Implications For Message Design Research Articles

The Effects of Fear and Shame in Health Testimonial Videos on Identification and Health Beliefs

Abstract: Two online experiments (Study 1 N = 310; Study 2 N = 967) using video testimonials manipulated the degree of fear and shame experienced by viewers by varying the degree of risk and stigma associated with the illnesses endured by the protagonists. Results showed that increasing risk and stigma intensified identification, which in turn affected story-consistent beliefs. Trait empathy, expected to increase identification did not predict higher identification. Both studies, using different videos depicting different illnesses, found similar results suggesting a general pattern. Results are discussed in the context of persuasion theory and implications for message design are suggested.

How Emotional Shifts Effect Youth Perceptions of Opioid Risk and Efficacy: Testing a Know the Truth Campaign Narrative

ABSTRACT Integrating the extended parallel process model (EPPM) and the emotional flow hypothesis, we tested the persuasive effect of emotional shifts during exposure to a Know the Truth anti-opioid campaign narrative in a sample of middle-school students (n = 480). Testing two emotional flow sequences (threat to efficacy and efficacy to threat) of the Know the Truth narrative against a static (threat-only) emotional condition, we found that youth exposed to any emotional flow narrative reported higher levels of hope and lower levels of fear than those exposed to a threat-only narrative. We also found that a threat to efficacy narrative elicited higher levels of self-efficacy than an efficacy to threat emotional flow condition, suggesting that the emotional sequence influences self-efficacy, a well-established predictor of health behavior change. We conclude that the traditional threat to efficacy emotional flow may be superior to its inverse (efficacy to threat) when communicating with young people about opioid addiction. Implications for message design are discussed.

On the Influence of Message/Audience Specifics and Message Appeal Type on Message Empowerment: The Austrian Case of COVID-19 Health Risk Messages

ABSTRACT A pandemic is a unique form of health crisis that requires intensive communicative efforts. In order to achieve positive health outcomes, messages need to be carefully designed. In this context, both message specifics and audience specifics receive consideration. This research tries to scrutinize (1) which message appeal (emotional vs. informative) is perceived more favorable by the Austrian public, (2) which message appeal (emotional vs. informative) leads to a higher degree of message empowerment, and (3) the degree to which message empowerment can be enhanced by (a) message specifics and (b) a combination of message and audience specifics. A quantitative survey with 337 Austrians revealed that the emotional appeal message led to a higher degree of message empowerment than the informative appeal message. Moreover, only message specifics were found to enhance message empowerment. Implications for message design are derived, before limitations and directions for future research are addressed.

Extending Efforts to Move Cigarette and e-Cigarette Beliefs: Message Exposure and Belief Structures

This study examines message exposure and belief structures in the context of tobacco prevention and education efforts. Though it is imperative that researchers identify and test messaging strategies that move beliefs in the desired direction, these efforts must take care to consider the existing belief structures of the target audience. A pretest-posttest design was employed in order to extend an existing tobacco-free initiative. The study examined how participants structured their beliefs about tobacco and the initiative at the first time point (T1: N = 404) and tested the impact of persuasive messages at a second time point (T2: N = 192). The findings indicated that while one message produced change in a targeted norms-oriented belief, a constellation of messages hold promise for modifying a broader belief structure. The results are discussed in terms of their implications for message design and tobacco-free initiatives.

Examining the Effectiveness of a Fear Appeal Message Regarding Calling While Driving: The Role of Perceived Behavioral Control and Subjective Social Norms

Based on the Extended Parallel Process Model, the authors explored the effects of a fear appeal message on people’s fear arousal, attitude and intention regarding calling while driving. Participants (N=200) were randomly assigned to either treatment group or control group. Treatment group were exposed to a full appeal message with both threat and efficacy components, whereas control group were exposed to the same message but without the efficacy component. All participants then completed a questionnaire measuring threat perceptions, fear arousal, attitude, and behavioral intention. Participants in treatment group also reported efficacy perceptions, subjective social norm, and perceived behavioral control. The treatment group reported higher level of advocated attitude and intention regarding calling while driving compared with the control group. It was also found that subjective social norm moderated the effects of perceived susceptibility on attitude. Efficacy beliefs led to future behavioral intention, mediated by perceived behavioral control. Implications for message design are discussed.

Theory-Based Formative Research on an Anti-Cyberbullying Victimization Intervention Message

Cyberbullying is a common byproduct of the digital revolution with serious consequences to victims. Unfortunately, there is a dearth of empirically based methods to confront it. This study used social cognitive theory to design and test an intervention message aimed at persuading college students to abstain from retaliation, seek social support, save evidence, and notify authorities—important victim responses identified and recommended in previous research. Using a posttest-only control group design, this study tested the effectiveness of an intervention message in changing college students’ perceived susceptibility to and perceived severity of cyberbullying as well as their self-efficacy, response efficacy, attitudes, and behavioral intentions toward each recommended response in future episodes of cyberbullying. Results indicated that the intervention message caused participants in the experimental condition to report significantly higher susceptibility, but not perceived severity, to cyberbullying than those in the control condition. The intervention message also caused expected changes in all outcomes except self-efficacy for not retaliating and in all outcomes for seeking social support, saving evidence, and notifying an authority. Implications for message design and future research supporting evidence-based anti-cyberbullying health communication campaigns are discussed.

The Moderated Influence of Perceived Behavioral Control on Intentions Among the General U.S. Population: Implications for Public Communication Campaigns

This study reports results from a large population-based survey of U.S. adults showing perceived behavioral control (PBC) moderations of associations between (a) attitude and intention and (b) perceived norms and intention to engage in 6 health behaviors. Results are based on data collected from a nationally representative sample of U.S. adults ages 40–70 (N = 2,489) and extend understanding of how behavioral theory can be used to guide the design and evaluation of health communication campaigns. Ordinary least squares regression analyses show evidence of a significant positive PBC moderation of (a) attitude and intention and (b) perceived norms and intention such that attitude or perceived norms toward the behavior is more strongly associated with behavioral intention among participants reporting higher levels of PBC. Implications for message design and the evaluation of communication campaigns are discussed.

Narrator Point of View and Persuasion in Health Narratives: The Role of Protagonist–Reader Similarity, Identification, and Self-Referencing

Narratives are often used in messages about health threats. We posited that a 1st-person point of view (POV) narrative would have a greater effect than a 3rd-person POV on the mediators identification and self-referencing—an effect moderated by protagonist–reader similarity. Higher levels of identification and self-referencing were expected to elevate susceptibility and severity perceptions, leading to persuasion. Participants ages ≤30 years were recruited from a crowdsource website and randomly assigned to read one version of a faux magazine article about caffeine overdose. Article versions were defined by a 2 (1st- or 3rd-person POV) × 2 (similar or dissimilar protagonist) design. To manipulate similarity, we had respondents read an article in which the protagonist was also young (24 years of age) and of the same sex or much older (54 years of age) and of the opposite sex. Participants then completed a questionnaire measuring study variables. Contrary to expectations, POV did not affect identification or self-referencing. However, similarity directly impacted identification, which in turn influenced severity perceptions. Self-referencing was not affected by the experimental manipulations but had a direct effect on susceptibility and also mediated the identification → susceptibility relationship. Susceptibility and severity perceptions were associated with greater levels of persuasion. Implications for message design are discussed.

Identity as a Moderator and Mediator of Communication Effects: Evidence and Implications for Message Design

ABSTRACTAdvertisements, movies, and other forms of media content have potential to change behaviors and antecedent psychological states by appealing to identity. However, the mechanisms that are responsible for persuasive effects of such content have not been adequately specified. A recently proposed model of communication effects (the prism model) advances the study of mechanisms and argues that identity can serve as both a moderator and mediator of communication effects on behavior-relevant outcomes. These intervening roles are made possible by the complex nature of identity (including multiple self-concepts and sensitivity to cues) and messages that cue the importance of and activate particular self-concepts. This article builds on development of the model by presenting empirical support based on re-analysis of an experiment in which participants viewed either a more-stigmatizing or less-stigmatizing portrayal of a recovering drug addict. In line with the model's propositions, exposure to the less-stigmatizing condition led to increases in perspective taking which then led to more acceptance (mediation by identity), while level of perspective taking also changed the effect of condition on acceptance (moderation by identity). These results provide support for the model's proposition of simultaneous intervening roles. The authors discuss implications for strategic communication research and practice.

Persuasive Effects of Linguistic Agency Assignments and Point of View in Narrative Health Messages About Colon Cancer

The authors explored the effects of linguistic agency and point of view on narrative force. Participants (N = 499) were randomly assigned to read one version of an article about colon cancer, defined by a 2 (disease agency: cancer, human) × 2 (temporal agency: death, human) × 2 (point of view: first person, third person) between-subjects design. Disease agency language assigned agency to cancer (e.g., “Cancer developed in me”) or to humans (e.g., “I developed cancer”). Temporal agency language described death as approaching humans (e.g., “as death closes in on patients) or as being approached by humans (e.g., “as patients close in on death”). The narrative was presented from the first-person singular or third-person plural viewpoint. Participants then completed a questionnaire measuring threat perceptions, efficacy, transportation, and other study variables. Language assigning agency to humans rather than to cancer elevated susceptibility beliefs. Death-approach language led to greater fear than human-approach language without impacting efficacy perceptions. Human-approach language was rated more persuasive than death-approach language, but only in first-person point-of-view narratives. Transportation and identification were positively associated with ratings of threat severity and susceptibility, fear, efficacy, behavioral intentions, and message persuasiveness. Implications for message design are discussed.

Perceptions of Oral Health in Appalachian Kentucky: Implications for Message Design

We conducted three studies to investigate Appalachian college students’ perceptions and behavior concerning oral health for the purpose of identifying salient factors to consider in designing persuasive messages to promote oral health. In Study 1, we conducted seven focus groups with 67 college students at a state university in Appalachian Kentucky. Using thematic analysis, we found that students based their oral health behavior on the perception that people living in Appalachia have poor oral health and that students denied, confirmed, reframed, or fulfilled this “misconception.” In Study 2, quantitative results from a representative survey of students (N = 587) at the same university indicated that the barriers to enacting good oral health behavior were primarily logistical in nature, whereas the facilitators of good oral health behavior were largely social. In Study 3, results from dental screenings (N = 364) of students at the university demonstrated that about one in five students presented with active, visible decay. We discuss how these results inform our understanding of oral health behavior in Appalachia and the implications of these results for designing messages to promote oral health in the region.

Using the Integrative Model of Behavioral Prediction to Identify Promising Message Strategies to Promote Healthy Sleep Behavior Among College Students

This research used the Integrative Model of Behavioral Prediction (IMBP) to examine cognitive predictors of intentions to engage in healthy sleep behavior among a population of college students. In doing so, we identify promising message strategies to increase healthy sleep behavior during college. In Phase 1, members of a small sample of undergraduates (n = 31) were asked to describe their beliefs about expected outcomes, norms, and perceived behavioral control associated with sleep on an open-ended questionnaire. We analyzed these qualitative responses to create a closed-ended survey about sleep-related attitudes, perceived norms, control beliefs, behavioral intentions, and behavior. In Phase 2, a larger sample of undergraduate students (n = 365) completed the survey. Attitudes and perceived behavioral control were the strongest predictors of both intentions to engage in sleep behavior and self-reported sleep behavior. Control beliefs associated with time management and stress also had substantial room to change, suggesting their potential as message strategies to better promote healthy sleep behavior in college. We conclude with a broader discussion of the study’s implications for message design and intervention.

Comparing Effects of “My Anti-Drug” and “Above the Influence” On Campaign Evaluations and Marijuana-Related Perceptions

Two national campaigns—My Anti-Drug and Above the Influence—have been implemented to prevent youth substance use. Although Above the Influence was conceptualized as a major shift in messaging from My Anti-Drug, no studies have reported head-to-head tests of message effects on behavior-relevant outcomes. An experiment was conducted in which participants viewed ads from one of the campaigns and answered questions about ad appeal and emotional tone; campaign appeal; and marijuana-related beliefs. Compared to My Anti-Drug ads, Above the Influence ads were associated with more positive emotional tone and with lower perceptions of marijuana risk. Implications for message design and evaluation are discussed.

An Application of the Integrative Model to Women's Intention to Be Vaccinated Against HPV: Implications for Message Design

Human papillomavirus (HPV) is the only definitively identified causal agent of cervical cancer. Given the availability of a vaccine that is effective against the two strains of HPV most commonly associated with cervical cancer, understanding the factors that influence women's decision to be vaccinated is crucial to uptake. Fishbein's (2000) integrative model of behavior provided theoretical guidance for a Web-based survey of college women (n = 174). Taken together, attitude, subjective norm, and perceived control predicted intention to vaccinate at R = .83, with attitude being the strongest single predictor by a factor of 2. However, attitude and subjective norm interacted with perceived control such that both were more potent predictors of intention at higher levels of control. These results suggest modification of the integrative model. Attention to the beliefs that underlie attitude revealed that the best candidates for change were feelings of security regarding future health and certainty that the vaccine will provide protection. The findings are discussed in terms of their implications for health education.

The Effect of Distressing Imagery on Attention to and Persuasiveness of an Antialcohol Message

Distressing imagery may inhibit health communications by inducing audiences to reduce distress by avoiding attention to persuasive messages. This study used eye-tracking methods to compare gaze time allocated to a persuasive textual message, accompanied by either distressing high-resolution color images or less distressing two-color images with degraded outline and detail. Participants in the distressing images condition showed lower intentions to reduce drinking in the following 3 months, which may have been mediated by lower gaze time to textual elements of the message. The effect was stronger in participants who both scored lower on dispositional mental disengagement and were more vulnerable to alcohol-related problems. These findings suggest that distressing imagery may inhibit persuasion by reducing audience attention to message components. Implications for message design are discussed.

The Impact of Attitude Accessibility and Decision Style on Adolescents' Biased Processing of Health-Related Public Service Announcements

This article examines how cognitive structures and processes that highlight some aspects of messages but inhibit the salience of others affect adolescents' processing of public service announcements (PSAs). The cognitive structures assessed were attitude accessibility and decision styles (need for cognition and faith in intuition). A 2 (gender: male vs. female) × 2 (race: Caucasian vs. African American) × 4 (message type) mixed design with message type as a within-subjects factor was utilized. Three hundred twenty-five teens ( M age = 14.97) were randomly assigned to view one PSA of each type, presented in a random order. Multilevel modeling analyses showed that attitude accessibility and need for cognition interact with attitude to affect adolescents' biased processing while faith in intuition negatively predicts perceived message bias. Race and gender were also significant predictors of perceived message bias. Implications for message design and health communication are discussed.

Believing in both genetic determinism and behavioral action: a materialist framework and implications

A disparity exists between studies reporting that genetics discourse produces deterministic or fatalistic responses and studies reporting that the majority of laypeople do not hold or adopt genetically deterministic views. This article reports data from an interview study ( n = 50), and an interpretation of those data grounded in materialist understandings of discourse, that explains at least part of the disparity. The article employs a detailed reading of an illustrative transcript embedded in a quantitative content analysis to suggest that laypeople have incorporated two sets of public discourses—one that describes genetic causation and another that describes behavioral causation. These different discourse tracks are presumed to be encoded in different sets of neural networks in people’s minds. Consequently, each track can be articulated upon proper cueing, but the tracks are not related to each other to produce a discourse for speaking about gene—behavior interactions. Implications for the effects of this mode of instantiation of discourse in human individuals with regard to genes and behavior are discussed, as well as implications for message design.

Subjective Knowledge and Fear Appeal Effectiveness: Implications for Message Design

This research investigates the role of perceived health knowledge on the effectiveness of fear-based persuasive appeals. Undergraduates (N = 263) read a strong fear, weak fear, or efficacy-only message encouraging breast or testicular self-examination. As expected, results indicated that men high in subjective knowledge were less reactant and more persuaded by the efficacy-only message whereas those low in subjective knowledge did not evidence this pattern. Contrary to expectation, women high in subjective knowledge had comparable reactions to each of the 3 messages. Implications for fear appeal theory and message design are discussed.

Adolescent Girls' Perceptions of Smoking Risk and Protective Factors: Implications for Message Design

ABSTRACT Using a snowball technique, in-depth interviews were conducted with 108 girls emanating from seven demographically dissimilar social networks. Girls were asked to classify 58 items as either a risk or protective factor for smoking initiation and then to assign an importance weighting to each. All items except one (worries about her weight) were clearly categorized as risk or protective; mean levels of agreement were 80.8% for perceived risk items and 92.6% for perceived protective items. Principal components analysis (PCA) of the weights given to the perceived risk items found that 28 items loaded on seven factors (social, affect, access, media, offers, family, and image) and explained 71.26% of the variance. PCA of 25 protective items revealed four factors (health, family, looks, and barriers) that explained 73.35% of the variance. Significant group differences on the importance weights were found, primarily by school (public or private), age (12–14 years or 15–16 years), having a friend who smokes (yes or no), and having tried smoking (yes or no). These group differences support the idea of having a broader array of antismoking messages for adolescent girls so that important subgroups can be targeted. Additional results support the position of developing antismoking messages with positive, affirming themes.

Integrating Personality and Psychosocial Theoretical Approaches to Understanding Safer Sexual Behavior: Implications for Message Design

The purpose of this study was to propose and conduct tests of a multivariate model of condom use utilizing data from 2 independent samples of young adults (City 1, N = 746; City 2, N = 743). The model examined the relations between personality characteristics, including sexual sensation seeking and sexual impulsive decision making; psychosocial variables, including condom attitudes, norms, and self-efficacy; and condom use behaviors, including carrying, communicating about, and using condoms. Structural equation modeling analyses indicated a good fit for both models (Confirmatory Fit Index =. 93; Average Absolute Standardized Residuals =. 05 for both), with each explaining 25% of the variance (R 2 =. 25) in condom use behaviors. Results support the fusion of personality and psychosocial approaches to gain a broader theoretical understanding of condom use in young adults. In addition, those developing and implementing health communication campaigns may find sexual sensation seeking and sexual impulsive decision making to be fruitful variables on which to target messages aimed at increasing safer sexual behavior.