Question-behavior Effect Research Articles

Investigating the impact of multiple priming questions on examinee effort during low-stakes testing

Priming examinees with questions about intended effort prior to testing has been shown to significantly increase examinee expended effort via self-reported effort and response-time effort. However, this question-behavior effect seems to wear off later in a testing session. We examined whether administering a second “dose” of the question-behavior effect could combat the decrease in examinee effort later in a testing session. We randomly assigned examinees to one of three question conditions prior to completing two low-stakes tests: answering three questions about intended effort directly before the first test in a session, answering three questions about intended effort directly before each test in a session, and answering no priming questions (control). Administering a second dose of questions directly before the second test in a session significantly increased response-time effort and self-reported effort for the more difficult test. This simple administration of multiple sets of questions throughout a testing session appears to combat issues with low effort on difficult tests that are administered later in a testing session.

Priming Examinees to Give Good Effort: Differential Utility Across Gender Identity

We examined the utility of a question-behavior effect (QBE) intervention on test-taking effort. Questioning individuals about future behavior influences the subsequent performance of that behavior. Previous research found this intervention to significantly increase test-taking effort for incoming university students but it was unknown if it would be effective for more advanced college students or differentially effective across gender identities. Thus, 503 more advanced college students were randomly assigned to one of three question conditions prior to completing a low-stakes test: answering five questions regarding intended effort prior to testing, answering five questions regarding intended effort that referenced positive self-identity prior to testing, or a no-question control condition. We then administered a multiple-choice test and collected two measures of test-taking effort: self-reported effort and response time. We found that students identifying as female had significantly and practically higher self-reported effort and response time when in the question conditions compared to the no question condition. There was no effect of condition for students identifying as male for either measure of test-taking effort. Implications for practically increasing motivation on low-stakes tests and surveys, especially for more advanced students, are discussed. Implications for QBE theory, including differential effects related to gender, are discussed.

A Pedagogical Strategy Applied in Physical Education to Encourage Sustainable Physical Activity

It is known that the practice of physical activity (PA) drops off drastically in late adolescence, during the transition to adulthood, leading to a deterioration in physical fitness among post-secondary students. Given the importance of the consequences of physical inactivity, interventions aimed at the sustained adoption of sufficient PA practice must be developed. The objective of this study is to evaluate the impact of a pedagogical strategy based on the question-behavior effect (QBE) implemented in the final post-secondary physical education and health (PEH) course and that capitalizes on the benefits derived from PA. An iterative, self-reflective exercise involving the personal benefits derived from PA practiced in PEH class was tested among 496 students (mean age: 19.10 [SD: 2.42]) from 15 post-secondary institutions and divided into three groups: self-reflection on benefits and on PA practiced (Group A; n = 152), self-reflection on PA practiced (Group B; n = 142), no self-reflection (Group C; n = 210). Two measurements of weekly PA practiced outside the school setting were taken: one week before the start of the final semester of PEH, and then six months after the end of that semester. In particular, the results indicate that PA practice outside of school increased among participants in Group A and that the proportion of students who were inactive at Time 1 who became active at Time 2 was higher in Group A. Thus, it appears that repeated awareness of the personal benefits of practicing PA in PEH class promotes engagement in PA done outside of class.

Examining the Question-Behavior Effect in Low-Stakes Testing Contexts: A Cheap Strategy to Increase Examinee Effort

ABSTRACT Questioning individuals about future behavior influences the subsequent performance of that behavior. This question-behavior effect may be enhanced when questions include positive self-identity prompts. To evaluate the effectiveness of this intervention in a testing context, we randomly assigned examinees to one of three conditions prior to completing a low-stakes test: answering five questions regarding intended effort prior to the test, answering five questions regarding intended effort that referenced positive self-identity prior to the test, or a control condition. We then administered two multiple-choice tests and collected two measures of test-taking effort: self-reported effort and response time effort. Answering questions about effort prior to completing the tests resulted in higher self-reported effort and perceived test importance. Moreover, in the question conditions, significantly fewer examinees were identified to be filtered from the dataset due to low effort. The easy strategy of asking examinees to report their intended effort appears to increase test-taking effort.

Helping on Social Media

Abstract: Direct persuasion (i.e., providing people with arguments in favor of a certain behavior) can activate resistance in the receiver and, thus, result in a hampered influence attempt. More promising techniques to influence people’s behavior are self-persuasion (SP; i.e., asking people to generate arguments themselves) and the question–behavior effect (QBE; i.e., asking people to predict their future behavior), which can be easily implemented in social media settings. As both rely differently on message elaboration and focus on different outcomes, we investigated whether SP or QBE is more effective in a social media setting to increase helping behavior. In a between-subjects design, participants viewed an online Facebook group related to United World Schools and either (a) read arguments regarding helping others (direct persuasion), (b) provided arguments regarding helping others (SP), or (c) stated whether they intended to help others (QBE), while their message elaboration was assessed. We hypothesized that both SP and QBE would positively impact attitudes and levels of helping behavior compared to the direct persuasion condition. Additionally, we hypothesized that QBE and SP are equally effective in changing behavior, but that SP is more effective than QBE in changing attitudes toward helping, especially when participants strongly elaborate on their own arguments regarding the positive aspects of helping. Results showed no evidence of SP and QBE influencing attitudes toward helping and helping behavior. For behavioral intentions, some, albeit limited, evidence was found that SP and QBE can have an effect.

The importance of psychological messages and the “questionbehavior effect” about remdesivir

Background: The FDA has been requiring that information about using remdesivir to treat COVID-19 be made available to healthcare providers and patients, including dosing instructions, potential side effects, and drug interactions. It is important to observe the initial indicators of anxiety, fear, and euphoria for families during emergencies, including information on the possible side effects. This situational context is very important in all the world, because it opens doors for providing the use of updated information about treatment follow-up and for offering improved mental health services. Method: The studies were identified in well-known international journals found in two electronic databases: Scopus and Embase. The data were cross-checked with information from the main international newspapers. Results: The high expectations supported by an immediate discourse culminate in frustration and displeasure, while more consistent empirical results are not generated. These two are predictors of psychic suffering, especially due to the scarcity of information and uncertainties. In parallel, recent studies indicate that spreading information without scientific basis intensifies damage to the routine and health of people, which are already impacted by the pandemic situation. This misrepresented spread may be a factor for unleashing fear and, as a consequence, social despair. Conclusions: Based on the impulsive scenarios stimulated in the context of hydroxychloroquine and on the high spread of fake or distorted news, the psychiatric impacts of COVID-19 pandemic associated with the use of remdesivir may be worsened and reflected directly on the population’s self-esteem.

Reducing bias in trials from reactions to measurement: the MERIT study including developmental work and expert workshop.

Measurement can affect the people being measured; for example, asking people to complete a questionnaire can result in changes in behaviour (the 'question-behaviour effect'). The usual methods of conduct and analysis of randomised controlled trials implicitly assume that the taking of measurements has no effect on research participants. Changes in measured behaviour and other outcomes due to measurement reactivity may therefore introduce bias in otherwise well-conducted randomised controlled trials, yielding incorrect estimates of intervention effects, including underestimates. The main objectives were (1) to promote awareness of how and where taking measurements can lead to bias and (2) to provide recommendations on how best to avoid or minimise bias due to measurement reactivity in randomised controlled trials of interventions to improve health. We conducted (1) a series of systematic and rapid reviews, (2) a Delphi study and (3) an expert workshop. A protocol paper was published [Miles LM, Elbourne D, Farmer A, Gulliford M, Locock L, McCambridge J, et al. Bias due to MEasurement Reactions In Trials to improve health (MERIT): protocol for research to develop MRC guidance. Trials 2018;19:653]. An updated systematic review examined whether or not measuring participants had an effect on participants' health-related behaviours relative to no-measurement controls. Three new rapid systematic reviews were conducted to identify (1) existing guidance on measurement reactivity, (2) existing systematic reviews of studies that have quantified the effects of measurement on outcomes relating to behaviour and affective outcomes and (3) experimental studies that have investigated the effects of exposure to objective measurements of behaviour on health-related behaviour. The views of 40 experts defined the scope of the recommendations in two waves of data collection during the Delphi procedure. A workshop aimed to produce a set of recommendations that were formed in discussion in groups. Systematic reviews - we identified a total of 43 studies that compared interview or questionnaire measurement with no measurement and these had an overall small effect (standardised mean difference 0.06, 95% confidence interval 0.02 to 0.09; n = 104,096, I2 = 54%). The three rapid systematic reviews identified no existing guidance on measurement reactivity, but we did identify five systematic reviews that quantified the effects of measurement on outcomes (all focused on the question-behaviour effect, with all standardised mean differences in the range of 0.09-0.28) and 16 studies that examined reactive effects of objective measurement of behaviour, with most evidence of reactivity of small effect and short duration. Delphi procedure - substantial agreement was reached on the scope of the present recommendations. Workshop - 14 recommendations and three main aims were produced. The aims were to identify whether or not bias is likely to be a problem for a trial, to decide whether or not to collect further quantitative or qualitative data to inform decisions about if bias is likely to be a problem, and to identify how to design trials to minimise the likelihood of this bias. The main limitation was the shortage of high-quality evidence regarding the extent of measurement reactivity, with some notable exceptions, and the circumstances that are likely to bring it about. We hope that these recommendations will be used to develop new trials that are less likely to be at risk of bias. The greatest need is to increase the number of high-quality primary studies regarding the extent of measurement reactivity. The first systematic review in this study is registered as PROSPERO CRD42018102511. Funded by the Medical Research Council UK and the National Institute for Health Research as part of the Medical Research Council-National Institute for Health Research Methodology Research Programme.

Increasing charitable donation intentions with preliminary importance ratings

In the question-behavior effect (QBE), making a prediction about one’s behavior moves the behavior in the direction of the prediction. The current experiments explore the use of preliminary questions to increase the pro-social nature of such behavior predictions in both charitable giving and charitable bequests. Initially requesting importance ratings of charitable causes – as compared with simply referencing the charitable causes – significantly increased subsequent donation and bequest intentions to related charities. Requesting additional importance ratings for specific projects of named charities significantly increased subsequent cause importance ratings and donation and bequest intentions for both named and similar unnamed charities. Preliminary importance rating questions were also more effective than otherwise similar preliminary donation intention questions, potentially because of the non-monetary nature and greater malleability of importance ratings. Rather than merely revealing a fixed, underlying donative intent, these results suggest that the elicitation process can alter underlying donation intentions.

Using the question-behavior effect to change multiple health behaviors: An exploratory randomized controlled trial

Asking questions about a behavior has been found to influence subsequent performance of that behavior, a phenomenon termed the question-behavior effect (QBE). The present study addressed two under-researched questions concerning the QBE: (1) Can the QBE be used to change multiple health behaviors, and (2) does enhancing dissonance during questionnaire completion increase the magnitude of the QBE? Participants (N = 1534) were randomized to one of three conditions (dissonance-enhanced QBE; standard QBE; control) that targeted three health-protective behaviors (eating fruit and vegetables, physical activity, dental flossing) and three health-risk behaviors (alcohol intake, sedentariness, unhealthy snacking). The dissonance-enhanced intervention comprised a message designed to pressurize participants into forming healthful behavioral intentions. Behavior was assessed via self-reports at four-week follow up. Findings showed significant overall effects of the QBE both in increasing performance of health-protective behaviors (p = .001) and in reducing performance of health-risk behaviors (p = .04). Compared to the standard QBE condition, the dissonance-enhanced QBE intervention increased performance of health-protective behaviors (p = .04) and marginally reduced performance of health-risk behaviors (p = .07). The dissonance-enhanced QBE intervention outperformed the control condition in all analyses. This is the first report that a brief QBE intervention influences performance of multiple health behaviors. Findings supported the idea that magnifying dissonance increases the impact of the QBE.

Self-affirmation and goal difficulty as moderators of the question-behavior effect

Self-affirmation and goal difficulty as moderators of the question-behavior effect

Enhanced Invitations Using the Question-Behavior Effect and Financial Incentives to Promote Health Check Uptake in Primary Care.

BackgroundUptake of health checks for cardiovascular risk assessment in primary care in England is lower than anticipated. The question-behavior effect (QBE) may offer a simple, scalable intervention to increase health check uptake.PurposeThe present study aimed to evaluate the effectiveness of enhanced invitation methods employing the QBE, with or without a financial incentive to return the questionnaire, at increasing uptake of health checks.MethodsWe conducted a three-arm randomized trial including all patients at 18 general practices in two London boroughs, who were invited for health checks from July 2013 to December 2014. Participants were randomized to three trial arms: (i) Standard health check invitation letter only; (ii) QBE questionnaire followed by standard invitation letter; or (iii) QBE questionnaire with offer of a financial incentive to return the questionnaire, followed by standard invitation letter. In intention to treat analysis, the primary outcome of completion of health check within 6 months of invitation, was evaluated using a p value of .0167 for significance.Results12,459 participants were randomized. Health check uptake was evaluated for 12,052 (97%) with outcome data collected. Health check uptake within 6 months of invitation was: standard invitation, 590 / 4,095 (14.41%); QBE questionnaire, 630 / 3,988 (15.80%); QBE questionnaire and financial incentive, 629 / 3,969 (15.85%). Difference following QBE questionnaire, 1.43% (95% confidence interval −0.12 to 2.97%, p = .070); following QBE questionnaire and financial incentive, 1.52% (−0.03 to 3.07%, p = .054).ConclusionsUptake of health checks following a standard invitation was low and not significantly increased through enhanced invitation methods using the QBE.

The question-behaviour effect in intergroup attitudes research: When do attitudes towards a minority predict a relevant behaviour?

We hypothesised that the question-behaviour effect, referred to as the influence of questioning about a given behaviour on its subsequent performance, is a relevant issue when exploring the external validity of intergroup attitudes. In a pair of studies, we have corroborated that merely expressing attitudes towards the Jewish minority affects people's relevant behaviour towards this group. In an Internet study, participants who first completed verbal attitude measures were more likely to donate to a Jewish organisation compared to those who completed the measures after making the decision to donate. Moreover, responses to attitude measures of various types and donating to the Jewish organisation were correlated when attitudes had been expressed in the first step. When attitudes were measured after the decision to donate, only the responses to the traditional anti-Semitic scale were correlated with this behaviour. In the field study, in which the time interval between attitude and behaviour measures was introduced, no question-behaviour effect was observed. We explain the results with reference to cognitive dissonance and attitude accessibility mechanisms and discuss them in a broader context of attitude-behaviour research.

Testing the Question-Behavior Effect of Self-Administered Surveys Measuring Youth Drug Use

PurposeConcern that asking about a specific behavior could elicit that behavior is often cited as a reason that communities and schools should not administer surveys about youth drug use. In this study, we investigated if this question-behavior effect exists related to substance use. We examined if simply asking a student about their current drug use leads to an increase in drug use 1 year later. MethodThis study tests the validity of the question-behavior effect on youth drug use in a longitudinal panel of 2,002 elementary school students. The sample of students was drawn from the Community Youth Development Study, a community-randomized test of the Communities That Care prevention system. If the prevalence of self-reported drug use in sixth grade in a sample surveyed in fifth and sixth grades was higher than in an accretion sample surveyed only in sixth grade, the difference could indicate a question-behavior effect. ResultsResults from logistic regression analyses did not provide any evidence of a question-behavior effect on 30-day or lifetime prevalence of alcohol, tobacco, inhalant, or marijuana use reported in sixth grade. ConclusionsAsking youth about drug use in a survey did not increase the rates of self-reported drug use measured 1 year later. The absence of evidence of a question-behavior effect should ease concerns of communities and schools when administering surveys asking youth about their drug use.

Varying cognitive targets and response rates to enhance the question-behaviour effect: An 8-arm Randomized Controlled Trial on influenza vaccination uptake

RationaleThe question-behaviour effect (QBE) refers to the finding that survey questions about a behaviour can change that behaviour. However, little research has tested how the QBE can be maximized in behavioural medicine settings. The present research tested manipulations of cognitive targets (questions about anticipated regret or beneficence) and survey return rates (presence vs. absence of a sticky note requesting completion of the questionnaire) on the magnitude of the QBE for influenza vaccination in older adults. MethodParticipants (N = 13,803) were recruited from general practice and randomly allocated to one of eight conditions: control 1 (no questionnaire); control 2 (demographics questionnaire); intention and attitude questionnaire (with or without a sticky note); intention and attitude plus anticipated regret questionnaire (with or without a sticky note); intention and attitude plus beneficence questionnaire (with or without a sticky note). Objective records of subsequent influenza vaccination from general practice records formed the dependent variable. ResultsIntention-to-treat analyses indicated that receiving an influenza vaccination questionnaire significantly increased vaccination rates compared to the no questionnaire, OR = 1.17, 95% CI = 1.01, 1.36 and combined control conditions, OR = 1.13, 95% CI = 1.01, 1.25. Including the sticky note significantly increased questionnaire return rates, OR = 1.25, 95% CI = 1.04, 1.50. However, there were no differences in vaccination rates between questionnaires containing different cognitive targets, a sticky note or not, and no interactions. There were no significant differences in the per-protocol analyses, i.e. among respondents who completed and returned the questionnaires. ConclusionThe QBE is a simple, low-cost intervention to increase influenza vaccination rates. Increasing questionnaire return rates or asking anticipated regret or beneficence questions in addition to intention and attitude questions did not enhance the QBE.

Varying cognitive targets and response rates to enhance the question-behaviour effect: An 8-arm Randomized Controlled Trial on influenza vaccination uptake

Varying cognitive targets and response rates to enhance the question-behaviour effect: An 8-arm Randomized Controlled Trial on influenza vaccination uptake

Promoting fruit and vegetable intake in childbearing age women at risk for gestational diabetes mellitus: A randomised controlled trial.

This randomised controlled trial verified the efficacy of an implementation intentions intervention ( n = 24) to promote fruit and vegetable consumption among childbearing age women at risk for gestational diabetes mellitus against a control condition based on the question-behaviour effect ( n = 26). There was only a significant time effect ( F(2,85) = 5.69, p = 0.0048). Both groups increased their vegetable consumption compared to baseline at 3 months ( p = 0.0022) and 6 months ( p = 0.0042). There were no significant effects on weight, waist circumference and blood glucose levels. Implementation intentions and the question-behaviour effect appear to be effective behaviour change techniques to promote vegetable intake among this high-risk population.

Enhanced invitation methods and uptake of health checks in primary care: randomised controlled trial and cohort study using electronic health records.

A national programme of health checks to identify risk of cardiovascular disease (CVD) is being rolled out but is encountering difficulties because of low uptake. To evaluate the effectiveness of an enhanced invitation method using the question-behaviour effect (QBE), with or without the offer of a financial incentive to return the QBE questionnaire, at increasing the uptake of health checks. The research went on to evaluate the reasons for the low uptake of invitations and compare the case mix for invited and opportunistic health checks. Three-arm randomised trial and cohort study. All participants invited for a health check from 18 general practices. Individual participants were randomised. (1) Standard health check invitation only; (2) QBE questionnaire followed by a standard invitation; and (3) QBE questionnaire with offer of a financial incentive to return the questionnaire, followed by a standard invitation. The primary outcome was completion of the health check within 6 months of invitation. A p-value of 0.0167 was used for significance. In the cohort study of all health checks completed during the study period, the case mix was compared for participants responding to invitations and those receiving 'opportunistic' health checks. Participants were not aware that several types of invitation were in use. The research team were blind to trial arm allocation at outcome data extraction. In total, 12,459 participants were included in the trial and health check uptake was evaluated for 12,052 participants for whom outcome data were collected. Health check uptake was as follows: standard invitation, 590 out of 4095 (14.41%); QBE questionnaire, 630 out of 3988 (15.80%); QBE questionnaire and financial incentive, 629 out of 3969 (15.85%). The increase in uptake associated with the QBE questionnaire was 1.43% [95% confidence interval (CI) -0.12% to 2.97%; p = 0.070] and the increase in uptake associated with the QBE questionnaire and offer of financial incentive was 1.52% (95% CI -0.03% to 3.07%; p = 0.054). The difference in uptake associated with the offer of an incentive to return the QBE questionnaire was -0.01% (95% CI -1.59% to 1.58%; p = 0.995). During the study period, 58% of health check cardiovascular risk assessments did not follow a trial invitation. People who received an 'opportunistic' health check had greater odds of a ≥ 10% CVD risk than those who received an invited health check (adjusted odds ratio 1.70, 95% CI 1.45 to 1.99; p < 0.001). Uptake of a health check following an invitation letter is low and is not increased through an enhanced invitation method using the QBE. The offer of a £5 incentive did not increase the rate of return of the QBE questionnaire. A high proportion of all health checks are performed opportunistically and not in response to a standard invitation letter. Participants receiving opportunistic checks are at higher risk of CVD than those responding to standard invitations. Future research should aim to increase the accessibility of preventative medical interventions to increase uptake. Research should also explore the wider use of electronic health records in delivering efficient trials. Current Controlled Trials ISRCTN42856343. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 84. See the NIHR Journals Library website for further project information.

Harnessing the Question-Behavior Effect to Enhance Colorectal Cancer Screening in an mHealth Experiment.

To assess whether asking questions about a future behavior changes this behavior (i.e., the question-behavior effect) when applied to a population-level intervention to enhance colorectal cancer screening. In 2013, text-message reminders were sent to a national sample of 50 000 Israeli women and men aged 50 to 74 years following a fecal occult blood test invitation. Participants were randomized into 4 intervention groups (2 interrogative reminders, with or without reference to social context; 2 noninterrogative reminders, with or without social context) and a no-intervention control group. The outcome was fecal occult blood test uptake (n = 48 091, following attrition). Performance of fecal occult blood test was higher in the interrogative-reminder groups than in the other 3 groups (odds ratio = 1.11; 95% confidence interval = 1.05, 1.19); the effect size was small, varying in the different group comparisons from 0.03 to 0.06. The question-behavior effect appears to be modestly effective in colorectal cancer screening, but the absolute number of potential screenees may translate into a clinically significant health promotion change.

The Economic Benefits to Retailers from Customer Participation in Proprietary Web Panels

Proprietary retailer-sponsored web panels are growing in popularity. We examine specific ways in which retailers may benefit from the creation of web panels and participation of customers in them. A quasi-experiment conducted in the field with a large online retailer using eighteen months of data and a difference-in-differences estimation approach reveals significant economic benefits to the retailer from web panels beyond generation of useful customer information. Web panel participation increased number of purchases by panel customers by 17 percent, cross-buying by 14 percent, and customer profitability by 36 percent. Contrary to conventional wisdom advocating moratoriums for respondents, we find that for web panelists answering each survey (up to a maximum of 27 in nine months) led to incremental positive effects with no evidence of tapering or reversal. Our results extend prior research and managerial implications regarding the question behavior effect by showing that proprietary web panels yield a substantial positive economic impact for retailers.

The question-behaviour effect: A theoretical and methodological review and meta-analysis

ABSTRACTResearch has demonstrated that asking people questions about a behaviour can lead to behaviour change. Despite many, varied studies in different domains, it is only recently that this phenomenon has been studied under the umbrella term of the question-behaviour effect (QBE) and moderators of the effect have been investigated. With a particular focus on our own contributions, this article: (1) provides an overview of QBE research; (2) reviews and offers new evidence concerning three theoretical accounts of the QBE (behavioural simulation and processing fluency; attitude accessibility; cognitive dissonance); (3) reports a new meta-analysis of QBE studies (k = 66, reporting 94 tests) focusing on methodological moderators. The findings of this meta-analysis support a small significant effect of the QBE (g = 0.14, 95% CI = 0.11, 0.18, p < .001) with smaller effect sizes observed in more carefully controlled studies that exhibit less risk of bias and (4) also considers directions for future research on the QBE, especially studies that use designs with low risk of bias and consider desirable and undesirable behaviour separately.