Because health communication initiatives often encourage individuals to take responsibility for their own well-being (Kirkwood and Brown, 1995; Knowles, 1977; Guttman, 2000), it is important for developers to assess environmental constraints, access to health care resources and facilities, and the values and beliefs of the group. In some health communication interventions, people may be urged to make prudent and responsible choices about food consumption, leisure activities, intimate relations, and other lifestyle options. In response, those who are economically or otherwise disadvantaged might be compromised in their ability to follow the recommendations and may, as a result, be viewed as lacking motivation to change, being “difficult to reach,” and deserving of negative health outcomes (Daniels, 1985). Although health messages do not usually blame individuals for being responsible for their illnesses, they may frame disease prevention as if it were primarily a matter of individual control (Wallack, 1989). In doing so, they deemphasize structural factors related to employment and housing, access to health care, access to healthy and inexpensive food stuffs, pollution, and other factors that can precipitate or exacerbate serious health risks. Such messages also may deemphasize the importance of institutional changes that may supersede changes by individuals alone (e.g., Ellison et al., 1989; Coreil and Levin, 1984; Glanz and Mullis, 1988; Glanz et al., 1995; Green and Raiburn, 1990; Milio, 1981; Wallack, 1989; Williams, 1990).

Appeals to personal responsibility also may be viewed as manipulative (Bayer, 1996; Niebuhr, 1978; Veatch, 1982). Persuasive messages using personal responsibility as an emotional appeal may warn people that failure to adopt a responsible lifestyle may lead to illness or disability, which could turn them into a burden on their family or society as a whole. Health behavior change messages may imply that people have an obligation to help promote or protect the health of significant others. For example, people may be told that they should help their spouses maintain a healthy diet, insist that their adolescent children use seatbelts, and support the efforts of siblings and friends to quit smoking. Such messages can reinforce moral commitments such as service, re-



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