Audience segmentation as a social-marketing tool in health promotion: Use of the risk perception attitude framework in HIV prevention in Malawi

Objectives. We sought to determine whether individuals' risk perceptions and efficacy beliefs could be used to meaningfully segment audiences to assist interventions that seek to change HIV-related behaviors. Methods. A household-level survey of individuals (N=968) was conducted in 4 districts in Malawi. On the basis of responses about perceptions of risk and beliefs about personal efficacy, we used cluster analysis to create 4 groups within the risk perception attitude framework: responsive (high risk, strong efficacy), avoidance (high risk, weak efficacy), proactive (low risk, strong efficacy), and indifference (low risk, weak efficacy). We ran analysis of covariance models (controlling for known predictors) to determine how membership in the risk perception attitude framework groups would affect knowledge about HIV, HIV-testing uptake, and condom use. Results. A significant association was found between membership in 1 or more of the 4 risk perception attitude framework groups and the 3 study variables of interest: knowledge about HIV (F _{8, 956}=20.77; P<.001), HIV testing uptake (F _{8, 952}=10.91; P<.001), and condom use (F_{8, 885}=29.59; P<.001). Conclusions. The risk perception attitude framework can serve as a theoretically sound audience segmentation technique that can be used to determine whether messages should augment perceptions of risk, beliefs about personal efficacy, or both.