Persuading Others to Avoid Persuasion: Inoculation Theory and Resistant Health Attitudes

"Health is an especially robust area for inoculation research. A wide variety of issues fit within the theory's boundary conditions (e.g., the 'right' attitude in place, likely attack messages from peers, media, etc.) The stakes, too, are high, affecting the well being of children and adults."

This paper explores the effectiveness of messages that are based on inoculation theory for creating positive health attitudes. It highlights the structure of typical inoculation-based health messages and examines the similarities and differences between this method of counter-persuasion and other techniques commonly employed by health researchers and practitioners. Finally, it considers contexts in which inoculation-oriented health messages could be particularly useful and describes how the health domain could be a useful context in which to study conceptual issues of the theory.

As Compton, Jackson, and Dimmock explain, healthy attitudes and behaviours can be vulnerable due to exposure to social, media, and peer-group factors; the use of strategies to help individuals prepare for and overcome such influence is a key objective of many health promotion campaigns. One such strategy was put forth by William J. McGuire (1964), who suggested that attitudes could be inoculated against persuasive attacks in much the same way that one's immune system can be inoculated against viral attacks. He contended that by exposing individuals to a persuasive message that contains weakened arguments against an established attitude (e.g., a message that presents both counterarguments and refutations of those counterarguments), individuals would develop resistance against stronger, future persuasive attacks.

"[A] conventional inoculation message begins with a forewarning of impending challenges to a held position, then raises and refutes some possible challenges that might be raised by opponents. For example, an inoculation message designed to discourage teen cigarette smoking...might begin with a warning that peer pressure will strongly challenge their negative attitudes toward smoking, then follow this forewarning with a handful of potential counterarguments they might face from their peers (e.g., 'Smoking isn't really bad for you') followed by refutations of these counterarguments (e.g., "Actually, smoking is harmful in a number of ways...'). This inoculation format can be adapted to a number of issues, so long as (1) the intended attitude or position is already in place with message recipients, and (2) message designers are aware of some counterarguments that might be employed in attack messages in order to provide weakened, or refuted, counterarguments in the inoculation treatment message..."

Compton, Jackson, and Dimmock assert that, although inoculation can function in interpersonal contexts, attitudinal inoculation can also involve brief or no interpersonal interactions, making it particularly well suited for mass health communication campaigns. Inoculation is also suitable, they say, in situations where extended involvement with recipients is impractical or impossible. They go on to explore applications of inoculation theory in health contexts. To cite a few recent examples: Cornelis et al. (2013) and Richards and Banas (2015) have offered empirical support for the notion that inoculation-based campaigns are effective at preserving anti-alcohol beliefs. Cornelis et al. (2013) found that inoculation messages can confer resistance against pressures to engage in marijuana use, and Parker et al. (2012) discovered that inoculation messages were effective at preserving positive attitudes about condom use. Inoculation scholars have found that inoculation can encourage adoption of healthier behaviors, including getting vaccines (e.g., Wong and Harrison, 2014), and that inoculation can lead to resistance to deceptive health- and nutrition-related claims of commercial food advertising (Mason and Miller, 2013).

The authors next discuss applications for inoculation-based health campaigns that they feel have unique potential. For instance, after childbirth, parents often face a multitude of unforeseen challenges to their own and their baby's health, and inoculation programmes could be effective at preparing parents for these challenges (e.g., prioritising sleep and making nutritional choices). Inoculation also seems suitable for this context; treatments based on inoculation theory can be administered quickly, prior to the time and resource demands of early parenting.

They suggest that additional theoretical work be done with receiver and message variables, which may act as influential moderators to inoculation's efficacy in a health context. The former includes such variables as self-efficacy, age, gender, and media skepticism. The latter, message variables, concern how the inoculation content is communicated. To date, studies in health behaviour contexts have looked at print- and video-based inoculation messages. For example, video games designed to promote better food choices and physical activity for children include inoculation theory components: a "bad guy" introduces counterarguments, and a "good guy" introduces refutations. More research is needed here - yet also in the investigation of how other modalities (e.g., peer interactions or social media) might influence inoculation in health contexts.

The authors conclude: "Although inoculation has established itself as a powerful communication theory, ...[w]hat is needed next is to connect the theoretical findings of inoculation theory, in general, to the health context, in particular, and build on this work. We hope that our ideas presented here are a step in that direction."