Writing Health Communication An Evidence based Guide, 1st

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 Chapter 1 © Marieke Kools and Charles Chapter 8 © Rob Ruiter and Gerjo Kok 2012
Abraham 2012 Chapter 9 © Marieke Werrij, Rob Ruiter,
Chapter 2 © James Hartley 2012 Jonathan van ’t Reit and Heinde Vries 2012
Chapters 3 and 4 © Marieke Kools Chapter 10 © Hans Brug and Anke Oenema
Chapter 5 © Pat Wright 2012 2012
Chapter 6 and 7 © Charles Abraham Chapter 11 © Charles Abraham and Marieke
2012 Kools 2012

First published 2012

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 Dedication

It was during work with Professor Herman Schaalma (1959–2009) at Maastricht

University that Charles Abraham and Marieke Kools met and began to discuss
this book. Herman spent his career working tirelessly to evaluate and improve
health promotion practice. He encouraged work on this book and would have
loved to have seen it in print. Sadly, he died before the project was completed. We
dedicate this book to his memory.

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 Contents

About the Editors xiii

About the Contributors xiv

1 Introduction: Steps Towards Writing Effective Educational Text 1

Marieke Kools and Charles Abraham

2 Designing Easy-To-Read Text 7

James Hartley

3 Making Written Materials Easy to Understand 23

Marieke Kools

4 Making Written Materials Easy to Use 43

Marieke Kools

5 Using Graphics Effectively in Text 63

Patricia Wright

6 Developing Evidence-based Content for Health Promotion Materials 83

Charles Abraham

7 Mapping Change Mechanisms onto Behaviour Change Techniques:

A Systematic Approach to Promoting Behaviour Change
Through Text 99
Charles Abraham

8 Planning to Frighten People? Think Again! 117

Robert A.C. Ruiter and Gerjo Kok

9 Message Framing 134

Marieke Q. Werrij, Robert A.C. Ruiter, Jonathan van ’t
Riet and Hein de Vries

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 10 Computer-tailoring of Health Promotion Messages 144
Johannes Brug and Anke Oenema

11 Conclusions and Recommendations 161

Charles Abraham and Marieke Kools

Index 170

viii
Contents

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 Detailed contents

About the Editors xiii

About the Contributors xiv

1 Introduction: Steps Towards Writing Effective Educational Text 1

Marieke Kools and Charles Abraham
1.1 Are written health education and promotion materials
evidence-based? 1
1.2 Aims of this book 2
1.3 Reading this book 2
1.4 The design process and the book structure 2
Note 6
References 6

2 Designing Easy-To-Read Text 7

James Hartley
2.1 Choosing page sizes and orientations 8
2.2 Spacing text 10
2.3 Choosing type-sizes and typefaces 15
2.4 Size matters 20
2.5 Conclusions 20
References 21

3 Making Written Materials Easy to Understand 23

Marieke Kools
3.1 Cognitive mechanisms underlying
comprehension 24
3.2 Constructing text that is easy to understand 26
3.3 Understanding graphics 29
3.4 Testing is crucial 39
3.5 Conclusion 39
References 41

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 4 Making Written Materials Easy to Use 43
Marieke Kools
4.1 Usability 43
4.2 Attention processes: top-down and botom-up 44
4.3 Designing for usability 46
4.4 How to apply the above usability criteria: an example 55
4.5 How to test for usability 58
4.6 Conclusion 62
References 62

5 Using Graphics Effectively in Text 63

Patricia Wright
5.1 Why include graphics? 64
5.2 Stage 1: what is the purpose of your graphic? 65
5.3 Stage 2: selecting among graphic styles 71
5.4 Stage 3: integrating graphics with text 78
5.5 Final note: ensuring that your graphics help not hinder 79
References 81

6 Developing Evidence-based Content for Health Promotion Materials 83

Charles Abraham
6.1 Identifying evidence-based content: research into condom
use health promotion 84
6.2 Useful models for identifying and designing the content of
health promotion messages 88
6.3 Matching messages to cognitive targets 93
6.4 Improving the effectiveness of an evidence-based
condom-promotion leaflet 94
6.5 Conclusion 96
Note 97
References 97

7 Mapping Change Mechanisms onto Behaviour Change Techniques:

A Systematic Approach to Promoting Behaviour Change Through Text 99
Charles Abraham
7.1 Planning, elicitation research and mapping change
processes onto BCTs 100
7.2 An intervention planning challenge 102
7.3 Beyond single-theory intervention design 110
7.4 Form antecedents, determinants and change processes to behaviour
change techniques (BCTs) 111
7.5 Developing and using lists of BCTs 111

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 7.6 Planning evaluation 113
7.7 Conclusion 115
References 115

8 Planning to Frighten People? Think Again! 117

Robert A.C. Ruiter and Gerjo Kok
8.1 Use of fear appeals in current health promotion practice 118
8.2 Fear appeals are popular 120
8.3 Quality of evaluation evidence 121
8.4 Does fear arousal promote behaviour change? Worrying evidence 123
8.5 What can we do to increase acceptance of fear arousing messages?
Encouraging findings 125
8.6 Understanding fear appeals 125
8.7 Designing evidence-based fear appeals 128
8.8 Bridging the intention–behaviour gap 129
8.9 Conclusion 130
Note 131
References 131

9 Message Framing 134

Marieke Q. Werrij, Robert A.C. Ruiter, Jonathan van ’t Riet
and Hein de Vries
9.1 Message framing and prospect theory 135
9.2 Perceived ‘riskiness’ of health-related
behaviours 136
9.3 Re-evaluating the concept of ‘risk perception’ 138
9.4 High self-efficacy matters 139
9.5 Establishing a ‘fit’ between receiver, message and frame 140
9.6 How to frame messages: conclusions and recommendations 141
References 142

10 Computer-tailoring of Health Promotion Messages 144

Johannes Brug and Anke Oenema
10.1 Advantages of personally-tailored messages 145
10.2 An outline model of planned health promotion 146
10.3 Generic, targeted and tailored health promotion 147
10.4 How is computer tailoring achieved? 149
10.5 Does computer-tailoring work? 155
10.6 Why are computer-tailored interventions more effective? 156
10.7 The future of computer-tailored interventions 158
10.8 Conclusion 159
References 159

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 11 Conclusions and Recommendations 161
Charles Abraham and Marieke Kools

11.1 A bite-sized summary 161

11.2 Summary of Chapter 2: Designing Easy-To-Read Text 161
11.3 Summary of Chapter 3: Making Written Materials Easy
to Understand 162
11.4 Summary of Chapter 4: Making Written Materials Easy to Use 163
11.5 Summary of Chapter 5: Using Graphics Effectively in Text 164
11.6 Summary of Chapter 6: Developing Evidence-based Content
for Health Promotion Materials 164
11.7 Summary of Chapter 7: Mapping Change Mechanisms onto
Behaviour Change Techniques: A Systematic Approach to
Promoting Behaviour Change Through Text 165
11.8 Summary of Chapter 8: Planning to Frighten People?
Think Again! 166
11.9 Summary of Chapter 9: Message Framing 167
11.10 Summary of Chapter 10: Computer-tailoring of Health
Promotion Messages 168
11.11 Conclusion 168
Note 169

Index 170

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 About the editors

Charles Abraham is Professor of Behaviour Change in the Peninsula College of

Medicine & Dentistry at the University of Exeter, UK. He conducts research into
health promotion and sustainable energy use, and studies motivational and voli-
tional processes that regulate action. His research focuses on developing and
evaluating behaviour change interventions. Charles also provides training, consul-
tancy and policy advice. Charles is a visiting professor at the Universities of
Sussex, Nottingham and Maastricht, and a Research Associate at the Center for
Health, Intervention, and Prevention (CHIP) at the University of Connecticut.
He has been co-editor of the journal Psychology and Health and was the founding
chair of the British Psychological Society, Division of Health Psychology. Charles
has also worked as a research consultant to the Department of Health in the UK.
He was a member of the National Institute for Health and Clinical Excellence
(NICE) group which developed the 2007 guidelines on Behaviour Change prac-
tice and was Specialist Advisor to the House of Lords Select Committee on
Science and Technology inquiry into Behaviour Change in 2011.
(http://www.pcmd.ac.uk/profiles.php?id= cabraham&tab=full).

Marieke Kools is a behavioural scientist at the Faculty of Health, Medicine and Life
Sciences at Maastricht University in the Netherlands. With a background in exper-
imental cognitive psychology (cognitive educational psychology as well as cognitive
ergonomics), her research focuses on the usability of written information, with a
specific interest in health education materials. Central in her applied experimental
studies is the question of how layout and design characteristics can influence mes-
sage comprehension and attention processes in readers. Marieke uses existing
health education brochure materials to assess effects of textual as well as graphical
design elements on how readers use and understand these materials. Marieke also
provides training and consultancy regarding the design and evaluation of health
promotion materials. She recently shifted her focus towards teaching and coaching
medical doctors at the Institute of General Practitioners Education at Maastricht
University.

(email: [email protected])

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 About the contributors

Johannes Brug is Professor of Epidemiology and Director of the EMGO Institute

for Health and Care Research at the VU University Medical Center, Amsterdam,
in the Netherlands. Johannes’s main research interests are in the development and
evaluation of health education and health promotion interventions, with a special
interest in behavioural nutrition and physical activity. His research covers studies
on the determinants of health behaviours, small-scale experimentation with inno-
vative health education interventions, and larger-scale field experiments in which
the efficacy and external validity of health-promoting interventions are evaluated.
(http://www.emgo.nl/personal_pages/profile/index.asp?id=476&page=1)
Hein de Vries is Professor of Health Communication at Maastricht University in
the Netherlands. He has a strong interest in theories and theory development on
psycho-social determinants of health behaviour, in particular, attitudes, social
influences and self-efficacy; planning models for health promotion and health
psychology; and development, evaluation and diffusion of interventions (e.g.
video-peer-led programmes, school programmes, work site programmes, self-help
manuals, computer tailoring).
(http://www.personeel.unimaas.nl/hein.devries/Default.htm)
James Hartley is Honorary Research Professor of Psychology at the University of
Keele, Staffordshire, UK. His main research interests lie in written communica-
tion, with especial reference to typography and layout, but he is also well known
for his research into teaching and learning in the context of higher education.
Professor Hartley is a Fellow of both the British Psychological Society and the
American Psychological Association. He has published a series of books including
Designing Instructional Text, 3rd edition (Kogan Page, 1994) and Academic Writing
and Publishing: A Practical Handbook (Routledge, 2008) (email: j.hartley@psy.
keele.ac.uk)
(http://www.keele.ac.uk/depts/ps/people/jhartley/index.htm)
Gerjo Kok is former Dean and Professor of Applied Psychology at the Faculty of
Psychology and Neuroscience at Maastricht University. He held the Dutch AIDS
Fund endowed professorship for AIDS prevention and health promotion, 1992–
2004. His main research interests are the application of social psychology to
health promoting behaviour, energy conservation, traffic safety, and the preven-
tion of stigmatisation.

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 (http://www.psychology.unimaas.nl/Base/Medewerkerspersonal/GerjoKok_
extended.htm)
Anke Oenema is Associate Professor of Health Communication in the Department
of Health Promotion at Maastricht University in the Netherlands. Her main
research interests are in development, evaluation and innovation of computer-
tailored interventions aimed at the promotion of dietary and physical activity
behaviours and obesity prevention. She focuses on improving efficacy and reach of
interventions by delivering computer-tailored interventions through new media, to
implement ‘new’ variables such as environmental factors, and on applying new
techniques such as motivational interviewing in computer-tailored programs.
(http://survey.erasmusmc.nl/intern/pwp/?aoenema)
Rob Ruiter is Associate Professor of Applied Psychology at Maastricht University
in the Netherlands. His research focuses on studying the effects of persuasive
health messages and the underlying change mechanisms. He also has a strong
interest in research capacity building in Sub-Saharan Africa through developing
and testing theory- and evidence-based health promotion interventions while
training young students to become fully qualified public health researchers.
(http://ruiter.socialpsychology.org)
Jonathan van ‘t Riet is a Researcher at Wageningen University and Research
Center. His research interests are in consumer behaviour. He specialises in the
determinants of food choice and the effects of health communication messages,
with a special interest in message framing and defensive reactions to health-
promoting messages.
Marieke Werrij is a Lecturer in the Department of Occupational Therapy of
Zuyd University of Applied Sciences in the Netherlands. Marieke previously
worked as a researcher in the field of health promotion at Maastricht University.
Her main research interests are persuasive communication, with a special interest
in message framing, and the cognitive approach to (the treatment of) obesity.
Patricia Wright is Professor Emerita at the School of Psychology, Cardiff
University, Wales. Patricia is a Fellow of the British Psychological Society. Her
research explores how the design of information influences people’s behaviour
with printed and online materials. (email: [email protected])

xv
About the contributors

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