Disparities in health outcomes across racial groups are particularly salient for African-Americans compared to European-Americans in the context of HIV-prevention. These differences in outcomes may be perpetuated, in part, by disparities in attention to health information. We used unobtrusive observation in a public health waiting room to examine if there are differences in attention to HIV- and flu-prevention information across observed racial groups, and whether the direction of the difference in attention implies a disadvantage for African-Americans. Results indicated that African-Americans paid less attention to an HIV- than a flu-prevention video. However, attention did not differ for European-Americans across information types. Disparities in attention yielded less access to HIV-prevention information for African- than European-Americans. Modifying the framing of health information to ensure attention by all ethnic groups may be a strategy to increase attention, and thereby prevent HIV infection as well as reduce disparities in health outcomes.

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.

Keywords: selective exposure; health disparities; social psychology; selective attention; health message design; health intervention; persuasive message; health research

Health communications are only effective if target audiences actually receive the messages. One potential barrier to effective health communication is the potential stigma of attending to health information, particularly for stigmatizing health issues. The purpose of the present paper was to examine when participants report self-conscious emotions (e.g., shame, embarrassment) in response to health communications, as well as likelihood of reading health information associated with these emotions. Across three studies, participants read information about preventing diseases that are either highly stigmatized or non-stigmatized. Increased accessibility of stigma cues by (a) manipulating the perceived absence vs. presence of others, or (b) measuring lower vs. higher rejection sensitivity resulted in increased self-conscious emotions in response to information about stigmatized health issues. In addition, stigma cues decreased the likelihood of reading information about stigmatized (but not non-stigmatized) health information. Implications for health outcomes and intervention design are discussed.

Keywords: Stigma Cues; Emotional Response to Health Information; Attention to Health Information; Self-conscious Emotions

HIV-prevention intervention effectiveness depends on understanding whether clients with highest need for HIV-prevention counseling accept it. With this objective, a field study with a high-risk community sample from the southeastern United States (N = 350) investigated whether initial knowledge about HIV, motivation to use condoms, condom-use-relevant behavioral skills, and prior condom use correlate with subsequent acceptance of an HIV-prevention counseling session. Ironically, participants with high (vs. low) motivation to use condoms, high (vs. low) condom-use-relevant behavioral skills, and high (vs. low) prior condom use were more likely to accept the HIV-prevention counseling. Moreover, the influence of motivation to use condoms, condom-use-relevant behavioral skills, and prior condom use on acceptance of the counseling was mediated by expectations that the counseling session would be useful. Methods to reduce barriers to recruitment of clients for counseling programs are discussed.

Keywords: counseling acceptance, selective exposure, intervention, HIV, condom use

Objective: Enrollment in HIV-prevention interventions is more likely when the audience has safer rather than riskier HIV-relevant behavior. Thus, a meta-intervention was designed to increase participation by an audience of infrequent condom users in Florida. Design: Participants (N
400) were randomly assigned to 1 of 4 conditions varying the introduction to a counseling program. In the experimental condition, participants were told that the intervention gave participants options but might not change their behavior. In a standard-introduction condition, participants were told that the program was highly effective at changing participants’ behaviors. There was also an information-control group containing a
description of the program, and a no-information-control group solely containing an invitation. Main outcome measures: The outcome measure was actual participation in the offered counseling. Results: Findings indicated that the experimental introduction was the most successful at yielding participation in the counseling program when the audience had low intentions to use condoms in the future. Conclusion:
Intervention introductions countering participants’ resistance to change increase participation in HIVprevention counseling among reluctant clients. Other meta-interventions may be explored to systematically augment the effectiveness of evidence-based health-promotion interventions.
Keywords: HIV prevention, intervention, selective exposure, health behavior, participation in health promotion programs

General action and inaction goals can influence the amount of motor or cognitive output irrespective of
the type of behavior in question, with the same stimuli producing trivial and important motor and cognitive manifestations normally viewed as parts of different systems. A series of experiments examined the effects of instilling general action and inaction goals using word primes, such as “action” and “rest.” The first 5 experiments showed that the same stimuli influenced motor output, such as doodling on a piece of paper and eating, as well as cognitive output, such as recall and problem solving. The last 2 experiments supported the prediction that these diverse effects can result from the instigation of general action and inaction goals. Specifically, these last 2 studies confirmed that participants were motivated to achieve active or inactive states and that attaining them decreased the effects of the primes on behavior.

Keywords: action goals; self-regulation; behavior

This research tested the prediction that reading a preventive brochure leads people to watch a preventive video, and that watching this video in turn leads to an increase in the likelihood of participating in a preventive counseling session. A sample of men and women from a southeastern community in the United States was recruited for a general health survey with the objective of examining participation in HIV-prevention interventions. Unobtrusive measures of exposure to HIV-prevention brochures, an HIV-prevention video, and an HIV-prevention counseling
session were obtained. Findings indicated that reading the brochures increased watching the video and that watching the video increased participation in the counseling session. The association between exposure to the video and exposure to the counseling was mediated by expectations that the counseling would be useful. Findings are discussed in terms of the need to ensure exposure to interventions to achieve intervention effectiveness.

Keywords: HIV prevention;
Selective exposure;
Participation in health promotion programs

Objective: To examine the long-term efficacy of both fear-inducing arguments and HIV counseling and testing at encouraging and maintaining knowledge about HIV transmission and prevention, as well as condom use. Design: Analyses were conducted with a sample of 150 treatment groups and 34 controls and included measures of change at an immediate follow-up and a delayed follow-up. Main outcome measures: The main outcome measures were perceived risk of HIV infection, knowledge about HIV, and condom use. Results: Results indicated that receiving fear-inducing arguments increased perceptions of risk at the immediate follow-up but decreased knowledge and condom use, whereas resolving fear via HIV counseling and testing decreased perceptions of risk and increased knowledge and condom use at both the immediate and delayed follow-ups. The effects on perceived risk and knowledge decreased over time, but the effects on condom use became more pronounced. Conclusion: Inducing fear is not an effective way to promote HIV-relevant learning or condom use either immediately following the intervention or later on. However, HIV counseling and testing can provide an outlet for HIV-related anxiety and, subsequently, gains in both knowledge and behavior change immediately and longitudinally.

Keywords: longitudinal behavior change; HIV prevention; fear appeals; HIV counseling and testing; meta-analysis

Over two decades of HIV-prevention attempts have generated a most impressive ecological data set for the test of behavioral-change and persuasion theories in the domain of condom use. An analysis of this evidence has yielded five important empirical and theoretical conclusions. First, interventions are more successful at achieving immediate knowledge and motivational change than they are at achieving immediate behavioral change. Second, the immediate motivational change decays over time, whereas behavior change increases over the same period. Third, interventions that engage audiences in particular activities, such as role-playing condom use, are more effective than presentations of materials to passive audiences. Fourth, interventions consistent with the theories of reasoned action and planned behavior, with self-efficacy models, and with information-motivation and behavioral-skills models prove effective, whereas interventions designed to induce fear do
not. Fifth, expert intervention facilitators are more effective than lay community members in almost all cases. When populations are unempowered, expert facilitators are particularly effective, and they are most effective if they also share the gender and ethnicity of the target audience.

Keywords: HIV; health promotion; persuasion; behavior change; attitude change; source effects

Commentary authors in this issue of Psychological Inquiry face several challenges. One is to contribute to the debate that motivates this issue. We first review the scope, precision, and heuristic value of the models. We then discuss the models’ assumption about reflection and control. We identify a need to investigate the ecological validity of the presence of intention and control in two types of data. Comparing the use of intentionality and control words in literary texts with intention reports in psychological studies suggests dramatic differences in the frequency of intention references. We propose that intentionality requires a translation from random, sequential contents in the stream of consciousness into a more coherent narrative in the first person. The mechanism for the translation is probably syntactic parsing. Some preliminary data and potential directions of this view are discussed.

A meta-analysis of 166 HIV-prevention interventions tested theoretical predictions about the effects of experts, lay community members, and similar and dissimilar others, as agents of change. In general, expert interventionists produced greater behavior change than lay community members, and the demographic and behavioral similarity between the interventionist and the recipients facilitated behavioral change. Equally importantly, there were differences across groups in the efficacy of various sources, especially among populations of low status and/or power. These findings support the hypothesis that unempowered populations are more sensitive to characteristics of the interventionists who can facilitate access to various resources. In addition, they suggest the need to ensure the availability of health professionals from diverse  demographic and behavioral backgrounds.

Keywords: HIV prevention; source features effect; similarities; source–audience effect

This meta-analysis tested the major theoretical assumptions about behavior change by examining the
outcomes and mediating mechanisms of different preventive strategies in a sample of 354 HIV-prevention interventions and 99 control groups, spanning the past 17 years. There were 2 main conclusions from this extensive review. First, the most effective interventions were those that contained attitudinal arguments, educational information, behavioral skills arguments, and behavioral skills training, whereas the least effective ones were those that attempted to induce fear of HIV. Second, the impact of the interventions and the different strategies behind them was contingent on the gender, age, ethnicity, risk group, and past condom use of the target audience in ways that illuminate the direction of future preventive efforts.

Keywords: behavior change; active intervention; HIV; health; communication