Advanced Introduction

Advanced introduction to communication theory on behavioural change and health actions


Health Action Process Approach (HAPA)
The health action process approach (HAPA) is a psychological theory of health behavior change. It has been developed by Ralf Schwarzer, Professor of Psychology at the Free University of Berlin, Germany. It is an open framework of various motivational and volitional constructs that are assumed to explain and predict individual changes in health behaviors such as quitting smoking or drinking, and improving physical activity levels, dental hygiene, seat belt use, breast self-examination, or dietary behaviors.

HAPA suggests that the adoption, initiation, and maintenance of health behaviors should be conceived of as a structured process including a motivation phase and a volition phase. The former describes the intention formation while the latter refers to planning, and action (initiative, maintenance, recovery). The model emphasizes the particular role of perceived self-efficacy at different stages of health behavior change.





In the more simple AIDA-model for persuasion-communication mentioned in our Basic Introduction only four goals and outcomes of communication were. In reality there are off course quite a few more nuances and a deeper understanding of these different outcomes may sometimes hold the key to developing good, targeted communication tools that address the specific issues that a selected target audience may have.

A more advanced model of a Persuasion-Communication Matrix is that of McGuire (1984, 1985, 2001) that has a bigger and more in-depth model for inputs and outputs applied to persuasion communication.

The inputs are the different aspects of the persuasion-communication attempt:

  1. message source (e.g., credibility, attraction, trustworthiness of the sender)
  2. message design (e.g. content, the type, strength, repetition of the argument)
  3. delivery channel (e.g. type of media, way the message is “broadcast”)
  4. receiver (e.g., attitude, beliefs, prior knowledge etc. of the person receiving the message). For instance health literacy is one of the aspects of Receivers.
  5. context (e.g. environmental factors, noise, clutter etc. influencing the message)

The outputs are 12 steps that an individual passes through in the persuasion-communication process:

  1. Exposure to the message (Exposure)
  2. Attention to the message (Attention)
  3. Interest in or personal relevance of the message (Interest/Liking)
  4. Understanding of the message (Comprehension)
  5. Personalizing the behaviour to fit one’s life (Acquisition)
  6. Accepting the change (Agreeing)
  7. Remembering the message and continuing to agree with it (Memorising)
  8. Being able to think of it (Retrieving)
  9. Making decisions based on bringing the message to mind (Deciding)
  10. Behaving as decided (Acting)
  11. Receiving positive reinforcement for behaviour (Reinforcement)
  12. Accepting the behaviour into one’s life (Consolidation)

There is some discussion about the linearity of the steps and the cognitive/rational/conscious nature of the steps. However, these steps once again show that there are different outputs of a communication, varying from awareness, knowledge, attitude change, decisions to behavioural change – they are therefore suited for a diverse array of target audiences, cultural settings, and medical conditions and behaviours.