Trust, truth and tactics: How PR teams can use psychological models of persuasion in public health campaigns during the age of misinformation

Harmful health misinformation has grown since the Covid-19 pandemic with disproven theories about vaccines spreading like wildfire on social media and anti-vaccine sentiment rising.[1]

Today, childhood vaccination rates in the UK for common diseases such as measles have fallen to their lowest levels in more than a decade, leaving the country at risk of serious outbreaks of potentially deadly diseases[2].

Over the past decade, while managing press and editorial content for one of UCL’s research centres, I have noticed the growing normalisation of health misinformation on social media.

I believe science communicators have a vital role to play in combating the spread of false information and engaging the public with credible scientific evidence.

In this article I will explain how science PR teams can use established models of persuasion to shape people’s attitudes and behaviours, so the public are better informed before making decisions about their health and wellbeing.

The rise of misinformation

In the past two decades, social media and citizen journalism has democratised information about science and health[3], but has supercharged the spread of health misinformation. This has created doubt about scientific evidence and consensus[5] and low levels of public media literacy have compounded the issue[6].

Misinformation is particularly worrying when it infringes on people’s attitudes and behaviours regarding their health and those of their loved ones.

Research has shown that although scientists and doctors are among the most trusted people in society, people with right-wing political beliefs, younger generations and those from disadvantaged backgrounds tend to have less faith in science[7] [8].

With less trust in our experts and scientific evidence among certain demographic groups, government public health policies are less likely to be accepted[9], with detrimental impacts on people’s physical and mental health[10] [11].

Health misinformation, especially about vaccines, is especially persuasive because of the use of emotional, personal stories[12].

In contrast, public health communications have traditionally relied upon experts presenting often sterile scientific evidence to persuade the public “until the science wins over the intended audience”[13].

Fact checking health claims online, while well-intentioned, do not always reach their intended audiences[14]. Research also finds that often when misinformation is debunked, affected communities become even more committed to their beliefs[15].

Building public trust

For science communicators trying to influence people’s attitudes and behaviours simply broadcasting scientific evidence is not enough. The first stage is to engage with audiences, listen to their interests and concerns and gain their trust.

Grunig claims communication is more effective and ethical if it involves “two-way symmetrical communication”, using negotiation and compromise with audiences to generate “mutual understanding”. Organisations should “communicate effectively with their stakeholders and take their views into account if they want to ensure long-term support”[16].

Health practitioners in the field are leading the way by forging trusting relationships with the public. Professor Elizabeth Whittaker, a paediatric expert in infectious diseases and immunology, listens to patients’ concerns about vaccines, building trust through conversation, honesty and transparency.

Her approach is to listen calmly and explain the evidence and facts and challenge the myths that many parents believe about vaccines[17].

How to reach different audiences

After securing public trust, science communicators should aim to undertake audience research to understand how individuals process and react to different types of persuasive messaging.

The first empirical studies of communication in the aftermath of the propaganda-laden second world war concluded erroneously that people were passive recipients of messages[18]. Scholars soon realised that individuals play an active role in the persuasion process by weighing up the pros and cons of a message before deciding whether to change their attitudes and behaviours. They must persuade themselves[19].

They also assumed that there was such a thing as a general public, and that everyone had the time, appetite and mental capacity to deliberate on every message they received.

Understanding audiences with the Elaboration Likelihood Model

The ‘Elaboration Likelihood Model’ (ELM) outlines the factors that drive successful communication and persuasion. It shows how likely it is that someone will think about, or as the term suggests, elaborate on the arguments in a message.

People tend to choose different routes when processing information, depending on their motivation to follow and ability to understand the argument. Tailoring messages to the specific audience is key.

People who follow the ‘central’ route are motivated and able to carefully consider rational arguments which require cognitive effort to process. According to Perloff, when people follow this route, they are willing and eager to “ponder implications of the communicator’s ideas, and relate information to their own knowledge, biases and values”[20].

Those who take the ‘peripheral’ route to persuasion are less likely to be motivated and able to elaborate on the intricacies of the message. They will tend to react emotionally and instinctively, examining the message quickly and focusing on simple cues, symbols and mental shortcuts. Attractive and charismatic communicators, celebrity and influencer endorsements, humour, alluring graphics and music combine with the messages to create a positive mood that suckers individuals into persuasion[21].

Crucially, the ELM emphasises that the same person can take different routes to different messages depending on how personally relevant the issues are to their lives. People can be “simple information processors” in some circumstances and “deep, detailed thinkers” in others[22].

Long-lasting attitudinal and behavioural change is less likely to happen via the peripheral route. Communicators should try a hybrid approach, by using cues to gain an audience’s attention, and then motivating them to process more deeply[23].

In today’s attention economy it could be argued that the peripheral route of communication is the new norm as “multiple stimuli, unfathomably complex issues and relentless social change” means people tend to rely on “mental shortcuts much of the time”[24].

Today’s public are often on ‘autopilot’ and are governed by ‘heuristics’: simple decision-making rules[25].

Corporate PR and comms teams have realised this and have adapted their tactics accordingly to sell products and services, but so increasingly have government and science communicators.

These ‘cues’, ‘mental shortcuts’, ‘nudges’, and ‘rules of thumb’ are the psychological levers communicators now pull to convince the time and attention poor public to buy their products, or more crucially, to convince them to improve their health.

Let’s look at how they work and how they’ve been used by science communicators in public health campaigns.

The psychological levers of persuasion

Fear

Fear can be used in public health communications to change attitudes and behaviours, but only if individuals believe they are able to effectively respond to the threat[26][xxvi]. Anti-smoking and driving safety campaigns have regularly invoked fear about illness, injury and death, but have also included simple information that shows how people can respond to these threats, such as wearing seatbelts and driving to the speed limit. Using fear can backfire, however, as shown by the “Don’t Die of Ignorance” HIV/AIDS campaign in the 1980s, which caused public panic and reinforced stigma[27].

Liking

People tend to like spokespeople who are similar to them. Research has shown that compliments also increase one’s affection for another, as well as the physical attractiveness of the speaker[28]. In public health communications, this tactic is often utilised by choosing appropriate messengers who have a connection with the audience. For example, during the Covid-19 pandemic, the Government of Jersey used care home staff who had initially been cautious but had then got vaccinated as spokespeople to convince other care home staff to get the jab[29].

Rewards and reciprocation

One of the basic norms of human culture is to pay back what another person has provided[30]. People can be motivated to be more health conscious if the desired behaviour can be made fun[31]. The Singapore government persuaded its citizens to be more active using gamification and financial rewards. For every 10,000 steps recorded in a mobile app each day, participants were rewarded points to exchange for grocery vouchers[32].

Social norms

Individuals are influenced by what others do[33]. People often ‘follow the herd’ during times of uncertainty and are more likely to bow to peer pressure from those who are similar to them[34]. To encourage vaccination during Covid-19, public health communicators used ‘social proof’ by highlighting the millions who had received a jab. They then encouraged people to show off their vaccination status by wearing stickers and changing their social media profile avatars.

Consistency and commitment

According to Cialdini, we have a need to appear consistent to others, so not following through would cause an uncomfortable feeling of “cognitive dissonance”. [35].

Health campaigns such as Stoptober and Dry January invite people to make a commitment by signing up online. This commitment is then reinforced by regular email communications offering encouragement and guidance.

Authority and expertise

In a democratic society, authority tends to come from expertise. When processing a persuasive message, people are usually comfortable following the information of someone who is more informed on a subject than them. Contrary to reports about declining faith in experts, doctors and scientists are the most trusted people in Britain to tell the truth[36]. The public also believe that scientists have become better at communicating their research findings[37]. Celebrity and influencer scientists and doctors now regularly share credible health information online.

Presentation

Making persuasive messaging simple and actionable means it is doesn’t take much cognitive processing and is easy to understand and remember[38]. The stroke awareness campaign Act F.A.S.T. was able to translate a serious health issue into an actionable message that could be easily recalled and used in a crisis. Using slogans that include a simple goal can also be effective in influencing health behaviours, as shown with This Girl Can, Dry January and Stoptober[39].

The future of public health messaging

In this post-truth world just debunking health misinformation with scientific evidence is no longer enough to change people’s attitudes and behaviours about their health.

Conversation, negotiation and compromise are the foundations of effective persuasion. Only by knowing your audience and securing trust can you “steer people’s choices in directions that will improve their lives” while preserving their “freedom of choice”[40].

The peripheral route to persuasion using cues, nudges and mental shortcuts can help the public take their first steps towards deciding to improve their health.

Appropriate spokespeople, simple, clear and actionable messaging, social proofs, rewards and reasonable fear can help people on their journey. Convincing them to sign up to long lasting behaviour change is a more difficult proposition for the science communicator.

However, with trust established and audiences engaged, communicators can then harness the strengths of both the peripheral and central routes to persuasion in their campaigns.

Social media influencers “have become our new public health allies”[41] according to Harvard Public Health. Science communicators, with their deep knowledge, must work with these masters of symbols, nudges and cues.

By providing innovative, research-backed resources and toolkits, science PR teams can empower influencers with accurate evidence about science and health to reach diverse audiences, especially those who may have the least trust in science.

With this alliance, science communicators stand a better chance of engaging the public with both accessible and accurate science. In an era of alternative facts, this is a vital step towards addressing harmful health misinformation and protecting public wellbeing.

ARTICLE ENDNOTES

Ryan’s perspective on studying for the CIPR Professional PR Diploma 

Ryan prepared this article for a CIPR Professional Diploma assignment while studying with PR Academy.

What do you see as the key benefits of studying the CIPR Professional PR Diploma?

Undertaking the CIPR professional diploma has been inspiring, informative and empowering. With such a deep emphasis on the academic and theoretical underpinnings of PR and communications practice, the course has helped me to define and reinforce the knowledge and skills I have developed over the past decades. I have learned about best practice for strategic communications, the importance of thought leadership and the need for self-reflection. This has bolstered my self-belief and helped to orient me more firmly in my team and organisation.

What has been your favourite part of the course so far?

Although it’s been quite tricky to balance the demands of the diploma with my full-time job and private life, the course syllabus has been consistently engaging and relevant. As a science communicator whose job it is to make research findings interesting to the general public, I particularly enjoyed the lessons on narratives and storytelling and the use of persuasion in PR. The diploma has been designed very thoughtfully, with each unit building on the last.

Have you been able to apply any of the learning, and if so, how?

I have been applying the learning from the course on a daily basis. Working on the situation analysis for the PR strategy and planning assignment was very valuable, and I now try to ensure campaign objectives are fully informed by objective data. The thought leadership article assignment reminded me of how much I enjoy the process of researching and writing longer-form articles, which has encouraged me to find more time for creative writing in my role.

About the CIPR Professional PR Diploma 

Thank you to Ryan Bradshaw for being happy to share this article, written as part of the second assignment for the Chartered Institute of Public Relations Professional Public Relations Diploma. 

The PR Diploma is a Master’s level qualification for more experienced practitioners who are looking to underpin what they do with theory and contemporary models.  Topics include PR strategy and planning, content management, media and engagement, measurement and evaluation, and PR leadership and process improvement. 

You have two years to complete it but with PR Academy you set your own study pace and many students finish in about ten months. 

Read our Complete Guide to CIPR Qualifications