Moral obligation, autonomous motivation and vaccine hesitancy: Highlighting moral obligation increases reactance in hesitant individuals

Vaccine hesitancy is widespread, and developing effective communication strategies that encourage hesitant individuals to choose vaccination is essential. This pre-registered research aimed to examine associations among moral obligation, autonomous motivation, vaccination intentions and reactance, and to test messages highlighting moral obligation and autonomy support. In Study 1, participants who had not received a Covid-19 vaccine (N = 1036) completed measures of autonomous motivation, moral obligation, reactance, intentions to vaccinate and vaccine hesitancy. Autonomous motivation and moral obligation emerged as strong independent predictors of lower reactance, lower hesitancy and greater vaccination intentions. In Study 2 (N = 429), the participants received a vaccination-promoting message that highlighted moral obligation versus personal protection and used autonomy supportive versus controlling language. Messages with autonomy-supportive language and highlighting personal protection elicited lower reactance and greater perceived legitimacy compared to messages with controlling language and highlighting moral obligation. All messages elicited greater reactance and lower perceived legitimacy compared to an information-only message, and there were no effects of message type on vaccination intentions or vaccine hesitancy. The research has implications for the design of communications encouraging vaccination in hesitant individuals and suggests caution should be taken when developing messages to encourage vaccination in hesitant individuals.

Effects of message framing and risk perception on health communication for optimum cardiovascular disease primary prevention: a protocol for a multicenter randomized controlled study

Background

Although several guidelines for cardiovascular disease (CVD) management have highlighted the significance of primary prevention, the execution and adherence to lifestyle modifications and preventive medication interventions are insufficient in everyday clinical practice. The utilization of effective risk communication can assist individuals in shaping their perception of CVD risk, motivating them to make lifestyle changes, and increasing their willingness to engage with preventive medication, ultimately reducing their CVD risks and potential future events. However, there is limited evidence available regarding the optimal format and content of CVD risk communication.

Objective

The pilot study aims to elucidate the most effective risk communication strategy, utilizing message framing (gain-framed, loss-framed, or no-framed), for distinct subgroups of risk perception (under-perceived, over-perceived, and correctly-perceived CVD risk) through a multi-center randomized controlled trial design.

Methods

A multi-center 3 × 3 factorial, observer-blinded experimental design was conducted. The participants will be assigned into three message-framing arms randomly in a 1:1:1 ratio and will receive an 8-week intervention online. Participants are aged 20-80 years old and have a 10-year risk of absolute CVD risk of at least 5% (moderate risk or above). We plan to enroll 240 participants based on the sample calculation. The primary outcome is the CVD prevention behaviors and CVD absolute risk value. Data collection will occur at baseline, post-intervention, and 3-month follow-up.

Discussion

This experimental study will expect to determine the optimal matching strategy between risk perception subgroups and risk information format, and it has the potential to offer health providers in community or clinic settings a dependable and efficient health communication information template for conducting CVD risk management.Clinical trial registration: https://www.chictr.org.cn/bin/project/edit?pid=207811, ChiCTR2300076337.

Investigating the impact of 'dark nudges' on drinking intentions: A between groups, randomized and online experimental study

OBJECTIVES

This study explored how 'dark nudges' (tactics used in alcohol industry-funded responsible drinking campaigns) affect drinking intentions, perceived source credibility and whether individual differences in perceptions of prototypical drinkers moderated these effects.

DESIGN

Two 2 × 2 between-groups online experimental studies.

METHODS

Study 1 (N = 164) presented three alcohol health messages per condition, comprising social norm (healthy/unhealthy ("dark nudge")) by frame (loss/gain). Study 2 (N = 229) presented one message per condition, comprising cancer causality (single cause/multiple causes (dark nudge)) by funding disclosure (disclosure/non-disclosure (dark nudge)). Outcomes were drinking intentions and perceived source credibility. Exploratory analyses considered prototype perceptions as a between-subjects moderator.

RESULTS

No significant effects of message frame, social norm, fundi or multiple cancer causality arguments on drinking intentions were found. In Study 2, in the dark nudge multiple cancer causality conditions, perceived source credibility was high when funding was undisclosed, but significantly lower when it was disclosed. Exploratory analyses suggested effects were moderated by prototype similarity. In Study 1, higher perceived similarity to a heavy drinker and lower perceived similarity to a responsible drinker were associated with higher drinking intentions in the unhealthy norm/gain frame condition, but lower drinking intentions in the other conditions.

CONCLUSIONS

Framing, social norm, funding disclosure and multiple causality manipulations as tested in this study did not exert a dark nudge effect on drinking intentions. However, the exploratory analyses suggest it could be hypothesised that the types of messages used in alcohol industry-funded responsible drinking campaigns may result in greater drinking intentions among those who identify more as heavy drinkers and less as responsible drinkers. Perceived prototype similarity may be an important moderator of the impact of alcohol health messages that warrants further research. Study 2 suggests disclosure of industry funding guides judgements of the credibility of sources of misleading messages about alcohol and cancer.

Effect of message framing on support for a sugar-sweetened beverage tax in Australia: a cross-sectional survey analysis

Sugar-sweetened beverage (SSB) taxes are present in many countries with evidence that they are effective in decreasing purchases of SSBs. However, in Australia where SSB consumption per capita is high, and calls for an SSB tax are frequent, there is no SSB tax and policymakers have stated their lack of support for such a tax. We examined whether political party voting preference and sociodemographic factors affect individuals' support for an SSB tax, and whether message framing affects this support. A nationally representative sample of 1519 Australian adults was recruited for an online experimental survey. Three persuasive frames and one control frame were randomly provided to participants and measures of agreement towards an SSB tax were assessed. Sociodemographic factors and political party preference were also captured. Message framing had minimal effect on the level of support for the tax. However, participants who received the 'supportive of food and drink companies frame' showed the highest positive feelings towards the tax, and participants in rural areas had higher levels of support for an SSB tax when receiving the 'protecting teenagers' frame. Participants who voted for conservative (right-leaning) parties and for Labour (a centre-left party) had similar levels of support towards the tax, which was considerably lower than Greens voters. Undecided voters had the lowest levels of support for the tax, and the frames had limited impact on them. These findings highlight the potential role of message framing in shaping public support for an SSB tax in Australia, particularly in the context of voting preference and sociodemographic factors.

Effects of Framed Mobile Messages on Beliefs, Intentions, Adherence, and Asthma Control: A Randomized Trial

We aimed to examine the effects of framed mobile messages (messages emphasizing losses or gains because of a behavior) on young adults' beliefs about their daily Inhaled Corticosteroids (ICS), intentions to take their ICS, adherence, and asthma control. College students (18-29 years) who owned a mobile phone and had a diagnosis of asthma with a prescription for an ICS were recruited. Participants (n = 43) were randomized to receive either gain- or loss-framed mobile messages three times per week for eight weeks. Engagement rates with messages were calculated. Outcomes included beliefs, intentions, adherence, and asthma control. Data collection was performed at baseline, week 4, and week 8. Mixed-design ANOVA assessed whether outcomes improved differentially from baseline to week eight between gain- and loss-framed groups. Twenty-two participants were randomly assigned to the gain-framed group and 21 to the loss-framed group. There was a 100% retention rate. The engagement rate with the text messages was 85.9%. There was a significant difference in participants' intentions to take medication and asthma control from baseline. There were no significant changes in other outcomes from baseline. There was no difference in changes in all outcomes between participants receiving gain- versus loss-framed messages. Framed mobile messages improved young adults' asthma control and intentions to take their medication as prescribed.

Overcoming Black Americans' Psychological and Cognitive Barriers to Clinical Trial Participation: Effects of News Framing and Exemplars

This study examines how news features (framing and the use of exemplars) can help overcome two common barriers (psychological and cognitive) impeding Black American participation in clinical trials. In an online experiment, Black participants (N = 390) viewed social media news posts varying in framing (focus on psychological vs. cognitive barriers) and use of an exemplar (present vs. absent and White vs. Black) and then responded to outcome measures including perceived message effectiveness, message attitudes, and intention to participate in clinical trials. The findings illustrate that including a racially matched (i.e. Black) exemplar improves attitudes toward clinical trial messages. Most notably, featuring a race-matched exemplar increases intention to participate in a trial when the messages discuss psychological barriers. These findings enhance our understanding of how messages can be better designed to increase Black American participation in clinical trials, thereby contributing to reducing health inequities and improving health outcomes.

Gain/loss framing moderates the VMPFC's response to persuasive messages when behaviors have personal outcomes

Activity within the ventral medial prefrontal cortex (VMPFC) during encoding of persuasive messages has been shown to predict message-consistent behaviors both within scanner samples and at the population level. This suggests that neuroimaging can aid in the development of better persuasive messages, but little is known about how the brain responds to different message features. Building on past findings, the current study found that gain-framed persuasive messages elicited more VMPFC activation than loss-framed messages, but only when messages addressed outcomes that would be experienced by participants directly. Participants also perceived gain-framed messages as more effective than loss-framed messages, and self-reported perceptions of message effectiveness were positively correlated with VMPFC activation. These results support theories that VMPFC activity during message encoding indexes perceptions of value and self-relevance and demonstrate that established theories of persuasion can improve the understanding of the neural correlates of persuasion.

The Influence of Green Product Type, Message Framing, and Anticipated Pride on Green Consumption Behavior: An Event-Related Potential (ERP) Study

Different types of green products require different marketing approaches to promote individual green purchasing behaviors. Previous studies have focused only on the effects of message framing on the promotion of different types of green products; however, little is known about the role of underlying emotions. Using event-related potentials (ERPs), this study investigated the neural responses to message framings and anticipated pride in green product types to assess their level of influence on green consumption. Participants in this study were randomly assigned to the anticipated pride versus control groups, and asked to make green consumption decisions involving different types (self- vs. other-interested) of green products, utilizing both gain and loss framing. The behavioral results demonstrated that participants in the anticipated pride group made more green product purchase choices than those in the control group. The ERP results showed that within the loss framing of the control group, other-interested green products induced larger N400 and smaller late positive potential (LPP) amplitudes than self-interested green products, whereas the results showed the opposite trend for the anticipated pride group. These results indicate that although individuals might have biases in their motivation that lead them to focus on self-interested green products, anticipating pride reduces cognitive conflicts and increases their motivation to focus on other-interested green products in the context of loss.

Why it is good to communicate the bad: understanding the influence of message framing in persuasive communication on consumer decision-making processes

Introduction

One approach to bridging the gap between consumer intentions and behavior is persuasive communication to reinforce their intentions and thereby support their behavior change. Message framing has proven to be a useful, persuasive communication tool. However, message framing is considered more complicated than other types of framing because, in addition to concept-specific elements, it is also strongly influenced by and, in turn, influences emotions. Therefore, it is almost impossible for consumers to verbally express their attitudes, so the challenge is to explain and measure its impact. This research aims to help in this regard by suggesting a theoretical model to understand how message framing is processed from a consumer neuroscience perspective. More precisely, the factors that constitute message framing are systematized and built on a reflective-impulsive model and a neural emotion-cognition framework interpreted to explain the persuasive effects of message framing.

Method

A functional magnetic resonance imaging (fMRI) experiment is used to examine the effects of message framing for four different frame types that are hypothesized to affect consumer information processing differently.

Result

The results suggest that communication strategies should take into account the valence of the objects and the frame used. The behavioral results partially confirm the assumption that two types of information processing could take place, as suggested by the reflective-impulsive model. At the neural level, using the network perspective, the results show that certain brain regions primarily associated with emotional and cognitive interaction processes are active during processing, depending on the framing of the message.

Discussion

In cases of indirect avoidance value-consistent framing, it may be good to communicate the bad in the appropriate frame to influence information processing.

Effects of Message Framing and Information Source on Consumers' Attitudes toward an Amino Acid-Based Alternative Meat Curing System

Recently, meat scientists have developed an innovative amino acid-based alternative meat curing system (AAACS). However, consumer skepticism toward novel foods presents challenges regarding the acceptance of food innovations like the AAACS. Effective communication about this and other food technologies is critical. Our study was a 2 × 4 randomized factorial between-groups experiment that investigated how two peripheral cues-message frame and information source-impact attitudes toward the AAACS. We used Qualtrics to randomly assign participants to one of eight treatment groups. Each group viewed a different video about the AAACS. Then, all participants were asked about their attitudes toward the alternative meat curing system. Data were analyzed using a two-way multivariate analysis of variance (MANOVA). The two-way MANOVA determined concurrently the experimental effects of message frame and information source on information recall, trust, source expertise, source credibility, and anticipated consumption behavior. A significant MANOVA was followed up using Discriminant Function Analysis (DFA). A significant main effect was found for information source. The DFA revealed only one significant underlying function and that source expertise was the most powerful discriminating variable for information source.

Message Framing for Men? Gender Moderated Effects of Culturally Targeted Message Framing on Colorectal Cancer Screening Receptivity among African Americans

Receptivity to recommended colorectal cancer (CRC) screening can be enhanced by use of loss-framed health messaging that emphasizes possible consequences of failing to act. However, a simultaneous use of culturally targeted messaging may be needed to achieve effectiveness when loss-framed messaging is used with African Americans, especially to reduce racism-related cognitions aroused by standard loss framing that impede CRC screening receptivity. This study considered whether effects of stand-alone and culturally targeted message framing on CRC screening receptivity differ between African American men and women. African Americans eligible for CRC screening (Men=117, Women=340) viewed an informational video about CRC risks, prevention, and screening, and were randomized to receive a gain or loss-framed message about screening. Half of participants received an additional culturally targeted message. Using the Theory of Planned Behavior, we measured receptivity to CRC screening. We also measured arousal of racism-related cognitions. A significant three-way interaction suggested effects of messaging on CRC screening receptivity were moderated by gender. Participants were no more receptive to CRC screening when standard loss-framing was used, but were more favorable if loss-framing was culturally targeted. However, these effects were more pronounced among African American men. Contrary to prior findings, gender moderated effects of culturally targeted loss-framed messaging were not attributable to reducing racism-related cognitions. Findings add to growing recognition of important nuance in effective use of message framing to also include gender, while suggesting a critical need to explore gender-relevant mechanistic pathways, potentially including how health messaging activates masculinity-related cognitions among African American men.

Loss-framing of information and pre-vaccination consultation improve COVID-19 vaccine acceptance: A survey experiment

Backgrounds

Vaccination remains one of the most effective ways to protect populations from COVID-19 infection, severe conditions, and death. This study aims to examine whether the gain/loss-framing of information, provision of subsidized pre-vaccination physician consultation, and cash incentives can improve COVID-19 acceptance amongst adults.

Methods

A survey experiment was conducted within a broader cross-sectional survey of people aged 18-64 years in Hong Kong, China. The participants were randomly assigned to one of the eight groups derived from full-factorial design of the three strategies with stratification by age and sex. The vaccine acceptance rate was compared between people with and without any of the strategies. The heterogeneous effects of these strategies were identified for those with different perceptions of the pandemics and vaccine in multiple logistic regressions.

Results

The survey experiment collected 1,000 valid responses. It found that loss-framed information and provision of subsidized physician consultation to assess suitability to be vaccinated, can improve vaccine acceptance, while cash incentives did not make a difference. The improvement effect of loss-framing information and physician consultation is stronger among those with higher perceived infection risk and severity of condition, as well as unvaccinated people with lower confidence in vaccine safety.

Conclusions

The findings indicated that individualized loss-framing messages and equitable provision of subsidized pre-vaccination physician consultations can be incorporated in efforts to promote vaccine acceptance and vaccination roll-out speed. However, it remains inconclusive whether and how universal cash incentives may be deployed to support vaccination promotion.

Reframing Adolescent Development: Identifying Communications Challenges and Opportunities

Understanding Americans' deeply held and widely shared assumptions about adolescents and their development can reveal key opportunities and challenges for developmental science communicators. Twenty-nine in-depth interviews were conducted with adolescents and adults about adolescence. We analyzed the cultural models the public use to make meaning about what adolescence is, what development involves, what adolescents need, and how adolescents can be supported. The analysis revealed several cultural models that may impede public engagement around youth issues. These dominant ways of thinking include a strong focus on the vulnerability of adolescence and a narrow understanding of how environments affect adolescent development. The findings have important implications for communicators seeking to expand and deepen public thinking about adolescence.

Influence of Appeal Type and Message Framing on Residents' Intent to Engage in Pro-Environmental Behavior

In this intervention study, we examined the effects and psychological processes of different types of messaging intended to promote waste-separation behavior on the intent of residents to separate household waste and to engage in other pro-environmental behaviors (PEBs). Based on three studies (one survey with 76 residents and two experiments with 446 residents) in China, our results revealed that environmental appeals increased residents' intent to separate waste and engage in other PEBs, whereas monetary incentives had no effect. Although the main effects of the framing of messages on the intent to separate waste and other PEBs were not significant, we found an interactive effect of appeal type and message framing. When matched with loss framing, an environmental appeal indirectly generated a stronger positive impact by stimulating an individual's environmental risk perception. When monetary incentives matched with loss framing, individual pro-environmental identity weakened, thereby inhibiting the positive impact on intent to separate waste. With this study, we provide important theoretical support for the selection and optimization of waste-separation intervention strategies and guidance for persuading residents to engage in more PEBs.

The Influence of Message Framing on Elderly Tourists' Purchase Intentions of Health Services: A Case Study of Guangxi Bama

Traveling has become an increasingly important lifestyle for the elderly to realize active aging. The elderly are more inclined to pay attention to wellbeing-related products whilst on vacations, representing a market opportunity for providers of tourism health services. This study conducted an experiment to explore how message framing affects intentions to purchase health services in elderly tourists over the age of 59 years. A total of 216 elderly tourists from Bama, a famous wellness tourism destination in China, were recruited as participants for a single-factor (message framing: positive versus negative) experiment. Our results indicate the following: (1) message framing has a significant impact on elderly tourists' intentions to purchase health services. Compared with messages that are negatively framed, positive messages are more persuasive. (2) Perceived benefits mediate the above relationship. (3) Perceived susceptibility moderates the impact of message framing around perceived benefits, as well as the indirect effect of perceived benefits on purchase intention. Theoretically, this paper clarifies the mechanism and conditions of message framing in relation to its effects on consumer intentions, enriching knowledge about the intersection between tourism and health consumption. This paper also provides guidance for providers of health tourism who are seeking to capture the market of elderly tourists.

Am I a responsible drinker? The impact of message frame and drinker prototypes on perceptions of alcohol product information labels

BACKGROUND

Current alcohol product labelling tends to include ambiguous messages such as 'drink responsibly'. Consumers who identify as responsible drinkers may not pay heed to health warning messages, believing that they are not the intended target.

AIMS

We aimed to determine how responses to responsible drinking labels would differ from responses to positively and negatively framed health messages. We also explored if prototype perceptions would moderate the message impact.

METHODS

A between groups, three arm (ambiguous, positive or negative messages) experiment recruited 465 participants. Outcomes were drinking intentions and label acceptability (novelty, believability, personal relevance, and potential to change behaviour). Measures of heavy and responsible drinker prototype perceptions were included for exploratory moderation analyses.

RESULTS

Positive and negative messages were rated significantly more likely to change behaviour than ambiguous messages. There was also a moderation effect: participants with stronger favourability and similarity to the responsible drinker prototype intended to drink more alcohol in the future after exposure to negatively framed labels, but not after exposure to ambiguous or positively framed labels.

DISCUSSION

Drink responsibly' messages are unlikely to lead to behaviour change. Incorporating theoretical moderators may have value in developing our understanding of the impact of alcohol product labelling.

The Influence of Framing Plant-Based Products in Terms of Their Health vs. Environmental Benefits: Interactions with Individual Wellbeing

Significant reductions in the consumption of meat and dairy products are required to limit environmental damage and meet climate targets. However, individuals choosing to adopt plant-based diets still form a minority. Whilst different types of message framings have been suggested to be a potential means of encouraging the uptake of plant-based diets, recent findings have often failed to document any differences in people's willingness to reduce their consumption of animal products based on whether messages emphasize the health or environmental benefits of plant-based diets. This research examined whether individual wellbeing might interact with health versus environmental message frames to determine people's liking and willingness to pay for plant-based products. Across two experiments with a university (Study 1) and a non-student, adult sample (Study 2), participants were exposed to different hypothetical labels for plant-based foods and asked to rate their liking and willingness to pay for each. In line with existing findings, results demonstrated a trend whereby showing health (versus environmental) information on food labels did not in itself influence participants perceptions of the food products. Higher levels of positive wellbeing were associated with greater liking and willingness to pay for the plant-based foods (B values ranging from 0.04 to 0.45). Further, there was an interaction effect whereby levels of negative affect were differentially linked to liking and willingness to pay across the health and environmental framing conditions (B values ranging from 0.03 to 0.38). In particular, negative affect appears to have a greater negative impact on the product liking and willingness to pay when environmental label framings are used. This effect was most pronounced for the product liking dependent variable (B = -0.29 in the environmental framing condition). This research therefore extends understandings of the more specific instances in which message framings can impact perceptions of plant-based foods. The implications of the findings for understanding how best to promote uptake of plant-based diets are discussed.

Reducing the Use of Disposable Plastics through Public Engagement Campaigns: An Experimental Study of the Effectiveness of Message Appeals, Modalities, and Sources

This study examines how different ways of presenting information about the ecological threats stemming from the use of disposable plastics may affect people’s willingness to reduce their use. To test our hypotheses, we used a 2 × 3 × 2 between-subjects experimental design, utilizing a sample of 1001 Hong Kong residents. The independent variables tested included: (a) message frame (gain vs. loss), (b) modality (text vs. image vs. infographic), and (c) information source (government vs. non-governmental organization). The findings demonstrate that the loss frame was more effective than the gain frame in persuading participants to reduce the use of disposable plastics. Furthermore, compared to image-based messages, text-based and infographic-based messages were more effective in promoting the reduction in the use of disposable plastics. For information sources, however, we found no main effect on behavioral intentions. However, this study still suggests an interaction effect of the loss frame and NGO source, as well as the interaction between text-based modality and government source, both leading to more positive outcomes. Furthermore, the study reveals that negative emotional responses mediate the effect of media frames on behavioral intentions. The findings offer useful insights for designing more effective communication campaigns aimed at curbing the use of disposable plastics.

The Effect of Message Framing in Promoting the Mediterranean Diet: The Moderating Role of Eating Self-Efficacy

Although a Mediterranean diet (MeDiet) provides several psychophysical health benefits, research on how to effectively promote MeDiet adherence is still lacking. In the present study, we tested the effectiveness of a messaging intervention aimed at promoting the adherence to the Mediterranean diet. A total of 435 Italian participants responded to a questionnaire on their eating self-efficacy and adherence to the MeDiet at Time 1. Then, participants were randomly assigned to three different conditions: (a) gain messages focused on the positive outcomes of MeDiet adherence; (b) non-loss messages focused on the avoided negative outcomes associated with MeDiet adherence; (c) no messages (control). After the 2 week intervention, participants answered some questions regarding their perception of threat and distress, evaluation of the messages, and adherence to the MeDiet at Time 2. We also tested whether the messaging intervention influenced participants' MeDiet adherence at Time 2. Results confirmed that the messaging intervention enhanced the MeDiet adherence (F(2,432) = 4.61; p = 0.01, ηp² = 0.02), with no difference between exposure to gain or non-loss messages (95% LLCI = -0.32; 95% ULCI = 0.54). We then tested whether message framing effectiveness was influenced by eating self-efficacy, and results showed that gain messages were more persuasive for participants with low eating self-efficacy (effect size = 0.01; p for interaction = 0.03). Discussion suggests that tailoring messages according to receivers' psychological characteristics seems to be pivotal to enhance the persuasiveness of messages aimed at promoting the MeDiet adherence.

The Influence of Message Framing on Residents' Waste Separation Willingness-The Mediating Role of Moral Identity

With serious environmental problems increasing, waste separation has drawn much attention. Message framing is an important way to popularize separation knowledge and increase people’s separation willingness. Message framing was classified into positive and negative frames in this study, and then based on moral identity theory from the social cognitive perspective, two dimensions of moral identity were introduced as mediating variables to construct a mechanism model of the influence of message framing on waste separation willingness. After a comparative study of three groups of subjects (N = 604), the following conclusions were drawn: (1) message framing positively influenced moral identity and waste separation willingness; (2) both positive and negative message framing positively influenced waste separation willingness through the partial mediating role of moral identity symbolization and internalization; and (3) the mediating role of symbolization was stronger in the effect of positive message framing on waste separation willingness, while the mediating role of internalization was stronger in the effect of negative message framing on waste separation willingness. The findings provide significant information for organizations to effectively carry out message strategies.

Increasing Receptivity to COVID-19 Public Health Messages with Self-Affirmation and Self vs. Other Framing

There remains an urgent need for effective communication about the importance of widespread adherence to behavioral recommendations to control the COVID-19 pandemic that will also reduce resistance to such guidance. We examined two strategies for COVID-19 communication- (1) self-affirmation (reflecting on a personal value in order to boost self-integrity and reduce defensiveness to potentially threatening information); and (2) manipulating self/other message framing - and moderation of these strategies by COVID-19 risk. 600 participants (M_age = 32.55, 51% female) were recruited for an online study and, after assessment of risk factors for severe COVID-19 infection, were exposed to the experimental manipulations. Three classes of defensive responses were considered as outcomes of interest: reactance, attitudinal responses, and behavioral responses. We found that participants derogated the self-focused message more than the other-focused message. Further, other-focused messaging and/or self-affirmation were more likely to elicit positive responses among individuals at higher risk for COVID-19 complications. Our findings suggest having individuals affirm values prior to viewing COVID-19 messages, and framing messages in terms of the importance of protecting others, may be beneficial strategies for encouraging responsiveness - particularly if the targets of such messages are at risk of COVID-19 complications themselves.

Framing and Tailoring Prefactual Messages to Reduce Red Meat Consumption: Predicting Effects Through a Psychology-Based Graphical Causal Model

Effective recommendations on healthy food choice need to be personalized and sent out on a large scale. In this paper, we present a model of automatic message selection tailored on the characteristics of the recipient and focused on the reduction of red meat consumption. This model is obtained through the collaboration between social psychologists and artificial intelligence experts. Starting from selected psychosocial models on food choices and the framing effects of recommendation messages, we involved a sample of Italian participants in an experiment in which they: (a) filled out a first questionnaire, which was aimed at detecting the psychosocial antecedents of the intention to eat red/processed meat; (b) read messages differing as to the framing of the hypothetical consequences of reducing (gain, non-loss) versus not reducing (non-gain, loss) red/processed meat consumption; (c) filled out a second questionnaire, which was aimed at detecting participants' reaction to the messages, as well as any changes in their intention to consume red/processed meat. Data collected were then employed to learn both the structure and the parameters of a Graphical Causal Model (GCM) based on a Dynamic Bayesian Network (DBN), aimed to predicting the potential effects of message delivery from the observation of the psychosocial antecedents. Such probabilistic predictor is intended as the basis for developing automated interactions strategies using Deep Reinforcement Learning (DRL) techniques. Discussion focuses on how to develop automatic interaction strategies able to foster mindful eating, thanks to (a) considering the psychosocial characteristics of the people involved; (b) sending messages tailored on these characteristics; (c) adapting interaction strategies according to people's reactions.

Opioids in acute pain: Towards getting the right balance

Misuse of prescription opioids forced an inevitable response from authorities to intervene with consequences felt by all.In the Australian community one person will die for approximately every 3600 adults prescribed opioids, while in the hospital setting a postoperative patient managed primarily with opioids, as opposed to epidural analgesia, has an additional risk of death as high as between one in 56 to 477.Opioids maintain a valid role in acute pain management when use is reasoned and with full awareness of the harms and how they are to be avoided, such as in those at risk of ongoing use, the opioid naïve, and when opioid-induced ventilatory impairment may occur.Clinicians managing acute pain can focus on assessing pain versus nociception, strategically apply antinociceptive medications and neural blockade when indicated, assess pain with an emphasis on the degree of bothersomeness and functional impairment and, finally, optimise the use of framing and placebo-enhancing communication to minimise reliance on medications.

"I" Am Willing to Disclose, but "We" are Unwilling: The Impact of Self-Construal on Individuals' Willingness to Disclose

Purpose

In the big data era, many institutions (ie, hospitals) and firms use various methods to encourage people to disclose more personal information to gain competitive advantages in many businesses, such as healthcare and the Internet of Things (IoT) devices. Discussions on antecedents of individuals’ willingness to reveal private data from individual differences perspective are limited. Drawing on information boundary theory, we examine how self-construal prompts a different regulatory focus (promotion focus versus prevention focus), thus, affects individuals’ willingness to disclose private data.

Methods

A mixed-method approach was used to examine our hypothesis. Study 1 (N = 93, participants in China) manipulated self-construal in lab experiments and examined participants’ actual disclosure behavior in the emerging IoT context of connected cars. Study 2 (an online survey, N = 200, participants in US) measured chronic self-construal in another disclosure context (healthcare app), replicating the preliminary effect and examined the mediating effect of the regulatory focus. Study 3 (an online experiment, N = 284, participants in US) tested the moderating effect of message framing.

Results

Study 1 showed that participants primed an independent self-construal were more willing to share private information, whether it is real driving data or private identity information. Study 2 showed that independent (interdependent) self-construal individuals tend to have promotion focus (prevention focus), thus leading to higher (lower) willingness to disclose personal health information. Study 3 demonstrated that independent (interdependent) self-construal individuals are more willing to share information when presented with gain-framing (loss-framing) information.

Conclusion

Independent (interdependent) self-construal positively (negatively) affects individuals’ willingness to disclose and these effects will be mediated by regulatory focus and moderated by message farming. Our study provides a theoretical paradigm that is new to the willingness to disclose literature, and offers an effective, actionable strategy on how institutions and firms can facilitate individuals’ personal information disclosure.

Mobile Text Messaging for Tobacco Risk Communication Among Young Adult Community College Students: Randomized Trial of Project Debunk

BACKGROUND

The use of new and emerging tobacco products (NETPs) and conventional tobacco products (CTPs) has been linked to several alarming medical conditions among young adults (YAs). Considering that 96% of YAs own mobile phones, SMS text messaging may be an effective strategy for tobacco risk communication.

OBJECTIVE

Project Debunk is a community-based randomized trial aiming to identify specific types of messages that effectively improve perceived NETP and CTP risk among YAs in community colleges.

METHODS

With YAs recruited offline from 3 campuses at the Houston Community College (September 2016 to July 2017), we conducted a 6-month randomized trial with 8 arms based on the combination of 3 message categories: framing (gain-framed vs loss-framed), depth (simple vs complex), and appeal (emotional vs rational). Participants received fully automated web-based SMS text messages in two 30-day campaigns (2 messages per day). We conducted repeated-measures mixed-effect models stratified by message type received, predicting perceived CTP and NETP risks. Owing to multiple testing with 7 models, an association was deemed significant for P<.007 (.05 divided by 7).

RESULTS

A total of 636 participants completed the baseline survey, were randomized to 1 of 8 conditions (between 73 and 86 participants per condition), and received messages from both campaigns. By the 2-month post campaign 2 assessment point, 70.1% (446/636) completed all outcome measures. By the end of both campaigns, participants had a significant increase in perceived NETP risk over time (P<.001); however, participants had a marginal increase in perceived CTP risk (P=.008). Separately for each group, there was a significant increase in perceived NETP risk among participants who received rational messages (P=.005), those who received emotional messages (P=.006), those who received simple messages (P=.003), and those who received gain-framed messages (P=.003).

CONCLUSIONS

In this trial, YAs had an increase in perceived NETP risk. However, with stratification, we observed a significant increase in perceived NETP risk upon exposure to rational, emotional, simple, and gain-framed messages. In addition, YAs generally had an increase in perceived CTP risk and presented nonsignificant but observable improvement upon exposure to emotional, complex, and loss-framed messages. With the results of this study, researchers and practitioners implementing mobile health programs may take advantage of our tailored messages through larger technology-based programs such as smartphone apps and social media campaigns.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03457480; https://clinicaltrials.gov/ct2/show/NCT03457480.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/10977.

Understanding patient factors to increase uptake of cancer screening: a review

Early detection of cancer through organized screening is a central component of population-level strategies to reduce cancer mortality. For screening programs to be effective, it is important that those invited to screening participate. However, uptake rates are suboptimal in many populations and vary between screening programs, indicating a complex combination of patient factors that require elucidation to develop evidence-based strategies to increase participation. In this review, the authors summarize individual-level (sociodemographic and psychosocial) factors associated with cancer screening uptake and evidence for the effectiveness of behavioral interventions to increase uptake. The authors reflect on current trends and future directions for behavioral cancer screening research to overcome challenges and address unmet needs in reducing cancer mortality.

Persuasive Effects of Message Framing and Narrative Format on Promoting COVID-19 Vaccination: A Study on Chinese College Students

During a public health crisis, the provision and dissemination of health-related information are important for the relevant authorities to keep the public informed. By using different types of message framing, the authorities can effectively guide and persuade people to adopt health-related behaviors (such as vaccination). In this study, a web-based experiment using a 2 × 2 (message framing: gain framing versus loss framing) × (message presentation: narrative versus non-narrative) design was conducted to investigate the effects of different message frames on vaccination promotion. In total, 298 college students were recruited to participate in this study. The results suggest that, for message framing, loss-framed (vs. gain-framed) messages lead to higher intentions to get vaccinated. Furthermore, compared with non-narrative messages, narrative messages are more persuasive in promoting vaccination behavior. However, the interaction effect between gain-loss message framing and narrative framing is not significant. Additionally, perceived severity, perceived benefits, and perceived costs mediate the effect of narrative framing on behavioral intentions. In other words, compared with non-narrative messages, narrative messages lead to higher levels of perceived severity and perceived benefits, and a lower level of perceived costs, which in turn increase intentions to get vaccinated. This paper provides insightful implications for both researchers and practitioners.

Self-Efficacy Mediates the Effect of Framing Eating Disorders Prevention Message on Intentions to Have a Sufficient Weight: A Pilot Study

BACKGROUND

In the context of social marketing, the effectiveness of prevention messages is a major issue. The main objective of the present study was to assess the effect of prevention messages framing on self-efficacy reinforcement in order to improve intentions to reach or maintain sufficient weight in a non-clinical sample. It thus focuses on testing the mediating role of self-efficacy.

METHODS

Two hundred and thirty-three university student women were randomly assigned to one of the two conditions (gain-framed versus loss-framed message). They were exposed to a short persuasive message and surveyed on self-efficacy and intention to maintain sufficient weight.

RESULTS

Loss-framed messages elicited higher levels of self-efficacy than gain-framed messages, which led to higher intentions to reach or maintain sufficient weight. This study sheds light on the mediating role of self-efficacy.

CONCLUSIONS

The results suggest ways to improve the persuasiveness of prevention campaigns, thereby opening up further research avenues.

Do Framed Mental Health Messages on Social Media Influence University Students' Motivation for Physical Activity?

Message framing has been used as a strategy for promoting physical activity (PA) in university students, but the effectiveness of gain-framed (GF), or loss-framed (LF) messages is variable. This study aims to investigate the effects on motivation and PA behaviour of framed messaging on social media in university students. Gain- and loss-framed messages communicated the mental health outcomes of PA. A three-arm feasibility study (n = 148) collected pre-post intervention online questionnaire responses to assess motivation for PA, exercise, active travel, and PA levels, in response to the messaging intervention on Facebook. Both GF and LF messages effectively increased average motivation for PA in comparison to controls (GF by 0.3 (on a 7-point Likert scale), 9% [95% CI: 3–17%], p = 0.007, LF by 0.3, 10% [CI: 3–18%], p = 0.005). Average motivation for exercise increased in comparison to controls (GF by 0.6, 16% [95% CI: 6–26%], p = 0.001, LF by 0.5, 14.6% [95% CI: 5–26%], p < 0.001). Average motivation for active travel increased in comparison to controls (GF by 0.7, 18% [95% CI: 8–29%], p < 0.001, LF by 0.6, 19% [95% CI: 8–30%], p < 0.001). No meaningful differences between GF or LF messages were observed. Framed messages regarding mental health outcomes of PA delivered via social media could be effective for increasing PA motivation in university students. However, based on our results there is no gain- or loss-framed advantage.

African American Parents' Perceived Vaccine Efficacy Moderates the Effect of Message Framing on Psychological Reactance to HPV Vaccine Advocacy

This experiment assessed how the frame of promotional vaccine messages elicited psychological reactance differently for African American parents according to their level of perceived vaccine efficacy. We found that those with low perceived HPV vaccine efficacy experienced more psychological reactance in response to loss-framed messages compared to gain-framed messages, whereas message framing made little difference for those with high perceived HPV vaccine efficacy. In addition, the interaction between frame and perceived HPV vaccine efficacy indirectly affected parents' intentions to vaccinate their child for HPV via reactance. These results support current theorizing about framing effects under defensive message processing specifically as it applies to psychological reactance.

Biodiversity conservation cannot afford COVID-19 communication bungles

With COVID-19 (coronavirus disease 2019) dominating headlines, highlighting links between the pandemic and biodiversity may increase public awareness of the biodiversity crisis. However, ill-considered messages that frame nature as the problem rather than the solution could inadvertently propagate problematic narratives and undermine motivations and individual self-efficacy to conserve nature.

Connecting Social Psychology and Deep Reinforcement Learning: A Probabilistic Predictor on the Intention to Do Home-Based Physical Activity After Message Exposure

Previous research has shown that sending personalized messages consistent with the recipient's psychological profile is essential to activate the change toward a healthy lifestyle. In this paper we present an example of how artificial intelligence can support psychology in this process, illustrating the development of a probabilistic predictor in the form of a Dynamic Bayesian Network (DBN). The predictor regards the change in the intention to do home-based physical activity after message exposure. The data used to construct the predictor are those of a study on the effects of framing in communication to promote physical activity at home during the Covid-19 lockdown. The theoretical reference is that of psychosocial research on the effects of framing, according to which similar communicative contents formulated in different ways can be differently effective depending on the characteristics of the recipient. Study participants completed a first questionnaire aimed at measuring the psychosocial dimensions involved in doing physical activity at home. Next, they read recommendation messages formulated with one of four different frames (gain, non-loss, non-gain, and loss). Finally, they completed a second questionnaire measuring their perception of the messages and again the intention to exercise at home. The collected data were analyzed to elicit a DBN, i.e., a probabilistic structure representing the interrelationships between all the dimensions considered in the study. The adopted procedure was aimed to achieve a good balance between explainability and predictivity. The elicited DBN was found to be consistent with the psychosocial theories assumed as reference and able to predict the effectiveness of the different messages starting from the relevant psychosocial dimensions of the recipients. In the next steps of our project, the DBN will form the basis for the training of a Deep Reinforcement Learning (DRL) system for the synthesis of automatic interaction strategies. In turn, the DRL system will train a Deep Neural Network (DNN) that will guide the online interaction process. The discussion focuses on the advantages of the proposed procedure in terms of interpretability and effectiveness.

Proscriptive Injunctions Can Elicit Greater Reactance and Lower Legitimacy Perceptions Than Prescriptive Injunctions

Based on previous research investigating proscriptive injunctions (requesting that one should not do something) versus prescriptive injunctions (requesting that one should do something), we propose that proscription leads to greater reactance than does prescription for a range of actions, and that this effect is associated with lower perceived legitimacy of the injunction. Across five experimental studies, our student and general population samples received proscriptions or prescriptions and reported their reactance. Proscription led to greater reactance than did prescription in all five studies. This effect was accentuated by an authoritative source (Study 2), was mediated by the perceived legitimacy of the request (Study 3 and Study 4), and was attenuated by a self-affirmation intervention (Study 5). We suggest that proscriptions are viewed as more obligatory than prescriptions, limit the scope of behavioral alternatives, restrict perceived autonomy, and elicit greater reactance. The findings have implications for the design of effective persuasive communications.

An Experimental Evidence on Public Acceptance of Genetically Modified Food through Advertisement Framing on Health and Environmental Benefits, Objective Knowledge, and Risk Reduction

Owing to the emerging challenges on global food security and the decade of controversies over genetically modified food (hereafter GMF), the present study aims to explore the effects of advertisement framing on health and environmental benefits, sources of perceived risk reduction, and domain-specific knowledge on the acceptance of GMF. The study conducted a quasi-experimental factorial 2 (advertisement message framing: health vs. environmental benefits) × 2 (expert endorsement: present vs. absent) between-subject design involving 300 adult participants from Pakistan. Using a multi-group structural equation model, the four conditions were assigned to each participant group (n = 75) to test the hypothesized relationships. The quasi-experiment results suggested that the advertisement messages (ad-framed) incorporated with the health and environmental benefits, as delineated by experts, can be a viable communication strategy in developing effortless cognitive cues towards GMF acceptance. The pioneer findings validate the significant efficacy of advertisement messages (ad-framed with expert opinions) in reducing perceived risk through augmented objective knowledge that activates the mechanism of favorable development of attitude and acceptance of GMF. The study findings offer strategic directions to policymakers, marketers, and food technologists in raising greater awareness and acceptance towards GMF products.

Be Part of the Conversation: Audiology Messaging During a Hearing Screening

OBJECTIVES

The moment patients learn the results from a hearing assessment can be a critical juncture on their journey to rehabilitation. Message framing (e.g., the positive or negative manner in which information is presented) has been explored in a wide range of health contexts as a method for shaping patients' decision-making. This study investigated whether attitudes toward hearing loss treatment varied as a function of how messages about treatment were framed, and whether such attitudes differed as a function of participants being led to believe they had failed a hearing screening.

METHODS

Sixty-four participants (18 to 39 years of age) took the Hearing in Noise Test. In the sound booth, participants saw a poster bearing either a gain-framed or loss-framed message about hearing loss treatment. During the test, half the participants were interrupted by the researcher who stated that their performance appeared to suggest a hearing loss, with the caveat that it might be due to an equipment malfunction. While the researcher investigated the problem, the participants completed an 11-item questionnaire asking about their attitudes toward help seeking for hearing loss. Participants in the control group completed the same questionnaire with no interruption.

RESULTS

Statistical analyses revealed no significant interaction effect between message type and experimenter feedback condition, though a significant main effect was present for message type. Post hoc testing showed medium to large effect sizes as a function of message type on five of the 11-questionnaire items. These data indicated that participants were more likely to endorse health-positive responses (i.e., greater interest in hearing treatment) when exposed to the gain-framed message than the loss-framed message.

CONCLUSIONS

The greater likelihood of health-positive responses in the presence of the gain-framed message suggests that this framing strategy may have a positive influence on attitudes toward hearing health behaviors among individuals under 40 years of age with no history of hearing loss.

Effects of culturally targeted message framing on colorectal cancer screening among African Americans

OBJECTIVE

This study examined how standard and culturally targeted versions of gain and loss-framed messaging affect African Americans' colorectal cancer (CRC) screening receptivity and behavior, as well as their anticipation of experiencing racism in undertaking CRC screening.

METHOD

Screening-deficient African Americans (N = 457) viewed an informational video about CRC risks, prevention, and screening and were randomized to receive a gain or loss-framed message about screening. Half of participants viewed an additional culturally targeted message about overcoming racial disparities in CRC by obtaining screening. Using the Theory of Planned Behavior, we measured general receptivity to CRC screening. We also measured arousal of anticipatory racism in response to messaging. Finally, we offered participants a no-cost fecal immunochemical testing kit (FIT Kit) and measured uptake and use.

RESULTS

Message framing interacted with culturally targeted messaging to affect CRC screening receptivity and behavior. Participants were no more receptive to CRC screening when standard loss-framing was used, but were more favorable if loss-framing was culturally targeted. Targeted loss-framing also reduced anticipatory racism, which partially mediated effects on screening receptivity. Finally, although participants least often accepted a FIT Kit with standard loss-framing, effects of messaging on FIT Kit uptake and use were not significant.

CONCLUSION

This study adds to growing recognition of important cultural nuance in effective use of message framing. Current finding also suggest that targeted and framed messaging could synergistically impact the extent to which African Americans engage in CRC screening, although specific impacts on FIT Kit screening are less certain. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Going Green, but Staying in the Black: How Framing Impacts the Agreement With Messages on the Economic Consequences of Environmental Policies

Past research suggests that although citizens are generally favorable to pro-environmental policies, their negative economic impact can be a relevant source of concern. In two studies, we investigated the agreement with messages highlighting the positive vs. negative economic impact of a pro-environmental policy (the creation of a protected natural reserve in a lakeside area), as a function of the framing of the policy itself in terms of local relevance (Study 1) and environmental impact (Study 2). In Study 1, participants (N = 514) were citizens of different Italian regions. Results showed that reference to the local (vs. global) relevance of the proposed policy increased the tendency to agree with loss-framed (vs. gain-framed) messages on the economic impact of the policy. In Study 2, participants (N = 500) were a sample of actual lakeside residents from the Garda Lake area in Italy. Results showed that reading messages promoting the policy through stressing the negative consequences of not implementing it (vs. the positive consequences of implementing it) increased the tendency to agree with a subsequent loss-framed (vs. gain-framed) message on the economic impact of the policy. This effect was more evident among participants with stronger place identity. Discussion focuses on the relevance of framing and matching effects in devising persuasive messages on the environmental and economic impact of pro-environmental policies.

Communication Campaigns to Support the Use of Nutritional Warnings: Different Messages for Different People?

Communication campaigns are expected to contribute to increase the efficacy of nutritional warnings. In this context, the aims of the present work were (a) to evaluate how citizens perceive different types of messages for a communication campaign and (b) to determine if personal characteristics such as gender, age, and educational level, as well socioeconomic and nutritional status, moderate how citizens perceive such campaign messages. A series of graphic pieces were designed for each of the following three types of messages: promotion of informed food choices; raising awareness of the negative health consequences of excessive consumption of sugar, fat, and sodium; and promotion of healthy food choices. An online study was conducted with 774 participants, who were randomly assigned to one of the three types of messages. The participants' self-reported perception of the graphic pieces was evaluated using 7-point Likert-type scales. After completing the evaluation task, the participants proceeded to a series of choices. This was implemented to evaluate whether exposure to different types of messages affected hypothetical food choices. Results revealed that messages related to the promotion of healthy eating were perceived as the most adequate as part of a communication campaign and had the potential to encourage more healthful hypothetical choices in the experimental task. However, gender, age, and nutritional status moderated the influence of the type of message on the participants' perception, meaning that different groups perceived different types of messages as the most adequate. The results from the present work stress the need to include different types of messages in a communication campaign to target individuals with different motivations and characteristics.

A Cognitive-Emotional Model to Explain Message Framing Effects: Reducing Meat Consumption

We tested the plausibility of a cognitive-emotional model to understand the effects of messages framed in terms of gain, non-loss, non-gain, and loss, and related to the health consequences of red/processed meat consumption. A total of 544 Italian participants reported their attitude toward reduced red/processed meat consumption and intention to eat red/processed meat (time 1 questionnaire). One week later, participants were randomly assigned to four different message conditions: (a) gain messages focused on the positive health outcomes associated with low meat consumption; (b) non-loss messages focused on the avoided negative health outcomes associated with low meat consumption; (c) non-gain messages focused on the missed positive health outcomes associated with high meat consumption; (d) loss messages focused on the negative health outcomes associated with high meat consumption (message sending). After reading the messages, participants answered a series of questions regarding their emotional and cognitive reactions to the messages, their evaluation of the messages, and again their attitude and intention toward red/processed meat consumption (time 2 questionnaire). Comparing different multivariate linear models under the Bayesian approach, we selected the model with the highest plausibility conditioned to observed data. In this model, message-induced fear influenced systematic processing, which in turn positively influenced message evaluation and attitude, leading to reduced intention to consume red/processed meat. Vice versa, message-induced anger reduced systematic processing, which in turn negatively influenced message evaluation, and led to no effect on attitude and intention. The comparison among message conditions showed that gain and non-loss messages activated integrated emotional and cognitive processing of the health recommendation, while loss and non-gain messages mainly activated emotional shortcuts toward attitude and intention. Overall, these results advance our comprehension of the effects of message framing on receivers' attitudes and intentions.

Message Framing Effects on Individuals' Social Distancing and Helping Behavior During the COVID-19 Pandemic

This research responds to urgent calls to fill knowledge gaps on COVID-19 (new coronavirus) in communicating social distancing messages to the public in the most convincing ways. The authors explore the effectiveness of framing social distancing messages around prosocial vs. self-interested appeals in driving message compliance and helping behavior. The results show that when a message emphasizes benefits for everyone in society, rather than solely for the individual, citizens find the message more persuasive to engage in social distancing, and also more motivating to help others. The results further demonstrate that the proposed effects are higher for individuals who have a lower locus of control and lower fear of coronavirus as prosocial messages lead them to feel a joint responsibility in protecting from the pandemic. Theoretical and practical implications of the results are discussed.

How Framed Messages Influence Depression Assessment Intentions: Interactivity of Social Media as a Moderator

This study examines how the framing and interactivity of messages influence the intentions of individuals to take a depression assessment. An experiment with a 2 (message framing: gain-versus loss-) × 2 (interactivity: low versus high) between-subject design was conducted among 269 Chinese participants (M = 30.70, SD = 7.34). The results showed that those reading loss-framed messages had a higher intention to take a depression assessment compared to those reading gain-framed messages. Secondly, those reading messages delivered with high interactivity had a higher intention to take a depression assessment than those reading messages delivered with low interactivity. Further, the interaction effect of framed messages and their varying degrees of interactivity was found to influence the intentions of individuals to take a depression assessment as well. Specifically, participants who read the loss-framed message reported stronger intention in the high interactivity group. In contrast, there was no significant difference between the effectiveness of loss-framed and gain-framed messages in promoting the intention to take a depression assessment in the low interactivity condition.

Communication of health risk in substance-dependent populations: A systematic review of randomised controlled trials

ISSUES

Individuals with substance use problems are at greater risk of chronic diseases due to their unhealthy lifestyle behaviours (e.g. alcohol use, smoking, physical inactivity, poor nutrition). There is increasing evidence that health risk communication is crucial in improving risk perception and knowledge of chronic diseases, and both factors are associated with health behaviour change. The aim of this systematic review is to provide a comprehensive overview of the current state of evidence on health risk communication on people with substance use problems.

APPROACH

A systematic search identified peer reviewed studies from the databases MEDLINE, PsycINFO, CINAHL and Scopus. Data were extracted from the included studies and a narrative synthesis of the results was conducted.

KEY FINDINGS

Eight articles, representing five unique studies, were included in the review. The overall risk of bias of the included studies was considered to be low. The studies evaluated the use of message framing and personalised/customised recommendations across smoking cessation and patient engagement with methadone maintenance treatment. Results revealed that message framing, specifically gain-framed messages, had a positive impact on smoking cessation. Risk perception, sex and level of nicotine dependence were also found to be associated with smoking cessation.

IMPLICATIONS AND CONCLUSIONS

The limited number of studies provides preliminary evidence that health risk communication promotes smoking cessation. However, studies included in the review were characterised by heterogeneous methods and measures. Further investigation of health risk communication using adequately powered randomised controlled trial is warranted.

Information Safety Assurances Increase Intentions to Use COVID-19 Contact Tracing Applications, Regardless of Autonomy-Supportive or Controlling Message Framing

Promoting the use of contact tracing technology will be an important step in global recovery from the COVID-19 pandemic. Across two studies, we assessed two messaging strategies as motivators of intended contact tracing uptake. In one sample of 1117 Australian adults and one sample of 888 American adults, we examined autonomy-supportive and controlling message framing and the presence or absence of information safety as predictors of intended contact tracing application uptake, using an online randomized 2 × 2 experimental design. The results suggested that the provision of data safety assurances may be key in affecting people’s intentions to use contact tracing technology, an effect we found in both samples regardless of whether messages were framed as autonomy-supportive or controlling. Those in high information safety conditions consistently reported higher intended uptake and more positive perceptions of the application than those in low information safety conditions. In Study 2, we also found that perceptions of government legitimacy related positively to intended application uptake, as did political affiliation. In sum, individuals appeared more willing to assent to authority regarding contact tracing insofar as their data safety can be assured. Yet, public messaging strategies alone may be insufficient to initiate intentions to change behavior, even in these unprecedented circumstances.

Avoidance of tobacco health warnings? An eye-tracking approach

AIMS

Among three eye-tracking studies, we examined how cigarette pack features affected visual attention and self-reported avoidance of and reactance to warnings.

DESIGN

Study 1: smoking status × warning immediacy (short-term versus long-term health consequences) × warning location (top versus bottom of pack). Study 2: smoking status × warning framing (gain-framed versus loss-framed) × warning format (text-only versus pictorial). Study 3: smoking status × warning severity (highly severe versus moderately severe consequences of smoking).

SETTING

University of Bristol, UK, eye-tracking laboratory.

PARTICIPANTS

Study 1: non-smokers (n = 25), weekly smokers (n = 25) and daily smokers (n = 25). Study 2: non-smokers (n = 37), smokers contemplating quitting (n = 37) and smokers not contemplating quitting (n = 43). Study 3: non-smokers (n = 27), weekly smokers (n = 26) and daily smokers (n = 26).

MEASUREMENTS

For all studies: visual attention, measured as the ratio of the number of fixations to the warning versus the branding, self-reported predicted avoidance of and reactance to warnings and for study 3, effect of warning on quitting motivation.

FINDINGS

Study 1: greater self-reported avoidance [mean difference (MD) = 1.14; 95% confidence interval (CI) = 0.94, 1.35, P < 0.001, ηp2  = 0.64] and visual attention (MD = 0.89, 95% CI = 0.09, 1.68, P = 0.03, ηp2  = 0.06) to long-term warnings, but not for reactance (MD = 0.14, 95% CI = -0.04, 0.32, P = 0.12, ηp2  = 0.03). Increased visual attention to warnings on the upper versus lower half of the pack (MD = 1.8; 95% CI = 0.33, 3.26, P = 0.02, ηp2  = 0.08). Study 2: higher self-reported avoidance of (MD = 0.70; 95% CI = 0.59,0.80, P < 0.001, ηp2  = 0.61) and reactance to (MD = 0.37; 95% CI = 0.27, 0.47, P < 0.001, ηp2  = 0.34) loss-framed warnings but little evidence of a difference for visual attention (MD = 0.52; 95% CI = -0.54, 1.58, P = 0.30, ηp2  = 0.01). Greater visual attention, avoidance and reactance to pictorial versus text-only warnings (all Ps < 0.001, ηp2  > 0.25). Study 3: greater self-reported avoidance of (MD = 0.37; 95% CI = 0.25, 0.48, P < 0.001, ηp2  = 0.33) and reactance to (MD = 0.14; 95% CI = 0.05, 0.23, P = 0.003, ηp2  = 0.11) highly severe warnings but findings were inconclusive as to whether there was a difference in visual attention (MD = -0.55; 95% CI = -1.5, 0.41, P = 0.24, ηp2  = 0.02).

CONCLUSIONS

Subjective and objective (eye-tracking) measures of avoidance of health warnings on cigarette packs produce different results, suggesting these measure different constructs. Visual avoidance of warnings indicates low-level disengagement with warnings, while self-reported predicted avoidance reflects higher-level engagement with warnings.

Pediatrician Delivered Smoking Cessation Messages for Parents: A Latent Class Approach to Behavioral Phenotyping

OBJECTIVE

Message framing can be leveraged to motivate adult smokers to quit, but its value for parents in pediatric settings is unknown. Understanding parents' preferences for smoking cessation messages may help clinicians tailor interventions to increase quitting.

METHODS

We conducted a discrete choice experiment in which parent smokers of pediatric patients rated the relative importance of 26 messages designed to increase smoking cessation treatment. Messages varied on who the message featured (child, parent, and family), whether the message was gain- or loss-framed (emphasizing benefits of engaging or costs of failing to engage in treatment), and the specific outcome included (eg, general health, cancer, respiratory illnesses, and financial impact). Participants included 180 parent smokers at 4 pediatric primary care sites. We used latent class analysis of message ratings to identify groups of parents with similar preferences. Multinomial logistic regression described child and parent characteristics associated with group membership.

RESULTS

We identified 3 groups of parents with similar preferences for messages: Group 1 prioritized the impact of smoking on the child (n = 92, 51%), Group 2 favored gain-framed messages (n = 63, 35%), and Group 3 preferred messages emphasizing the financial impact of smoking (n = 25, 14%). Parents in Group 2 were more likely to have limited health literacy and have a child over age 6 and with asthma, compared to Group 1.

CONCLUSIONS

We identified 3 groups of parent smokers with different message preferences. This work may inform testing of tailored smoking cessation messages to different parent groups, a form of behavioral phenotyping supporting motivational precision medicine.

Using behavioral economics to promote advanced directives for end of life care: a national study on message framing

Advance directives (AD) are a crucial method for individuals to communicate their directions regarding medical decisions to their families and health care professionals when they are no longer able to make these decisions for themselves. However, not many individuals have an AD. We present the results of a survey-based experiment on how message framing (positive, negative and social norm) in educational videos affects (a) the individual's decision to acquire more information about an AD and (b) the change in stated likelihood of obtaining an AD. Our message framing is centered on the family burden aspect of end-of-life care. We also survey participants about which type of framing they view as more persuasive in terms of obtaining an AD. We find that participants who watched the negative framed video were more likely to request more information about ADs. However, for those who had not sought information on ADs prior to the study, positive framing has a small positive impact on the approximate change in stated likelihood of obtaining an AD. On average, positive framing is perceived as more convincing to obtain an AD. Ranking the positive framed video as first or second in terms of convincingness is correlated with self-reported creation of an AD, whereas ranking the negative framed video as first or second is correlated with not creating an AD.

Uruguayan Citizens' Perception of Messages to Promote Healthy Eating Through the Use of Nutritional Warnings

OBJECTIVE

To explore the specific type of messages people consider most appropriate for a mass communication campaign aimed to promote healthy eating in the context of the implementation of nutritional warnings.

DESIGN

Online study including multiple-choice and open-ended questions.

SETTING

Uruguay, 1 of the Latin American countries with the highest prevalence of overweight and obesity.

PARTICIPANTS

A total of 859 participants were recruited using social media. They were diverse in terms of gender, age, educational level, socioeconomic status, and self-reported body mass index.

PHENOMENON OF INTEREST

Participants were presented with 3 series of messages and were asked to select the 1 they perceived as the most appropriate and to provide a brief explanation for their selection.

ANALYSIS

Descriptive statistics for the multiple-choice questions and inductive coding for the responses to the open-ended questions.

RESULTS

Participants tended to prefer messages that conveyed a cue to action for achieving changes to their perceived ability to make healthful food choices. Although messages related to the promotion of informed food choices were the most frequently preferred, messages related to negative health consequences and health benefits were also selected repetitively.

CONCLUSIONS AND IMPLICATIONS

Communication campaigns aimed at promoting healthy eating through the use of nutritional warnings could include different contents to target specific segments with different motivations.

Education and Message Framing Increase Willingness to Undergo Research Lumbar Puncture: A Randomized Controlled Trial

Reluctance to undergo lumbar puncture (LP) is a barrier to neurological disease biomarker research. We assessed whether an educational intervention increased willingness to consider research LP and whether message framing modified intervention effectiveness. We randomly assigned 851 recruitment registry enrollees who had previously indicated they were unwilling to be contacted about studies requiring LP to gain or loss framed video educational interventions describing the procedure and the probability of experiencing adverse events. The gain framed intervention emphasized the proportion of individuals free of adverse events; the loss frame emphasized the proportion experiencing adverse events. The primary outcome for the study was the participant's post-intervention agreement to be contacted about studies requiring LP. Participants were mean (SD) age 60.1 years (15.7), 69% female (n = 591), and mostly college educated and white. Among the 699 participants who completed the study, 43% (95% CI: 0.39, 0.47; n = 301) changed their response to agree to be contacted about studies requiring LP. We estimated that participants randomized to the gain framed intervention had 67% higher odds of changing their response compared to those randomized to the loss frame (Odds Ratio = 1.67; 95% CI: 1.24, 2.26; p < 0.001). A classification and regression tree model identified participants' pre-intervention willingness as the strongest predictor of changing response. Education, in particular education that alerts participants to the probability of not experiencing adverse events, may be an effective tool to increase participation rates in research requiring LP.

A smoker's choice? Identifying the most autonomy-supportive message frame in an online computer-tailored smoking cessation intervention

OBJECTIVE

To test the effect of autonomy-supportive message framing on people's perceived autonomy-support while considering the individual need for autonomy as a moderator. Also, to test whether autonomy-supportive message frames - through increased perceived autonomy-support - lead to more self-determined motivation, and increased intention to quit smoking.

DESIGN

An online 2(autonomy-supportive; controlling language) × 2(choice; no choice) between-subjects design with control condition (generic advice) with adult smokers intending to quit (N = 626).

MAIN OUTCOME

Intention to quit smoking (Theory of Planned Behaviour).

MEASURES

Perceived autonomy-support (Virtual Climate Care Questionnaire), need for autonomy (Health Causality Orientations Scale), self-determined motivation (Treatment Self-Regulation Questionnaire), attitudes, social influence, self-efficacy (I-Change Model).

RESULTS

Structural equation modelling revealed no significant effect of autonomy-supportive-message frames on perceived autonomy-support or self-determined motivation, neither did the need for autonomy moderate these effects. Self-determined motivation had a positive, significant effect on intention to quit, mediated by attitudes, social influence, and self-efficacy.

CONCLUSION

Although message frames did not affect perceived autonomy-support or self-determined motivation, higher self-determined motivation increased intention to quit via attitudes, social influence, and self-efficacy. Before drawing the conclusion that message framing has no effect, we recommend to replicate this study in a real-life setting with smokers more likely to read and process the message frames more attentively.

Incorporating Message Framing into Narrative Persuasion to Curb E-Cigarette Use Among College Students

This study examines the interaction effect of message format (narrative vs. nonnarrative) and message framing (gain vs. loss) in e-cigarette prevention targeting young adults. Results of a two-way experiment (N = 439) revealed that transportation and discrete emotions mediated message effect on risk perception and behavioral intention. Compared to the gain-framed nonnarrative, the gain-framed narrative reduced feelings of guilt, and guilt was negatively related to risk perception and positively related to behavioral intention. Thus, the gain-framed narrative achieved desirable persuasive outcome through guilt-increasing risk perception and decreasing intention to use e-cigarette. Similarly, the loss-framed narrative evoked greater sadness, which also led to increased risk perception and decreased behavioral intention. Transportation and discrete emotions mediated message effect in a serial order. This research not only contributes to the literature on narrative persuasion and emotion, but also provides insight for health communication designed for e-cigarette prevention.