The goal of this dissertation is to advance theorizing about how people working together in groups understand health issues and make health decisions. The theoretical framework draws from a variety of extant health communication theories, as well as theories of social influence and social contagion. Thus, rather than solely emphasizing individual level behavior change, this dissertation recognizes that individuals exist within social groups. To further theory around social norms and how they may relate to understanding of health issues, a new methodology to examine group social norms about a health issue, H1N1 flu, through social network analysis is proposed. Specifically, this dissertation hypothesizes that attitudes, self-efficacy, subjective and descriptive norms, and social network group norms will all be associated with behavioral intentions. Additionally, moderators of the relationship between group norms and behavioral intentions are explored. Finally, collective group norms are expected to influence behavioral intentions beyond how individual group members perceive those norms. Building on existing social network analysis techniques, a new method for assessing social norms within groups, the cognitive social norm structure (CSNS), is developed and tested. Data were collected from twenty complete work groups using an online survey tool. Two specific H1N1-related behaviors were studied: intention to get the H1N1 flu vaccination and willingness to stay home from work if sick with the H1N1 flu. The data were analyzed using social network analysis and hierarchical linear modeling (HLM). As predicted, attitudes, self-efficacy, and social norms all related to behavioral intentions for at least one of the behaviors under study. While controlling for these individual level predictors, the groups’ consensus about the social norms of the whole group had an additional impact on behavioral intentions. For members of work groups in which pairs were perceived to agree in their support for H1N1 vaccination, the effect of individually perceived group norms on behavioral intentions was stronger than for groups with less agreement. Taken together, these group level effects highlight the importance of assessing entire groups and explicitly incorporating the social environment into understandings of health behaviors. Individually perceived norms alone cannot fully account for individuals’ health behaviors choices. Instead, group level effects are also important, even in cases where the individual perceptions of group norms may not be predictive of behavioral intentions. Thus, the incorporation of the cognitive social norm structure (CSNS) into studies of health communication was supported. Moreover, these data underscore the importance of using existing, complete groups to examine the group social influence process. Integrating group level conceptions of social norms into health communication theories will allow for a more complete and nuanced understanding of health behavior choices. Guidance for future studies and for the development of health communication campaigns is provided.
The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the author, as the original true and official version of the work, but does not grant the reader permission to use the work if the desired use is covered by copyright. It is the author, as rights holder, who must provide use permission if such use is covered by copyright. The original signature page accompanying the original submission of the work to the USC Libraries is retained by the USC Libraries and a copy of it may be obtained by authorized requesters contacting the repository e-mail address given.