A Conceptual Model for Communicating Nutrition Ardyth H. Gillespie' and Paul Yarbrough2

1 Division of Nutritional Sciences and 2 Department of Communication Arts, Cornell University, Ithaca, New York 14853

ABSTRACT This paper presents a communication model for planning, implement­ing, and evaluating nutrition education programs. The theoretical underpinnings of this conceptual model contain elements from four perspectives: "individual differ­ences," "social categories," "social relations," and "pragmatics." We discuss the model's components and its applications for nutrition education.

Nutrition educators have become increas­ingly aware of the importance of under­standing the audience they want to influ­ence. The field of communications offers nutrition educators practical theories for understanding the audience and influencing people's knowledge, attitudes, and behav­iors regarding nutrition.

In this paper, we present a communica­tion model that we have used in designing and evaluating nutrition education pro­grams (e.g., 1, 2). This model aids in: 1) organizing available information about the target audiences, 2) making choices about the communication strategy based on pro­gram objectives, and 3) evaluating the pro­gram process and outcomes. The theories presented are not new; however, by integrat­ing and applying research findings from communications and related fields, we have developed a model that offers a comprehen­sive framework for the many factors in­volved in how people respond to nutrition intervention programs.

THE MODEL: OVERVIEW AND THEORETICAL (Note 1) BASIS

Two key questions for nutrition educators are how and why receivers respond in cer­tain ways to particular communications. Nutrition educators can improve their com­munications to the extent that they under­stand why different people respond differ­ently to the same message and why an individual responds differently to different messages.

The nutrition communication model pre­sented here attempts to shed light on audi­ence response by drawing together divergent concepts derived from empirical research about the communication process in general and its application to nutrition education in particular. The focus of this model is on purposive communications ini­tiated by nutritionists. It is most applicable

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to short-term interventions or at least to programs that are limited in time and scope. This includes most nutrition education pro­grams. We feel that theory development, interpretative models such as the one pre­sented here can be valuable for advancing the practice of communicating nutrition in­formation. The importance of a theoretical base for nutrition education has been dis­cussed elsewhere (3).

The nutrition communication model in­cludes three major components: inputs, in­tervening process, and outcomes (Figure 1). Inputs include both the decisions the nutri­tion communicators make about the com­munication strategy (nutrition communica­tor inputs) and the predispositions the receivers bring to the communication event (receiver inputs). The combined contri­butions of the receiver and nutrition com­municator inputs, as well as the situational context, influence the responses to a com­munication. Although the communicator inputs are under the control of the nutrition educator, the receiver inputs and usually the situational context (e.g., money available for food expenditures, availability of food) are not. Both inputs influence the second compnent, the intervening process. Impor­tant stages of the intervening process are attention, comprehension, and interaction. The results, or outcomes, of the communi­cation event are the receivers' acceptance or rejection of the communicator's objectives. Acceptance or rejection may be in the cogni­tive (knowledge), affective (attitude), and/ or behavioral domains (including behav­ioral intent and behavior). Although nutri­tion educators usually consider these types of outcomes, they less frequently plan for and evaluate the intervening process com­ponent proposed by this model.

The communication event has been ana­lyzed in many ways. Four of the most im­portant perspectives on how people respond

to communication are the following: the in­dividual differences, social categories, social relations (4), and pragmatics (5). These are summarized in Table 1 (Note 2).

Although the individual-differences per­spective and the social-categories perspective are powerful in their ability to predict audi­ence responsiveness to communication (6), the model presented in this paper reflects more recent communications-effects re­search, research that includes variables from both perspectives and demonstrates that so­cial status influences responses to the com­munication directly and indirectly. Indirectly, social position influences the beliefs, atti­tudes, values, and habits individuals hold about the topic being communicated, the source of the message, and the channel through which the message is conveyed (7). Nevertheless, all four perspectives make im­portant contributions to understanding the nutrition communication process and have been incorporated into the following discus­sion of the three main components of our communication model: the inputs, interven­ing process, and outcomes.

NUTRITION COMMUNICATOR INPUTS When attempting to communicate with an audience, the message sender has a number of options that should have a bearing upon the receivers' responses. Communicators determine the channels through which the message is conveyed, identify the source or apparent sender of the information, choose the ideas (message content) to be empha­sized or ignored, and decide on the treat­ment of these ideas. They can also control system design and influence metacommuni­cation (aspects that provide the rules for interpretation).

Messages can be sent through interper­sonal channels or mass channels. Interper­sonal communication is face-to-face; peo­ple interact one-to-one or in small groups in private conversations and small confer­ences. Mass channels include radio, televi­sion, telephone, direct mail, newspapers, and printed bulletins.

The apparent sender or source of a com­munication is the person or organization whose name accompanies the message. This mayor may not be the same as the program

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Interaction • Communicator-Receiver • Reference Group

Acceptance or Rejection • Cognitive • Affective • Behavioral Intention • Behavior

Table 1 Overview of theoretical perspectives

Perspective Individual Differences

Theoretical Origin Representative Work Central Theme Psychological learning Hoveland and associates at Yale (1959) experiments

Social Categories

Social Relations

Pragmatics

Sociology

Sociology and rural sociology

Psychology and communications

planner. The source's perceived credibility and similarity to the receivers may affect receivers' responses to the message (8).

The concepts and ideas included in a mes­sage must provide enough information for decision making and, at the same time, be manageable in length and complexity. The nutrition communicator decides what con­cepts to include, how to organize them, and

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Lazarsfeld and others (1949)

Katz and Lazarsfeld, et al. (1955); Rogers and Shoemaker (Adoption-Diffusion)

Watzlawick and associates (1967)

the appropriate level of abstraction. There are a number of options for treat­

ment of a message such as brief vs. detailed exposition, humorous vs. serious context, and emotional vs. rational appeal. How the argument is organized is also part of the treatment. The number, format, and style of messages may be varied to fit the intended audience. The more specific and well-de-

In accordance with the circumstances and views in which individuals are raised, they acquire unique attitudes, values, and beliefs that influence their responses to communicators.

People who occupy similar social status roles will develop similar folkways (orientations and modes of behavior) as a result of role-socialization processes that influence responses to outside communications.

People are socially organized, so their formal and informal group memberships influence their responses to mass communications.

Metacommunication . Whether intentional, conscious, or successful, communication always occurs if there are interacting units. Every communication has a content and a relationship aspect (metacommunication) that classifies the content. Metacommuncational aspects provide the rules for interpreting the content - that it is humorous or serious, important or not, etc .

fined the audience, the easier it is to orient the treatment.

How the communicator manipulates the situational factors determines the system's design. A system's design includes decisions concerning the time and place for receiving messages, repetitiveness of the signal, and whether the communication is primarily one-way or reciprocal.

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The system design is often linked to meta­communication. This concept comes from Watzlawick's pragmatics approach (9), in which he argues that response to a message is influenced by the rules (usually not ex­plicit) for interpreting the manifest content. In most cases these rules are inferred from the context of the communication situation or gained from nonverbal cues (e.g., facial expressions). In the case of printed mes­sages, metacommunication cues often come from typographic devices such as layout, type, and the ordering of the content. In any case, the cues are implied rather than stated. However, it is possible for the communica­tor to talk about the rules. This is probably most appropriate when the communicator is not familiar to the audience or is changing the rules. For example, in a nutrition pro­gram for young families in which interac­tion was encouraged, participants were told how the system was supposed to work be­cause the proposed interaction within the families, and between them and the exten­sion home economist differed from the way the families were used to communicating (1). Watzlawick suggests that at least in in­terpersonal communication, communica­tion dysfunction is more likely to occur be­cause of disagreement over the rules than over the manifest content (9).

Communications research has focused primarily on the message, the channels, and the attributes of the receivers. Few studies have manipulated the situational and meta­communicational variables. We suggest that these areas be addressed in future research and be considered in nutrition education programs.

RECEIVER INPUTS - PREDISPOSITIONS

Our nutrition communication model is con­cerned with the reasons behind the different responses individuals make at the various stages of the communication process. The theoretical perspectives reviewed above sug­gest that the inputs the receivers bring to the communication process can explain a major part of these different responses. Audience members seldom come to a program or a communication about nutrition without skills, beliefs, attitudes, and habits that will influence their response to the message. They are" predisposed" by their experiences to react to messages in a certain way. In addition, they are in a social situation (refer­ence group), and they have certain defined status roles that help to shape their re­sponses.

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The skills of major concern to us are the receivers' abilities to listen, read, write, think, and deal with abstract symbols. Es­tablished food habits, misconceptions from incomplete or erroneous information, and attitudes toward health are examples of nu­trition-related beliefs, attitudes, and habits that influence responses to nutrition mes­sages. Other beliefs, attitudes, and habits not related specifically to nutrition, such as whether receivers normally read the news­paper and where they usually obtain scien­tific information, may be important as well. This set of receiver inputs comes from the individual-differences perspective.

According to the social-categories per­spective, social status roles are thought to influence responses by affecting both mental dispositions and the situation. Social status roles are situational in that they refer to the behavior expected of anyone holding a par­ticular social position. For example, the sta­tus role "mother" suggests certain food preparation responsibilities. These role ex­pectations, although socially determined, then become individual mental constructs as a person internalizes and accepts them as appropriate behavior guidelines. Thus these food preparation responsibilities may be­come part of a mother's self-image.

Relationships with others also may pre­dispose receivers to respond in different ways. As suggested by the social-relations perspective, an individual's reference group may be an important influence. In nutrition education, the attitudes of the food refer­ence group-for example, the family or teenage peer group - toward nutrition and toward the message content may influence the receiver's response.

These receiver inputs will influence all stages of the communication process, and the influence will be predictable. Different responses to a single message are not ran­dom; they can be predicted according to the receivers' inputs. Therefore, the better we understand an audience's predispositions to respond in certain ways, the better we can orient the messages to improve communica­tion.

Initially, receiver inputs are "givens"; however, in a sequence of communications, the sender may influence some of these in­puts for subsequent messages, as illustrated by the feedback loops in Figure 1. Like the communicator inputs, the receiver inputs affect both the intervening process and out­comes.

INTERVENING PROCESS

Between the delivery of the message and its effects, something must occur within the re-

ceivers. This intervening process requires the receivers' active mental participation in terms of attention, comprehension, and, in many cases, interaction.

Attention. Because individuals are bom­barded daily by thousands of stimuli or mes­sages, they must choose which messages they will attend to. Individuals may make a conscious decision not to pursue a message because: 1) It is not relevant to their needs and wants; 2) The information would make the satisfaction of their needs and wants more difficult; or 3) The message, though potentially useful, is blocked by competing stimuli or activity. Thus, the problem of gaining the attention of a potential audience is formidable.

Attention includes awareness and dif­ferential exposure (degree and quality of at­tention). Awareness depends upon the mes­sage and the audience. First, the audience must be attending to the channel through which the message is conveyed. Once the receivers' become aware of the message, dif­ferential exposure comes into play: the quantity and quality of attention will vary. Competing messages or other demands on the receivers' time may limit the amount of attention. In the "differential exposure" stage, receivers tend to pay attention to the extent to which a message meets some per­ceived need. Thus, at this point, the treat­ment and content of the nutrition message are very important in maintaining atten­tion.

Intended receivers of nutrition messages, especially those who are not involved in food planning and preparation, may not perceive that they can use nutrition infor­mation. Therefore, cues indicating the im­portance of a message should precede or accompany it. These cues must be designed to capture the attention of intended receiv­ers who might otherwise ignore nutrition messages. For example, reference to a fa­ther's influence on his child's food habits might enhance the attention-gaining power of a nutrition message for fathers.

Social categories predict quite well whether an individual will attend to a given message (10). For example, because of the differences between traditional gender roles, women are much more likely to attend to nutrition messages than men, even when special efforts are made to communicate with men (1).

Comprehension. To comprehend, a person must transform sensory stimuli - either oral or visual- into meaning. From the commu­nicator's viewpoint, success is measured by

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the extent to which receivers comprehend the intended meanings. This objective is dif­ficult to achieve because receivers usually see or hear messages in light of previous experiences that may differ somewhat from those of the communicator. Receivers tend to focus on some details and ignore others, in order to recast the message to fit the world as they know it. For example, consider a paraprofessional aide who did not fully comprehend a training message about ex­tending fluid milk by adding reconstituted nonfat dry milk and, therefore, mixed non­fat dry milk powder with fluid whole milk without adding water. Due to previous expe­riences the aide either ignored or missed the concept of extending the fluid milk with re­constituted nonfat dry milk .

Interaction. There is evidence that commu­nication systems are more likely to gain at­tention and have messages accepted if they provide for interaction. This interaction may be of two types: between the audience and communicator and between receivers and their peers. Research indicates that re­sponse to a communication is a social phe­nomenon that involves not only receivers' own evaluations, but also the evaluations of "trusted others" such as close friends, co­workers, and family members (11). Re­sponses to mass media are then mediated by the receivers' evaluations of what others will think of the receivers' opinions and actions. Thus, teenagers are more likely to change snack food choices if they think recom­mended changes would be acceptable in the eyes of peers.

Conversing about a message may also spread the impact of the original message. Through conversations, individuals impart information, change opinions, and some­times affect the behavior of others. Lewin (12) has reported a series of studies that demonstrate the importance of interaction in achieving behavior change. He found that group decisions were more effective in changing specific food practices than were requests by superiors, lectures, or individual counseling by professionals.

Interaction between receivers and senders also promotes acceptance of new informa­tion . One limitation of mass channels in per­suasive communication is that they ordinar­ily provide only one-way communication. In some cases, however, it is possible to per­sonalize mass channels with receiver-sender interaction and to provide the senders with information about receiver inputs. This was tried in two direct-mail nutrition programs. In a program for young families, Gillespie et

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al. (1) asked for feedback from those who received messages, and this feedback be­came input for the next mailed message. Communicator-receiver interaction was also found to enhance responses to a by­mail nutrition education program for coop­erative extension agents (2) .

Taking another approach to personalize communication, a group at Stanford Uni­versity compared the effects of a mass-me­dia campaign alone to a mass-media cam­paign coordinated with face-to-face counseling (13). They found that both ap­proaches resulted in increased knowledge about risk factors and in reductions in satu­rated fat intake, cigarette smoking, plasma cholesterol levels, and systolic blood pres­sure. Counseling in addition to the mass­media campaign had a significantly greater effect than mass media alone at the end of the first year, but differences between the two treatments narrowed by the end of the second year.

There is a reciprocal influence among the three components of the intervening proc­ess. Without a modicum of attention, there can be no comprehension. However, lack of comprehension may be a reason for with­drawing attention. Interaction may affect both attention and comprehension and be influenced by them. For example, attention may be enhanced through discussion or through interaction with the nutrition com­municator.

OUTCOME: ACCEPTANCE AND REJECTION The desired outcome of nutrition communi­cation is the receivers' acceptance of a mes­sage. Receivers may accept or reject all or part of a program on four different levels: cognitive, affective, behavioral intent, and behavioral. Thus, a response is not a single dimension, nor is it an "either/ or" proposi­tion; it can range from complete acceptance to complete rejection. The responses of the audience may not be consistent with the communicator's intent. A variety of sources in social psychology provide important in­sights into receivers' levels of response. We have drawn heavily from Fishbein and Ajzen's model (14). For a discussion of other perspectives on attitudes and behav­ior, see Tan (15).

Cognitive acceptance. One measure of indi­viduals' acceptance of a message may be the validity they assign to the concepts being communicated, or the degree to which they cognitively accept as valid, factual, correct,

or true, the meanings intended by the com­municator. This belief-level acceptance in­cludes knowledge, which has often been the focus of nutrition education programs. Ac­quiring knowledge of the roles of nutrients and of food composition is an example of cognitive acceptance. Cognitive acceptance also occurs if, for example, a message ex­plains how a father plays an important role in influencing his child's developing food habits, and the receivers believe the mes­sage.

It is important to distinguish understand­ing, or comprehension, from cognitive ac­ceptance. Comprehension deals only with adequate translation or encoding and de­coding of the message. Receivers may com­prehend a message without internalizing it, but cognitive acceptance implies internaliz­ing the message or believing it to be true.

Affective acceptance. Affective acceptance occurs when the audience accepts the con­clusions or proposed changes as good or desirable. An individual's evaluation of whether a particular suggestion is good or bad for him or her is an example of attitude. Although cognitive acceptance (believing something) often precedes affective accept­ance (feeling something is desirable), cogni­tive acceptance is not a prerequisite. In fact , the two responses may be in conflict. An overweight person may believe that decreas­ing energy intake will reduce body weight but may not feel that it is personally desir­able to eat less.

Affective acceptance is a matter of de­gree; there may be conflicting goals. For ex­ample, a short-term goal such as hunger satisfaction may take precedence over a long-term goal such as weight control or over an abstract goal such as "better health." For a more detailed discussion of attitudes and attitude measurement in nutri­tion education see Sims (16).

Both cognitive and affective acceptance are more likely to occur through reinforce­ment of previously held beliefs and atti­tudes. Nutrition communicators can and do produce change, but it is generally in rela­tively small increments and in a manner con­sistent with the receivers' beliefs and atti­tudes (e.g., see 1, 13). These observations suggest that expectations for change should be modest.

Behavioral acceptance. Changing a person's actual eating behavior is often a goal of nu­trition education programs; communica­tors usually want people to take some spe­cific action. But behavioral acceptance is

JOURNAL OF NUTRITION EDUCATION 171

often the most disappointing and/or diffi­cult to measure of the outcome levels in nu­trition communication programs.

Whereas other theorists have considered behavioral intention as part of attitude, Fishbein and Ajzen (14) designate it as a separate outcome. We think this differentia­tion is useful. It suggests that we can look at immediate intended changes in behavior, which should be a better predictor of behav­ior than a "liking for" (affective response to) a particular message. Often behavior change is not immediate; thus, it should be measured after a period of time to allow application once the intervention (or partic­ular component of the intervention) has been completed. Of course, to influence health, the intended behavior ultimately must be translated into actual behavior change.

Adoption-diffusion research (8) indicates that although individuals can be persuaded to change, they are very resistant to change - particularly in the short-term. This resistance can be seen as a protective psychological device. If an individual were to change in response to every communica­tion to which he or she is exposed, life would soon become chaotic.

The findings of adoption-diffusion re­search also indicate that adopting a behav­ior is the result of the interaction of commu­nication, behavior, and decision making over a period of time. Repeated exposure to many messages, through diverse channels over a period of time, is usually needed to move the individual from awareness of the innovation to adoption. Perhaps the most optimistic expectation for a single commu­nication message would be to move the indi­vidual from one stage in the adoption proc­ess to another.

Acceptance or rejection responses are in­fluenced by elements in the intervening process. These responses may also serve as receiver inputs into subsequent messages. Acceptance or rejection responses are also related to each other. Some argue that the receiver must first accept the message on a cognitive level and that this cognitive ac­ceptance leads to affective acceptance - and both levels are prerequisite for behavioral acceptance. However, research suggests that

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the order of this sequence may differ from time to time. It may be possible to change behavior without first changing the other two levels (13). How and at what level a receiver responds to a communication are highly influenced by the inputs.

APPLICATION OF THE MODEL IN PLANNING AND EVALUATION

The first step in using the model for plan­ning is to clarify the objectives, i.e., the de­sired outcomes. The nutrition communica­tor must also consider the resources available and assess the knowledge and other predispositions of the intended audi­ence. With this information, nutrition edu­cators can make decisions about the com­municator inputs and try to shape the intervening process.

This model also provides a framework for evaluation. Although most evaluations of nutrition education programs have fo­cused on changes in knowledge and behav­ior and to some extent attitudes, the model suggests that each component of the inter­vening process should be assessed as well. If only outcomes are measured, there are no data to indicate why the outcomes were or were not achieved. Ideally, all the response stages in the intervening process and the outcomes would be evaluated. This would allow us to get a good idea about where a program is working and where it is not. This aids in determining not only whether it was effective, but why or why not. Evaluation of this type is most useful for planning future programs.

Another level of evaluation possible with use of the model is linking receiver inputs to responses. This helps identify who is re­sponding in what ways to what message. A third level of evaluation suggested by the model is experimental manipulation of the inputs. This allows comparisons of the ef­fectiveness of the many possible influencing factors that can be controlled by the com­municator. At this level, data will aid in building toward a generalizable theory of nutrition education.

We have presented a heuristic model to serve as a basis for further research. We have found it useful for nutrition interven­tion programs and for the particular con-

straints and situations encountered in nutri­tion education. It is a beginning. We hope the model can be expanded and refined through future research in nutrition com­munications. 0

NOTES 1 Although most of communication "theory" (as well as the­

ory from other fields) does not qualify as such according to the rigorous standards of philosophers of science, this usage is consistent with the common usage in communications and the social sciences.

2 A number of new models or perspectives have been intro­duced recently, but they are limited either in their applica­tions to nutrition education or in empirical data on which they can be evaluated. We believe that the model presented here represents the best predictive model for nutrition educa­tion and certainly the one that best fits the current approach to nutrition education in the field (see, e.g., 4,15,17,18).

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3 Gillespie, A. H. Applying communication theory in nutri­tion education research. Journal of Nutrition Education J3:S29-S34,1981.

4 DeFleur, M. L. t and S, Ball-Rokeach. Theoriesofmasscom­munication. New York: Longman, 1982,288 pp.

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7 Yarbrough, P., G. E, Klonglan, and G. M, Lutz. System and personal variables as predictors of individual adoption be­havior, Rural Sociology Report no. 86. Department of Soci­ology and Anthropology. Ames, IA: Iowa State University, 1970, 121 pp.

8 Rogers, E. M. Diffusion of innovations, 3d ed. New York: The Free Press, 1983,453 pp.

9 Watzlawick, P., H. J. Beavin, and D. D. Jackson. Pragmatics oj human communication: A study of interactional patterns, pathologies and paradoxes, New York: W. W. Norton, 1967, 296pp.

10 Beal, G. M., G. E. Klonglin. 1. M. Bohlen, and P. Yarbrough. Communication impact, Rural Sociology Re­port no. 41. Department of Sociology and Anthropology, Ames, Iowa: Iowa State University. 1967, 339 pp.

11 Katz, E., and P. F. Lazarsfeld. Personal influence: The part played by people in the flow of mass communications, Glen­coe,IL: The Free Press, 1955,400 pp.

12 Lewin, K. Group decision and social change. In Readings in social psychology, 3d ed., E. E. Maccoby. T. M. Newcomb, and E. L. Hartley, eds. New York: Holt, Rinehart, and Win­ston, 1958, pp. 197-211.

13 Maccoby, N., J. W. Farquhar, P. D. Wood, and J. Alexander. Reducing the risk of cardiovascular disease: Effects of a com­munity based campaign on knowledge and behavior. Journal o/Community Health 3:100-14,1977.

14 Fishbein, M., and I. Ajzen. Belie/. attitude, intention and behavior: An introduction to theory and research, Reading, MA: Addison-Wesley, 1975, pp. 129-384.

15 Tan, A. Mass communication theories and research, Colum­bus, OH: Grid Publishing Inc., 1981, pp. 81-90.

16 Sims, L. S. Toward an understanding of attitude measure· ment in nutrition research. Journal of the American Dietetic Association 78:461-66, 1981.

17 Clarke, P., ed. New models for mass communication re­search. Sage annual review's of communication research, vol. II. Beverly Hills, CA: Sage Publications, 1973, 307 pp.

18 Severin, W. J., and J. W. Tankard, Jr. Communications the­ories, New York: Hastings House, 1979,286 pp.

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