USING THE HEALTH BELIEF MODEL TO INVESTIGATE PARENT PERCEPTIONS OF LEAD TESTING: IMPLICATIONS FOR HEALTH COMMUNICATION RESEARCH AND PRACTICE Kaitlyn Hannah Kruer Submitted to the faculty of the University Graduate School in partial fulfillment of the requirements for the degree Master of Arts in the Department of Communication Studies, Indiana University December 2020 Accepted by the Graduate Faculty of Indiana University, in partial fulfillment of the requirements for the degree of Master of Arts. Master's Thesis Committee ______________________________________ Katharine J. Head, PhD, Chair ______________________________________ Maria Brann, PhD, MPH ______________________________________ Jennifer J. Bute, PhD ii © 2020 Kaitlyn Hannah Kruer iii DEDICATION This thesis is dedicated to my parents, Kevin and Becky, who always believe in me and my desire to strive for more. Thank you for loving me and finding value in my education. iv ACKNOWLEDGEMENT I would first like to thank my committee for the support and guidance they offered throughout this research. This project would not have been possible without them. Nor would it be possible without the special guidance of my advisor, Dr. Katharine J. Head, who spent countless hours helping me understand what it means to conduct research and solving my crises. I must also acknowledge my family and friends: my parents, who are always there for me, lending a listening ear and supportive word; to Lindsey, my built-in best friend and one of the smartest people I know; to George, who shows me love and support every day; to Kathi, who became a source of guidance through support and humor during my time in this program; to the Department of Communication Studies, for seeing the potential I had as an undergraduate and allowing me to explore my passions further; and to all my unnamed friends and family, whose support means the world to me. Thank you. v Kaitlyn Hannah Kruer USING THE HEALTH BELIEF MODEL TO INVESTIGATE PARENT PERCEPTIONS OF LEAD TESTING: IMPLICATIONS FOR HEALTH COMMUNICATION RESEARCH AND PRACTICE Children are at increased risk for harmful lead exposure due to their behavior and the increased percentage of lead absorption. While lead levels and the possible adverse health effects vary by age and level absorbed, the medical field agrees that lead is a persistent public health issue of the first order. Importantly, Hoosier children are at an increased risk for possible negative side effects because of the small percentage of children who are being tested; despite the AAP’s recommendation. The Health Belief Model (HBM) provided a strong and appropriate framework for guiding this formative research about parents’ perceptions of blood lead testing. This study aimed to answer two research questions based on HBM concepts and utilized both quantitative and qualitative methods to help answer them. Using snowball and convenience sampling, 14 Hoosier parents were recruited to participate in this study during the spring of 2020. Parents were recruitment from four counties across the state with known high rates of lead and/or low rates of blood lead testing among babies and small children. The findings from this study yield broad suggestions for future work within the field of communication research and specific suggestions for applied communication campaign research and clinical interventions within the state of Indiana. This study suggests we still have a long way to go as a state in addressing the dangers of lead toxicity and increasing regular testing among Hoosier children. Katharine J. Head, PhD, Chair vi TABLE OF CONTENTS List of Tables ..................................................................................................................... ix List of Figures .....................................................................................................................x Chapter One: The Problem of Lead Testing ........................................................................1 Lead – The Ongoing Public Health Threat ....................................................................1 Defining Lead Toxicity ............................................................................................2 Reduction in Lead Poisoning and Lead Prevention Campaigns ..............................7 Lead in Indiana ......................................................................................................11 Summary ................................................................................................................12 Chapter Two: Theoretical Framework ...............................................................................14 Health Belief Model History ........................................................................................14 Conceptual Underpinnings of the HBM ................................................................16 Constructs of the HBM ..........................................................................................17 Health Behavior Research Using the HBM ...........................................................23 The Current Study ........................................................................................................26 Chapter Three: Methods ....................................................................................................27 Method .........................................................................................................................27 Participants and Recruitment .................................................................................27 Procedures ..............................................................................................................31 Data Analysis .........................................................................................................36 A Mixed Methods Approach .................................................................................38 Summary of Chapter Three ..........................................................................................38 Chapter Four: Results ........................................................................................................39 Results .........................................................................................................................39 Parent Survey – Descriptive Information of Sample .............................................39 Themes ...................................................................................................................42 Summary of Chapter Four .....................................................................................58 Chapter Five: Discussion and Conclusion .........................................................................59 Discussion ....................................................................................................................60 Parent Perceptions of Childhood Health ................................................................60 Barriers Exist that Make Lead Toxicity Unrelatable .............................................64 Communication Occurrence ..................................................................................65 The Medical Field as a Reliable Source ................................................................68 Terminology ...........................................................................................................69 Limitations ...................................................................................................................70 Limitations Related to Potential Personal Bias and Role in Research...................71 Limitations Related to Recruitment and Representativeness.................................72 Limitations Related to Survey and Interview Questions .......................................73 Limitations Related to Survey and Interview Format ............................................74 Limitations Related to Self-Reporting of Lead Testing .........................................74 Conclusion ...................................................................................................................74 Appendices .........................................................................................................................76 Appendix A: Original Plans .........................................................................................76 Appendix B: Social Media Post ...................................................................................77 Appendix C: Email Correspondence ...........................................................................79 vii Appendix D: Online Survey.........................................................................................82 Appendix E: Interview Guide ......................................................................................85 Appendix F: Debriefing Material.................................................................................88 References ..........................................................................................................................93 Curriculum Vitae viii LIST OF TABLES Table 1: Blood Lead Levels and Associated Possible Health Effects in Children ..............6 Table 2: Description of Criteria for Selecting High Risk Indiana Counties in the Current Study .....................................................................................................................29 Table 3: Sample Descriptives ............................................................................................39