is
perceived as identity-congruent.
KEY ISSUES FOR FUTURE RESEARCH
Determining why individuals are selectively attending to health information
is only the first step in increasing the efficacy of public health campaigns.
Applications of Selective Exposure and Attention to Information
9
Future research must also address ways to mitigate the motives underlying
selective exposure and selective attention as a way of increasing the efficacy
of health campaigns. Recent research on defense motives has shown that
decreasing levels of controlling language in health messages increases
attention to the message (Miller, Lane, Deatrick, Young, & Potts, 2007). It
may also be possible to increase attention to health messages without editing
the message. For instance, self-affirmation decreases the attentional bias
away from self-relevant threat information (Howell & Shepperd, 2012; Klein
& Harris, 2009). In addition, impression motives could drive participants
toward behavior-consistent or behavior-inconsistent information depending
on the identity one is trying to convey. Presumably, encouraging participants
to appear open-minded may increase approach to behavior-inconsistent
information. Future public health research would do well to focus on lessening the negative impact of defense and impression motives on attention
to health information.
Finally, it has become increasingly clear that attention to information is an essential component of intervention effectiveness. Recently,
meta-intervention methods have been designed to increase attention by
means of empowering potential audiences. A meta-intervention is a supplemental program designed to increase participation in a pre-existing
preventive program (Albarracín et al., 2008). Meta-interventions have been
successfully used by Albarracín et al. (2008) to increase acceptance of an
HIV-relevant video as well as enrollment in an HIV-prevention counseling
session. In this case, determining the barriers to attention could aid in the
design of meta-interventions to increase exposure and attention to messages
designed to change health behaviors. Thus, this work provides a critical first
step to reduce barriers to attention to health information.
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ALLISON EARL SHORT BIOGRAPHY
Allison Earl received her BA in Anthropology and BS in Psychology from the
University of Florida, and her PhD in Psychology from the University of Illinois at Urbana-Champaign. She is an Assistant Professor of Social Psychology at the University of Michigan, and Director of the University of Michigan
Health, Attitudes, and Influence Lab (HAILab). She is also a Faculty Associate at the University of Michigan’s Research Center for Group Dynamics in
the Institute for Social Research, and a Faculty Affiliate of the Joint Program
in Social Work and Psychology. The overarching goal of Dr. Earl’s research
program is to better understand what we pay attention to and why, and how
14
EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES
to best use this knowledge to increase attention to health promotion programs, particularly for high-risk audiences. More information about her current research is available on her website: http://hailab.psych.lsa.umich.edu/
CHRISTINA NISSON SHORT BIOGRAPHY
Christina Nisson received her BA in Psychology and Economics from
Cornell University in 2009 and her MS and PhD in Social Psychology from
the University of Michigan in 2011 and 2014, respectively. Broadly, Christina
is interested in applying social psychological research to the study of health
messaging and health behaviors. Her primary line of research examines the
role of select health message characteristics (e.g., approach vs avoidance
goals; action vs inaction orientation) on message processing and healthy
eating behaviors.
RELATED ESSAYS
Health and Social Inequality (Sociology), Bernice A. Pescosolido
Social Relationships and Health in Older Adulthood (Psychology), Theodore
F. Robles and Josephine A. Menkin
The Role of Cultural, Social, and Psychological Factors in Disease and Illness
(Sociology), Robert A. Scott
Incarceration and Health (Sociology), Christopher Wildeman
-
Applications of Selective Exposure
and Attention to Information for
Understanding Health and Health
Disparities
ALLISON EARL and CHRISTINA NISSON
Abstract
In this essay, we discuss how social psychological work on selective exposure and
attention can be used to understand information selection decisions in a health context. In particular, we begin with an overview of the selective exposure and attention
literatures, including a summary of literature suggesting that people are more likely
to seek out (selective exposure) and pay attention to (selective attention) information
they agree versus disagree with. We then discuss various motives that may influence
information selection and attention. Finally, we conclude with a summary of how the
work on selective exposure and attention can be brought to bear on health message
design and reduction of health disparities.
INTRODUCTION
Interventions designed to change health behaviors often assume that the people who could most benefit from the intervention are the ones receiving the
message. Ironically, but perhaps not surprisingly, people are less likely to
seek out and pay attention to messages that advocate changing what they
are currently doing. Interventionists may, in fact, be preaching to the choir,
rather than reaching target audiences. Unfortunately, this suggests limited
efficacy of health intervention programs that could ultimately be successful
if received by target audiences.
FOUNDATIONAL RESEARCH
What do you do if you want to persuade people to change their attitudes or
behaviors? For instance, what is the best way to convince someone that smoking is bad for them, or to engage in safer-sex behaviors such as condom use?
Emerging Trends in the Social and Behavioral Sciences. Edited by Robert Scott and Stephen Kosslyn.
© 2015 John Wiley & Sons, Inc. ISBN 978-1-118-90077-2.
1
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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES
One strategy that has received much attention by both persuasion researchers
and lay theorists alike has been to design an advertising campaign or intervention program directed at changing a specific set of beliefs or behaviors
(e.g., “Don’t Smoke” or “Use a Condom”). However, this strategy is only
effective up to the point that the target audience actually sees and pays attention to the message. Unfortunately, 60 years of social psychological research
suggests that exposure and attention to persuasive messages may be critical
barriers to address, as people are more likely to both seek out and pay attention to information they agree with compared to information they disagree
with (Eagly, Chen, Chaiken, & Shaw-Barnes, 1999; Festinger, 1964; Frey, 1986;
Hart et al., 2009). One consequences of this bias is that persuasive campaigns
may simply be preaching to the choir, without reaching the audiences for
whom they are intended.
Preferential selection of, and attention to, messages that are supportive
(vs challenging) of one’s attitudes or behaviors are well-established phenomena in the social psychological literature. Recent meta-analytic evidence
suggests that people show a selective exposure bias by preferring information that is supportive (vs challenging) of their own attitudes or behaviors
(d = 0.36; Hart et al., 2009). Similarly, people are more likely to store and recall
attitude-supportive versus attitude-challenging information from memory,
a phenomenon labeled selective attention (d = 0.23; Eagly et al., 1999).
Message reception by target audiences may be difficult because people
selectively attend to information. No matter how many times an intervention
program is offered or prevention messages are played in the waiting room
of a health clinic, clients can always tune out the message. For instance,
prejudiced people are less likely to attend to anti-prejudice propaganda
than nonprejudiced people (Cooper & Jahoda, 1947). Furthermore, heavy
drinkers tend to watch more advertisements for alcohol than do light
drinkers and nondrinkers (Perrissol, Boscher, Cerclé, & Somat, 2005). In
the area of human immunodeficiency virus (HIV)-prevention, participants
with higher motivation to use condoms, stronger condom use behavioral
skills, and more frequent past condom use are more likely to accept an
HIV-prevention counseling session than participants with lower scores on
these dimensions (Earl et al., 2009).
PREDICTING ATTENTION TO HEALTH INFORMATION
Several models have been proposed to conceptualize the process from
information reception to behavior change (Greenwald, 1968; McGuire, 1968;
Petty & Cacioppo, 1986). According to McGuire’s (1968) reception-yielding
model, receiving a message can be separated into three discrete steps:
exposure, attention, and comprehension. In this model, exposure involves
Applications of Selective Exposure and Attention to Information
3
initial presentation of a persuasive message, attention concerns whether or
not participants choose to attend to the information, and comprehension
entails whether or not participants understand the persuasive message.
In the case of health information, it is rarely the case that people have not
been exposed to at least some information. On the contrary, prior work
suggests that people often feel inundated with informational overload
(Bargh & Thein, 1985; Edmunds & Morris, 2000), particularly in a health
context (Cline & Haynes, 2001; Hall & Walton, 2004). Furthermore, health
clinics and hospitals frequently play educational videos in their waiting
rooms to give clients additional exposure to messages, and high school
students are often required to go through health classes that feature health
education (Centers for Disease Control and Prevention, 2012). However,
presentation of information does not necessarily ensure that participants
will pay attention to messages.
Models of attention frequently differentiate information processing as
a function of amount of attentional resources allocated to a particular
stimulus. For instance, Broadbent’s (1958) filter theory of early selection
posits that sensory stimuli are selectively filtered, with attended stimuli
being further processed and unattended stimuli being summarily ignored.
In contrast, Deutsch and Deutsch (1963) posit a late disengagement model in
which all stimuli are initially processed, at least until an object is identified,
at which point selective processing occurs. Work by Posner and Peterson
(1990) integrated these two seeming disparate viewpoints by suggesting
that three attentional systems of alerting, orienting, and executive control
may operate independently. In particular, alerting is related to achieving and
maintaining a state of alertness, orienting refers to selection of information
from sensory input, and executive control is defined as resolving conflict
among responses (Posner & Peterson, 1990).
MEASURING SELECTIVE EXPOSURE AND SELECTIVE ATTENTION
Selective exposure is frequently measured by the amount of supportive (congenial) versus challenging (uncongenial) information participants choose to
view. In a typical selective exposure paradigm, participants may be asked to
select from among arguments on both sides of an issue (e.g., the validity of
an intelligence test: Frey & Stahlberg, 1986). In this case, selective exposure
would be calculated by creating a difference score between the number of
congenial articles selected and the number of uncongenial articles selected.
Selective exposure can also be measured by recording whether or not participants enroll in an intervention program (Earl et al., 2009), or if people recall
seeing a public service announcement on television (Siska, Jason, Murdoch,
Yang, & Donovan, 1992).
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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES
Common measures of selective attention include self-reported attention to
a message (e.g., “How much attention did you pay to the message”), recall
and recognition measures of message content (e.g., “What did you read
about”), as well as behavioral measures of amount of time spent reading a
message or coders’ observation of overt attention to a message. Recently, psychophysiological measures have been used to measure eye-gaze, as well as
brain electrical response to messages [e.g., event-related potentials (ERPs) or
functional magnetic resonance imaging (fMRI); Falk, 2010; Ruiter, Kessels,
Jansma, & Brug, 2006]. These approaches have distinct advantages and
drawbacks. For instance, self-report measures are cheap and easy to administer, but are subject to biases in reporting (Nisbett & Wilson, 1977; Schroder,
Carey, & Vanable, 2003). Physiological measures (e.g., eye-tracking, ERP,
and fMRI) are expensive and open to interpretation, but are not dependent
on participant’s conscious awareness of attentional allocation.
MOTIVES UNDERLYING SELECTIVE EXPOSURE AND SELECTIVE ATTENTION
Both selective exposure and selective attention are driven by defense,
impression, and accuracy motives (Chaiken, Giner-Sorolla, & Chen, 1996;
Chaiken, Liberman, & Eagly, 1989; Hart et al., 2009). For instance, activation
of a defense motive drives people to buffer current beliefs and behaviors
from attack, and promotes avoidance of information that threatens current
views and approach to information that supports current views. Activation of an impression motive heightens concerns about how selecting or
attending to information would influence perceptions about the self, and
would facilitate the selection of information that would help convey a
desired identity or image to an audience and avoidance of information that
undermines a desired identity (Schlenker, 1980). In contrast, activation of an
accuracy motive drives people to form and maintain beliefs and behaviors
that are consistent with relevant information, and would prompt selection
of information evenhandedly, and as well as a preference for high quality
compared to low quality information regardless of its stance on an issue.
There are several factors that may spark defense motivation and subsequent avoidance of uncongenial information. For instance, defense motives
are likely to operate when participants feel committed to a decision (Brehm
& Cohen, 1962; Kiesler, 1971), when the issue is relevant to important values (Johnson & Eagly, 1989), or when participants are close minded (Adorno,
Frenkel-Brunswik, Levinson, & Sanford, 1950). In addition, dispositional perceptions of one’s inability to defend personal views from persuasive attacks
may promote avoidance of dissenting opinions (Albarracín & Mitchell, 2004;
Albarracín, Durantini, Earl, Gunnoe, & Leeper, 2008). In contrast, increasing
one’s perceived ability to defend cherished beliefs may facilitate approach
Applications of Selective Exposure and Attention to Information
5
to attitude-inconsistent information (Albarracin, Leeper, Earl, & Durantini,
2008; Albarracín & Mitchell, 2004). More generally, receiving a threat to the
self immediately before exposure to either supporting or threatening information increases avoidance of threatening information (Frey, 1986), as does
receiving a threat after recently reporting a position or belief (Festinger, 1964).
In the context of health information seeking, examining perceptions of one’s
ability to defend oneself may be particularly relevant for those with chronically low perceived power or self-efficacy, as these groups are often the target
audiences of health promotion campaigns. A second factor that may influence avoidance of dissenting opinions is commitment to the beliefs or behaviors in question. For instance, participants avoid information that challenges
their current beliefs or behaviors, but only for those beliefs that are strongly
held and thus represent a threat (Brehm & Cohen, 1962). Similarly, making participants self-aware may produce avoidance of threatening information, presumably because heightened awareness of one’s own beliefs should
lead to unwillingness to be inconsistent, even to the self (Diener & Srull,
1979). In the case of health promotion, heightened self-awareness may trigger
beliefs that threatening health messages (i.e., messages that contradict one’s
self-views) are irrelevant and thus not deserving of attention.
Furthermore, the decision to attend to health information may be based,
in part, on the impression that seeking this information might make on
others. The focus on external evaluations triggered by impression motives
is often separate from the focus on internal evaluations triggered by defense
motives. According to impression management theory, people are motivated
to control the perceptions others have of them (Schlenker, 1980) and focus
on the interpersonal outcomes of a given behavior (Chaiken, Giner-Sorolla,
et al., 1996). As a result, people are aware of the views of others and take
those views into account before they act (Chaiken, Giner-Sorolla, et al., 1996;
Schlenker, 1980). There are likely several factors that trigger impression
motives. For instance, chronic sensitivity to rejection entails heightened
awareness of others and their evaluations of one’s behavior (Downey &
Feldman, 1996). Similarly, the presence of others may also influence the
activation of impression motives by heightening norms about how to
behave (Ajzen & Fishbein, 2005; Goffman, 1963; Shah, 2003). In addition,
telling participants that they will be discussing an issue after reading
information also prompts activation of an impression motive and a focus
on self-presentational concerns (Leippe & Elkin, 1987). In contrast, heightening accuracy concerns in addition to an impression motive manipulation
mitigates bias in information search (Lundgren & Prislin, 1998).
In contract, accuracy motives may have opposing effects on information
processing compared to defense and impression motives. In particular, activation of an accuracy motive should increase seeking of high quality versus
6
EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES
low quality information, regardless of its congeniality (Lowin, 1967, 1969;
Lundgren & Prislin, 1998). Accuracy motives are likely to operate when the
issue is tied to an outcome or performance (e.g., you have to give a speech
later on the topic; Johnson & Eagly, 1989), and when the utility of the information is high (Canon, 1964; Freedman, 1965).
CUTTING-EDGE RESEARCH
APPLICATIONS TO HEALTH: FOCUS ON MESSAGE CHARACTERISTICS
The principles of selective exposure and attention can be applied to increase
the efficacy of public health campaigns by ensuring that target audiences
actually receive the message. One strategy to increase attention to health promotion campaigns has been to focus on features of the message that may facilitate attention. For instance, patients who were discharged from the ER with
wound-care information that contained both text and pictures were more
likely to report reading the information than patients who received the text
information alone (Delp & Jones, 1996). More broadly, a review of graphics
on attention to health information suggest that pictures linked to written or
spoken text can significantly increase attention to and recall of health information when compared to text alone (Houts, Doak, Doak, & Loscalzo, 2006).
Perhaps the most widely researched message characteristic in selective
attention to health information is the presence of threatening information.
Public health campaigns often use threatening information as a means of
conveying risk and reducing the occurrence of an unhealthy behavior (e.g.,
graphic anti-smoking ads). Unfortunately, however, numerous studies now
indicate that participants may be less likely to attend to messages containing threatening information compared to similar low threat messages
(Albarracin et al., 2005; Brown & Richardson, 2012; Earl & Albarracin, 2007;
Kessels, Ruiter, & Jansma, 2010). For example, Brown and Richardson (2012)
found that anti-alcohol persuasive messages paired with distressing images
resulted in lower message gaze time, which further resulted in lower intentions to reduce drinking in the following three months compared to the same
messages paired with less distressing images. Furthermore, meta-analytic
evidence in the area of HIV-prevention suggests that fear appeals decrease
learning about health recommendations, both immediately following the
intervention as well as longitudinally (Earl & Albarracin, 2007). Other highly
researched message characteristics in this area include the benefit of tailored
versus nontailored interventions (Kessels et al., 2010; Ruiter et al., 2006), gain
versus loss framed health messages (O’Malley & Latimer, 2012; Rothman
& Salovey, 1997), and novel versus familiar information (Fox, Krugman,
Fletcher, & Fischer, 1998; Krugman, Fox, Fletcher, Fischer, & Rojas, 1994).
Applications of Selective Exposure and Attention to Information
7
APPLICATIONS TO HEALTH: INTERACTION bETWEEN AUDIENCE AND MESSAGE
CHARACTERISTICS
Research on selective attention in public health has also focused on the
interaction between audience and message characteristics. For instance,
investigating how specific audiences (e.g., adolescents) may process messages related to specific health topics (e.g., cigarette ads; Krugman et al.,
1994). In addition, meta-analytic work suggests that the decision whether
or not to enroll in an intervention program may be based in part on if the
intervention program meets individual preferences. For example, men are
more likely to enroll in HIV-prevention intervention programs when they
provide instrumental and financial resources (e.g., payments), whereas
women are more likely to enroll when programs are run in a group format
(vs individual counseling; Durantini & Albarracin, 2009). Furthermore,
disenfranchised groups prefer interventions led by experts compared to
peers (Durantini, Albarracin, Mitchell, Earl, & Gillette, 2006). In addition,
acceptance of low investment intervention strategies (e.g., brochures) can
lead to greater acceptance of high investment intervention strategies (e.g.,
counseling sessions; Albarracin et al., 2008). This work lends support to the
notion that taking both the message and the audience into consideration
when designing an intervention program is critical to success.
Beyond demographic variables, another example of work examining the
interplay of message and audience characteristics involves the study of attention to health information as a function of health optimism. In particular,
those high versus low in health optimism are more likely to attend to threatening health information (Aspinwall & Brunhart, 1996). Furthermore, understanding that audiences may differentially react to features of health message
is a key tenant of the message-framing effects literature (e.g., Rothman &
Salovey, 1997). Although the dependent measures in these studies are often
intention change, rather than attention, this work may be brought to bear on
understanding the parameters of selective exposure and selective attention
in a health context.
APPLICATIONS TO HEALTH: HEALTH DISPARITIES
Disenfranchised groups often bear the brunt of disease burden (National
Association of Chronic Disease, 2010). For instance, African-Americans
relative to European-Americans carry a disproportionate weight of a wide
variety of conditions including heart disease, hypertension, cancer, diabetes,
stroke, and HIV (Centers for Disease Control and Prevention, 2005). These
disparities in health outcomes across groups may be triggered by myriad
causes. For instance, African-Americans compared to European-Americans
8
EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES
may have systemically less access to healthcare, incomplete or nonexistent
insurance coverage, or may simply not receive necessary medical procedures (Agency for Healthcare Research and Quality, 2000; Center for Health
Equity Research and Promotion, 2010). From a public health perspective, the
existence of health disparities suggests that work is needed to ensure that all
people receive needed medical care and prevention services.
Although past work has been done to address health disparities at a
system level (Agency for Healthcare Research and Quality, 2000; Center
for Health Equity Research and Promotion, 2010), comparatively little
has been done to examine how individual level factors may also perpetuate these gaps. For instance, health disparities may also be due in
part to discomfort and unwillingness to approach health information by
African-Americans. One possibility is that attention to HIV-prevention
information may be modulated by how identity-congruent attending to
information is perceived to be. Work by Oyserman, Fryberg, and Yoder
(2007) suggests that health disparities for African-American and Latino
children may be explained, in part, by the perceived discrepancy between
engaging in healthy behaviors and children’s currently accessible identity.
Other work in the realm of HIV-prevention suggests that African-American
clients of a public health clinic report that reading a brochure or watching
a video in a health-department waiting room is identity incongruent and
potentially stigmatizing, as others in the waiting room may infer that the
reader/watcher is HIV-positive and/or engages in behavior that puts them
at risk for HIV infection (e.g., uses drugs or has promiscuous sex; Albarracín,
Durantini & Earl, 2006). Taken together, this work suggests that one crucial
consideration of whether or not African-Americans will attend to health
information may be how identity-congruent health information is perceived
to be for African-Americans. For instance, if information is perceived to be
identity-congruent (i.e., reading health information is something “someone
like me” does), one might predict increased attention to the information. In
contrast, if information is perceived to be identity-incongruent (i.e., people
like me do not pay attention to health information), one might instead predict decreased attention to the information. If this is the case, one potential
intervention point to minimize heath disparities may be to begin by closing
the attention gap to health information for African-Americans compared
to European-Americans by ensuring that attention to health information is
perceived as identity-congruent.
KEY ISSUES FOR FUTURE RESEARCH
Determining why individuals are selectively attending to health information
is only the first step in increasing the efficacy of public health campaigns.
Applications of Selective Exposure and Attention to Information
9
Future research must also address ways to mitigate the motives underlying
selective exposure and selective attention as a way of increasing the efficacy
of health campaigns. Recent research on defense motives has shown that
decreasing levels of controlling language in health messages increases
attention to the message (Miller, Lane, Deatrick, Young, & Potts, 2007). It
may also be possible to increase attention to health messages without editing
the message. For instance, self-affirmation decreases the attentional bias
away from self-relevant threat information (Howell & Shepperd, 2012; Klein
& Harris, 2009). In addition, impression motives could drive participants
toward behavior-consistent or behavior-inconsistent information depending
on the identity one is trying to convey. Presumably, encouraging participants
to appear open-minded may increase approach to behavior-inconsistent
information. Future public health research would do well to focus on lessening the negative impact of defense and impression motives on attention
to health information.
Finally, it has become increasingly clear that attention to information is an essential component of intervention effectiveness. Recently,
meta-intervention methods have been designed to increase attention by
means of empowering potential audiences. A meta-intervention is a supplemental program designed to increase participation in a pre-existing
preventive program (Albarracín et al., 2008). Meta-interventions have been
successfully used by Albarracín et al. (2008) to increase acceptance of an
HIV-relevant video as well as enrollment in an HIV-prevention counseling
session. In this case, determining the barriers to attention could aid in the
design of meta-interventions to increase exposure and attention to messages
designed to change health behaviors. Thus, this work provides a critical first
step to reduce barriers to attention to health information.
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ALLISON EARL SHORT BIOGRAPHY
Allison Earl received her BA in Anthropology and BS in Psychology from the
University of Florida, and her PhD in Psychology from the University of Illinois at Urbana-Champaign. She is an Assistant Professor of Social Psychology at the University of Michigan, and Director of the University of Michigan
Health, Attitudes, and Influence Lab (HAILab). She is also a Faculty Associate at the University of Michigan’s Research Center for Group Dynamics in
the Institute for Social Research, and a Faculty Affiliate of the Joint Program
in Social Work and Psychology. The overarching goal of Dr. Earl’s research
program is to better understand what we pay attention to and why, and how
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to best use this knowledge to increase attention to health promotion programs, particularly for high-risk audiences. More information about her current research is available on her website: http://hailab.psych.lsa.umich.edu/
CHRISTINA NISSON SHORT BIOGRAPHY
Christina Nisson received her BA in Psychology and Economics from
Cornell University in 2009 and her MS and PhD in Social Psychology from
the University of Michigan in 2011 and 2014, respectively. Broadly, Christina
is interested in applying social psychological research to the study of health
messaging and health behaviors. Her primary line of research examines the
role of select health message characteristics (e.g., approach vs avoidance
goals; action vs inaction orientation) on message processing and healthy
eating behaviors.
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