Part Five: Theory Behind EE

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Several theories and models from the behavioral and social sciences are relevant to EE, perhaps most directly being the “Two path to persuasion” frameworks, like the Elaboration Likelihood Model of Persuasion (ELM) by Petty and Cacioppo shown here and here and. ELM posits that there are two routes to persuasion (e.g., the desired behavior or action)—the central route and the peripheral route

(See also the Messages  module).

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The central route (i.e., high-involvement) is effective when someone already cares about the topic and is paying attention to information about it, i.e. when they are “highly involved” with the topic. It is a highly cognitive and conscious state targeting people who are already invested in the health issue, so there is “high elaboration likelihood”. The term “elaboration” is referring to the extent to which an individual carefully thinks about the message presented through persuasive communication, and, hopefully, leads to the desired destination.

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The peripheral route (i.e., low-involvement) can be effective when someone does not already care about the topic and is not paying attention to information about it, i.e. when they have “low involvement” with the topic. The peripheral route is good for getting people to become aware of the health issue without requiring them to think deeply about it. However, using the peripheral route to encourage behavior change is more difficult, because it is not a conscious, cognitive process. Given it is more unconscious, people are not very involved in the argument being presented (i.e., they have low-involvement). Thus there is “low elaboration likelihood” because it is largely relying on people’s heuristic cues to make quick decisions.

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Using entertainment to move people from low-involvement (the peripheral route) to high-involvement (the central route) is sometimes referred to as “issue involvement conversion.”

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ELM is related to the Communication Contracts discussed above, because if we go through persuasion we want the audience to be highly-involved. If we want high-involvement, the audience will have to consciously think about the information and make a rational decision. This usually requires the issue or topic to be important or relevant to the receiver (i.e., receiver involvement) and/or a high need for cognition (i.e., think through ideas, even if it is not personally relevant). However, many people often do not have high receiver involvement or high need for cognition, especially related to public health messages. Therefore, it is possible to go through the entertainment route, where the audience can initially have low-involvement with the topic. Then the topic or issue is subsequently subtly woven in while they are being entertained and they are less likely to be actively guarding against a direct pitch.

Part Six: The "Front Door" vs. "Back Door" Approach

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First "Frontdoor"=high-involvement with the issue: to communicate messages that the audience finds personally relevant, one could discuss topics like morbidity and mortality rates. This would work best for the central route.

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In contrast, Backdoor=low-involvement with the issue: the goal is simply to get people to engage at all, which is more similar to the peripheral route. Sometimes the backdoor approach is called “wrong reason” health promotion, because it encourages people to become interested in the health information or behavior because of a superficial reason that is not directly related to being healthier (e.g., exercise to “look good naked” or seek preventive care to save money). The backdoor approach is about meeting people where they are,

(see Channels module), and not operating off the assumption that everybody should care about something simply because we (in the field of public health) care about it.

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Arguably, our default assumption should be that generally people won’t care about what we in health promotion are trying to teach them. Remember that people will notice things once their attention has been drawn towards those things (e.g., once someone is thinking about buying a certain kind of car, he/she will see that car everywhere). An example is getting people to eat healthy and exercise to lose weight because they are motivated to look better. This is using the backdoor approach because they may already care about how they physically look and could adopt those behaviors, but they could still not care about the numerous other long-term benefits of the healthy behaviors. The NYT recently published an article about exercise as the closest thing to a “wonder drug” because of evidence of numerous benefits (see example 1); this is a clear example of the frontdoor approach. In contrast, The e-card in (example 2) and an actress who exercised to lose weight (example 3) both demonstrate the backdoor approach.