Mayhorn, C. B., Wogalter, M. S., Goldsworthy, R. & McDougald. B. (2014). Creating inclusive warnings: The role of culture in the design and evaluation of risk communications (pp. 97-128). In Smith-Jackson, T., Resnick, M., & Johnson, K. T. (Eds). Cultural Ergonomics: Theories, Methods, and Applications. Boca Raton, FL: CRC Press.

5

CONTENTS

Creating Inclusive Warnings The Role of Culture in the D esign and Evaluation of Risk Communications

Christopher B. Mayhorn/ Michael S. Wogalte0 Richard C. Coldsworthr and Brannan R. McDougal

Creating Inc lusive Warning s: Rol e of Culture in the Des ign and Evaluation of Risk Com1nunications ........................................................................... ............. ...... 98 Culture, Subc ulture, and Ethnicity: Definitions and Dist inctio ns .............. .... .......... 99 Mode ling Behavior: How Peop le Intera ct with Warnings ........ ............. ................ 100 C-HIP Mod el ....... .................................... ......... ............................................... ... .... JOI Source ................................................ ...... ..... ............... ......................... .......... ....... 102 Channe l ............... ...... ............. .......... ...................................................................... I 03 Delivery ........................................................................................ ....... ... .... .... ........ 103 Environ 1nenta l Sli1nuli .. ................ .... ........ ..................................... ...... ... .............. . 104 Receiver ................................................... ............................. ................................. l 05

Allention Switch .................................. .. ...... ............................... ....... ................ 105 Allen ti on Maintenance ...................................... ............................... ....... .......... 106 Comprehension and Memory ......................................... ........ .... ............. ... ..... .. I 07

Signal Words ............ ............. ....................... ............ ........... ......................... 107 Mes sage Content ......................... ....... ................................. .......... ............... 108 Symbol s ........... ................ ................ ............................................................. 109 Level or Knowl edge ..................................................................................... 111

Be liefs and Altit udes ......................................................... ....... ............. ...... ...... l I l Mot ivation ........ .................................................... .................................... ......... 1 I 3

Behavior ....... .......................................... ....... .... ...... ........................... .... ................ 114 Refining Teratogen Warning Symbols: A Case Study in Inclu sive Warning Design and Eva luatio n Methodo log y .... .... ..... .................. ........... .......... ...... ..... ...... 115 Aud ience Analysis Using Latent C lass Analysis ............................... .................... 116

97

98 Cultural Ergonomics: Th eo ry, Methods , and Applications

Conclusions and Recommendation s ....... ............................................................... 119 Identifying the Target Audience .................................................... ........... ......... I 19 Using Participatory Des ign Technique s to Recruit Participant s and E ngage the Community ......... ....... ......... ......................................................................... 119 Deve loping and Evaluatin g the Warning Content via Iterative Design ............. 120 Fo llow-Up Evaluation after Warning Deployment ......... ....... ......... .................. 120

Conclu sion ............ ....... ............... ... ..... ......... ... ................ ..... ....... .......... ...... .... ..... .. 120 Refer ence s .......... .... ................................................. ........... ......... ........... .............. .. 121

CREATING INCLUSIVE WARNINGS: ROLE OF CULTURE IN THE DESIGN AND EVALUATION OF RISK COMMUNICATIONS

Warnings are ri sk communications used to inform people aboul ha za rds and to pro ­vide instructions so as to avoid or minimize unde sirabl e consequence s such as death , injury , or property damage. Warning s are used in a variety of contexts for numerou s kinds of potential ha zards. Fo r instance , a product warning might be used to inform users about the electrocution haza rd assoc iated with a kitc hen appliance, wherea s an environmental warning might be used to advi se peopl e to evacuate the area where a hurri cane is expected to mak e landfall. While the se example s of warnings might appear to be very different , they share a number of commonalit ies becau se they are both persuas ive safety co mmunication s used to guid e the behavior of tho se who rece ive them.

Ba sed on the classic work of Lasswe ll (1948) and Hov land , Jani s, and Kelley (1953), all per suasive communi ca tions should be ana lyzed in ter ms of sou rce (the entity that initiates communicat ion), message (content of communi cation), chan nel (how the message is communicated) , receiver (target of the communi ca tion), and effec t (des ired behavioral chan ge). These components of risk communications have been studied in depth over the past several decades (see Lindell and Perry, 2004; Wogalter, 2006 for exte nsive reviews). Th e pre sent chapter focuses on one of these components, receive rs. The characteri stics of the perso n being warned are subdi ­vided into topics that are disc ussed.

Althou gh it is often recog nized that warning effec tiveness depends on the extent to wh ich these risk co mmunic ations have been des igned to match the needs and capabiliti es of the targe t audience, it is equally import ant to und erstand that the charact eristics of message recipi ents vary from one indi vidual receiver to the nex t; therefore, warn ing des igner s need to understand that their target audience may not be homoge neo us (Smith-Jackson, 2006a) . For insta nce, a number of rese arch­ers such as Go ldh aber and deTurck (1988) and Flynn, Slovic , Mertz , and Carlis le (1999) have investigated the role of gend er on warning complianc e and risk percep­tion . Others have investigated chron ologica l age as an indi vidual differe nce when people enc ounter warnings and other ri sk communi cation s (Mayhorn and Podan y, 2006 ; Rou ssea u, Lamson, and Roge rs, 1998; Young, Laughery , Woga lter, and Lo vvo ll, 1999) . Unfortunate ly, not all receiver characteristic s have bee n as exte n­sively studi ed. In particular , there is a demon strated paucity of rese arch in the area of understanding how cultural attribut es of receivers impact warning effec tiveness (Reid, 1995; Smi th-Jack son, 2006b). As will be discussed later in the chapter, the

Creating In<

co mmunicat expose the n gaps in the c

CULTURE, DEFINITIC

Perhaps one context com the term culi fied I 64 sep; Fortunately, honed theore tive, culture co mmuni cat, book as aw : psychologist: that ... provi (p. 11). Beca , ent cultur es, orcommunit the most sigr

Acco rd in; following ch be differe nt, pate in shan Moreove r, et and religio n for understa1 information values of the cu lture " (Gu from pot enti the warnin g.

To illustr. imp act the d trends withi indicates the the most po1 (15.4%), Afr cate that by more than 5'. 42 milli on , .; Ce nsus, 200 within our c1 affect warni 1

i Applicatfons

................. 119

................. 119 Engage ................. 119 gn ............. 120

················· 120 ................. 120 ................. 121

N THE IS

~ds and to pro -such as death ,

; for num ero us used to inform :e, whereas an he area where arning s mi ght cau se they are of those who

is, and Ke) ley of source (the 1tion) , channel .nication), and nication s have 1 Perry, 2004; n one of these 1ed are subdi -

; on the extent :he needs and stand that the er to the next; mdience may r of researc h­' and Carlisle d risk percep­'ference when 1 and Podany, Nogalter, and ,een as exten­ch in the area effect iveness

e chapte r, the

Creat ing Inclusive Warnings 99

comm unication - human information processing model (C-HIP ) will be used to expose the need for co nsideration of cultural ergonomics becaus e there are ser ious

gaps in the current warning literature .

CULTURE, SUBCULTURE, AND ETHNICITY: DEFINITIONS AND DISTINCTIONS

Perhap s one explanation for the relati ve lack of research regard ing cultur e in this co ntext comes from an incomp lete (and often co ntentious) understand ing of how the term culture can be defined. For insta nce, Kroeber and Kluckhol n (1952) identi­fied 164 separab le definitions of culture within the anthropologi ca l litera ture alone. Fortunately, the design and evaluation of warnings docs not require a ll of the finely honed theoretical distinctions made by anthropologists. From a soc iologica l per spec­tive, culture is the agg regatio n of expe rien ces, values, bel iefs, and attitudes that are commun icate d by socia l gro ups (Hofstede, 1997). Consistent with the purposes of this book as a whole , "cultur e" within this chapter will follow the definition of cultural psychologists Goldberger and Veroff (1995) as being "a system of shared meanings that ... provide a common lens for perceiv ing and structur ing reality for its members " (p. 11). Because a pop ulati on of ten include s large number s of peop le who share differ ­en t culture s, subcultur es ofte n coexis t within groupin gs such as national bound aries or co mmuniti es . Subcu ltures can be defined usin g a var iety of dimension s, but one of the most significant in term s of warning and risk commu nica tion is ethni city.

Accordin g lo Yinger (1994), member ship in an ethnic group is defined by the following characte ristics: (I) others in the soc iety perceive the gro up members to be different , (2) members identif y thems elves as different , and (3) membe rs parti c i­pate in shar ed activit ies related to their perceived co mmon orig in or culture (p. 3). Moreover , ethni c groups are often defined in terms of national orig in, race, language, and religion (Gudykun st and Kim, 1997). In the development of warni ngs, the need for under standin g how peop le of different e thni cities will interact with safety-related inform ation is crit ical becau se members of subcultur es typically share many of the va lues of the culture , but they "also have some values chat differ from the larger cultur e" (Gudykunst, 1998, p. 43). Thus, efforts to prot ec t the sa l'ely of the public from potential haza rds must co nsider the heterogeneity of the people who receive

the warni ng. To illu strate the need for better under standin g of how cultu ra l attributes m ighl

imp ac t the des ign and evalua tion of warn ings, consider the follow ing demogra phic trends within the United States. Recent data from the US Cen sus Bureau (2009) indica tes that the Ameri ca n population tota ls approx ima tely 304 million and that the most populous et hni c min ority groups include those repor ting Hispanic orig in (15.4%), African American s (12.9%), and Asian s (4.5%). Population est imates indi­ca te th at by 2015, the number of those repo rtin g Hispanic origin will increase to mor e than 57 million, the numb er of African Ameri cans will increase to more than 42 million , a nd the numb er of A sians wi ll increase to more than 16.5 milli on (U.S. Cen sus, 2008). Thu s, the abi lity lo inform and protect all subgroups and ethni cities wit hin our cu ltur e is depe ndent on und erstandin g how these cullu ra l attribute s might

affe ct warning effect iveness and related issues.

100 Cultural Ergonomics: Theory, Methods, and Applications

MODELING BEHAVIOR: HOW PEOPLE INTERACT WITH WARNINGS

A numb er of models co uld be used to serve as the basis of this discussion on warn ing s a nd cu ltur e (e.g., Edworthy and Adams, 1996; Lehto and Miller, 1986; Lindell and Perry, 2004; Rogers, Lamson, and Rousseau, 2000); however, the com­munication-human information proce ssing (C-HIP) model described by Wogalter and associates (e.g., see Wogalter, 2006) provides a reasonable framework that is both comprehensive and cons istent with the aforementioned persuasive com­munications models. In this chapte r, C-HIP wi ll be used to provide a theoretical framework for the discussion of cultural attrib utes. It is the context within which culture is discussed.

The C-HIP model has two major sections eac h wit h severa l compone nt stages. A representation of the model can be seen in Figure 5.1. The first section of the framework uses some of the basic stages of a persuasive comm unicati on model (Hov land , Janis, and Kelley, 1953; Lasswell, 1948). To illustrate how these general

Environmental Stimuli

t i I . i ' ' J ---i J

Source

Channe l

Mai nt enance

Comprehension Memory

Attitudes Beliefs

Motivation

Behavior

FIGURE 5.1 Communication-human information processing (C-HIP) model.

Creating Inc

communicati (1980) provi< warnings . Tt ing message I through somi a cultural co1 should be co sources, choc safety inform

The secon internally pre tive delivery <

warning info1 not blocked i 1

attention mai tion, and pos individual dif to a particula population is operate at all

C-HIP MOC

The C-HIP m usefu l in desc tion might ha, stage, the in ti: unsucce ssfu l, gett ing to the i ng, then proc noticed and at no additional stood, it sti ll n If the person instructed bet occur. Succes processing of ance stage, it enhance unde aspects of the se rves to prov

In the sect described. The n ication from analy sis of inf

nd Applications

.s di sc uss ion on 1d Mill er, 1986; ,wever, the com­)e d by WogaJt er framework that >ersuasive com­de a theoretic a l xt within which

mponent stages. ;t section of the mic ation model ,w these general

lei.

Creating Inclu sive Warnings 101

communication mode ls ca n be altered to und erstand the warning pro cess, McGuire (1980) pro vide s a de ta iled description of communication theo ry with respect to warning s. Thus, the ge neral framework for the C-HIP mod el focus es on a warn­ing me ssage being se nt from one ent ity to another, that is, se nt by a source (sender) throu gh some channel( s) to a receiv er. To place these C-HIP co mponent s within a cultural co ntext , the In st itut e of Medi c ine (2002) sugges ts that cultural diversit y should be considered when planning co mmuni ca tion effo rts by selectin g cre dible sources, choosi ng message strat eg ies, and determining channels for the deli very of

sa fe ty in formatio n. Th e secon d main sect ion of the model focuse s on the rece iver and how people

internally pro cess information. Thi s sec tion interfaces with the first throu gh effec ­tive deli very of the warnin g to individual s who are part of the tar ge t audience. When warning information is deliver ed to the rece iver, pro cess ing may be initi ated , a nd if not blocke d in so me way, will co ntinu e acro ss seve ral stage s: from attention sw itch, attention maintenance , com preh ension and memor y, beli efs and altitud es, motiv a­tion , and poss ibly ending in behavior. Cultural attribut es can be considered as an individual difference variable beca use each person who rec eives a warning belongs to a particular culture, and this vari es from one indi vidual to the next because the popu lati on is heteroge neo us and diverse. T he cultural as pec t can be expecte d to operate at a ll levels of in formati on proce ss ing within the rece iver.

C-HIP MODEL

The C-HIP model is both a s tage model and a pro cess model. The C-HIP model is use ful in de scribin g a ge nera l se quenc ing of stages and the effec ts warnin g inform a­tion might have as it is proce sse d. If inform atio n is successf ully processe d at a give n stage, the in form at ion "flow s through " Lo the next stage. If proces sing a t a stage is unsuccess ful , it ca n produ ce a bottleneck, block ing the flow of inform ation from ge ttin g to the next stage. If a person does not initiall y noti ce or attend to a warn ­ing, then processing of the wa rnin g goes no furth er. Howeve r, eve n if a warning is no ticed and attended to, the individual may not und ers tand it, and as a conseq uen ce, no ad ditional proces sing occur s beyo nd that point. Eve n if the message is und er­stoo d, it st ill might no t be believed, thereby ca using a blockage to occ ur at thi s point. If the per son believes the mes sage but is not mo tivated (to ca rr y out the warning's instructed behavior), then the fina l stage involving co mplian ce behavio r might not occ ur. Successfu l pro cessi ng in all stages res ult s in safety comp lian ce . Whi le the pro cess ing of the warning may not mak e it a ll of the way to the behavioral co mpli­ance stage, it ca n still be effec tive at ea rlie r s tages. For exa mple, a warning might enhan ce und ersta ndin g a nd beliefs but not change behavior . Whi le there are other aspects of the model (e.g ., feed back loops), thi s basic mode l and its organization serves to provide a framework for ou r d isc uss ion of culture and wa rnin gs .

In the sections fo llowing, facto r s a ffec ting each stage of the C-HIP model ar e described. T he fir st thr ee sec tions co ncern the sec tion of C-HIP concerning commu­nica tion from the so urce via some channel( s) to the receiver. Lat er sections concern analy sis of infor mati on proce ssing fac tors that are internal to the rece iver.

102 Cultural Ergonomics: Theor y, Method s, and Applications

SOURCE

A warning source is the entity or age ncy respo nsib le for initiating haza rd co mmuni ­ca tion with the publi c. Sources ca n be gove rnment au thoriti es, produ ct manufa ctu r­ers, media figures, or peers such as friends and relat ives (Lind ell and Perry, 2004; Wogalter, 2006). When an indi vidual first enco unters a warnin g, he or she jud ges the credibilit y of the source. Warnings originating from credibl e sour ces are likely to promote warning compliance, whereas less credible sources are likely to prompt informati on see kin g. Thi s process is known as warning confirmation and entails seeking inform ation from other warn ing messages and different sources (Danzig, Thayer, and Gal ater, 1958). Beca use credibility var ies betwee n individuals, some have suggested tha t environm ental warnin gs may be more believa ble to a large r seg­ment of the population if they come from a mixed panel of sc ientists, public officials, reputable organizations, and familiar per sons (Drabek and Stephenson, 1971). In fact, people are more likely to pay attention to warning s when they per ce ive that the source of informati on is " in the sa me boat " that they are; thus, shared involveme nt between the source and the rec eiver is likely to enhance risk perc eption (Aldoory and Yan Dyk e, 20 06). Lik ewise, Weinstein's (1988) precaution adoption model sug­gests that the realization that a probl em affec ts others " like you" ca n sti mulat e peo­ple to think about hazard s and might lead them to plan to take preventative action by co mplying with a warning.

As so urce cre dibility is inh erently tied to the co ncept of " trust," it is not surprisin g that tru st is a topic of co nsidera ble d iscussion with no uni versally accepted schol­arly definiti on (Roussea u, Sitkin , Burt , and Ca merer, 1998). Although definitions of trust vary from one academ ic discipline to another , one findin g from a grow ing body of research is particularly robu st: trust and message cred ibilit y va ries quit e significantly by rac ial and ethnic status (Spence, Lac hla n, and Griffin, 2007). For instance, African Americans frequently cite a distrust of gove rnm ent institutions and describe incident s of past exp loitat ion such as the Tuskegee syphili s tria ls or Hurri cane Katrina as explanations for an unwillin gness to attend to or be lieve mes­sages (Andru lis, Siddiqui, and Gantner, 20 07; Freimuth et a l., 2001). Lik ewise, dif­fere nces in wa rnin g information exchange and dissemin at ion have been observe d between Mexican American s, Ca ucas ian Ame ricans, and African A merica ns (Fot herg ill , Maesta s, and Darlin gto n, 1999).

To comba t these deleter ious effects of trust, obtaining communit y engagement durin g warning development is esse ntial (Pa lenchar and Heath, 2007). Ge nera lly, such effort s have been describ ed as one option for underrepresented segments of the popul ation to take "co mmunity co ntrol " in an effor t to co unterb alance the power of the majority (Hacker, 1995). Thus, engag ing particip atory techniqu es that enta il active collabora tion between communitie s and other stakeholders suc h as govern­ment entities and aid orga nization s should prov ide a mea ns of achieving thi s goal (Geo rge, Green , and Daniel, !996). For instance, the formation of a com munit y advi sory board that includes faith -based organization s, co mmunit y leaders, and co mmunit y-o utreac h workers might be predic ted to be useful in fac ilit ati ng emer­gency risk communi cat ions such as warning s (Andruli s et al., 20 07; Vaughan and Tinker, 2009). T his approach where co mmunit y leader s in refugee camps acted as

Creat ing Ir

part of a n 1

outbreak of tion betwee that loca l sc " insider inf federal go v1 and Leal-A

CHANNEi

Warning ch information warnrng s ca uct manuals presen tation warnings m news papers, warnings of voice) moda an odor add and the rou1 provide tact Cohen, Men

Eac h oft specific ity o radio broadc segme nt of ti for the stat ic also receive Also, rece nt incorrec t inf information to-face warn these sho rtcc nels be used da tions rega authoriti es ta TY" (Vaugh:

DELIVERY

While the sc warnin gs mi : refers to the 1 as a separa te its importa nc

Applications

ird communi­t manufactur -1 Perry , 2004; or she judge s ·ces are likel y ely to promp t in and entails rces (Dan zio 0'

1idual s, some ) a larger seg-1blic officials , ;on, 1971). In ·ceive that the J involvement tion (Aldoory rn model sug­timulate peo­.tive ac tion by

not surprising cepted sc hol­~h definition s >ma grow ing , var ies quit e n, 20 07). For H institution s hili s trials or believe mes ­

) kewise, dif­ee n obse r ved 1 American s

' engagement 7). Generally . gmems of the ce the power es Lhat em ail :h as go\'ern­·i ng this goa l

1 cummunil\ leaders . :rnd

-------~

Creating Inclu sive Warnings 103

part of an ea rly warnin g sys tem was demonstrated to be usefu l in pre venting the outbreak of in fec tious di seases in Darfur (Pinto et a l., 2005). Moreo ver, the interac­tion betw ee n credibility and source is furth er supp orte d by research that sugges ts that loca l sour ces such as friends, family, and local news med ia might be co nsidered " insider infiuenc es," which can be tru sted more than "o utsider influence s," such as federal gove rnm ent entiti es or env ironment al gro ups (Bax ter , 2009; Riley , Newby,

and Lea l-Alm eraz, 2006).

CHANNEL

Warning channels refer to the co mmunication s med ium used to tran smit haza rd informati on. Warnings ca n be transmitted in many ways. For insta nce, product warnin gs can be pre se nted on labels directl y on the product, on containers, in prod ­uct manual s or inse rts, on poste rs/placa rds , in brochur es, and as part of audio - video presentations on various media (e.g., DVD or Internet). By contrast, environmental warnings might be di sse min ated via face-to-face contact, telephone , siren, radi o, newspap ers, te levis ion, and the Internet (e.g., Facebook , Twitt er). Mo st comm only, warnin gs of either type use the visual (text and sy mbols) and auditor y (alarm s and voice) modalitie s as oppo sed to the o ther se nses. T here are exceptions, for exam ple, an odor added to petrol eum -based gases to enab le detection by the o lfac to ry sense, and the rough vibration of a produ ct that is not mec hanica lly fun ction ing we ll ca n prov ide tact ual, kinesth etic, and haptic se nsat ion (Mazis and Morri s, 1999; Cohen ,

Co hen, Mendat, and Wogalter, 2006 ). Each of these channel s varies in term s of the precision of di sse min atio n and the

spec ificity of the message (Lindell and Perry, 1987) . For instance, a television or rad io broad cast co ntainin g a flood wa rnin g might quickly reach the intended at-risk seg ment of the population , but dissemination is impr ec ise becau se the rece ption area for the station is la rger than the risk area such that others who are not at ri sk will also receive the hazard in formation and errone ous ly believe them se lves to be at ri sk. A lso, rece nt ev idence sugges ts that chann el might intera ct with cre dibilit y such that inco rre ct information obtained from the In tern et might be tru sted, wher eas correc t in formati on might be viewed with susp ic ion (Woga lter and Mayhorn, 20 08) . Fac e­to-face wa rnin gs ca n be much mor e tar geted than mass med ia broadcasts. Given these shortcomings for eac h of the channels , it is o ften suggested that multipl e chan­nels be used to comm uni ca te with all members of soc iety . For insta nce, reco mmen­datio ns rega rdin g hea lth com muni cat ions about pa ndemic influ enza suggest that auth or ities target severa l of the afo rementioned channels as well as "e thni c rad io an d

TV" (Va ughan and T ink er, 2009) .

DELIVERY

Wh ile the so urce may try to disse minate wa rning s in one or more channels, the \l.arnings might not rea:h ~""me of the ta rgct s ac ris k (Wi lliam so n, 2006). Delivery r~frrs iO lhe ~,.,int of re pt..k..n .i. h~r-= .... \\ 1rning arri\e - ,, ilh the re eiYer. ll i show n ~ .. Scf...L~ 5:.....~c i - the· :-cl're-· C-:l~ :"'."' ~: ~ :: ic. F,g _re :.: re e~pbize

104 Cultural Ergonomics: Theory, Methods, and Applications

delivered. Safety information provided on a DVD that is produced but never reaches the individual would be delivery failure. The reasons for failure to deliver the warn­ing to targeted individuals can be multifold. The DVD may not have bee n distributed and sitting in bulk boxe s in a warehouse. Or the di stribution could be haphazard reaching some intended persons and not others. But even if individuals receive the video (e.g., via the Internet) they may not recei ve the needed information. For instanc e, groups with high rat es of poverty may not have the playback equipment to see it or there might be a language barrier (e.g. , limited proficiency in English). Of course, even if the person does see the video, it may not includ e the necessa ry warn­ing. Thus, it may be necess ary to distribute warning information in multiple ways to reach receivers at risk. The point is that if warnings given by a so urce do not reach the targets at risk, then the warning will have no or limited effects on the receiver.

Because technology is becoming ubiquitous in our society, the Int e rnet is a constantly evolving channel for the delivery of satety information (Wogalter and Mayhorn, 2005). Although some portion of a population may have ready access to the Internet and frequently act in a proactive manner to search for information , oth­ers simply may not know that there is safety material (e.g., a I ist of recalled consumer product s) that could be accessed. Thus, the existence of a digital divide must be recogniz ed along with other disadvantages (and advantages) when Internet deliv­ery is being considered as a mechanism for di sse min at ing safety information to the publi c . Advantages mi ght include the potential for timely , targeted, multimedia pre­se ntati on of sa fety information that includ es a gateway for further inform at ion seek­ing, whereas di sadva ntag es might include the potential for inadv erte ntly creating pa ssivity as information is "pushed" to people thereby reducing int eract ivity with knowledgeable others (e.g., gove rnment official s). Ultimately, these advantages and di sadva nta ged nee d to be inve stigated via empirical resea rch to determine whether the benefits exceed the costs in term s of safe ty.

ENVIRONMENTAL STIMULI

Besid es the subject warning, other s timuli are usually si multan eo usly present. These stimuli may be other warnings or a wide assortment of nonwarning st imuli. These stimuli compete with the warning for the person's att ention (desc rib ed further below). With respe ct to a given warning, these other stimuli may be described as "no ise" that could potentially interfere with warning processing. For example, a cel­lular telep hone ringing or a baby crying just when an indi vidual begins to examine a warning may cause distraction and lead to the warning not being fully read. The environment can have other effects. The illumination can be too dim to read the warning. In these ca ses of distraction or legibility , warnings of grea ter sa lience (e.g., light source added) could have better capability to attract and hold a person's focus.

Environmental influences often include other people as described in the social amplification of risk framework (Kasperson et al., 1988) that illu strates how inter­personal intera ction s in a social context can influ ence perception of ri sk. Awareness about what other people are doing in the loca l environment and elsewhere can affect warning compliance positively or negatively. As research by Ma suda and Garvin (2006) illu strate s, situated experiences of place can act as conflicting cultural

C

Creating I

world view . risk. Fore) ba sed on ti Likewise, 1 are surrou equipment ronment c~ modeling< ment can a

RECEIVE!

The rece iv For aw;

warn mg m long enou~ must be un Finally, th( next seven

ATTENTIOI'

An effecti, ciently sa l i other st im1 well warni and Vigila

Lar ger : and contra important tive to ot h rate attenti Brelsford, severity a~ fered signi rank order Beyond in

gests that J

Reidel, an< the presen, not be reli1 ponent in ,

Warnin word pane include an noting sig1

.. ~ . .. ~ . , .... ~.,, - ... -~· ~ -·~ ... -~ ,.~ ...__. ~,.,,,.~ '

App licat ion s

never reaches ver the warn­... n di stributed be hapha zard duals rece ive Jrmation. For eq uipm ent Lo

1 Eng lish). Of ::essary warn ­iltipl e ways to ! do not reach the receiver. Internet is a

Wogalt er and :ady access to )rmation, 0th­lied consumer ivide mu st be .ntern et del iv­rmation to the ultimedia pre­>rmation se ek­ently creating :ract ivity with :!vantages and mine whether

ously present. trning stimuli. ;cribed further ~ described as :xample, a ce l­ns to examine ·u11y read. The

.m to read the : salie nce (e.g., >erson's focus. j in the socia l He how inter ­sk . .-\w arene here can affect :... and G~, in

Creating Inclusive Warnings 105

worldviews that lead some individual s to act as risk amplifiers while others allenuate risk. For examp le, risk amplifiers might co nclude that the risk of head injury is high , based on their observations that other people are wearing safe ty helmet s on bicycles. Likewise, ri sk attenuators might co nclude that the same risk is re latively low if they are surrounded by advert ise ment s depi c ting people not wearing needed protectiv e equ ipm ent, eve n though the product warning requires its use. Clea rly then, the envi­ronment can have effec ts on warning processing. It shows a way of demonstrating or modeling ongoing processing. The source, receiver, other entitie s, and the env iron­ment can act on the situation and change it.

RECEIVER

The rece iver is the person( s) or target audience to whom the warn ing is directed. For a warning to effec tively communicate information and influence behavior, the

warning mu st first be delivered. Then atte ntion must be swi tched to it and maintained long enough for the receiver to extract the necessa ry information. Next, the warning must be und erstood and mu st concur with the rece iver's existing beliefs and atlitudes. Finally, the warn ing mu st motiva te the rece iver Lo perform the dir ec ted behavior . The next severa l sect ions are organized around these stages of information processing.

ATTENTION SWITCH

An effective warning must initiall y attract attention , and to do so, it needs to be suffi­ciently sa lient (consp icuous or prominent). Warnings typ ica lly have to compete with ot her stimuli in the environment for auention. Several design factors inf-luence how well warn ings may compete for auention (see Woga lter and Leonard, 1999; Woga lter and Vigi lante, 2006).

Larger is ge nerally be LLer. Incr eas ing the overal l size of the warning, its print size and contrast, gener a lly facilitates warning conspicuousness. Context a lso play s an important role. It is not ju st the abso lute size of the warning, but a lso its size re la­tive to other disp layed informati on. Co lor is an important attribute that can facili­tate atte ntion attraction (Bzostek and Wogalter, 1999; Lau ghery, Young, Vaube l, and Brelsford, 1993). Howe ver, recent ev idence sugges ts that the interpretation of ha za rd seve rity associated with co lor var ies by culture such that Chinese pani c ipanr s dif ­le red significantly from participant s in the Un ited States when both were asked to rank ord er co lors in term s o f perce ived hazard s (Lesc h, Rau, Zhao, and Liu, 2009). Beyo nd interpretation of colors and their se manti c meanings , other evide nce sug­gests that perception of co lors may a lso vary across cultures (Hupka , Zaleski, Otto, Reidel, and Tarabrina, 1997). Moreover, other problems unrelat ed to culture such as the presence of color blindness in some individuals sugges ts that co lor a lone should nOL be relied on to attract atte ntion yet color remains a frequen tly used design com­ponent in warnings.

Warning standards often use color as one of seve ral co mpon ents of the signal v.ord pan el to au ract al!e ntion Oth er design co mpon ents in the signal word pane l indude an alen ~ mb.: L the tri:rngldexclamation poin c. and one of th ree ha zard con­n :i::g , ;n.J ',\vnb DA~°'\GER. W . .\R. ·1.\'.'G . .... '1-J C..\CTlO ~ . Cc nte,t again can

106 Cultural Ergonomics: Theory, Methods, and Applications

also play a role with respect to color as a salience fealure. An orange warning on a product label located on an orange product will have relatively less sa lience than the same warning conveyed using a different color. Th e color should be di stinctive in the environment in which it is placed.

Symbols can also be usefu l for capturing attention. One example already men­tioned is the alert symbol (triangle enclosing an exclamation point) used in the signal word panel in ANSI Z535 (2002; Bzostek and Wogalter, 1999; Laughery , 1993). Thi s symbol only serves as a general alert. Bzostek and Wogalter (1999) found results showing people were faster in locatin g a warning when it was accompied by an icon. Other kinds of symbols may be used to convey more specific information. This lat­ter purpose is discu ssed in the comprehension section (discussed later), but the point here is that a graphic configuration can also benefit the attention switch stage.

ATTENTION MAINTENANCE

Individuals may notice the pre sence of a warning but not stop to examine it. A warn­ing that is noticed but fails co maintain anention long enough for its content to be encoded might serve as being of very little dire ct value. Attention must be main ­tained on the message for some length of time to extract meaning from the material. During this proc ess, the information is encoded or assimilated with existing knowl­edge in memory.

With brief text or symbols, the warning message may be grasped very quickly, sometim es maybe as fast as a g lance . For longer , more co mplex warning s, attention must be held for a longer duration to acquire the information. So to maint ain atte n­tion in these cases, the warning needs to have qualitie s that generate interest so that the person is willing to maintain attention to it instead of somethin g else. The effort necessa ry to acquire the information should be reduced as much as possible. Thus, there is a desire to enable the information to be graspe d as eas ily as po ssible. Some of the same des ign features that fac ilitate the switch of attention also help to main­tain attention. Fo r exa mple, large print not only attrac ts atten tion , but it also tends to increase leg ibilit y, which makes the print eas ier to read.

People will more likely maintain attention if a warning is well designed (i.e., aesthetic) with re spec t to formatting and layout. Research with western cultures sugges ts that people generally prefer warnings that are in a list outline format as opposed to continuous prose text (Desaulniers, 1987). Also, text messages presented in all caps are worse than mixed-case text in glance legi bilit y studie s (Poulton, 1967) and centered-line formatting is worse than lef t justifi ed text (Hooper and Hannafin, 1986) . Moreover , visual warnings formatted with plenty of white space and contain­ing organized information gro upings are more likely to hold attention than a single chunk of den se text (Wogalter and Vigilante, 2003; 2006). Int erest ingly, the lack of resea rch with diverse samples may limit the potential usability of such design guideline s. For instance, the recommendations regarding the use of all caps may not be applicable to people who use pictofo rm languages such as Chinese, Japanese, or Korean. Likewi se, suggest ions regardin g the use of left-ju stified text may not be applicable to readers of Arabic or Hebrew langu ages. Thus, there is an obvious need to tes t warning de sign features with other culture s.

Creating Inc

Becau se i text, structur ception of di attention to !

pleasing to h1 the informat i structure or < late the info n Wogalter, 201 with homoge cessed simil, usi ng the Cu tion regardi n often reduce< tion are cons

COMPREHENS

Comprehensi intended me~ nents: subjec1 guage and S)

Background peopl e carry cept ual resea much of this across cultun investigat ing

Signal Wore

Aspects of a ANSI (2002 : ing levels of WARNING, Westinghous when seriou s panel is used The CAUTI( may occur if and WARNJ indicate that has been she than DANG! Magurno, an

While the often used tc

<\ppl ications

warnrng on a ~nee than the inctive in the

1lready men ­I in the signal r, 1993). Thi s found result s :d by an icon. ion. This lat­but the point

1 stage.

1e it. A warn­::ontent to be ust be main­the material.

isting know!-

very quickly, 1gs , attention 1intain atten-1ter est so tha t ,e . The effor t >ss ible. Thus , )Ssible. Some 1elp to main-also tends to

es igned (i.e., tern cu ltur es ne format as

5es presented oulton, 1967) nd Hannafin , and contain ­than a single 1gly, the lack ' such design all caps may :se, Japane se, :t may not be obvious need

Creating Inclu sive Warnin gs 107

Becau se individual s may decide it is too much effort to read large amounts of text, structured formattin g could be beneficial in lessening the mental load and per­ception of difficulty. With perc eption s of Loo much text , many prefer co direct their attention to somethin g else. Formatting can mak e the visual di splay aesthetically plea sing to help hold people' s atten tion on the material. Formatting can help process the information by "chunking" it into smaller unit s. Formatting can also show the structure or organization of the mate rial , makin g it easier to search for and assimi ­late the information into ex isting knowledge and memory (Hanley, 1994; Shaver and Woga lter, 2003). Aga in , the se reco mmendations are the resu lt of very limit ed test ing with hom oge neo us samples, a nd there is no guarantee that information will be pro­cessed similarly acros s culture s. Even if in formation process ing is similar , resea rch using the Cultural Sen sitiv ity Assessment Tool to evalu ate health-related informa­tion regardin g cancer that targets African Americans sugges ts that readability is often reduced for these groups because efforts to use formatting and visual pre senta­tion are cons istent ly underd eveloped (Guidry, Faga n, and Walker, 1998).

COMPREHENSION AND MEMORY

Compreh ension concerns understanding the mean ing of somethin g, in this case, the intended message of the warning. Com prehension may derive from severa l co mpo­nents: subjective under standin g such as its ha zard connotation , under standin g of lan­guage and symbols, and an interplay with the individual's backgro und knowledge . Background knowledge is relatively permanent long-term mem ory structure that people ca rry with them. The sections below contain short reviews of some maj or con­ceptual research areas with respect to warnings and the compre hension stage. Again , much of this informa tion is derived from limited test ing that has not been validated across cultures; therefore, this sect ion might be considered a set of "lessons lea rned " in investigating the use of var ious components of warnin g messages wrillen in Eng lish.

Signal Words

Aspects of a warnin g can convey a level of subjec tive hazard to the recipie nt. T he ANS I (2002) Z535 sta ndard recommends three signal words to denot e decreas­ing levels of haz ard when US Engl ish is th e language of the warnin g: DANG ER, WARNING, or CAUTION (see also FMC Co rpora tion, 1985; Peckham, 2006; Westinghouse Electric Corporation, 198 1). The DANGER panel should be used when serious injury or death will occ ur if the dir ect ive is not followed. A WARNING panel is used when serious injur y or dea th may occ ur if the directive is not followed. The CAUTION pane l is used when less seve re per sonal injuries or property dama ge may occur if the dir ect ive is not followe d. While the standard describes CAUTION and WARNING with differen t definiti ons, num ero us empirica l rese ar ch studie s indica te that people do not readil y d istinguish between the two. The term DEADLY has been shown in severa l resea rch studie s to co nnote significa ntly higher haz ard than DANGER (e.g., see Hell ier and Edworthy, 2006; Wogalter, Ka lsher, Frederick ,

Magu rno, and Brews ter, 1998; Wogalter and Silver, 1990, 1995). Wh ile these general recommendation s made in the ANSI standard (2002) are

of ten used to construct safety messages for warnin g rec ipients within the Un ited

108 Cultura l Ergo nom ics: Theory , Met hod s, an d App licatio ns

Stat es, cro ss-cultural sa fety researc h involving internati onal populations suggests that differ ences in compre hension of signal word and co lor comb inations might exis t (Lesch et a l., 2009) . For instance, Lesch et al. (2009) found that US participants prov ided significantl y higher mea n rat ings of perceived haza rds to signa l words than did the Chine se participants. Int eresting ly, other ev idence suggests that hazard con­notations assigned to colors and signa l words might a lso vary betw ee n English-o nly and Spani sh-speak ing pa rtic ipants ; therefor e, warning des igners wit hin the United State s might a lso exerc ise caution by examining the effects of culture (Wogalter, Frederick , Herrera, and Mag urn o, 1997).

Message Content

The co ntent of the wa rnin g message shou ld include inform at ion abo ut the haz­ard , instructions on how to avoid the ha za rd , and the potential consequences if the haza rd is not avo ided (Woga lter, Godfrey, Fo ntenelle, Desa uln iers, Rothstein , and Laug hery, 1987).

a. Hazard information . At a minimum, the warn ing should identif y the sa fety proble m. Often, however, warn ings might requir e more informati on regard­ing the nat ure of the hazard and the mec hani sms that produc e it.

b. Instructions. Warning s should instruc t peop le about what to do or not do. Th e instruction s should be spec ific inasm uch as reaso nab le to tell what exactly should be done or avoide d. A classic nonexplicit warn ing state ment is "Use with adeq uate ventilation. " Two others are "May be hazardou s to health" or "Ma intain your tire pressure." These statemen ts are inadequate by themselves to appri se peo ple what they shou ld or sho uld not do. In the case of the sta te­ment "inad eq uate ventilati on," does it mean to open a wind ow, two windows, use a fan, or something more tec hnica l in terms of volume of airflow per unit time? In eac h case, witho ut more informat ion, users are left making infer­ences that may be partly or wholly incorrect (La ughe ry and Paige- Smith , 2006; Laug hery, Vaubel, Young, Bre lsford, and Rowe, 1993). C learly, the use of certa in termin ology will be depe ndent on the language of the target audi ­ence. For instance, spea kers of Ame rican or Cana dian English are likely to recogn ize the term truck and make appropr iate inferences, whereas speakers of British E nglish, being more familia r with the term Lorry, may not.

c. Consequences . Con sequences in forma tion co nce rn s what co uld result. It is not a lways neces sa ry to state the conse quences. Howev er, one shou ld be cau tious in omitting it, beca use people may mak e the wro ng inference . A co mm on short comi ng of warnings is that the conseq uences information is not exp licit, that is, it is lack ing imp ort ant specific deta ils (La ughe ry and Paige -Smith, 2006; Laughery et al., 1993). The stateme nt "May be haza rd­ous to yo ur health" in the co ntext of an invis ible rad iation hazard is insuf­ficient by itself as it do es not te ll wha t k ind of hea lth problem cou ld occ ur. The reader could believe it cou ld lead to minor burns not thinkin g that it co uld be somethin g more seve re, li ke cancer and per haps dea th. In a later section, the tellin g of seve re conseq uences is d iscussed as a factor in moti­vating compl iance behavior.

Creati ng Inc

The informal perception ol resea rch has whet her such With this cav assessme nt o: shou ld do to gove rnin g tht clarity . Simpl de livered wit ! rence a nd thE When mes sa~ threat is erect wi ll take som , of the approx they enco unt1 ments such as make human 2006). A lthot been desc ribt shame fu l in tt even thoug h ti socioeconomi disaste r becai trates that ju s1 not be applica

Symbols

Safe ty sy mbo in lieu of or i Goldsworthy , 2004; WoI ff c 1984). Poten ti ers or the prin

Comprehe, that d irect ly r prehended th, 1994; Woga lt1 Less directly and arbitrary mea ning has to using sy mb ies that show One exa mple , describ ed a c, symbol was p,

;\Ai·,."'·!!f,/'4'

- "

lications

suggest s ight exist rticipant s ords than rnrd con­lish-only 1e United Nogalter,

the ha z­:es if the tein , and

safe ty :gard-

). The xact ly "Use

th" or selves sta te­dows, :r unit infor­:mith, 1e use audi­ely to ,akers

ult. It tld be ce. A 1011 IS

y and zard­nsuf -1ccur. hat it lat er

moti-

Creating Inclusive Warnings 109

The information contained in a warning message is also likely to influence puhlic perception of situational risk associated with a particular hazar d. Although much research has been conducted with receivers who spea k English, it remain s unclear

whether such results (as illustrat ed below) can be generalized to other population s. With thi s caveat in mind , warning mes sage content ge ner a lly represents a source's assessment of the existence and seriousn ess of a thre at as well as what the public should do to protect themselves (Lind ell and Perr y, 2004). Stylistic considerations governing the communication of warning content in English include certainty and clarity. Simply worded warning messages under standable to the public should be de livered with a high degree of certainty co ncern ing the likelihood of hazar d occ ur­rence and the nee d to take pre ventati ve action (Pe rry, Lindell, and Greene, 1982). When message content is spec ific, warning recipients are likely to bel ieve that the threat is credible and to personalize the risk that increases the likeliho od that they will take some preve ntative action (Drabek and Stephe nson, 1971). To illu strate, 80 % of the approximately one million res iden ts of New Orleans evac uated sa fely once they encountered dramaticall y worded wa rning messages that used strong state­ment s such as "The area will be uninhabitabl e for weeks" and "Wa ter shortag es will make human sufferin g incredible by modern standard s" (McCa llum and Hemin g, 2006). Although the forecast and warning compo nents of Hurricane Katrina have been described as well const ru cted , the post -Kat rin a re lief and aid effort s were sha meful in that they expose d complex societal issues linked to culture. For instan ce, even though the warnings were exce llent , African Americans and tho se with a lower soc ioeconomi c stat us were later identifi ed as being particu larly vulnerable to thi s disaster because they lacked the resou rces to evac uate . This insta nce clearly illus­trat es that ju st bec ause a warning may work for one culture or income group . it may not be app licable to others .

Symbols Safety symbol s may also be use d to comm unicat e the above-mentioned information in lieu of or in conjunct ion with text statements (e.g., Dewar, 1999; Mayhorn and Gold sworthy, 200 7; Mayhorn and Go ldsworthy, 2009 ; Mayhorn, Woga lter, and Bel l, 2004; Wolff and Wogalter , 1998; Young and Woga lter , 1990; Zwag a and Easterby, 1984). Potential ly, they can co ntribut e to under standin g when illit era tes or nonread­ers or the pr imary lang uage are part of the tar ge t audience.

Comprehension is important for effect ive sa fety symbo ls (Dewa r, 1999). Symbo ls that dir ec tly repr ese nt concepts are preferred because they are usuall y better com ­prehended than more abstract symbo ls (Mag urn o, Wogalter, Kohake , and Wolff, 1994; Wogalter, Si lver, L eon ard , and Zaikina, 2006; Wolff and Woga lter, 1993). Less direct ly rep rese nted co ncep ts cannot always be devel oped , but with abstract and arbitrary symbo ls (Le sch, 2004; Wogalter, Sojourner , and Brelsford, 1997), the meanin g ha s to be learn ed via trainin g. Despite the se appare nt potentia l bene fits to using symb ols to co nvey hazard information , there ha ve been a numb er of stud­ies that show cultural differences in how people interpre t the meanin g of sy mbols. One examp le of such cultural differences wa s doc umented by Casey (1993 > whe n he describ ed a case report of Kurd v illagers in nonh ern Iraq . A skull and ..::rossbones symbo l wa s prom inent ly d isplayed on contai ners or g rain inte nded on l;- for plan ti ng

110 Cultural Ergonomics: Theory, Method s, and Applications

but not eating. De spiLe see ing the sym bol , so me Kurd villa gers consumed the grain and beca me ser iously ill because they thought that the picture of the skull and cross­

bone s was ju st a logo of some com pan y. Int erestin g ly, cultural differences in sym bol comprehension have been well do cu­

mented by other resea rcher s as well. When ANSI symbol s were tes ted for compre­hension in Ghana, seve re interpretati on di screpancies were noted for a numb er of sy mb ols and their intended mea nings (Smith -Jack son and Essuman-Johnson, 2002). Other resear ch found that drivers from Canada , Israel, Finland , and Poland displ ayed larg e compr ehension differences wit h traffic sign s (Shinar, De wa r, Summala, and 2akow ska, 2003). As already mentioned, Chinese and US participants va ried in their interp ret ation of perc eived hazards in a variety of warning component con figu­rations. Likewi se, resident s of Hong Kong had difficulty interpreting the mea ning of some safety sign s used in mainland China (Chan and Ng, 2010). Thus, sym bols should be tes ted for comprehen sion within the intended tar ge t audience (even when the per ce ived subculture s are geogra phically proxima l to one another) prior to

deplo yment in a public warnin g system. Given these app arent cultural diff erences, it is important to assess sa fety symbol

co mpreh ension. What is an acce ptable leve l of co mpr ehen sion for safe ly sym bol s? Symbols should be des igned to have the high est level of compreh ension attainable ; however, a quantitative metric would be useful to guide those taske d with develop­ing such wa rnin g sy mbol s. ISO 9 186 (2001) prov ides comprehension crit eria (see Deppa, 2006; Peckham, 2006 ) and specifie s that testing shou ld be cond ucted in at leas t thr ee countri es that vary by cu lture. Within the United Sta tes, the ANSI (2002) 2535 standard sugges ts a goa l of at least 85% comprehens ion using a sample of 50 individu als representative from the target audience for a symbol to be used without acco mp anyin g text. If 85% ca nnot be achieved, the symbo l ma y sti ll have utility (e.g., for atte ntion captu re) as long as is not badly misinterpreted. According to the ANS I (2002) 25 35 sLandard, an accepta ble symb ol within the United State s mu st prod uce less than 5% criti ca l confu sions (oppos ite meaning or a mea nin g that would produ ce unsafe behav ior). For instan ce, the pharmaceuti ca l wa rnin g (see Figure 5.2)

Do Not

Get Pregnant

FIGURE 5.2 Accutane wa rnin g.

Creating Inc

used on Acc 1

during pregr Pr eg nan t" in pregnanl ferr Goldsworthy

Level of Knc Th e leve ls o take n into cc by cultur e ar,

In ge nera Lion in the l skill level ol should be re<

syste m. Unfc For example, tio nall y illiLe ra tes can be success ful w levels to a rr

progra ms m, benefit 1 item a population cultura lly di 1 of culLure re, small regio n: Hofslede Va l Brazi l, co uld tinct difforen T hus, these , 10 cross c ult1 was assessed wa rm ngs rec sion through

BELIEFS AND

Bel iefs and " cultural dive cess ing. As 1

collec tive be individ ual's I ally be true). ory srructun Specifica lly, of r isk (Ka si:

and Applications

::msumed the grain he skull and cross-

ve been well doc u­tes ted for compre ­d for a numb er of rn-Joh nson, 2002). j Poland displayed ar, Summala, and icipants varied in >mponent configu­~ting the meanin g 0). Thus , symbols iience (even when another) prior to

ess safety symbol ,r safety sy mbol s? ension attainable; ked with develop-1sion cr iteria (see ,e co nducted in at , the ANSI (2002) 1g a sample of 50 ) be used without · sti fl have utility According to the nited States mu st !anin g that would g (see Figure 5.2)

Creating Inclusi ve Warnings 111

used on Accutane rega rdin g the potential for birth defec ts if the substance is taken during pregnancy migh t be wrongly interpreted such that the text ··o o Not Get Pr eg nant " in com binati on with the sy mbol (circle/s lash im age supe rim posed over a pregnant female bod y) means that the substance is for birth co ntrol (May horn and Goldsworthy, 2007; 2009).

Level of Knowledge The levels of knowledge and under sta ndin g of the wa rnin g rec ipients should be taken into cons ideration. Three cognitive characteristics of receivers that may vary by culture are import a nt: language skill , readin g ability, and technical knowledge.

In general, readin g levels should be as low as feasible. Fo r the genera l popula­tion in the United Sta tes, the readi ng level probably shou ld be approximately the sk ill level of grad es 4 to 6 (expecte d ability of 10- to 12-year-old read ers), yet it shou ld be reco gn ize d that other nation s and cultures may utili ze a di fferent school sys tem. Unfortunately, fun ctional illit eracy pervad es soc iety on a worldwid e scale. For exa mple, in the United States, there are est imate s of more than 16 million fun c­tionally illit erate adults. In other are as of the world such as Gh ana, national lite racy rates can be as low as 41% in rural areas (Ghan a Statistical Service, 2000 ). If so. success ful wa rnin g com muni catio n may require more than simpl y keepi ng rea din g levels to a minimum. The use of symbo ls, speec h warn ings, and spec ial traini ng programs may be benefic ial adju ncts. M oreove r, these po tential methods may also benefit literate persons. A related co nsidera tion is that diffe rent subgroups within a population may speak and read different languages, or in other words, they are cu ltur ally different from the majorit y in a reg ion or nation. Interes ting ly, measur e of cultur e revea l remarkab le d iversity between geog raphic loca tion s w ithin relative!~ small reg ions (Hofstede, de Hila!, Malve zzi, Tanure , and Yinkin , 2010). Using the Hofstede Value s Sur vey Module , these rese archers found that one nation, in thi s case Braz il , co uld be decomposed into as man y as five cullu ral regions that illustra ted di -­tinct di fferences due to the presence of Afro-Braz ilian and indige nous Indian ro ots. Thus , these results suggest that an effect ive warnin g within a co untr y must be able to cross cultural and lan guage barriers. One such att empt within the United States was assessed by Lim and Wogalter (2003) , who co ncluded that culturall y inclusi\e warn ings requir e the use of multiple lan guage s, comb ined grap hic s, and tra nsm is­sion throu gh mul tiple method s to reac h various subp opu lations that rece ive it.

BELIEFS AND ATTITUDES

Beliefs and attitude s is the next major stage of the C-HIP mode l, and it is here th...i! cultural di versity plays an espec iall y significant ro le in hum an inform ation pro ­cess ing. As the cla ss ic work of Dou glas and Wildav sky ( 1982) sugge sts, ri sk i:. ~ collect ive belief that is subject to cultur al and soc ial co ntexts. Beliefs refer i. ..1 :.,.r. indi vidual's knowled ge that is accept ed as true (although some of it may not a~iu­

ally be true). It is related to the pre vious stage in that belief s are formed from mem­ory stru ctu re deriv ed from socia l interaction s wit h those who share their cultu re . Specifi ca lly, interpersonal interac tions in a soc ial co ntext ca n influence percep i1. :1

of risk (Ka sperso n et a l., 1988; M asuda a nd Ga rvin , 2006) . In som e respects . beh:f:.

112 Cultural Ergonomics: Theory, Methods, and Applications

tend be more global and overarching co mp ared to specific memories. An attitude is simil ar to a belief except it includ es more affect or emoti onal involv eme nt. Past research suggests that risk att itudes vary acro ss culture (Smith-Ja ckso n, 2006b). Fo r instance , culLUre-spec ific fa tali sm, defined as the belief that safety outcomes are pre dete rmined and externall y controlled by others, was a powerful dete rminant o f safety -re lated be hav ior in the Ivory Coast, West Afr ica (Ko uab ena n, 1998). More rece ntly, Latino farmworkers reporled higher ri sk perception assoc iated w ith the use of pest icides and lower perceived control of their work environments than Americans of E urop ea n de sce nt (Sm ith-Jac kso n, Wogalter, and Quintela, 2010) .

People' s benign exper iences with a potentiall y ha za rdo us prod uct can produce belie fs that a product is sa fer than it is. This qui ck ly changes after being involved in some way with (or seeing) a seriou s injur y eve nt. According to the C-HIP model , a warning will be success full y processed at the beliefs and att itude s stage if the mes sage concurs (or at least is not discrepant) with the receiver's current beliefs and attitudes. However, if the warnin g information does not concur, then beliefs and att itudes may nee d to be altered so that they conc ur before a person can have som e moti vation to carr y out the warning's direct ed behavior. The message and/ or ot her inform ation nee ds to be per suas ive to ove rride ex istin g incorrect belief s and attitudes. Methods of persuasion are com mon ly used in advertising and have been empirically explored in the soc ial and cognitive psycholo gy litera tur es.

Per haps one of the largest areas of resear ch involve s tai loring wa rnin g messages to meet the needs and capab iliti es of a spec ific targe t audi ence (Woga lter and Mayhorn , 2005) . Efforts to engage in this use of pers uasive messagi ng can be observed in the area of hea lth-r e lated com muni cat ion. For instance, Usk ul and Oyster man (2010) suggest that message frames or wordin g sho uld be culturall y sa lien t and momentarily sa lien t in co nvin ci ng peop le to comply with per suasive sa fety messages. In th is work, hea lth co mmuni ca tions we re tai lored to meet the cultu ra l aspect s of the audience members (i.e., Americans of Eu ropea n or As ian descent) to crea te se lf-re levance, termed cultural salience, whereas del ivery of the matched messages followin g pre ­sen tation of cullurall y releva nt them es made the me ssages situationally relevant or "momentar ily sa lient." To create these me ssage characterist ics, thi s resea rch relied hea vily on the cultural di stinc tion that suggests that western cultur es tend to po ssess an ind ividuali stic or ien tation that focu ses on ind ividu al ach ieveme nts and ind epen­dent decision makin g, whereas easte rn cu ltur es tend to be collectivist cu ltures that va lue gro up relatio nships (Ha n and Shavi tt , 1994; Triandis, 1995). Cons istent with thi s co ncep t, Usku l and Oyste rman (2010) fo und lhat E uropea n Amer ica ns found indi vid ualistic message frame s more persua sive than co llect ivist message fram es, yet the oppos ite trend was tru e for Asian Americans. Furlh er ev idence sugges ts me s­sage tailor ing can be used to a lter antitobacco ad vert ising in terms of theme and language to specifically targe t bicultural Mexi ca n Am erican youth, thereby resultin g in changes to tobacco-r elated attitude s that were fou nd to be moderator s for a behav­ioral decrease in smok ing (Ke lly, Co rnelio, Stan ley, and Gon za lez, 20 10).

Two releva nt and inter related factor s assoc iated wit h the beliefs and attitu des stage are hazard perception and relevan ce (see DeJoy , 1999; R iley, 2006; Vredenburg h and Zackow itz, 2006). In vest igat ions of haza rd pe rcep tion suggests that the greater the perceiv ed haza rd , the more responsive people will be lo warn ings, as in loo kin g

Creating

for, readi, likely lo I, low in ha . used duri , that pract man y of tl hazardo u5 delayed fc This is im abo ut inju to act caul Brelsford , likelihood mund ane , Wogalter,

In sud ing recipi, warnin g c instea d at exa mple, pattern ba co me into aspec t yet Go ldswo r because n from com warnrn g s it is relev, make hea l levels of r stimu1atin preve ntior

MOTIVATI•

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:titude s stage lenburgh and

e greater the s in looking

Creati ng Inclusive Warnings 113

for, reading , and complying with them. The con verse is also true. Peop le are less likely to look for, read , or comp ly with a warn ing for produ cts chac chey believe are low in hazard. For instance, poisonous substa nces such as mercury are frequently used dur ing cultural and religious practices by Latino and Ca ribb ean comm unitie s that practice Santeria (Riley, Newby, and Leal-Almera z, 2006). Not surpri singly, man y of the se re ligio us users and practitioner s did not perce ive the mate rial as being hazardous. Because the hea lth-re lated consequences of mer cury expo sure are of ten delayed following expos ure, many people may not tie the hazard to the co nseq uence. This is important becau se the leve l of perceived hazard is also close ly tied to beliefs abo ut injur y seve rity. People that perce ive a product to be ha zard ous arc more likely to act ca utiously when they under sta nd that injuries can be severe (Wogalter , Youn g, Brelsford, and Barlow, 1999) . In co ntra st to these environmental haza rds, injury likelihood is a much less important factor in perce ptions of ri sk or ha zard for more mundane consume r products (Wogalter, Brel sford , Desaulni ers, and Laug hery, 1991; Wogalter, Brem s, and Martin, 1993).

In such cases where perceived risk is low, it is espec ially important that warn ­ing rec ipients perceive that a safety mes sage is being directed to them and that the warning content is applicable to them. ff perc e ived as irrelevant , the individual may instead attribute the warni ng as being dire cted to others and not per so nally. For examp le, men may utiliz e pharma ce utical subst ance s such as Pro pecia (for male pattern baldne ss) that might cause birth defect s if pregnant fema le family members come into contact with this med icat ion . Ideally, men should be made aware of this aspect yet they might not believe pregnancy warnings apply to them (Mayhorn and Goldsworthy , 2007 , 2009) . In thi s particular case, there is a failure of comprehens ion becau se men may not understand their role in prevent ing fe mal e family member s from coming in contact with the dru g. One way to co unter this is to personalize the warning so that it get s directed to relevant use rs and co nveys fact s that indicat e that it is re levant (Wogalter, Racic ot, Kal sher , and Simpson, 1994). Similarly, efforts to make health-related information culturally specific via tailoring (based on individual leve ls of religiosity, collectiv ism, rac ial pride, and time orientation) ha s resulted in stimulating information process ing for African -Americ an women exposed to cancer prevention and screen ing informat ion (K reuter and Haughton, 2006).

MOTIVATION

Motivation ene rg izes the indi v idua l to carry out an act ivity. Some of the main factor s that can influence the motivation stage of the C-HIP model are cost or compliance, seve rity of injury, and soc ial influ ence. These topics are discussed below.

Compliance generally requir es that pe ople take so me action, and usually there are costs associated with doing so. When faced with a wa rn ing, people frequ ent ly co nsider what comp liance wi ll cost them in terms o r reso urc es such as mon ey, time , and effort (Ka lsher and Williams, 2006). When describing their fai lure to evac ­ua te from Hurricane Charley in 2004, many elderly Americans stated that they had nowhere to evacuate to (soc ial cost), and they lived on a fixed income and lacked the finan cial resources (e.g., car, money) to evacuate (Mayho rn and Wat son, 2006). Likewise , many people often c ite their fear of looters as a reason to ignore

114 Cultural Ergonomics: Theor y, Meth ods, and Appli cati ons

evac uati on orders (May horn and Watson , 2006; Mc Ca llum and Hemin g, 2006). Prac tical in terventions that might be used to rec tify these co ncerns by al leviati ng fear s mi ght inclu de ass uran ces of sec uri ty from auth ority figures as we ll as height­ened awa reness of free shelter s.

T he cos ts of noncomplianc e can also exert a power fu l influenc e on co mplian ce

motivation. Wi th respec t to warnin gs, a main cost for noncomp liance is seve re injur y con sequences. Previou s resea rch suggests that people report higher willin gness to comply with warning s when they believe there is high probability for incurrin g a severe injury (e.g., Woga lter e t al., 1991, 1993, 1999) . In fact, cultu ra l diff ere nces in mot ivatio n and co mpliance lesse n if people are co nvince d that a warning is acc urate and risk is high (Perry and Linde ll , 199 1). When archi val data for three ethni cities (i.e., Caucas ian s, Afri ca n American s, and Mexi ca n American s) were eva luated for evacuation compliance follo w ing a haza rdous chemica l spill , ethnicity was not a predictor of mo tivation to engage in protective act ion behavior.

Anoth er motivato r is soc ial influ ence (Woga lter, A lli son , and McKenna, 1989; Edw orth y and Dale , 2000) . For insta nce, see ing others not co mply lesse ns the like­lih ood of co mpli ance. However, when peop le see ot hers co mply wit h a warn ing,

they are more likely to co mply the mselves (Cox a nd Woga ller, 2006) . Often , gro up com pliance might be con sidered an esse ntia l com ponent or hea lthca re interven­tions. Pr ev ious resear ch al so sugges ts that the developme nt of cu lturall y targe ted smoki ng cessatio n pro gram s is mor e effec tive than traditional 12-step smoking ces­sa tion program s w ith Af rican-A meri ca n smokers (Matt hews, Sa nchez-Jo hnso n, a nd King , 2009).

BEHAVIOR

The las t stage of the sequential proc ess is for indi viduals to ca rry out the instruc ­tions for warnin g-dir ec ted safe behavior (Ka lsher and Willi ams, 2006 ; Silver and Bra un , 1999) . Warnin gs do not alway s affec l behavior beca use of processi ng fail­ures at ea rlier stages . Most resea rch in thi s area focuses on the factors that a ffec t co mplian ce likelih ood.

So me rese archers have used " int entions to co mply" as the meth od or meas ure­

ment as a proxy to behaviora l measure ment becaus e it is usually quite difficult to co nduct behavi oral tests. Th e reaso ns includ e the follow ing difficu lties: (a) rese arch­ers ca nnot expose participant s to rea l risks beca use of et hical and safe ty co ncerns; (b) events that cou ld lea d to injur y are relat ively rar e; (c) the co nstruction scenario must appear to have a believable risk, ye t at the same tim e must be safe; and (d) co ndu cti ng behaviora l compli ance rese arch is cost ly in term s of tim e and effo rt. Neve rtheless, actual com pliance is an imp orta nt cri terion for determ inin g which factors work bet­ter than o thers to boost warnin g effect iveness and, co nsequently, safe ty behavior. Additionally , many product s are used inside homes where access to determine how the product was used and whet her a wa rnin g was comp lied with is difficu lt. In the

futur e, it is lik ely that virtu al rea lity will play a role in a llow ing resea rch to be co ndu cted in simulat ed co nditions Lhat avo id so me of Lhe above prob lems (D uarte ,

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Creating Inclu sive Warnings 115

Rebelo, and Wo ga lter, 20 10). Unfortunately, these tools are not in widespread use and may not ye t be avai lable to man y other resea rchers interested in cultural ergo nomics.

Below, the following sec tion on terat oge nic warnings se rve s as a case study to

illustrate the curr ent , co mm only avai lable meth odol ogy and anal ysis tech niqu es that ca n be use d to assess the affect s of culture on warning expos ure. Consistent with the definition of cultur e used by Go ldberger and Vero ff (1995), young adult women co nstitut e a cu ltur e in the sense that they shar e demograp hic/physica l charac teri stics that separa te them from mal es and they posse ss a sys tem or attitudes rega rdin g their own reproductive hea lth that might imp ac t how they perce ive risks posed by phar­mace utical product s.

REFINING TERATOGEN WARNING SYMBOLS: A CASE STUDY IN INCLUSIVE WARNING DESIGN AND EVALUATION METHODOLOGY

M edica tion s such as Acc utane, Pro pec ia , and Thalid omide are used to trea t a var iety of clinical cond itions such as acne, male pattern baldn ess, and cance r yet they shar e tera toge nic pro perties that are known to ca use seve re birth defect s. These propert ies are so tox ic that eve n brier expos ure to these med ica tions duri ng preg nancy or prior to co ncep tion ca n ca use sign ificant harm to the fetu s (Mea dows, 200 1; Per lman , Leach , Domin guez, Rusz kowski , and Rudy, 200 1). One approac h to miti ga ting thi s increased ri sk of acc identa l expos ure to teratoge nic substances is to improv e wa rn ­ings that ap pear on phar mace utical label s.

Unfortunate ly, prev ious research conduc ted at the Cente rs for D isease Co ntrol a nd Prevention (CDC) suooests that the teratooe n wa rnino that appeared on Accu tane 00 ' 0 0

(up until it was recal led from U.S . market s in 2009) may be con fu sing to those who enco unter it (Da nie l, Go ldm an, Lac henm ayr, Er ickso n, a nd M oore, 2001). Illu strated in Figure 5.2 , the warnin g co nsists o f a sy mbol showi ng a c ircle an d a slash mark superimpo sed over a graphi c repr ese ntati on of a preg nant woman with the accom­panying text "Do Not Gel Pregnant. " Res ults reported by Daniel and her co lleag ues indi cated that only 2 1 percent of the women exposed to the curr ent warning were ab le to correct ly interp ret it. Moreover , 27 perce nt of those tes ted mi sinterpr eted the wa rnin g to mean that the medica tion was a form of birth con trol.

As addr essed above, a well-esta blished benefit assoc iated with the use of symb ols is that peop le who ca nno t und ers tand printed text wa rnin gs mi ght be ab le to take advantage of pictor ial safe ty in form ation. Given the increasi ng cultural diversity of the U.S . pop ulation , the use of pictorial safety symbo ls has the pote ntial to be "culturall y neutr a l" (Edwo rthy and Adams , 1996). Unfortunat e ly, ass um ptions of cultural neutra lity ca nnot be relied upon unless ver ified by empirical investigation.

G iven the sho rtco min gs of the warn ing, effort s to improve patient co mpr ehen­sion th ro ugh iterative des ig n were implemented. Using such a techniqu e, prototyp e

warni ngs should be developed and tested for co mpr ehension with a sample of the at-risk population. Warnin gs that do not mee t acceptab le levels of compr ehension should be redes igned based on fee dback fro m ea rlier test participant s and retested for comp rehen sion in an iterative proc ess (desig n, tes t, redes ign, tes t, etc.) unti l a

116 Cultural Ergono mics: Th eo ry, Methods, a nd Applications

sa tisfact ory b ·el of co mpr ehen sion is reac hed. To demonstrate and carry out the proce ss . Goldsworth y and Kaplan (2006 a) describe d a process whe re rapid proto­typing, expe rt rev iew, and user-ce ntered design tec hniqu es were utili zed to develop alterna te teratogen warnin gs. Later, a field tr ia l so licited ope n-ended in terpretation of six ca ndid ate sy mbols from 300 parti c ipa nts (Goldsworthy and Kaplan, 2006b) . These in itia l finding s were promis ing beca use they revealed that participants' abili­ties to correctly interp ret the meanin gs of severa l of the alternate warnin gs exceede d that of the exis ting warning , with several can did ates eme rgi ng as v iable a lternat ives Lo the ex isting warn ing. The ca ndi dates were furth er refined base d on the results and a secon d, larger-sca le field stud y (N = 700) was cond ucted to furth er valida te these alternative warnin gs (Mayhorn and Gold swo rthy , 2007). Results indi ca ted that two of the alternate symbols exceeded 85% compr ehen sion, and none exceeded 5% cr iti­ca l confusion. Al so, the sa me two a lternate sy mbols consistently elic ited acc urate respo nding in terms of message interpr etat ion, ta rget aud ience, intended ac tion, and perceived co nsequ ences of ignorin g the warning.

While the se findings are useful in illustrati ng how warnin gs and other risk co m­munication s might be designed and eva luated , a related top ic include s efforts to tar­ge t a spec ific audience for com muni ca tions purposes. To this end, audien ce analysis is a recog nized tec hniqu e that has been used for identif ying the appropriate peop le and subgroups within a population that receive a warnin g (Sm ith-Jackso n, 2006b). The sect ion below offe rs an illu stratio n of ana ly tica l too ls that can be used to acco m­plish this task.

AUDIENCE ANALYSIS USING LATENT CLASS ANALYSIS

It is we ll known that audiences var y by a wide range of charac ter istics-so me obvi ­ous, ot hers not. It has becom e increasin gly com mon to exa min e message interpre ta­tion not only by whether audi ences get it right , but by who is gett ing it more or Jess right. For instance, risk percept ions associated wit h pesticide wa rnin g labels was found to diff er between two ethni cit ies of farmwork ers. The likelihood of wa rnin g complianc e was fou nd to be higher fo r European-A merica n farm workers tha n for Latino farmworker s (Smith -Jackso n, Wogalter , and Quint ela, 20 10). Simi larly, in a study that exa mined severa l poss ible birt h defects warn ing labels among a diverse gro up of wo men of chi ldbearing age, both accuracy of warni ng interpretation and wa rnin g pre ference varied significa ntly by participant characteris tics (Go ldsworthy and Kaplan, 200 6a; Mayhorn and Go ldsworthy, 2007). Th ese ana lyses typically exa min e commo n audience charac teristics, such as age, gender, race and/or e thni c­ity by using simpli stic sta tist ica l ana lytica l tool s such as Chi -sq uare or Fisher's Exact Test to determi ne wheth er "correc tness" or rate s of particular responses vary by those demographic characterist ics.

Such analytica l approache s are usefu l in providing more inform at ion than sim­ple de scrip tive statistics regard ing perce ntages of correc tnes s or types of responses across a sample. Howev er, other statistica l too ls can provide a riche r pictur e of aud i­ence segme ntation, especia lly, but not only, when the hazardous situation invo lves multipl e informa tional or beh aviora l co mpon ents, when a sizab le numb er of beliefs might be impli ca ted in engage ment (or disen gageme nt) in a part icu lar haza rdous

Creati ng Ir

act ion, or v vious resea (2003) foun and Englisl is not a lwa: ulation, ont receive r ch ana lysis (LI

LCA is I latent cla ss and general these analy! subpopu lati i ngly, thi s fr as part of ti de nts into h est. Thus, b precise desc

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1d Applications

d carry out the ere rapid prot o-1 i zed to develop d interpre tati on Kaplan, 2006b). ~ticipa nts' abili­·ning s excee ded 1ble alt ernatives 1 the results and :r validat e these 1ica ted that two :eeded 5% crili ­:J ic ited acc urat e 1ded action, and

other risk com­es effort s to tar-1d ience analys is >ropriate peopl e ctckson, 2006b) . used to acco m-

cs-so me obvi­sage interp reta­~ it more or less 1ing labels was ood of wa rnin g 10rkers than for . Simil arly, in a mong a diver se erpretati on and s (Goldsworthy :1.lyses typically ~ and/or et hni c­,r Fis her's Exact ponses vary by

at ion than sim­es of responses picture of audi­uation involves .mber of beliefs ular hazardous

Creating Inclusi ve Warnings 117

ac tion, or when a comp lex se t or dem ograp hic character istics is sugge sted by pre­viou s resea rch or previous researc her expe rience. For insta nce, Lim and Wogalter (200 3) found that the perception s of lengt hiness and print size varied when Spa nish and English speakers assessed multilingual warni ngs . With the reali zation that it is not a lways poss ible to ge nerate diff erent warnin gs for a ll subgro ups of the pop­ulation, one meth odologica l approac h that may be useful in ide ntify ing perti nent receive r charac ter istics for those interested in cultu ra l ergonomics is latent cla ss ana lys is (LCA).

LCA is part of a broad class of analyses that also includes late nt profi le analysis , laten t c lass grow th anal ys is, late nt transition analysis , grow th mi xture mode ling, and genera l growth mi xture modelin g (Mut hen, 200 1). Th e co mm on denomin ator in these analyses is that respo ndents are ass umed to come from di fforent populati ons or subpopu lations rather than from a single uniform pop ulati on of respo nde nts; accord­ingly, this fam ily of analy ses atte mpt s lo estimate and accou nt for gro up membership as part of the analytic process. In prac tice, LCA is a method of gro uping respon­dent s into homogeneous subgro ups based on their responses to a mea sure of inter ­es t. Thus, behavior and atti tudes rather demo graphic var iab les might offe r a more prec ise desc ripti on of cu ltur e and it pertain s to sa fety-related contex ts.

Rese arch by Go ldsworthy, Mayhorn, and Meade (20 10) exa min ed the presc rip­tion medication loaning and borrow ing behavior or 700 parti cipant s for 13 hypothet ­ica l sce nari os. Examinati on of item endor seme nt probabilities and odds-ra tios for a ll items included in the LCA revealed four d istinct clas ses of medication loa ners/ borrowers. C lass I memb ers had ex tremely low probab ilities of eve r having loa ned or borrowed medicin e and were very unli kely to share or borrow medicine und er any hypo thet ical c ircumstance. For thi s rea son, thi s cla ss was labe led "Abstainers. "

C lass 2 respon de nts were very li kely to have loa ned or borrowed pre sc ripti on medicines in the past. All C lass 2 member s ind icated that they would sha re a medi ­c ine if they rece ived it fro m a fami ly member. Members or this class were also highly likely to share when they had the same problem as the person with the medicine or already had a pre scription but ra n out or did not have it with them. They would al so be likely to share or borr ow if' they had an eme rgency, cou ld not affo rd to buy the medicine, or wanted to help a friend. Converse ly, respo ndents in thi s c lass were far less likely to share or borrow med icine when they wanted Lo rela x or reel good, had hea rd a lot about the med ic ine from com mercials, or wanted somethin g to help them sleep. They were eve nly split on whether they would share or borrow medici ne for pa in . Because med icatio n history indi ca ted a high probability of hav ing prev iously loa ned or borrowed medi c ine and the pattern or endor sement ind ica ted that sharing likely occ urr ed (or wou ld occ ur) for prag matic, situat ion -spec ific reaso ns, this gro up was labeled "Pragmatic Freq uent Sharers."

Cla ss 3 respo ndents were even ly sp lit in their probability of hav ing loane d or borrowed medicine during the pas t. However the probab ilit ies o r endor sing hypo­thetical situatio ns under wh ich they would share or borrow were very high. Thal is, while C lass 3 respo ndents were so mewhat less Ii kely than C lass 2 respo ndents to indi ca te prev ious loa ning or borrowing, they were more likely than members of a ll ot her clas ses to say that they would share in eac h situation (with the excep tion of "go t it from a fami ly member" ). C lass 3 respondent s were not only likely to endor se

118 Cultural Ergonomics: Theory, Methods, and Applications

pragmatic reasons for loa ning/borrowi ng, but they were also likely to endorse shar­ing situations that have little to do with access: they would borrow medicine to relax or foci good, help them sleep, or for pain. The probability of endors ing these items was much higher for Class 3 than for any other class. Member s of Class 3 were also far more likely than members of other classes to indicate they would share or borrow a prescription medication that they had hea rd about from advertisements. Given the somew hat lower frequency of actua l repo rted loaning/borrowing but the high prob ­ability of loaning or borrowing in the futur e in bot h prag matic and outcome-based situatio ns, this gro up was labeled "At-Ri sk Sharers." The At-Risk Sharers were sig­nificantly more likely tha n the other three classes to report making less than $25,000/ year, despite showing no differences in emp loymen t statu s. The At-Risk Shar ers also had a high er percentage ofrespon dent s, indi cati ng that they were Hispanic and spoke Spanish as their primary language.

Finally, Class 4 respondents were unlik ely to have loaned or borrowed medi­cine in the past and were genera lly unlikely to shar e or borrow in the future. The low probability of having previo usly loaned clearly differentiates this class from Class 2, as do the genera lly lower probabilities of future shar ing associa ted with the hypot hetica l sce nario s. However, unlike Class I Abstainers, this group would be somewhat likely to share under some circumstances (e.g., eme rgencies). Cla ss 4 was labeled "Emerge ncy Sharer s."

T he ident ifica tion of latent cla sses ba sed on be hav iors of interest to warnings resea rchers facilitate s tailoring warn ing messages to spec ific group s that can impr ove the cultura l se nsitivity or warn ings as described above. Such targetin g cou ld increase the effec tiveness of the se warn ings ther eby promoting safe ty beh av­ior for a ll seg ments of the popu lation. For examp le, in thi s study, four type s of medicati on sharers were identified based on pattern s of endorsemen t: Abstai ners, Pragmatic Frequent Sharers, At-Risk Sharers, and Emerge ncy Sharers. Becau se each of the se groups demon strate s different med ica tion loan ing and borrowing behavior s, they are likely to respond in diff erent ways to message s abo ut medica­tion sharin g.

Efforts to tailor safety-re lated message s for At-Risk Sha rers might include the followin g examples. Becau se At-R isk Sharers are less lik ely to have previously shar ed but are more like ly to do so in a wider variety of circumstances than all othe r groups, they shou ld be made aware of the wide range of issues associated wi th spec ific types of sharing. Intere stin gly, the result s al so confirmed prev ious finding s that low- income and Hispanic individuals may be disproportionately at risk for engaging in ri sky shar ing behavior s than are othe r indi vidua ls. Given the high repr esen tation of low-income and Hispanic individual s in the At-Risk cla ss and the finding that At-Ri sk Shar ers are more likely to share when havin g heard about a medicine in advert iseme nts, it seems important lo note that drug adve r­tis ement di sclaimer s abou t ri sks and side effects are usuall y presented verbally in En glish , w ithout v isua l accompaniment. It is reasonable to pre sume that such ver­bal messages are not d isce rn ed, much less understood , by non-Englis h speakers. Chang ing these messa ges to more clearly co mmunic ate the potent ial side effects may be an importa nt step toward mitigating ri sk broadly as well as spec ifica lly withi n these gro ups.

Creat ing Inell

CONCLUSI<

The preceding model (Woga l related in form proces sing or, pieced for com proce ssing at~ ear lier stages. · with safety-re l valuable in de :

In this cha1 tha t ex ist in o examples fron how comm un provid e conte : des ign and ev:

IDENTI FYING 1

Before a warr tion, effort s at pas t behav ior der, soc ioeco , research mett Lea l-Almera; ca n be used t< tion and attiti.: vulnerable to archival anal: It make s sens 10 taking the exist (and res related problt by commo n a of descriptiv1 Mayhorn, an of such info, neede d. Mor access to or 1

USIN G PARTI

PARTICIPANT5

Because cull variable s rel,

---~--.-...~ ~ . ~~· ·--""-·~· - .

d App li cat ions

o endorse shar ­:!dici ne to relax i ng the se iLems ass 3 were also ;hare or borrow ents. Given the the high prob­

outcome-based iarers were sig­s than $25,000/ ,t-R isk Sharers e Hispanic and

orrowed medi­the futur e. The this cla ss from 1ciated with the roup would be :s). C lass 4 was

:st to warn ings ·oups that can Such Large ti ng g safe ty behav­, four types of nt: Ab sta iner s, arers. Because :ind borrowin g about medica-

ght include the ave prev ious ly ta nces than all :ues associated rm ed previous portionately at Ja!s. Given the : At-Risk class 1 havin g heard iat dru g adver­ted verba lly in ! that such ver­gl ish speaker s . ial side effects as specifically

Creating Inclusive Warnings 119

CONCLUSIONS AND RECOMMENDATIONS

The preceding review of the warnings literature was organized around the C-HIP model (Wogalter, 2006) and demonslraLed how cu ltura l factors can impact safety­related information transmitted via risk communications. This model divides the processing of warning information into separate stage s that must be succes sfully com­pleled for comp liance behavior to occur. A bottlene ck at any given stage ca n hinder process ing at subsequent stages. Feedback from later stage s ca n affect proc ess ing at earlier stages. Mor eove r, culture can influenc e information processing and interaction w ith safe ty-related information al any of the stages described in C-HIP. The model is valuable in desc ribin g some the proces ses and orga nizing a large amount of resea rch .

In thi s chapter, the C-HIP model was used to demonstrate the rather siza ble gap s that exisL in our knowled ge of warning diverse population s. While a number of Lhe examp les from Lhe !iterati ve review did not measure culture per se, they did illuslrate how communicating with diver se populat ions can be cha llenging. Using C-HIP to provide context, a numb er of genera l reco mm endati ons can be made to inform the design and evaluation of cu ltura lly inclusive warnings.

IDENTIFYING THE TARGET AUDIENCE

Before a warning ca n be effecti vely tar ge ted to a particu lar segment of the popula­tion , efforts at audience analysis should be conducted to gather inform ation regard ing past beh avior as well as the man y dimensions of cu lture, including ethnicity, ge n­der, soc ioeconom ic status, age, and literacy (Sm ith-Jackson, 2006b). Ethnographic research method s such as interview s and participant observation (R iley, Newby, and Leal-A lmeraz, 2006) or focus gro ups (Mayhorn, Nichols, Roger s, and Fisk, 2004) can be used to gain insight into exis ting audien ce characteri stics such as risk percep­Lion and attit udes regard ing particular hazar ds. To verify that the targeted gro ups are vu lnerable to injury , so me recent effo rts have used focus gro ups in combination with archiva l ana lysis of nat iona l injur y databa ses (McLaugh lin and Mayhorn, in press). It make s se nse to under stand whether a hazardous situation ex ists or is probable prior to taki ng the time and effort Lo ge nerate a warn ing . If such injury databases already ex ist (and researchers ca n ga in access to them) to con firm the exi stence or a sa fety­related probl em, it should be poss ible to analy ze for behaviora l differences that exist by com mon audi ence characteristics (e.g., e thnicity , ge nder , and age) through the use of descr iptive stati stica l tools or latent -class analysis as describ ed by Goldsworthy, Mayhorn, and Meade (20 10). It should be recog nized that somet imes the absence of such informational databa ses does not necessa rily mean that a warning is not needed. Moreover, not all researc hers or warning designers around the world have access to or understand comp lex stat istical ana lyses.

USING PARTICIPATORY DESIGN TECHNIQUES TO RECRUIT

PARTICIPANTS AND ENGAGE THE COMMUNITY

Because cultural fac tors may be partic ularly associated with so urce cred ibility and variable s relat ed to message delivery, it is important to ga in Lhe confidence and active

120 Cultural Ergonomi cs: Theory, M ethods, and Appli cation s

par ticipation of the members of the target audience (Geo rge, Green, and Daniel, 1996; Pa lenchar and Heath, 200 7). Not only will this relationship be usefu l in recruitin g part icipants for later warnin g evaluati on efforts, but it will also be useful in engag ing the co mmunit y in safety-related issues. Par ticipatory ergonomics is an approach that has been widely used to understand the preex isting knowledge and exper ience of those who compri se the target audience (Kuorink a, 1997; van Eerd et al., 2010), and this has been panicul arly useful in promoting "safety cultur e" (Bentley and Tappin , 2010). For instanc e, the form ation of a communit y advisory board that includes faith-ba sed orga­nizations, communit y leade rs, and communit y-outr each workers should be an effect ive mea ns of communicatin g with the target audi ence and potentially recruitin g resea rch participant s who represent thi s populati on of interest (Smith-Jack son , 2006b ; Vaughan and Tink er, 2009 ). In effec t, such efforts will allow safety practitioners to beco me a part of the credibl e " insider influences " that can be trusted , thereby enablin g access to memb ers of different cultur es (Bax ter, 2009 ; Ril ey, New by, and Lea l-Alm eraz, 2006 ).

DEVELOPING AND EVALUATING THE WARNI NG CONTENT VIA ITERATIVE DESIGN

Once the cha racteristics and activ ities of the target audi ence are known from pre­vious interaction s with the target audienc e v ia co nsumer testing and interviews, effort s to develop the content of safe ty co mm unica tions can begin . Using what is known abo ut the message frames or wording co mbin ations that are most cultur a lly sa lient (and understandable/c redibl e, etc.), warnin g content ca n be tail ored to meet the needs of the target audience (Us kul and Oyster man, 2010). Pro toty pe warnin gs should be developed and tested for comprehension with mult iple sampl es such as different ethic and cultu ra l subgroup s of the target audi ence in an itera tive fas hion (design, test, redes ign, tes t, etc .). Warnin gs that do not mee t acce ptable levels of compr ehension should be redesigned based on fee dback from earli er test par ticipa nts and retested for co mpr ehen sion until a sa tisfactory level of comprehension is reac hed (Goldsworthy and Kaplan, 20 06a, 200 6b; Mayhorn and Go ldswo rth y, 2007 , 200 9).

FOLLOW-UP EVALUATION AFTER WARNIN G DEPLOYMENT

Once a proto type warnin g has unde rgone the afor ementioned itera tive process a nd it has been deplo yed to the pu blic, the job of a safe ty communi ca tions pract itioner is not yet co mplete. Effo rts should be made to co nduct a follow-up evaluation of warn­ing message co mpr ehension using a d iverse, ra ndom sa mple of the targe t audience. W hil e ANS I (200 2) spec ifies that a minimum of 50 pa rti cipa nts an d ISO (200l) spec ifies that parti cipants should co me from at lea st three dif ferent countri es, p icto­ria l symbol comprehension tes ting needs to be cultu ra !Jy inclusive; therefore, stra ti­fied sampling methods that consider et hnicity, ge nder, age , and literacy should be implemented (Smith-J ackson , 200 6b).

CONCLUSION

Al ong with the rea lizat ion that culture ca n interac t with any of the stages of the model , C-H IP ca n also be a valuable too l in systematizing the assessme nt pro cess

Creati ng lnclu

to help determ get audience . I occurrin g and ! Warnin g effoct vious rese arch. described in ti compr ehension In effect, the m is inadeq uately work to highli§ a rece iver char:

In closing, t in r isk co mmu1 here was not rr could potential inform tho se i1 lyrical techniqt goal was to pn much empiri ca warnin g systerr

REFER EN C E5

Aldoo ry, L. , and info rmatio bioterror is

Andruli s, D . P., diverse co,

ANS I (200 2) . Ac Electrical ·

Baxte r, J . (2009 : theory of r

Bentle y, T. , and nomics pn

Bzostek, J . A ., a, ing label a: Human Fa

Casey, S. (1993 Human Er

Chan. A. H. S., a Effects of Indus trial

Co hen, H. H., < Modality , L awrence

Cox, E. P., III, an of Warnin g chap. 8: Pf

,d Applicatio ns

.nd Daniel, 1996;

.ful in recruiting

:efu l in engag ing

an approach that perienc e of those

)10) , and this has appin , 2010). For faith-bas ed orga­.ld be an effective

cruiting research 2006b; Vaughan

1ers to become a nabling access to -Almeraz, 2006).

VE DESIGN

~nown from pre­

and int erview s, n. Using what is ~ mo st cu ltu rally tailored to meet

>totype warnings samples such as

iterative fash ion eptab le levels of r te st participant s ension is reac hed hy, 2007, 2009).

1tive proc ess and ms practitioner is aluat ion of warn­

: tar get audien ce. . and ISO (2001) co untri es, picto­

; therefore, strati­,teracy sho uld be

th e stages of the

sess me nt pro cess

Creating Inclusive Warnings 121

to help determine why a warning is not effect ive for pa rticular portions of the tar­get audience. It can a id in pinpointing where the bottleneck s in proc essing may be

occurring and suggest so lutions to allow processing to con tinue to subsequent stages .

Warning effectiveness test ing can be perform ed using method s desc ribed in the pre­

vious resea rch. Eva luations of the proce ss ing ca n be directed to any of the stages described in th e C-H IP model: source, channel, environm e nt , deli very, attention, comprehension, attitudes and beliefs, motivati o n, behavior, and receiver va riables. In effect, th e model can be used as an investigative tool to determine why a warn ing

is inad equately ca rr ying out its function. In this chapt er, C-HIP was used as a frame­work to highlight existing gaps of knowl edge associated with the affect or c ulw re as a receiver characte ristic dur ing the warning process.

In closin g, there is an increasin g recognition that culture p lays an important role in risk communication (Kr euter and McClu re, 2004). While the discussion pr ese nted here was not meant to provide a comprehensive revi ew on all the ways th at cul wr c cou ld potentially influence warning compliance, it was meant to act as a prim er to

in form those interested in cultura l ergonomics of existing methodolo gical a nd ana­lytical techniques that might be emp loyed to deve lop inclusive warning system s. The goa l was to provide direction for future warning development and researc h. W hile much empirical work remain s to be done, the promise of more culturall y se nsitive warning systems sho uld be effective in promotin g safety for all memb ers of th e pu bl ic.

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CONTENTS

Introductio n ... Workers and (

Ethnic Gro Gender ..... .

Cu ltura lly Rel Soc iotech n Perso nne l ~ Organiza ti< Tec hnolog i

Cultural Ergo 1 Key Pr inciple: Practi ce ....... . . Refere nces ... .

INTRODU{

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