It's Not What You Say, but How You Say It: African American College Students' Perceptions of Mental Health Messaging

Background and Purpose: Emerging adults attending college may experience social, psychological, and emotional changes that hinder their academic success and social mobility. Race/ethnicity is a well-documented contributing factor to the deleterious impact of mental illness (MI) on college students. Receiving mental health (MH) services can potentially mitigate negative consequences of MH issues. However, African American college students (AACS) are less likely to utilize MH services. Targeted health messaging is cited to improve health-related service use. Thus, this collaborative pilot study investigated AACS’ perceptions of MH messages. Specifically, we sought to determine how generic vs. targeted and literal vs. metaphorical MH messages were perceived by AACS.

Methods: Researchers used the extended parallel process model (EPPM) to design four MH message brochures (targeted/literal, targeted/metaphorical, generic/literal, and generic/metaphorical). EPPM posits high levels of severity and susceptibility with high levels of self-efficacy and response efficacy are more likely to lead to message acceptance; therefore, each message addressed these components.

Participants were recruited via flyer distribution across campus and emails sent to individual and clubs/organizations. Of 101 total inquires, 45 students qualified for participation. Of those, we conducted semi-structured interviews with 36 African American undergraduate students, ages 18 to 29, enrolled in a Midwestern university, and who had not previously sought MH services. Participants were randomly shown two messages before responding to interview questions. A cognitive response testing interview protocol was utilized to elicit participants’ thought processes related to MH messaging.

Results: Nvivo software and inductive coding with four coders were utilized to generate categories and subthemes, with an intercoder reliability of k =0.66. Seven broad categories emerged; however, for this study, we focused on student message-based perceptions. Subthemes of this category included types and prevalence of MI, personal relevance, prompts to discuss MI, and comprehension of MI and MH services.

Participants had substantially varied perceptions of the severity of MI and many conveyed surprise at its high prevalence rate. Participants found targeted/metaphorical messages to be personally relevant and indicated they were more likely to share information from those messages with others, compared to generic/literal messages. Many participants indicated the car metaphor was useful for understanding MI and MH services, although there were some participants who disliked the metaphor.

Conclusions and Implications: Targeted content was deemed more personally relevant than generic content, and most participants understood and/or appreciated the car metaphor (compared to literal messages). Participants indicated the targeted messages and car metaphor were message components they would share with others. The targeted and metaphor messages were also useful in helping participants comprehend and think about MI and MH services.

This novel study addresses a significant gap in the literature related to AACS and their perceptions of MH, particularly as it relates to social impact on a marginalized population. Given the substantial adverse effects of untreated MI, coupled with the cumulative vulnerabilities of African Americans, these findings have implications for MH professionals at every level as they provide insight into marketing, programming, and outreach initiatives targeting AACS specifically, and African Americans in general.