Message Recall Research Articles

Participation in a Nutrition Education and Demonstration Program in Rural Senegal Is Associated with Higher Household Dietary Diversity

Abstract Objectives We conducted a non-randomized evaluation of a nutrition education program delivered by Soins de Santé Primaire in rural Senegal to identify the impact of participation on household dietary diversity scores (HDDS). We also sought to understand participant's perceptions of program strengths and weaknesses. Women participated in a single education session that emphasized hygiene, selecting from a variety of food groups, risk awareness of diet-related non-communicable diseases, and a recipe demonstration of a locally-sourced, balanced meal. We hypothesized that program participation would be associated with increased HDDS. Methods We surveyed 20 female program participants sampled from two communities and compared their responses with 20 women sampled from two non-intervention communities (n = 40). Surveys collected 24-hour dietary recall to calculate a dietary diversity score using the 12-point HDDS scale. The mean difference in HDDS was evaluated between post-program and comparison groups using linear regression. Models controlled for household size, employment, education, marital status, and the Food Insecurity Experience Scale. We conducted key informant interviews with post-program participants (n = 19) to understand message recall, reported behavior change, and feedback for future sessions. Results Women in intervention households reported higher HDDS than comparison households [Mean (SE) = 9.0 (0.39) vs. 7.65 (0.24), P = .003]. In the adjusted model, program participation was positively associated with HDDS (β = 1.16, P = .041). Household food insecurity was associated with lower HDDS (β = −0.52, P = .024). Program participants recalled the importance of reducing bouillon cube usage and eating from each food group. Participants reported changes in food preparation and hygiene routines, such as adding more beans or vegetables and changing dirty dishwater often. The key improvement suggestion was to increase session frequency and expand education on hygiene and sanitation. Conclusions Low intensity nutrition education programs that include meal demonstrations may be a low-cost, effective method for improving dietary diversity among a population with moderate food insecurity in rural Senegal. Funding Sources World Renew, Services Luthériens pour le Developpement au Sénégal, and the Wheaton Human Needs and Global Resources Program.

Children’s learning from a Smokefree Sports programme: Implications for health education

Objective: This article reports on a qualitative evaluation of the Love Life, Smokefree Sports primary school pilot intervention. This 8-week programme used sports and physical activity sessions to convey Smokefree messages to 120 children aged 10 and 11 in two primary schools in Sheffield in 2018. The study aimed to understand children’s experiences of participating in the programme. Its objectives were to explore children’s recall of the health promotion messages associated with each of the learning sessions; explore children’s perceptions of the meaningfulness of those messages in the context of their everyday lives; and identify and understand any contextual factors that might impact upon children’s recall and/or the meaningfulness of the Smokefree messages. Method: Qualitative data were generated with 25 children through focus groups after the programme concluded. Data were analysed thematically using cross-sectional, categorical indexing. Results: Learning from the programme was particularly likely to be described as meaningful by children when they could interact with material and visual representations of complex ideas and when sessions involved strongly embodied experiences. However, children did not always find it easy to relate learning to their everyday lives and sometimes struggled to reconcile pre-existing, contextualised understandings with intervention messages. We mobilise the concept of critical health literacy as a theoretical lens through which to interpret these findings. Conclusion: Health education should be meaningful in the context of children’s everyday lives. Starting from the premise that children are active critical health literacy practitioners and working with them to design and evaluate health education initiatives can promote this.

Preventing Child Sexual Abuse Using Picture Books: The Effect of Book Character and Message Framing

ABSTRACTThe aim of this study was to investigate whether and how a picture book preventing child sexual abuse can improve children’s self-protection skills. The study was conducted in China with Chinese children. In a 2 × 2 between-subjects design, character in the book (human versus animal) and message framing (gain versus loss) were manipulated. Compared to a baseline group who were not exposed to the prevention book, children in the experimental groups significantly enhanced their ability to recognize a potential abuse situation and refuse an inappropriate touch request. Results suggest that the prevention picture books are more effective when using a human character and a gain-framed message. The explanation for this was that human characters simulated children’s perceived norm and gain-framed messages increased children’s message recall, perceived self-efficacy and positive attitude toward the message, all of which in turn positively affected children’s self-protection skills.

Message-Elicited Brain Response Moderates the Relationship Between Opportunities for Exposure to Anti-Smoking Messages and Message Recall

Campaign success is contingent on adequate exposure; however, exposure opportunities (e.g., ad reach/frequency) are imperfect predictors of message recall. We hypothesized that the exposure-recall relationship would be contingent on message processing. We tested moderation hypotheses using 3 data sets pertinent to "The Real Cost" anti-smoking campaign: past 30-day ad recall from a rolling national survey of adolescents aged 13-17 (n = 5,110); ad-specific target rating points (TRPs), measuring ad reach and frequency; and ad-elicited response in brain regions implicated in social processing and memory encoding, from a separate adolescent sample aged 14-17 (n = 40). Average ad-level brain activation in these regions moderates the relationship between national TRPs and large-scale recall (p < .001), such that the positive exposure-recall relationship is more strongly observed for ads that elicit high levels of social processing and memory encoding in the brain. Findings advance communication theory by demonstrating conditional exposure effects, contingent on social and memory processes in the brain.

핵심정보 중심 건강 메시지가 메시지 수용 및 건강증진 의도에 미치는 효과

Objectives: Building upon from the Fuzzy Trace Theory, this study aimed to examine the effects of gist-based health messages on message reception and behavioral intention. Methods: We conducted online experiments employing 2 by 2 between-subject design with 451 adults in 20s in the context of sugar overconsumption. We performed analysis of variance and multiple regressions to test the effects of message features on participants’ message recall and interpretation, risk perception, self-efficacy, and behavioral intention, as well as their interaction effects with participants’ thinking style. Results: Overall, exposure to gist-based messages was likely to increase message recall and interpretation. There were some noteworthy interaction effects between message exposure and participants’ thinking style on outcome variables. Conclusions: These findings suggest that more efforts be made to develop effective gist-based health messages and invite further research for empirical evidence.

Narrative Styles and Narratology Formats in PSAs: Assessing the Effects on Arousal, Attention, and Memory

The following study aims to advance knowledge about the effects of narration and point-of-view formats on attention, arousal, and recall for persuasive messages relayed in public service announcements (PSAs). The experiment combines two frameworks, narratology and valence, to expose subjects to 12 different PSAs concerning the topic of animal abuse. Both psychophysiological data and self-report measures were analyzed to determine if three formats of narratology regarding point-of-view (no vocal POV vs. first-person vs. third-person) with two valences (positive vs. negative) have an effect on arousal, as indicated by skin conductance; attention, as indicated by heart rate and memory, and recall as indicated by a posttest unaided recall. The findings contribute toward understanding the emotional and cognitive effects that stimuli have on arousal, attention, and memory.

Baseline assessment of noticing e-cigarette health warnings among youth and young adults in the United States, Canada and England, and associations with harm perceptions, nicotine awareness and warning recall.

Health warnings on tobacco products can inform users of potential risks. However, little is known about young people's exposure to health warnings on e-cigarette products. This baseline assessment of young people's noticing e-cigarette warnings uses nationally representative data from three countries.Data were collected under Wave 1 of the ITC Youth Tobacco and E-cigarette Survey, conducted in Canada, England, and the US. Online surveys were completed by 16–19-year-olds in July/August 2017 (n = 12,064), when warnings were either newly required (England) or voluntarily carried by some manufacturers (US, Canada). Analyses examined prevalence and correlates of noticing warnings and associations between noticing warnings and product perceptions, adjusting for country, sex, age, race/ethnicity, and cigarette/e-cigarette use status.About 12% reported noticing warnings on e-cigarette packaging in the past 30 days. Noticing warnings was significantly more likely among youth in England (AOR = 1.3, p < .01) and the US (AOR = 1.3, p < .01) versus Canada, and was most likely among dual e-cigarette/cigarette users (AOR = 4.69, p < .001) versus nonusers. Unaided recall of the keyword “nicotine” was low among those who noticed warnings (7.5%). However, ever e-cigarette users who noticed warnings had higher odds of knowing whether e-cigarettes contained nicotine (AOR = 2.26, p < .001). Noticing warnings was significantly associated with higher odds of believing e-cigarettes cause at least some harm to users (AOR = 1.19), are as harmful as cigarettes (AOR = 1.45), and can be addictive (AOR = 1.43).Baseline assessment reveals that youth's noticing of e-cigarette warnings and recall of nicotine-addiction messages was low. Research should track exposure over time as warning requirements are implemented across different countries.

Perceptions of effectiveness and believability of pictorial and text-only health warning labels for cannabis products among Canadian youth

BackgroundHealth warnings have been shown to increase knowledge and awareness of health risks, influence social norms, and reduce consumption of tobacco products. With the legalization of non-medical cannabis in Canada and other subnational jurisdictions, there is a need for empirical studies to examine the impact of cannabis health warnings on consumer perceptions and behaviour relevant to cannabis. MethodsIn October 2017, a between-group experiment was conducted as part of an online survey of Canadians aged 16 to 30 years (N = 870) recruited from a national consumer panel. Participants rated the perceived effectiveness and believability of either text-only or pictorial cannabis health warnings and then completed a message recall task. Participants also reported their level of support for cannabis warnings, and support for including cessation information and a quitline on the warnings. ResultsPictorial health warnings for cannabis products were perceived as more effective and believable than text-only warnings (p < 0.001), and the superiority of pictorial warnings was found across different warnings: dose (p = 0.039), co-morbid drug use (p = 0.006), and pregnancy (p < 0.001). Pictorial warnings were also rated as more believable (p = 0.048). Overall, 87.7% respondents supported having health warnings on cannabis products, and 84.0% supported the inclusion of a quitline number on cannabis health warnings. ConclusionThe current study provides the first empirical test of cannabis health warnings, consistent with the considerable body of evidence on the effectiveness of pictorial warnings on tobacco products. There was strong support for the inclusion of picture warnings and the inclusion of resources and quitlines on cannabis packaging.

Communicating safety information: Investigating how distractors affect the recall of key safety information in pre-flight safety briefings

Distractors have been shown to adversely impact individuals' ability to acquire target information. However, not all distractors are the same. Distractors that compete/interfere for the same cognitive resources as the target, are thought to be more detrimental to performance than those that do not compete for the same resources. The aim of the present research was to examine the effect of distractors on individuals' memory, namely recall of key safety messages presented in an airline's pre-flight safety briefing. In a laboratory experiment in which one-hundred and twenty-four participants watched one of four different videos, two of which were paired with a distractor task (grammatical reason and computation task), we identified the adverse effect of the distractor task on recall performance. Minor differences were noted between the two distractor task groups. These results suggest the effect of a distractor on performance may be explained, in general by the additional cognitive load imposed, as opposed to the more specific competition for the same cognitive resources. From an applied perspective, these results highlight the importance of limiting distractors when important information to be remembered is communicated.

What goes up must come down: an evaluation of a zoo conservation-education program for balloon litter on visitor understanding, attitudes, and behaviour

Balloons used outdoors can fly away, posing ingestion and entanglement hazards to wildlife. “When Balloons Fly” (WBF) conservation-education program seeks to educate zoo visitors about these threats and encourage the use of wildlife-friendly bubbles at outdoor events. We examined the effect of WBF on visitor knowledge, attitudes, and behaviours (intentions and actions) over 6 months (N = 624). We compared outcomes among visitors who viewed a presentation and exhibit, to viewing the exhibit-only, and investigated the priming influence of completing a survey before entering the exhibit (pre-survey). Visitors had greater depth of understanding about the impact of balloons immediately following the visit, but post-visit message recall was low. General Linear Models revealed that over 6 months WBF significantly (p < .05) influenced positive attitudes concerning balloon use, increased likelihood to use bubbles, and reduced likelihood to use balloons. Completion of a pre-survey significantly influenced positive attitudes and reduced likelihood to use balloons. WBF is promoting conservation behaviour, with two-thirds of the follow-up sample reporting that behaviours they changed while hosting or attending an outdoor event since their visit were influenced by the zoo experience. Future work can investigate materials that might mimic a priming effect (e.g., worksheets).

What Marketing Messages Do Adults Remember About Health and Nutrition? (P04-179-19)

ObjectivesTo determine the salient elements of nutrition and health marketing messages recalled by U.S. adults in a Midwestern state. MethodsConvenience sample of 700 adults was collected via an intercept survey to elicit up to six marketing messages respondents could recall pertaining to nutrition or health. Results2689 individual messages (M = 3.8 messages per person; SD = 1.79; CI = 3.71–3.97) were coded for food group or macronutrient content; additional codes emerged for specific marketing messages that emerged. Participants who identified as a racial or ethnic minority listed fewer messages on average (M = 3.5; SD = 1.83) as compared to those identifying as non-Hispanic White (M = 3.9; SD = 1.78), t(698) = 2.424, P = .016 (CIdiff = 0.07–0.75). Men listed fewer messages (M = 3.4; SD = 1.83) than women (M = 3.9; SD = 1.76), t(698) = 3.548, P = .000 (CIdiff = 0.25–0.88;). The correlation between the number of messages reported and participant age was not significant; r = .07, P > .05. Stepwise binary logistic regression indicated that older respondents, males, and those identifying as racial or ethnic minorities were less likely to name a message coded as a Fruit, Vegetable, Protein Group, or Grain. Similarly, older respondents and those identifying as a racial or ethnic minority were less likely to have a message coded as Fat or Water. ConclusionsGreater degree of recall of messages by women and adults who are not racial/ethnic minorities may indicate more successful marketing of these messages to these target groups. Funding SourcesFunded in part by USDA SNAP.

The Use of Narratives to Deliver Information in Direct-To-Consumer Prescription Drug Commercials: A Content Analysis

Information communicated through a narrative format is typically processed and evaluated differently compared to non-narrative formats. Therefore, differences in the use of narratives across various information categories within direct-to-consumer prescription drug advertisements (DTCA) could have significant implications for consumers’ processing of that information. Such differences could have further implications regarding the “fair balance” rule put forth by the Food and Drug Administration (FDA). This study sought to document the presence and nature of narrative and non-narrative messages in a content analysis of 61 U.S.-based broadcast DTCA airing during 2016. Specific narrative styles (classic drama, vignette, first person, second person, third person) were distinguished from non-narrative styles (lecture, directive, endorsement, graphic/demonstration) according to key characteristics of each (chronology and character, showing versus telling). Results indicated widespread use of narrative styles in DTCA overall, but the styles used differed substantially between different types of information. Narrative styles were delivered prominently to present health condition and drug benefits information while non-narrative styles primarily reinforced drug benefits and presented drug risks. These differences offer a new frame through which to view an imbalanced presentation of drug risks and benefits and provide a foundation for future research to test the effects of various narrative and non-narrative forms on patient understanding and message recall.

Key Messages in an Early Childhood Obesity Prevention Intervention: Are They Recalled and Do They Impact Children's Behaviour?

Knowledge of the impact of health messages as an intervention strategy is sparse. The aim of this study was to explore recall and use of health behaviour messages among mothers, and whether recall is associated with child health behaviours. Intervention group data from the 15 months Melbourne Infant Feeding, Activity and Nutrition Trial (InFANT) were used (n = 127, children 4 months at commencement). Mothers recalled (unprompted then prompted) at 2 and 3.5 years post-intervention six key messages used in the program, and reported whether they had used them. Children’s food intake was measured by three days of 24-h recall; physical activity by accelerometers; and television viewing by parent report. Unprompted recall ranged between 1–56% across messages and follow-up points, and 37–90% for prompted recall. The most commonly recalled messages “tap into water”, “parents provide, kids decide” and “color every meal with fruit and veg” were also most commonly used. There were few associations between recall and children’s health behaviours. Given the association between recall and reported use, it is important to plan messages so they resonate well with the target group and its needs. Messages should be used as one of multiple strategies within health promotion programs.

Ad Creativity via Augmented Reality Technology in Online Video Ads: the Differential Role of Novelty, Message Usefulness, and Ad-Consumer Association

This study aims to examine the role of ad creativity in YouTube video ads featuring augmented reality (AR) technology. Through an online experiment, we compared people who hold positive preexisting attitudes toward a familiar brand, people who hold negative preexisting attitudes toward a familiar brand, and people who are unfamiliar with a brand in terms of their perceived creativity of a video ad featuring AR technology. Further, we explored the differential effect of three dimensions of ad creativity, namely, message usefulness, ad novelty, and ad-consumer association, on short and long-term brand name recall, short and long-term brand message recall, ad attitudes, and brand attitudes. Results demonstrated that for a familiar brand, people’s perceived creativity of an ad is biased by their preexisting brand attitudes. For an unfamiliar brand, since people do not hold preexisting attitudes toward it, their perceived creativity of an ad for the unfamiliar brand is mostly shaped by their ad evaluations. Moreover, results revealed that the three dimension of ad creativity play different roles in ad effectiveness.

Does Perceived Message Effectiveness Predict the Actual Effectiveness of Tobacco Education Messages? A Systematic Review and Meta-Analysis

ABSTRACTTarget audience ratings of the likely impact of persuasive messages, known as perceived message effectiveness (PME), are commonly used in health communication campaigns. However, applications of PME rely on a critical assumption—that is, that PME is a valid indicator of the likely effectiveness of messages. To examine the evidence supporting this assumption, we conducted a systematic review and meta-analysis of longitudinal studies in the tobacco education campaigns literature. Six longitudinal studies examining the predictive validity of PME met inclusion criteria. Results indicated that PME ratings were significantly associated with the majority of outcomes studied. In fact, each of the six studies found PME to be associated with at least one outcome, and across the six studies, PME was associated with message recall, conversations about ads, beliefs about smoking and quitting smoking, quit intentions, and cessation behavior. Meta-analyses demonstrated that PME predicted quit intentions (r = .256, p < .001) and cessation behavior (r = .201, p < .001), revealing effects that were small to medium in magnitude. Our results suggest that PME provides some predictive value as to the likely effectiveness of messages, although additional work using different validation designs, with other health behaviors, and among other populations is needed.

Factors affecting tuberculosis health message recall 2 years after active case finding in Blantyre, Malawi.

SETTING:Urban slums, Blantyre, Malawi.OBJECTIVE:To explore tuberculosis (TB) community-wide active case finding (cwACF) recall and accompanying messaging 2 years after the intervention.DESIGN:This mixed-methods study used population-weighted random cluster sampling to select three cwACF-receiving and three non-cwACF-receiving neighbourhoods in Blantyre. Qualitative data were collected using 12 focus group discussions (community peer-group members) and five in-depth interviews (TB officers) with script guides based on the concepts of the Health Belief Model (HBM). Thematic analysis was used to explore transcripts employing deductive coding. Questionnaires completed by focus group participants were used to collect quantitative data, providing a ‘knowledge score’ evaluated through univariate/multivariate analysis, analysis of variance and multiple linear regression.RESULTS:Community peer-group participants (n = 118) retained high awareness and positive opinions of cwACF and recognised the relationship between early diagnosis and reduced transmission, considering cwACF to have prompted subsequent health-seeking behaviour. TB-affected individuals (personal/family: 47.5%) had significantly higher knowledge scores than unaffected individuals (P = 0.039), but only if resident in cwACF-receiving neighbourhoods (P = 0.005 vs. P = 0.582), implying effect modification between exposures, albeit statistically under-powered (P = 0.229).CONCLUSION:Consistent with epidemiological evidence and HBM theory, cwACF may have a permanent impact on knowledge and behaviour, particularly in communities with a high prevalence of TB-affected individuals. Behaviour change strategies should be explicitly included in cwACF planning and evaluation.

Accuracy and congruence of physician and adolescent patient weight-related discussions: Teen CHAT (Communicating health: Analyzing talk)

ObjectiveWe assessed the accuracy and congruence of recall of weight topics during clinical encounters between adolescent patients with overweight/obesity and physicians (randomized to Motivational Interviewing education vs. control arm). MethodsWe audio recorded 357 clinic encounters and coded topics of weight, physical activity (PA), breakfast, and fast food. We assessed recall accuracy/congruence. Generalized estimation equation modeling assessed associations between selected factors and recall accuracy. ResultsAccuracy for physicians was: weight (90%), PA (88%), breakfast (77%) and fast food (70%). Patient accuracy was: weight (94%), PA (94%), breakfast (73%) and fast food (61%). Physician/patient congruence was: weight (89%), PA (90%), breakfast (71%) and fast food (67%). Use of a reminder report indicating adolescent’s weight behaviors in the physician control group resulted in increased adolescent (p = 0.02) and physician accuracy (p = 0.05) for fast food. Adolescents were more likely to recall discussions of fast food (odds ratio, 0.87; 95% CI, 0.77–0.97) as encounter time decreased; male adolescents were less likely to recall breakfast than females (odds ratio, 0.52; 95% CI, 0.28–0.95). ConclusionAdolescents and physicians recall weight and PA more often, perhaps indicating greater engagement in these topics. Practice ImplicationsReminder reports might possibly enhance discussion and recall of diet related messages.

Temporal Effects of Message Congruency on Attention to and Recall of Pictorial Health Warning Labels on Cigarette Packages.

Recent research has shown that message congruency is beneficial to recall of pictorial health warning label (PWL) content after initial exposure. Despite less attention to the text warning, smokers exposed to congruent PWLs were more likely to recall the text and the message. This study aimed to replicate these findings and to examine whether congruency also affects recall after multiple exposures over time. A total of 320 daily smokers (39.7% female; cigarettes/day: M = 15.31, SD = 7.15) were randomized to one congruent or incongruent PWL and attended 4 laboratory sessions over 10 days. During each session, eye movements were recorded while viewing the PWL and open-ended recall of label content was assessed after exposure. Smokers who were exposed to a congruent PWL were more likely to recall the text (p = .01) and the message (p = .02) and less likely to recall the image (p = .003) of the PWL after initial exposure. By day 4, incongruent PWLs were recalled equally well as congruent PWLs. Independent of condition, image recall was initially high and remained high whereas text and message recall was relatively low initially but increased over time. It was not until day 7 that about 80% of text and message recall was observed. Even when exposed to the same PWL over time, smokers require multiple exposures to recall the text and the message of a PWL. More research on the effects of congruency in the natural environment, where smokers are exposed to multiple PWLs, is needed. The findings of this study, and of previous work showing that message congruency in PWLs is beneficial to initial recall of PWL content, could potentially help to address legal challenges regarding the implementation of PWLs in the United States. Factually correct text warnings have been uncontested on US cigarettes packages since 1966. Congruent PWLs simply provide a means to visually support the same information as the existing text using a medium that better garners attention to the health information. Investigating and understanding longer-term effects of congruency are important and can empirically inform future warning label development, both in the United States via the Family Smoking Prevention and Tobacco Control Act, and via other governing bodies.

Factors influencing the uptake of a mass media intervention to improve child feeding in Bangladesh.

Mass media are increasingly used to deliver health messages to promote social and behaviour change, but there has been little evidence of mass media use for improving a set of child feeding practices, other than campaigns to promote breastfeeding. This study aimed to examine the factors influencing the uptake of infant and young child feeding messages promoted in TV spots that were launched and aired nationwide in Bangladesh. We conducted a mixed‐methods study, using household surveys (n = 2,000) and semistructured interviews (n = 251) with mothers of children 0–23.9 months and other household members. Factors associated with TV spot viewing and comprehension were analysed using multivariable logistic regression models, and interview transcripts were analysed by systematic coding and iterative summaries. Exposure ranged from 36% to 62% across 6 TV spots, with comprehension ranging from 33% to 96% among those who viewed the spots. Factors associated with comprehension of TV spot messages included younger maternal age and receipt of home visits by frontline health workers. Three direct narrative spots showed correct message recall and strong believability, identification, and feasibility of practicing the recommended behaviours. Two spots that used a metaphorical and indirect narrative style were not well understood by respondents. Understanding the differences in the uptake factors may help to explain variability of impacts and ways to improve the design and implementation of mass media strategies.

Preflight Safety Briefings: Understanding the Relationship Between Mode of Delivery, Recall of Key Safety Messages, and Mood

ABSTRACTObjective: The aim of this research was to examine how mode of delivery affects recall of key information presented in the preflight safety briefing as well as mood.Background: Preflight safety briefings are required prior to every commercial flight. To meet this requirement, airlines often use prerecorded briefings, in the form of audio or video, which can sometimes be supplemented with a live demonstration.Method: One hundred and sixty-two participants were randomly divided into 5 groups—control (no briefing), audio only, audio plus live demonstration, video only, and video plus live demonstration—and exposed to a prerecorded safety briefing. Recall performance in terms of key safety messages was analyzed postbriefing, as well as changes in mood from pre- to postbriefing.Results: Recall of certain key safety information is related to both cabin crew members and the medium in which the safety material is delivered. Native English speakers also recalled more information than their non-native counterparts. Participants' mood was adversely affected in the video condition.Conclusion: These results highlight the limitations associated with the way many airlines presently deliver their preflight safety briefing.