Third-Person Perception and Health Beliefs

doi:10.4236/psych.2011.24055

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Psychology

2011. Vol.2, No.4, 355-358

Third-Person Perception and Health Beliefs

John Chapin

Pennsylvania State University, Monaca, USA.

Email: [email protected]

Received March 26th, 2011; revised May 2nd, 2011; accepted June 11th, 2011.

A survey of 316 medical professionals was used to study third-person perception (TPP) within the context of a

public health issue, intimate partner violence (IPV) and to explore theoretical linkage between TPP and the

health belief model. Medical professionals exhibit TPP, believing they are less influenced than patients by media

depictions of IPV. In terms of the Health Belief Model, one element, perceived susceptibility, emerged as a pre-

dictor of TPP.

Keywords: Third-Person Perception, Health Belief Model, Intimate Partner Violence

In lay terms, third-person perception (Davison, 1983) is the

belief that media messages affect others more than they affect

oneself. The phenomenon has become a mainstay of communi-

cations theory, with a growing literature documenting the im-

pact of third-person-perception (TPP) on attitudes and behav-

iors (For reviews, see Conners, 2005; Golan & Day, 2008).

TPP has been documented in a number of contexts, including

advertisements (Chia, 2009; Sigal, 2009), news coverage (Coe

et al., 2008; Frederick & Neuwirth, 2008), and on-line games

(Boyle, McLeod, & Rojas, 2008; Zhong, 2009).

While TPP is well established in the literature, the phe-

nomenon remains of interest to scholars and practitioners, be-

cause people act on their perceptions. The most established

attitudinal/behavioral link is the willingness to censor (Boyle,

McLeod, & Rojas, 2008; Cohen & Weimann, 2008). For in-

stance, college students who exhibit third-person perception

regarding Internet pornography are also more willing to censor

content or support stricter legislation (Zhao & Cai, 2008). Per-

son-perception has also been linked with a number of attitudes

and behaviors, including voting decisions (Golan, Banning, &

Lundy, 2008; Jeffres et al., 2008), support for legal action (Day,

2008; Frederick & Neuwirth, 2008), and decreased risk behav-

iors (Chapin, 2000; Lewis, Watson, & Tay, 2007).

A smaller, but growing literature is exploring TPP and health.

The purpose of the current study is to examine TPP within the

context of a public health issue (intimate partner violence) and

to explore theoretical linkage between TPP and the health belief

model.

Only in recent years has the medical community begun to

fully recognize intimate partner violence (IPV) as a public

health crisis. According to a popular website for medical pro-

fessionals (emedicinehealth.com), women in the U.S. are more

likely to have been injured, raped, or murdered by a male part-

ner than by all other types of attackers. Twice as many women

report sexual assault by their husbands as report assault by

strangers. Every year, about 2,000 women are murdered by

their current or former male partners in the U.S. One in seven

women going to the doctor’s office have a history of partner

abuse. One in four women seeking care in the emergency de-

partment, for any reason, is a domestic-violence survivor, and

one in four women has been abused at some point in her life.

The current study surveys medical professionals about third-

person perception, health beliefs, and IPV.

TPP and Health

While third-person perception is a broad concept, applicable

to any type of media messages, only a small percentage of pub-

lished findings explore TPP regarding health-related topics. A

study of Chinese college students (Chia & Wen, 2009) found

TPP regarding the impact of idealized body images in adver-

tisements. Students who exhibited higher degrees of TPP also

tended to make more negative self-assessments about their own

body image. The findings have clear implications for eating

disorders, as well as mental health issues. Two studies (Cho &

Boster, 2008; Chock et al., 2007) documented TPP regarding

anti-drug advertisements among adolescents. College students

exhibiting first-person perception, the belief that oneself is

more influenced by media messages than are others, also ex-

hibit increased information seeking about bird flu (Wei, Lo, &

Lu, 2008); thus TPP may be linked with more active media

consumption. Another study of adolescents (Chapin, 2000)

documented TPP regarding safer-sex messages. Adolescents

who exhibited higher degrees of TPP were more likely to en-

gage in sexual activity at earlier ages and less likely to use

condoms during intercourse.

Health Belief Model

One of the cornerstones of health communication is the

Health Belief Model (HBM). The model is a cognitive decision

theory. As such, it assumes that individuals make rational deci-

sions about their health, based on an internal cost/benefit analy-

sis. According to the model, there are four types of health be-

liefs: 1) perceived susceptibility, 2) perceived severity, 3) per-

ceived benefits, and 4) perceived barriers.

A vast literature documents the ability of the HBM to predict

health behaviors. Two of the elements, perceived susceptibility

and perceived severity, emerge as strong predictors. For in-

stance, Lin, Simoni and Zemon (2005) studied sexual behaviors

and HIV risk among Taiwanese college students. The rate of

HIV infection in Taiwan has risen 15% each year since 1997,

ranking it among the highest in HIV/AIDS cases in Asia. Ac-

J. CHAPIN

356

cording to the Global Sex Survey, the Taiwanese are one of the

least sexually active peoples in the world, but they engage in

unprotected sex more frequently: 38% reported having unpro-

tected sex without knowledge of their partner’s sexual history.

The study reported that 57% of female and 69% of male stu-

dents were sexually active. Consistent with previous surveys,

only 27% of males and 18% of females reported consistent

condom use; on the other end of the spectrum, 11% of males

and 18% of females reported never using condoms. Elements of

the HBM did not predict the number of sexual partners or the

frequency of sex, but did predict consistent condom use. Stu-

dents who believed they were susceptible to HIV infection,

believed condoms would protect them from infection (per-

ceived benefits), and reported fewer barriers (access to con-

doms, embarrassment, cost) were the most likely to use con-

doms consistently. Perceived severity also predicted condom

use, but in the opposite direction: students who viewed HIV as

a treatable condition were more likely to use condoms consis-

tently than students who viewed AIDS as a death-sentence. A

likely reason for this unexpected finding is stigma—if some-

thing is too horrible to think about—we don’t.

A key to applying the HBM to IPV is understanding beliefs.

A study of domestic violence in the military revealed that over

half of enlisted women (57%) support routine domestic vio-

lence screening among the ranks (Carlson et. al, 2006). Women

in the military differ from civilians in that 73% of enlisted

women vs 43% of civilian women believe routine screening

and reporting would increase womens’ risks of subsequent

violent attacks. When battered women leave their abusive part-

ners, they are at their highest risk of murder. Because the mili-

tary reports domestic abuse among the ranks, the risk of vio-

lence could similarly be heightened as batterers are exposed

and their careers are at stake. Several factors emerged as barri-

ers to disclosing abuse, including perceived damage to their

own or their partner’s military careers, embarrassment, and loss

of control (about when or if to involve the police).

Another study (Campo, Poulos, & Sipple, 2005) applied the

HBM to hazing. Hazing is under-reported for a number of rea-

sons, but 20 to 50 hazing-related deaths are reported from col-

lege campuses in the United States each year. Around a third

(36%) of the college students surveyed reported that they were

involved in activities that constitute hazing. Most occurred

within fraternities or varsity athletic programs. The most com-

monly reported hazing activities were drinking contests/games

and sleep deprivation. Overall, students agreed that hazing was

harmful, but were neutral about perceived benefits including: 1)

their susceptibility to harm; 2) whether their friends approved

of their activities; 3) the enjoyment of hazing activities; 4) and

the belief that hazing builds group cohesion. Three factors that

best predicted students’ ability to remove themselves from po-

tentially dangerous situations included having friends outside

the organization, perceived likelihood of being harmed, and

friends within the organization that support the decision. Per-

ceived susceptibility fits well with the HBM. The other two

elements are purely social. If students will maintain friendships

both inside and outside the organization, they are better able to

withstand the pressure to endure h a z i n g.

Hypotheses

Based on the preceding review of the literature, the following

hypo theses are posited:

H1: Medical professionals will believe patients are more af-

fected than themselves by media depictions of IPV (Third-

person perception).

H2: TPP will increase as elements of the HBM (perceived

susceptibility, perceived severity, perceived benefits, and per-

ceived barriers) increase.

In order to test the behavioral component of TPP, an addi-

tional hypothesis is posited:

H3: Beliefs about community attitudes and willingness to in-

tervene in IPV cases will be predicted by TPP.

Method

Participants

A total of 316 medical professionals participated in the study,

between July 2009 and June 2010. Participants were medical

students/interns (69%), nurses (24%), and administrators (7%)

in Pennsylvania. Individuals were targeted for inclusion be-

cause they either currently screened patients for IPV or were

preparing to do so in the future. The sample was 89% female,

90% Caucasian, ranging in age from 27 to 66 (X = 32.1, SD =

13.3). The sample is representative of people enrolled in nurs-

ing programs in this region.

Procedures

Participants were recruited by a women’s center providing

IPV training to improve screening quality in the region. All

study measures were completed prior to the training to prevent

priming or skewing results. Participation was voluntary. In

some cases, participants did not respond to all survey items.

The most common items skipped were age and race. Missing

cells were not including in analysis, resulting in a lower N for

some tests. The study was approved by the university’ s IRB for

use with human subjects. APA ethical guidelines were strictly

adhered to.

Materials

Third-person perception was measured with a standard in-

strument (Rubin, Rubin, Graham, Perse, & Seibold, 2009).

Participants completed the following two items on a Likert-type

scale (1 = not at all; 7 = very much): 1) how much are patients

affected by media depictions of intimate partner violence? 2)

how much are YOU affected by media depictions of intimate

partner violence? A measure of TPP is obtained by subtracting

the “other” rating from the “self” rating. TPP is indicated by a

negative mean, which can be interpreted as the perception that

others are more influenced than oneself.

Two items measured beliefs about community attitudes and

willingness to intervene in IPV cases: “Most community mem-

bers are willing to intervene in cases of spousal abuse once they

become aware.” “Most community members do not approve of

spousal abuse.” Both items were measured on a Likert-type

scale ranging from strongly disagree (1) to strongly agree (7).

The Health Belief Model was measured through a series of

questions, each measured on a Likert-type scale ranging from

strongly disagree (1) to strongly agree (7): 1) perceived suscep-

tibility: “Compared to other people my age in the US, my

chances of being abused by an intimate partner are lower”; 2)

J. CHAPIN 357

perceived severity: “The physical impact of domestic abuse can

be severe;” the emotional impact of domestic abuse can be

severe.” These two items were summed; 3) perceived benefits:

“Domestic violence services available to patients at the hospital

are useful and easily accessible”; 4) perceived barriers: “There

are numerous obstacles which impact a victim’s ability to leave

their situation.” All of the items were summed to create a HBM

scale. The resulting scale demonstrated low to moderate inter-

nal consistency (α = .71).

Participants also self-reported their age, race, and gender.

Results

Table 1 displays zero-order correlations among the variables

predicting third-person perception. Doing so allows readers to

compare and weigh the relationships across variables. Standard

multiple regression was used to identify the predictors of TPP.

Analysis of residual plots indicates that assumptions regarding

normality, linearity and homoscadasticity were met. Table 2

displays the regression analysis.

H1 predicted TPP, that medical professionals believe they

are less likely than patients to be influenced by media portray-

als of IPV. TPP is indicated by a group mean significantly less

than zero. As predicted, Participants believed they (X = 2.2, SD

= 1.1) were less influenced by news coverage of crime than

others (X = 3.4, SD = 1.1), t (301) = 2.1, p < .000. H1 was sup-

ported. The finding is consistent with the literature. No rela-

tionship between TPP and demographic variables (age, gender,

and race) was predicted, and none emerged. Because TPP is

indicated by a negative mean, signs are reversed in the table for

ease of interpretation.

H2 predicted TPP would increase as elements of the Health

Belief Model (perceived susceptibility, perceived severity, per-

ceived benefits, and perceived barriers) increased. While a sig-

nificant relationship between the HBM and TPP is indicated on

Table 1, the relationship fails to explain any unique variance in

the regression model. A single HBM element, perceived sus-

ceptibility, emerges as the strongest predictor of TPP: 41.4% of

participants agreed or strongly agreed with the statement,

“Compared to other people my age in the US, my chances of

being abused b y an in tim ate par tn er ar e lowe r.” N earl y on e th ird

(30.2%) disagreed or strongly disagreed with the statement. The

remaining 11.8% responded in the middle of the scale. The

remaining components of the HBM were not significantly re-

lated to TPP. H2 was partially supported.

H3 tested the attitudinal/behavioral component of TPP, pre-

dicting a relationship between TPP and beliefs about attitudes

and willingness to intervene in IPV cases. While most partici-

pating medical professionals (84.3%) agreed or strongly agreed

that most communi ty membe rs do not approve of IPV, less than

one fourth (23.1%) believe most community members are will-

ing to intervene in IPV cases. TPP predicts beliefs about will-

ingness to intervene, but not beliefs about attitudes. H3 is par-

tially supported.

Discussion

The purpose of the current study was to examine third-person

perception within the context of a public health issue (intimate

partner violence) and to explore theoretical linkage between

TPP and the health belief model.

Nurses and medical interns were selected to participate in the

study, because they are likely to screen incoming patients for

IPV. Findings suggest medical professionals do exhibit TPP,

believing they are less influenced than are patients by media

depictions of IPV. Previous findings indicate that people who

exhibit TPP engage in less information seeking about the topic

and may be less critical viewers. This is especially problematic

in the case of IPV, because medical dramas, police dramas, and

court dramas tend to showcase extreme cases for dramatic ef-

fect. Ultimately, misperceptions gleaned from TV could nega-

tively impact effective screening of IPV and the quality of pa-

tient care. In this case, TPP was related to beliefs about com-

munity members’ willingness to intervene in IPV cases. Be-

tween advertisements, public service announcements, news

coverage, and entertainment programs, there is a rich area of

health-relate d me ssages yet to be explored in future research.

In terms of the Health Belief Model, one element, perceived

Table 1.

Zero-order correlations among variables predicting third-person perception.

2 3 4 5 6 7 8

1. TPP .24** .18* .18* .09 .09 .08 .05

2. HBM/Susceptibility - .14 .16* .14 .01 .04 .06

3. HBM - .60** .75** .67** .24** .18*

4. Interve ntion - .21** .03 .13 .09

5. Attitude - .36 ** .10 .19*

6. HBM/Severity - .06 .13

7. HBM/Benefits - .33**

8. HBM/Barriers -

Note. *p < .05, **p < .01. 1) TPP (Third-person perception); 2) HMB/Susceptibility (Health Belief Model, Susceptibility to IPV); 3) HBM (Health Belief Model); 4)

Intervention (Perceived wil lingnes s of communit y members to intervene in IPV cases); 5) Attitude (Perceived approval of community members of IPV); 6) HBM/Severity

Severity of IPV for victims); 7) HBM/Benefits (Benefits of hospital resources for IPV victims); 8) HBM/Barriers (Barriers to victims for IPV services). (

J. CHAPIN

358

Table 2.

Summary of linear regression analysis for variables predicting third-

person perception.

Adj. r2 = .10

N = 306

Predictor B SE B β

HBM/Susceptibility .11 .06 .16*

HMB .04 .10 .08

*p < .05

susceptibility, emerged as a predictor of TPP. A similar con-

struct, optimistic bias, has been linked with TPP in the past

(Chapin, 2000; Salwen & Dupagne, 2003). Perceived suscepti-

bility and perceived severity tend to be the strongest predictors

of attitudes and behaviors in the HBM literature. In this case,

98.7% agreed or strongly agreed that the emotional impact of

IPV is severe and 98.1 agreed or strongly agreed that the physi-

cal impact of IPV is severe. The lack of variance may explain

the insignificant finding. While it was not the focus of this paper,

it’s interesting to note that both community attitudes about IPV

and willingness to intervene were more strongly related to the

HBM than to TPP. The finding solidifies the value of the model

for IPV scholars and advocates. It also provides the groundwork

for future linkages between the HBM and TPP literatures.

A number of limitations should be considered before inter-

preting the results of this study. The study is based on a con-

venience sample of medical personnel gathered for training on

intimate partner violence. Test measures were collected prior to

the training to limit skewed responses, but participants were

aware of the topic and some priming may have occurred.

Conflict of Interest Statement

None to report.

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