Approach/avoidance motivation, message framing and skin cancer prevention: a test of the congruency hypothesis

Promoting a hand sanitizer by persuasive messages: moving bottle and background color as approach and avoidance cues

In message-based health interventions, peripheral cues such as motion and color capture exogenous attention. These cues may elicit approach and avoidance motivation and the core ingredients of persuasion (argument framing, source of the message, and persuasion knowledge). In two studies, we presented participants with persuasive messages about a hand sanitizer. Messages varied by the framing of the arguments (gain vs. loss) and by the source of the message (healthcare industry vs. public health agency). In Study 1 (N = 137), the forward apparent motion of the hand sanitizer bottle compared to a backward apparent motion increased a positive attitude toward the hand sanitizer, the intention to buy it, and ease of judgment. In Study 2 (N = 280), a small main positive effect of a green background was observed for attractiveness of the hand sanitizer, but only when a green background followed a red one. Green (vs. red) background increased willingness to buy the hand sanitizer. We observed no main effects of argument framing or source of the message. The discussion emphasizes approach and avoidance motivation as a common framework for understanding the respective contribution of peripheral cues and core ingredients of messages to the persuasion process.

The structural model of cyberchondria based on personality traits, health-related metacognition, cognitive bias, and emotion dysregulation

INTRODUCTION

Cyberchondria is excessive seeking for online health-related information related to increasing health anxiety and distress levels. The current study investigated the mediating role of health-related metacognition, cognitive bias, and emotion dysregulation in the relationship between personality traits and cyberchondria.

METHODS

Participants were 703 individuals 18+ years old who had access to the internet (males = 43.8%, mean age = 33.82 ± 10.09 years and females = 56.2%, mean age = 34.37 ± 11.16 years). They voluntarily completed a questionnaire package that included the Cyberchondria Severity Scale (CSS), the revised NEO Personality Inventory (NEO-PI-R), the Difficulties in Emotion Regulation Scale (DERS), the Meta-Cognitions about Health Questionnaire (MCQ-HA), and the Health Cognitions Questionnaire (HCQ).

RESULTS

The initial evaluation of the model demonstrated that the personality traits of openness to experience, agreeableness, and conscientiousness had no significant relationship with other variables in the structural model, and the effects of neuroticism and extroversion were the only significant results. Rerunning the model with the removal of non-significant variables revealed a full mediation of health-related metacognition, cognitive bias, and emotion dysregulation in the relation between personality traits (neuroticism and extraversion) and cyberchondria. Fit indices demonstrated the acceptable fit of the model with the collected data (χ² = 979.24, p <.001; NFI = 0.92, CFI = 0.93, GFI = 0.90, IFI = 0.93, RMSEA = 0.071, and SRMR = 0.063). The results indicated that the present model could explain R ² = 54% of cyberchondria variance.

DISCUSSION

These findings suggest that health-related metacognition, cognitive bias, and emotion dysregulation could demonstrate a full mediating role in the correlation between personality traits and cyberchondria.

The Role of Approach and Avoidance Motivation and Emotion Regulation in Coping Via Health Information Seeking

When dealing with a health threat, health information seeking (HIS) is a prominent way of engagement coping. Yet, there is only limited research as to its motivational and emotion regulatory antecedents. We present a theoretical model integrating approach and avoidance motivation, emotion regulation, HIS self-efficacy, and problem and emotion coping focus as predictors of HIS. We propose that, in the context of HIS, (1) approach and avoidance motivation have a direct effect on emotion regulation ability (positive and negative, respectively), (2) approach and avoidance motivation have indirect effects on intended comprehensiveness of search via emotion regulation, HIS self-efficacy and problem coping focus, (3) avoidance motivation has a direct effect on emotion coping focus. Our model was tested by means of structural equation modeling in a sample of university students (N = 283). Model fit was good, and all three hypotheses were supported. We show that emotion regulation ability is essential to explain the effects of approach and avoidance motivation on HIS as it fosters self-efficacy and a problem coping focus. The direct effect of avoidance motivation on emotion focus may represent an alternative way of coping with a health threat for those individuals who are highly sensitive to threat-related emotions.

Effects of Message Framing on Cancer Prevention and Detection Behaviors, Intentions, and Attitudes: Systematic Review and Meta-analysis

Background

With the increasing health care burden of cancer, public health organizations are increasingly emphasizing the importance of calling people to engage in long-term prevention and periodical detection. How to best deliver behavioral recommendations and health outcomes in messaging is an important issue.

Objective

This study aims to disaggregate the effects of gain-framed and loss-framed messages on cancer prevention and detection behaviors and intentions and attitudes, which has the potential to inform cancer control programs.

Methods

A search of three electronic databases (Web of Science, Scopus, and PubMed) was conducted for studies published between January 2000 and December 2020. After a good agreement achieved on a sample by two authors, the article selection (κ=0.8356), quality assessment (κ=0.8137), and data extraction (κ=0.9804) were mainly performed by one author. The standardized mean difference (attitude and intention) and the odds ratio (behaviors) were calculated to evaluate the effectiveness of message framing (gain-framed message and loss-framed message). Calculations were conducted, and figures were produced by Review Manager 5.3.

Results

The title and abstract of 168 unique citations were scanned, of which 53 were included for a full-text review. A total of 24 randomized controlled trials were included, predominantly examining message framing on cancer prevention and detection behavior change interventions. There were 9 studies that used attitude to predict message framing effect and 16 studies that used intention, whereas 6 studies used behavior to examine the message framing effect directly. The use of loss-framed messages improved cancer detection behavior (OR 0.76, 95% CI 0.64-0.90; P=.001), and the results from subgroup analysis indicated that the effect would be weak with time. No effect of framing was found when effectiveness was assessed by attitudes (prevention: SMD=0.02, 95% CI –0.13 to 0.17; P=.79; detection: SMD=–0.05, 95% CI –0.15 to 0.05; P=.32) or intentions (prevention: SMD=–0.05, 95% CI –0.19 to 0.09; P=.48; detection: SMD=0.02, 95% CI –0.26 to 0.29; P=.92) among studies encouraging cancer prevention and cancer detection.

Conclusions

Research has shown that it is almost impossible to change people's attitudes or intentions about cancer prevention and detection with a gain-framed or loss-framed message. However, loss-framed messages have achieved preliminary success in persuading people to adopt cancer detection behaviors. Future studies could improve the intervention design to achieve better intervention effectiveness.

Systematic Review of Interventions to Increase Awareness of Ultraviolet Radiation-Induced Harm and Protective Behaviors in Post-Secondary School Adults

College and university students are a group known for excessive sun exposure and indoor tanning. Health education campaigns for avoidance of ultraviolet (UV) radiation have been relatively unsuccessful in this population. This systematic review examines interventions aimed at post-secondary school young adults on college and university campuses for skin cancer awareness, photoprotection, and change in UV-exposure-related behavior. Fifty-nine studies were identified for inclusion according to predetermined criteria. Study heterogeneity was high; methods of intervention were individual or group-based, and were mostly visually delivered and/or passive learning. Most interventions occurred at a single time point. Intervention success was assessed by evaluating subject behavior, intention, attitudes, knowledge, and emotion. Multicomponent interventions, generally consisting of UV photography and a passively delivered educational component, may be more effective than a single component alone. Overall, study quality was poor. Sample size of the majority of studies was <150 subjects. Most studies used self-report of behavior and had a short follow-up time. Generalizability of findings may be impacted as women, particularly white/Caucasian women, were overrepresented in the studies identified by this systematic review. For this specific target population, themes arising from the review include the importance of self-relevance and message framing. Self-affirmation was identified as a potential challenge in designing interventions for this target group, which can lead to defensiveness and a negative reaction to the health message. The findings of this systematic review may inform future research in this field, as well as guide planning of effective interventions in this target population.

Effects of Goal-Framed Messages on Mental Health Education Among Medical University Students: Moderating Role of Personal Involvement

Mental health problem among university students is an emerging public health issue, and mental health education has always been the focus of attention for universities. However, limited attention has been paid to the effect of students' acceptance of health messages. Previous studies have found that message framing plays a key role in the process of responding to health-promoting messages. In this backdrop, the study aimed to examine the effects of goal-framed messages on mental health education among medical university students and investigate the moderating role of personal involvement. A cross-sectional study was conducted on medical university students. An online self-administered questionnaire was used to collect data. Wilcoxon rank-sum test and ordinal logistic regression were used for data analysis. Results showed significant differences in message acceptance between the gain- and loss-framed groups (p < 0.001). Participants with high personal involvement had higher message acceptance than those with low personal involvement in gain- and loss-framed message models (p < 0.05). Specifically, participants who related to roommates with high intimacy had higher message acceptance than those who related to roommates generally (p < 0.05). Participants who were concerned about their health condition had higher message acceptance than those who were neutral about their health condition (p < 0.001). Evidence of advantages of gain- over loss-framed messages on mental health among medical university students was found. The hypothesis that personal involvement with a health issue affects the acceptance of message framing was supported. Public health advocates can use framed message as a strategy to improve the efficacy of intervention in mental health education.

Why do we want health information? The goals associated with health information seeking (GAINS) questionnaire

Objective: Individual goals of health information seeking have been widely neglected by previous research, let alone systematically assessed. The authors propose that these goals may be classified on two dimensions, namely coping focus (problem versus emotion oriented) and regulatory focus (promotion versus prevention oriented).Methods: Based on this classification, the authors developed the 16-item Goals Associated with Health Information Seeking (GAINS) questionnaire measuring the four goals 'understanding', 'action planning', 'hope' and 'reassurance' on four scales, and a superordinate general need for health information. Three studies were conducted to assess the psychometric properties of the questionnaire.Results: In the first two studies (N = 150 and N = 283), internal consistency of the scales was acceptable to very good, and all items had a satisfying discriminatory power. Factorial validity was corroborated by an acceptable model fit in confirmatory factor analyses. In the third study, which included a patient sample (N = 502), the questionnaire proved to be suitable for its target group and nomological relationships with personality as well as with situational variables providing evidence for construct validity.Conclusion: The GAINS is a reliable and valid assessment tool, which enables researchers and practitioners to identify an individual's goals related to health information seeking.

Designing Skin Cancer Prevention Messages: Should We Emphasize Gains or Losses? Message Framing, Risk Type, and Prior Experience

PURPOSE

To test whether message framing (ie, gain vs. loss) and risk type (ie, health vs appearance risk) in skin cancer prevention messages interact with one's prior experience.

DESIGN

Two experiments with a 2 (message framing: gain vs loss) × 2 (risk type: health vs appearance risk) factorial design were conducted.

SETTING

The participants were given a URL to the experiment website via e-mail. On the first page of the website, the participants were told that they would be asked to evaluate a skin cancer print public service announcement (PSA): Online experiments.

PARTICIPANTS

A total of 397 individuals participated (236 for experiment 1 and 161 for experiment 2). Apparatus: Four versions of the skin cancer print PSAs were developed. Four PSAs were identical except for the 2 manipulated components: message framing and risk type.

MEASURES

Measures were adopted from Cho and Boster (message framing), Jones and Leary and Kiene et al. (risk type), De Vries, Mesters, van't Riet, Willems, and Reubsaet and Knight, Kirincich, Farmer, and Hood (prior experience), and Hammond, Fong, Zanna, Thrasher, and Borland and Hoffner and Ye (behavioral intent).

ANALYSIS

General linear models were used to test hypotheses.

RESULTS

Three-way interactions among message framing, risk type, and prior experience were found: When the intent of the message was to encourage sunscreen use, the effects of message framing and risk type were shown to be the exact opposite directions from when the intent was to discourage indoor/outdoor tanning.

CONCLUSION

To discourage tanning among those with prior experience, messages emphasizing losses in terms of one's health will work better. For those with no prior experience, messages emphasizing potential appearance losses will work better for discouraging tanning while messages emphasizing gains like improving appearance will do a better job in encouraging sunscreen use.

Predicting the sun-protective decisions of young female Australian beachgoers

We tested the theory of planned behaviour with additional norms to predict the sun-protective decisions of young female beachgoers in Australia. Participants ( N = 336) completed standard theory of planned behaviour measures and additional normative factors (group, image and personal norms). Attitude, subjective norm, and both personal and group norms predicted intention. Intention and group norm predicted follow-up behaviour. These findings provide further evidence that it is the more proximal sources of norms reflecting one’s personal and referent group influences, rather than perceptions of broader societal norms about the attractiveness of tanned images, that are important in determining young women’s sun-protective decisions.

The physical sacrifice of thinking: Investigating the relationship between thinking and physical activity in everyday life

Physical activity level is an important contributor to overall human health and obesity. Research has shown that humans possess a number of traits that influence their physical activity level including social cognition. We examined whether the trait of "need for cognition" was associated with daily physical activity levels. We recruited individuals who were high or low in need for cognition and measured their physical activity level in 30-second epochs over a 1-week period. The overall findings showed that low-need-for-cognition individuals were more physically active, but this difference was most pronounced during the 5-day work week and lessened during the weekend.