Summary with the article: The role of the self in responses to health communications: a cultural perspective by Sherman et. al. (2011)

Health problems are of a pancultural nature and because of this, some researchers think that there might be a pancultural health solution. Every country needs to deal with problems of oral health, smoking-related illnesses and many other problems. Many problems arise from issues of self-regulation and health problems can be changed by changing health behaviours. Researchers need to find a way to put health communications together with dimensions of the self, in order to change health behaviours. In this article, the writers argue that a cultural consideration of the self can help create more effective health messages. A cultural consideration of the self means how people see themselves in relation to other people and their goals.

The writers are obviously looking at the culture, but they are also looking at psychological theories that will help them to find good features of health messages and that help them to find which psychological aspects are the most relevant to look at. More and more studies show that messages are more persuasive when the content of the message matches the recipient’s affective, cognitive or motivational characteristics. So the variability in how people respond to health messages can be ascribed to the matching of the messages to affective, cognitive or motivational characteristics. Culture in its turn, has an impact on these psychological characteristics.

The self and culture

There are many differences between cultures and cultural psychologists and anthropologists have proposed many constructs to account for some of those differences. They created the constructs of individualism and collectivism. The constructs of individualism and collectivism are useful to show cultural differences in how people see themselves in relation to others.

The United Kingdom and United States are examples of individualistic cultures. In this culture, the independent self is the dominant form of the self. This self has self-defining attributes to fulfil personal autonomy and self-expression. The people in these cultures see themselves as agents and they see themselves determining their decisions and actions. In these cultures individuals are more motivated to pursue opportunities than to not make mistakes.

The collectivist cultures are basically the opposite of the individualistic countries. Many East-Asian countries are collectivistic and the dominant model of the self is an interdependent self. This self is defined by social relations and membership in groups and the self is all embedded within the social context. People in these cultures are more relational and their decisions are based on mutual obligations and fulfilling the in-group expectations. People from this culture want to fit in with their group and want to keep the peace and quiet between group members.

Keeping their responsibilities and avoiding behaviours that disrupt others is where they focus on. In collectivistic cultures people are more focused on not making mistakes than to pursue opportunities. They rather try to avoid negative outcomes than try to achieve the positive outcome they want to achieve.

Crafting health messages

In order to put culturally congruent health messages together, one must find characteristics that vary cross-culturally. One must also examine whether framing messages matching those characteristics are more persuasive and lead to health behaviour change. The regulatory focus theory found that individuals from collectivistic cultures are more focused on prevention and sensitive to the presence or absence of negative outcomes. People from individualistic cultures focus more on promotion and are sensitive to the presence or absence of positive outcomes. This means that health messages that emphasize the potential losses associated with not performing a behaviour might be more effective among people from collectivistic cultures and messages that emphasize the potential gains with performing a behaviour might be more effective among people from individualistic cultures. These two types of messages can also be called loos-frame messages and gain-frame messages. Studies have shown that people who are more avoidance orientated are more persuaded by loss-frame health messages and individuals who are more approach oriented are more persuaded by gain-framed health messages. Gain-frame and loss-frame health messages may be differentially effective as a function of culture.

There have been many studies testing the cultural congruency hypothesis. One of these studies looked at dental health. The participants in these studies were from collectivistic cultural backgrounds (East Asia) or individualistic cultural backgrounds (Britain). They received one of two messages about flossing recommendations. These recommendations either focused on the benefits of flossing (this is the gain-frame) or the costs of not flossing (loss-frame). People from individualistic cultures had more positive attitudes towards flossing and more intention to floss when they were presented with the gain-framed message. Participants from collectivistic cultures could be more persuaded by the loss-frame messages. Other research has looked at matching aspects of health messages to cultural differences in self-construal. People with an independent self are more motivated to achieve personal goals, so they should also be more motivated to perform health behaviours when the message is framed in terms of personal consequences. People with a more interdependent self will be more motivated by messages emphasizing relational consequences. One study supporting this was about caffeine use. Women read an article linking caffeine use to negative health outcomes. Women with a strong interdependent self-construal and who were exposed to health messages that emphasized interpersonal consequences had higher perceived levels of personal risk.

Nowadays, we live in a multicultural world and people are exposed to multiple cultural influences at different times and this causes different aspects of the self-concept to be salient. There are also studies that have found that matching health messages to cultural themes does not lead to greater persuasion. One study looked at the individual consequences associated with sexually transmitted diseases. These individual consequences were found to be less effective for White Americans than a message that focused on relational consequences. This study shows that increased personal relevance could lead to greater defensive processing. This is especially the case for self-threatening health information. Future research must therefore identify when information framed to be congruent to the self leads to greater acceptance and when it leads to greater defensiveness. Research should figure out under which circumstances the self-construal needs to be primed to increase the effectiveness of matched health messages.

Cultural congruent self-affirmation

Researchers have tried to increase health persuasion by having people complete self-affirmations by providing them with threatening health information. According to the self-affirmation theory, the goal of the self-system is to maintain an image of self-integrity rather than responding to specific threats. People might respond defensively to threatening health messages and because of this, it might be difficult to promote positive health behaviours. A recent study has shown that a graphic cigarette advertisement to make negative associations with smoking might actually evoke defensive responses and lead to a bigger desire to smoke! However, when self-affirmation is provided, this defensive response might be reduced. In one study, heavy smokers completed a self-affirmation (moments in their life that they saw the value of kindness) and they were more accepting of anti-smoking information than heavy smokers who didn’t complete self-affirmation. They also increased their intentions to reduce smoking and also were more likely to take a brochure on how to quit smoking.

However, one must take the cultural generalizability into account, because research has found that self-affirmation has no effect on people from an East-Asian cultural background. Self-affirmation needs to be reshaped to fit the collectivistic cultures. One study matched the affirmation to the culture of the individual and kept the content of the message constant. Some of the affirmations led individuals to focus on approaching positives or on avoiding negatives. The researchers chose this distinction, because health decisions often have approach/avoidance conflicts. Also, research has found that there are cultural differences in the attention people pay to approach-oriented and avoidance-oriented information. East Asians were more attentive to avoidance-oriented information, while North Americans were more attentive to approach-oriented information. The results showed that an affirmation focused on how values can help people approach positive things were more effective at changing health behaviours amongst White Americans, while an affirmation focused on how values can help people avoid negative things was more effective among Asian Americans.

Organizing framework

In social and personality psychology, the self is one of the most important constructs. Self processes have a big influence on a person, they directly affect emotion, memory, motivation and behaviour. All those processes are central to health persuasion and culturally variant and the self can therefore give us a useful framework for understanding when psychological constructs will be effective or ineffective in attempts of health persuasion. The writers of this paper encourage researchers to look at the cultural background of the participants. They also encourage researchers to use a non-college student population. This will give the researchers a broader, more diverse population.