Dr. Jamie Wiebe

Responsible Gambling Conference um BCLC
3. Mar 2017

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Dr. Jamie Wiebe

  1. GOAL OBJECTIVE • Improve the promotion and adoption of responsible gambling behaviour and player support service provision • Discuss practical ways to effectively promote safer gambling behaviours, with insights on what we know about how best to influence people
  2. DEFINITIONS AND PERSPECTIVES • No single definition of responsible gambling • Positive actions that can help to limiting risks and prevent harm • Many perspectives on RG, differ in context and strategies
  3. Executing a Responsible Gambling Initiative Define your Target Group Outline your Objectives Choose your Channels Select your Message Know your Audience Test and Evaluate
  4. Gamblers Gambling staff Friends and family TARGET GROUPS FOR RG High Risk Gamblers Low Risk Gamblers No Risk Gamblers
  6. • Nudges alter how choices are presented • Favour the most beneficial choice by making it the most attractive, easiest, or default • RG nudges: – Self-Exclusion – Break Prompts – Distancing ATMs/RG Messaging – Voluntary Limit Setting NUDGES (Thaler and Sunstein 2008)
  7. INSIDE THE GAMBLING VENUE Messaging: Player Support: • Posters • Brochures and Pamphlets • Player Activity Reports • Audio-Visual Ads • Gaming Staff and RG Staff • RG Staff • Credit Access Limitations • Treatment Referral
  8. • Public awareness campaigns • Prevalence surveys • Peer-reviewed publications • RG conferences • School programs OUTSIDE THE GAMBLING VENUE Current RGC Awareness Campaign
  9. PEOPLE AS CHANNELS • Be creative • People can be used for RG messaging • RG for those at key points of access – Primary Health Care Providers – Bank Employees – HR Personnel
  10. • Positive frames for prevention behaviours • Negative frames for detection behaviours • Focus on social consequences and consequences for others FRAMING Positive Prevention Ad (Gallagher and Updegraff 2012; Keller and Lehmann,2010; Rothman et al.,2006)
  11. Negative Detection Ad Other Consequences Ad
  12. • Fear appeals are effective but risky • Narratives are more influential than factual statements • Images increase the impact of communications CONTENT Fear Appeal with Narrative (Houts et al. 2006:; Shen et al 2015; Witte and Allen 2000)
  13. Messages can be personalized and tailored to an individual’s health situation TAILORING (Krebs, et al. 2010; Lustria et al.,2013; Noar et al. 2007) Tailored more effective than non-tailored • Relevant • Attention-getting • Deeply processed • Remembered • Viewed positively
  15. CULTURAL TARGETING • Cultural targeting increases message relevance and acceptance, and behaviours • Target cultural groups using: – Colours, images, and music – People and language – Group-specific evidence – Cultural understandings of health (Devos-Comby and Salovey 2002; Kreuter et al. 2003)
  16. BEWARE OF LABELLING • Avoid labelling people or their behaviour • ‘Problem gambler’ label has negative impacts – Stigma and stereotyping – Distance and judgment – Reduced self-esteem, confidence in quitting – Physical health problems – Secrecy and treatment avoidance (Hing et al. 2016)
  17. • Promotion focus on achieving good health or prevention focus on avoiding poor health • Promotion = achievement behaviours and positive frames • Prevention = avoidance behaviours and negative frames PROMOTION OR PREVENTION FOCUS (Higgins 2002; Lee and Aaker 2004)
  18. Positive Promotion Ad Negative Prevention Ad
  19. PRESENT OR FUTURE FOCUS • Present-focused emphasize immediate consequences, future-focused emphasize delayed consequences • Present-focused: immediate benefits, delayed negative consequences • Future-focused: immediate negative consequences, delayed benefits (Orbell and Kyriakaki 2008) Delayed Benefits Ad
  20. • Higher perceived risk – vulnerability to and severity of the health threat – predicts behaviour change • Negative frames for high risk, positive frames for low risk • Increased using negative frames, daily health risks, and featuring frequent behaviours PERCEIVED RISK (Chandra and Menon 2004; Lee and Aaker 2004; Menon et al. 2002; Witte and Allen 2000) Daily Risk Ad
  21. • Higher health involvement – motivation, relevance, attention to health – leads to healthier behaviours HEALTH INVOLVEMENT Statistics Moderately Fearful Strong Messages Images Moderately Fearful Positive Frames Consequences for Others Source Credibility Humour (Jayanti and Burns, 1998; Keller and Lehmann 2010; Petrovici and Ritson,2006; Yoon and Tinkham 2013)
  22. • Perceived effectiveness – the belief that the recommended action will address the health threat – predicts health behaviours • Can be increased by health messages • High = positive AND negative frames • Low = negative frames PERCEIVED EFFECTIVENESS High Effectiveness Ad (Becheur et al.,2008; Block and Keller 1995; Witte and Allen 2000)
  23. • Perceived ability – a person’s belief in whether they can implement a recommended solution to a health threat – leads to behaviour change 1. Ability to make the decision 2. Ability to maintain the behaviour change • Can be increased by health messages PERCEIVED EFFECTIVENESS High Ability Ad (Becheur et al. 2008; Schwarzer and Renner 2000; Witte and Allen 2000)
  24. • Improve message understanding and impact with: – Two or three concepts – Simple illustrations – Simple wording – No unnecessary words – Clear and logical formatting – Small-numbered ratios (1-in-3 vs. 6-in-15) – Round numbers (50% vs. 50.21%) HEALTH LITERACY AND NUMERACY (Schlosser, 2012; Seligman et al. 2007; Zhang & Wadhwa, 2015)
  26. • Fit the objectives to the target group • Be creative when selecting dissemination channels • Carefully consider the details of the message and the audience • Test your initiatives before and after implementation CONCLUDING REMARKS
  27. Thank you! Jamie Wiebe, Director Research and Development Responsible Gambling Council
  28. References Becheur, I., Dib, H., Merunka, D., & Valette-Florence, P. (2008). Emotions of Fear, Guilt Or Shame in Anti-Alcohol Messages: Measuring Direct Effects on Persuasion and the Moderating Role of Sensation Seeking. E - European Advances in Consumer Research, 8, 99-106. Block, L. G., & Keller, P. A. (1995). When to Accentuate the Negative: The Effects of Perceived Efficacy and Message Framing on Intentions to Perform a Health- Related Behavior. Journal of Marketing Research, 32(2), 192-203. Chandran, S., & Menon, G. (2004). When a Day Means More than a Year: Effects of Temporal Framing on Judgments of Health Risk. Journal of Consumer Research, 31(2), 375-389. doi: 10.1086/422116 Devos-Comby, L., & Salovey, P. (2002). Applying persuasion strategies to alter HIV-relevant thoughts and behavior. Review of General Psychology, 6(3), 287-304. doi: 10.1037/1089-2680.6.3.287 Gallagher, K. M., & Updegraff, J. A. (2012). Health Message Framing Effects on Attitudes, Intentions, and Behavior: A Meta-analytic Review. Annals of Behavioral Medicine, 43(1), 101-116. doi: 10.1007/s12160-011-9308-7 Higgins, E.T. (2002). How self-regulation creates distinct values: The case of promotion and prevention decision making. Journal of Consumer Psychology, 12(3), 177-91. Hing, N., Nuske, E., Gainsbury, S.M., & Russell, A.M.T. (2016). Perceived stigma and self-stigma of problem gambling: perspectives of people with gambling problems, International Gambling Studies, 16(1), 31-48, DOI: 10.1080/14459795.2015.1092566 Houts, P. S., Doak, C. C., Doak, L. G., & Loscalzo, M. J. (2006). The role of pictures in improving health communication: a review of research on attention, comprehension, recall, and adherence. Patient education and counseling, 61(2), 173-190. doi: 10.1016/j.pec.2005.05.004 Jayanti, R. K., & Burns, A. C. (1998). The Antecedents of Preventive Health Care Behavior: An Empirical Study. Journal of the Academy of Marketing Science, 26(1), 6-15. doi: 10.1177/0092070398261002 LaPlante, D. a., Gray, H. M., LaBrie, R. a., Kleschinsky, J. H., & Shaffer, H. J. (2012). Gaming Industry Employees’ Responses to Responsible Gambling Training: A Keller, P.A., & Lehmann, D. R. (2008). Designing Effective Health Communications: A Meta-Analysis. Journal of Public Policy & Marketing, 27(2), 117-130. doi: 10.1509/jppm.27.2.117
  29. Keller, P. A., & Lehmann, D. (2010). Promoting Health-Related Consumer Research: Arc Model Application to Cdc’S Health Campaign. Advances in Consumer Research, 8, 207-210. Krebs, P., Prochaska, J. O., & Rossi, J. S. (2010). A meta-analysis of computer-tailored interventions for health behavior change. Preventive medicine, 51(3-4), 214-221. doi: 10.1016/j.ypmed.2010.06.004 Kreuter, M. W., Lukwago, S. N., Bucholtz, D. C., Clark, E. M., & Sanders-Thompson, V. (2003). Achieving Cultural Appropriateness in Health Promotion Programs: Targeted and Tailored Approaches. Health Education & Behavior, 30(2), 133-146. doi: 10.1177/1090198102251021 Lee, A. Y., & Aaker, J. L. (2004). Bringing the frame into focus: the influence of regulatory fit on processing fluency and persuasion. Journal of personality and social psychology, 86(2), 205-218. doi: 10.1037/0022-3514.86.2.205 Lustria, M. L., Cortese, J., Noar, S. M., & Glueckauf, R. L. (2009). Computer-tailored health interventions delivered over the Web: review and analysis of key components. Patient education and counseling, 74(2), 156-173. doi: 10.1016/j.pec.2008.08.023 Menon, G., Block, L. G., & Ramanathan, S. (2002). We're at as Much Risk as We Are Led to Believe: Effects of Message Cues on Judgments of Health Risk. Journal of Consumer Research, 28(4), 533-549. doi: 10.1086/338203 Noar, S. M., Benac, C. N., & Harris, M. S. (2007). Does tailoring matter? Meta-analytic review of tailored print health behavior change interventions. Psychological bulletin, 133(4), 673-693. doi: 10.1037/0033-2909.133.4.673 Orbell, S., & Kyriakaki, M. (2008). Temporal framing and persuasion to adopt preventive health behavior: moderating effects of individual differences in consideration of future consequences on sunscreen use. Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 27(6), 770-779. doi: 10.1037/0278-6133.27.6.770 Petrovici, D. A., & Ritson, C. (2006). Factors influencing consumer dietary health preventative behaviours. BMC public health, 6, 222. doi: 10.1186/1471-2458-6- 222 Responsible Gambling Council. (2010). Informed Decision Making (techreport). Toronto, Ontario. Responsible Gambling Council. (2016). Identity Checking Strategies at Land-Based Venues : An Exploration of Mandatory ID Checking and Other Approaches. Toronto, Ontario. Retrieved from Report - Identity Checking Strategies at Land-Based Venues %28final%29.pdf
  30. Rothman, A. J., Bartels, R. D., Wlaschin, J., & Salovey, P. (2006). The Strategic Use of Gain- and Loss-Framed Messages to Promote Healthy Behavior: How Theory Can Inform Practice. Journal of Communication, 56(s1), S202-S220. doi: 10.1111/j.1460-2466.2006.00290.x Schlosser, A. (2012). When 1-in-3 is Greater than 4-in10: Why Lower Probability Events Can be More Persuasive in Public Service Announcements. Advances in Consumer Research, 38. Schwarzer, R., & Renner, B. (2000). Social-cognitive predictors of health behavior: action self-efficacy and coping self-efficacy. Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 19(5), 487-495. Seligman, H. K., Wallace, A. S., DeWalt, D. A., Schillinger, D., Arnold, C. L., Shilliday, B. B., . . . & Davis, T. C. (2007). Facilitating behavior change with low-literacy patient education materials. American journal of health behavior, 31 Suppl 1, S69-78. doi: 10.5555/ajhb.2007.31.supp.S69 Shen, F., Sheer, V. C., & Li, R. (2015). Impact of Narratives on Persuasion in Health Communication: A Meta-Analysis. Journal of Advertising, 44(2), 105-113. doi: 10.1080/00913367.2015.1018467 Thaler, R.H., & Sunstein, C.R. (2008). Nudge: Improving Decisions About Health, Wealth, and Happiness. New Haven, Connecticut: Yale University Press. Witte, K., & Allen, M. (2000). A Meta-Analysis of Fear Appeals: Implications for Effective Public Health Campaigns. Health Education & Behavior, 27(5), 591-615. doi: 10.1177/109019810002700506 Yoon, H. J., & Tinkham, S. F. (2013). Humorous Threat Persuasion in Advertising: The Effects of Humor, Threat Intensity, and Issue Involvement. Journal of Advertising, 42(1), 30-41. doi: 10.1080/00913367.2012.749082 Zhang, K., & Wadhwa, M. (2015). Numbers and Preventive Decision Making. Asia-Pacific Advances in Consumer Research, 11, 19-20.

Hinweis der Redaktion

  1. This presentation aims to improve the promotion and adoption of responsible gambling behaviour and player support service provision, by discussing practical ways to effectively promote safer gambling behaviours using what we know about how best to influence people.
  2. There is currently no universal definition of responsible gambling. Our understanding of the concept is in continual development and includes many different dimensions and perspectives. However, at its core, RG is parallel with health promotion. It’s focus is on limiting gambling risk and preventing gambling harm. The various perspectives on RG differ in context and strategy, with focuses on gambling risk behaviour, gambling harms, education for individuals and populations, treatment, and business ethics.
  3. Executing a responsible gambling initiative involves several key steps, which we will review in turn. These are: Define your Target Group Outline your Objectives Choose your Channels Select your Message Know your Audience Test and Evaluate
  4. Gamblers are, as you would assume, a primary target for responsible gambling information and support services. RG for gamblers generally targets both gambler knowledge about risk factors, game mechanics, and support services, and behaviours like limit setting and help seeking. RG tools and services typically target a certain type of gambler: either those at no, low, or high risk of gambling problems. Those at no risk, or non-problem gamblers, make up the largest proportion of gamblers. Gamblers at high risk, or with severe gambling problems, make up the smallest proportion of gamblers. Gaming staff have the difficult task of facilitating help-seeking for players. Gaming staff can also develop gambling problems themselves. RG training can help staff deal with these issues. RG training that builds knowledge and teaches best practice behaviours lead to a more confident and RG capable staff. Further, when venues have RG features, gaming staff have more trust in the organizations they work for. Risk and harm experienced by gamblers can often be extended throughout their social networks, having financial, health and emotional impacts for family and friends. Family and friends benefit from RG resources that provide information on problem gambling and how to support loved ones that engage in risky gambling behaviour.
  5. The objectives of RG initiatives depend on the type of gambler being targeted. When targeting casual gamblers, the objective is increasing knowledge about basic gaming information, how games work, and key safeguards. Messages may touch on the unpredictable nature of gambling, spending only what can be affordably lost, and avoiding loss chasing. For frequent gamblers, the objective is increasing self-awareness around gambling concepts, blind spots, risk factors, and teaching practical skills for maintaining control. Messages may touch on explanations of randomness, common fallacies, illusion of control, setting limits, and mindful reflection on behaviours and their impact. With intensive gamblers, the focus is on the gambler’s options around obtaining help and cautionary information. Messages focus on raising awareness of and easy directions on how to access specific support services. Content is also individualized to make players aware of their activity level and any risky practices. Examples include play history reports and self-assessment tools (e.g., gambling risk quizzes).
  6. There are several channels that can be used to disseminate RG messages. Nudges change behaviours at the point of decision, by altering how choices are presented. Nudges favour choices that benefit the individual or society by making them the more attractive, easiest, or default choice. For example, assuming everyone wants to be an organ donor unless otherwise stated – making the default opt-out – increases organ donation rates. Nudges are successful because they capitalize on the mindless way people make decisions and biases in how people think. A few RG nudges currently exist that are placed where gambling decisions are made, like on the machines, at the ATMs, and in gambling venues. These include self-exclusion, break prompts, distancing ATMs, ATM RG messaging, and voluntary limit setting.
  7. RG information and support should be available throughout the gambling venue, not just at points of decision. RG information should be communicated using printed materials like posters, brochures, and player activity reports. Audio-visual ads and gaming and RG staff are also important sources of information. Players should be supported through conversations with RG staff, credit access limitations, and treatment referrals.
  8. RG messaging also has a role to play outside of the gambling venue—and even among current non-gamblers in the general public who may benefit for an improved understanding of this activity. Examples include social marketing campaigns, prevalence surveys, peer-reviewed publications, conferences, and school programs.
  9. It is important to be creative when selecting channels in order to increase the impact of the message. People can be important channels for RG messaging, including those outside of the gambling industry. People that have close and professional contact with a person with a gambling problem are unique points of access to provide additional support and information, perhaps at times when the individual is struggling. For example, primary health care providers have a unique opportunity to ask questions about problem gambling and even administer screening tools at checkups, in a professional, private, and non-threatening environment. Bank employees and HR personnel likely see people with gambling problems in times of struggle, as they battle with financial troubles or work absences. If equipped with RG information and tools, these professionals can provide support when they encounter someone suffering from these problems. This approach has been used successfully in other areas. For example, a sunscreen brand trained tattoo artists to look for signs of skin cancer, and if they spot them, to refer the person to a dermatologist.
  10. The effectiveness of health messages, like those for RG, depends on various aspects of the message itself. Health messages can be framed in several ways, including whether they are positive or negative and the type of consequences they highlight. Positive messages focus on the gains that come with performing a particular health behaviour, while negative messages highlight the losses that occur from not engaging in the same health behaviour. Positive frames generally have a greater impact for behaviours that prevent poor health, while negative frames are sometimes more effective for increasing behaviours that detect the presence of a problem. This is because prevention behaviours are viewed as less risky than detection behaviours, which include the risk of detecting a health problem. When people are thinking about possible losses, they are more likely to take a risk (like performing a detection behaviour). Messages can also frame the consequences of health behaviours in different ways. Messages leads to higher intentions to perform the behaviour when they highlight social (i.e. embarrassment) over physical consequences, because social consequences seem more immediate. Also, messages have larger impacts on intentions when they feature consequences for others instead of for the individual, since they avoid defensive reactions.
  11. Messages also vary in their content, including emotion, narratives, and images. The main emotion used in health communication is fear. When people see a fear appeal, they feel negative emotions like fear, feel vulnerable to the threat, and view the threat as serious, all of which lead them to change their behaviour. However, most people react defensively, so fear appeals must be used sparingly and provide a specific way to deal with the threat. Narratives like testimonials, anecdotes, and stories have positive impacts on behaviour change over factual statements. Narratives transport the viewers into the story, leading them to focus on the argument and see themselves as vulnerable. Health communications are also more effective when they include images that are linked to the accompanying text. Messages with images are more likely to be read and remembered, improve comprehension of the message, and have greater impacts on health behaviours than text only messages.
  12. Health information can be personalized with the person’s name and tailored to their health situation, including their background, needs, preferences, stage of change, benefits, barriers, and risks. Tailored messages are more effective at achieving behaviour change than non-tailored messages, and the impact is long lasting (peaking around 12 months). Tailored messages have positive impacts because they are more personally relevant, generate more attention, are more deeply processed, are more likely to be remembered, and are viewed more positively.
  13. While tailoring focuses on the individual, targeting focuses on a population subgroup. Health messages can target cultural groups in several ways. On the surface, messages can target a cultural group by using people, language, clothing, colours, images, fonts, or music that are familiar to, preferred by, or relevant for the target group. Messages can also provide evidence of how the health threat impacts the group. On a deeper level, messages can reflect how groups conceptualize health and barriers to health by using particular examples and arguments. Culturally targeted messages increase the acceptance and relevance of the message. They can make viewers aware of the issue and their vulnerability to it, and lead to emotional reactions, which can all contribute to behaviour change.
  14. When directing message and player supports to intensive gamblers or those with a gambling problem, it is important not to label the individual or their behaviour. The ‘problem gambler’ label negatively impacts the individual in several ways. It is associated with a great deal of stigma (more than cancer) and various stereotypes, being viewed as caused by personal failings. People tend to keep their distance from those with gambling problems, and judge them as stupid, selfish, or worthless. When those with a gambling problem believe negative things about themselves, their self-esteem is reduced, they feel less able to solve their gambling problem, and they can have physical health problems like stomach pains. Many people with gambling problems keep their troubles a secret because they are afraid and ashamed. These same feelings lead people to avoid seeking formal help, including self-exclusion and in some cases peer support groups and counselling.
  15. There are several audience factors that can influence the reception and therefore the effectiveness of health messages. For example, individuals differ in how they think about health: whether they are focused on promotion or prevention. When an individual has a promotion focus, they have a preference for behaviours designed to achieve good health, like starting new activities. When an individual has a prevention focus, they prefer behaviours that are aimed at avoiding poor health, like abstaining from or cutting back on certain activities. Individuals tend to have a general and stable preference for thinking about health in promotion terms or prevention terms. It is also possible to trigger an individual to think with a prevention or promotion focus using the contents of a health message. Health messages are more influential when they feature behaviours and frames that fit with the viewer’s focus. For individuals with a promotion focus, messages that include behaviours designed to achieve good health lead to more behaviour change and messages that use a positive frame lead to more attitude change. For those with a prevention focus, messages that include behaviours designed to avoid poor health lead to more behaviour change and messages that use a negative frame lead to more attitude change. The fit between the message and the individual’s focus increases the impact of health communications because it ‘feels right’. Viewers understand the importance of the behaviour and find the message easy to process and understand.
  16. Some individuals generally place more emphasis on the immediate consequences of their actions while others are more focused on the delayed consequences. Compared to those focused on the present, future-focused individuals have more positive attitudes and intentions towards health behaviours with distant benefits, like sunscreen use and health screening. The type of messaging that leads to higher intentions is different for present and future focused people. Intentions are increased for future focused individuals when a message frames positive outcomes as long lasting and negative outcomes as immediate. In contrast, messages that frame positive outcomes as immediate and negative outcomes as occurring in the future lead to higher intentions among present oriented people. This fit increases intentions by making people feel positive about the recommended behaviour, feel like they can perform the behaviour, and feel fearful of the health threat.
  17. People also differ in their perceived level of risk. The level of risk that people perceive involves two assessments: their vulnerability to it and the severity of it’s consequences. Generally, higher perceived risk leads to more behaviour change. As discussed under message content, fear appeals lead to higher intentions and behaviours by increasing individuals’ perceptions of their vulnerability to and the severity of the health issue. This is because when individuals feel vulnerable they have negative emotions towards the health threat and positive attitudes towards the recommended behaviour. The level of perceived risk changes the impact of message framing. Negative frames leads to larger attitude changes when the viewers feel vulnerable because they are hoping to avoid a negative outcome. In contrast, positive frames have a greater impact on attitudes for those who feel less vulnerable because they are hoping to reach a positive outcome. Perceived risk can be increased by using negative frames, featuring behaviours that the audience frequently engages in, and framing health risks as occurring on a daily rather than yearly basis.
  18. Some people are more involved in their health than others. They pay more attention to health issues, view them as more relevant, and are more motivated to stay healthy. People who are more involved in their health have more positive attitudes towards health behaviours, are more likely to engage in them, see them as more effective, and are more likely to believe they can perform them. Level of health involvement influences the impact of several message factors. Those with high health involvement react more positively to messages that include statistics and moderately fearful strong messages. In contrast, those with low health involvement respond well to messages with moderately fearful positive frames, images, consequences for others (not the individual), strong source credibility, and humour. People who are involved in their health process health messages more deeply, which is why they prefer statistics and strong arguments.
  19. People differ in whether or not they think a recommended action will address a health threat. When individuals think the behaviour will be effective, they have higher intentions to and are more likely to perform the behaviour. Health messages can change how individuals think about the behaviours by describing them as more or less likely to reduce the health threat. For example, fear appeals that emphasize the effectiveness of the recommended behaviour lead to greater increases in attitudes, intentions, and behaviours. One study finds that the impact of message frames depends on the level of perceived effectiveness of the behaviour. When people think a recommended action will limit the threat, they have more positive attitudes towards and intentions to perform the behaviour regardless of the type of frame used. However, when the effectiveness is less clear, people are influenced more by negatively framed messages. In these cases, they are processing the message more deeply, and negative messages typically include more information than positive ones.
  20. Some people believe that they can implement the recommended solution to a threat while other’s do not. When a person believes they can perform the health behaviour, they have higher intentions to do so and are more likely to act on these intentions by carrying out the behaviour. Perceived ability works at two phases in the behaviour change process. It helps people make the decision to make a behaviour change, and it helps them maintain the new behaviour. Confidence in one’s ability can be bolstered by health messages that emphasize how manageable it is to perform a certain behaviour. For example, when fear appeals use this type of messaging, attitudes, intentions, and behaviours are increased.
  21. Health literacy is the ability to retrieve, understand, and apply health information in order to make health decisions. A concept that is related to and often included in measures of health literacy is health numeracy – the ability to comprehend and use numerical health information. Health literacy and numeracy are generally low, with half of Americans scoring poorly on these measures. Health communications can be easily understood by those with low levels of health literacy if they: focus on two or three concepts; use simple illustrations to emphasize key concepts; use short words, general terms, and the active voice; do not use more words than necessary; and use clear and logical formatting (i.e. large font). Beyond increasing comprehension, health messages can encourage behaviour change among those with low literacy by placing the focus on providing practical strategies for dealing with a health threat instead of relaying facts about the health issue. Health messages can also increase their impact by using certain types of numbers. Small-numbered ratios with denominators under five (i.e. 1-in-3) convey more risk than large-numbered ratios with denominators of 10 or above (i.e. 6-in-15). In a similar vein, round (i.e. 50%) versus precise (i.e. 50.21%) numbers have greater impacts on intentions and behaviours because they increase worry. Basically, small numbered ratios and round numbers are easier to visualize and process.
  22. Because RG casts a wide net, RG information and interventions cannot be implemented as one-size-fits-all. They must define a target group and establish objectives based on this audience. Initiatives must be creative when selecting channels for dissemination in order to increase impact. Particular attention must be paid to the details of the message and important differences that may exist amongst the target audience. Finally, RG initiatives must be tested before and after they are implemented, to avoid complete misses and provide information for future interventions.