Threatening Health Information Research Articles

Health Information as “Fodder for Fears”: A Qualitative Analysis of Types and Determinants of the Nonuse of Health Information

ABSTRACT As not all individuals are willing to pay attention to health information it is crucial to understand and distinguish the underlying motives and the scope of various nonuse behaviors. To increase conceptual clarity and specify theoretical assumptions about the types of nonuse of health information and their determinants, we used a qualitative research approach. Semi-structured interviews with 11 female, 10 male, and 10 non-binary participants aged between 18 and 67 (M = 39.7) showed that information ignoring and avoidance are two distinct behaviors characterized by their motivational patterns. Information ignoring is a preference for other content, serving as a strategy to manage limited time resources and receptivity. Information avoidance is understood as a decision to avoid threatening health information serving emotion regulation. Our data further indicate that information ignoring and avoidance are not unidimensional constructs. Instead, the selectivity and consistency of both behaviors build various types of information ignoring and avoidance, which need to be explained differently considering individual differences, cognitive, affective, socio-normative, and structural factors. Further, theory specification should build on the revealed findings and test which factors relate to which kind of nonuse behaviors.

Low Health Literacy and Health Information Avoidance but Not Satisficing Help Explain "Don't Know" Responses to Questions Assessing Perceived Risk.

People who say they don't know (DK) their disease risk are less likely to engage in protective behavior. This study examined possible mechanisms underlying not knowing one's risk for common diseases. Participants were a nationally representative sample of 1005 members of a standing probability-based survey panel who answered questions about their comparative and absolute perceived risk for diabetes and colon cancer, health literacy, risk factor knowledge and health information avoidance, and beliefs about illness unpredictability. Survey satisficing was a composite assessment of not following survey instructions, nondifferentiation of responses, haphazard responding, and speeding. The primary outcomes were whether a person selected DK when asked absolute and comparative risk perception questions about diabetes or colon cancer. Base structural equation modeling path models with pathways from information avoidance and health literacy/knowledge to DK responding for each DK outcome were compared to models that also included pathways from satisficing or unpredictability beliefs. Base models contained significant indirect effects of health literacy (odds ratios [ORs] = 0.94 to 0.97, all P < 0.02) and avoidance (ORs = 1.05 to 1.15, all P < 0.01) on DK responding through risk factor knowledge and a direct effect of avoidance (ORs = 1.21 to 1.28, all P < 0.02). Adding the direct effect for satisficing to models resulted in poor fit (for all outcomes, residual mean square error estimates >0.17, all weighted root mean square residuals >3.2, all Comparative Fit Index <0.47, all Tucker-Lewis Index <0.49), indicating that satisficing was not associated with DK responding. Unpredictability was associated with not knowing one's diabetes risk (OR = 1.01, P < 0.01). The data were cross-sectional; therefore, directionality of the pathways cannot be assumed. DK responders may need more health information, but it needs to be delivered differently. Interventions might include targeting messages for lower health literacy audiences and disrupting defensive avoidance of threatening health information.

Effects of self-transcendence on neural responses to persuasive messages and health behavior change

Self-transcendence refers to a shift in mindset from focusing on self-interests to the well-being of others. We offer an integrative neural model of self-transcendence in the context of persuasive messaging by examining the mechanisms of self-transcendence in promoting receptivity to health messages and behavior change. Specifically, we posited that focusing on values and activities that transcend the self can allow people to see that their self-worth is not tied to a specific behavior in question, and in turn become more receptive to subsequent, otherwise threatening health information. To test whether inducing self-transcendent mindsets before message delivery would help overcome defensiveness and increase receptivity, we used two priming tasks, affirmation and compassion, to elicit a transcendent mindset among 220 sedentary adults. As preregistered, those who completed a self-transcendence task before health message exposure, compared with controls, showed greater increases in objectively logged levels of physical activity throughout the following month. In the brain, self-transcendence tasks up-regulated activity in a region of the ventromedial prefrontal cortex, chosen for its role in positive valuation and reward processing. During subsequent health message exposure, self-transcendence priming was associated with increased activity in subregions of the ventromedial prefrontal cortex, implicated in self-related processing and positive valuation, which predicted later decreases in sedentary behavior. The present findings suggest that having a positive self-transcendent mindset can increase behavior change, in part by increasing neural receptivity to health messaging.

Colorectal cancer screening: Associations between information provision, attitudes and intended participation

ObjectiveProperly informing target audiences is crucial in population-based screening programs. We aimed to evaluate the impact of information about CRC screening on attitudes and intended participation in a screening-naive population. Methods614 persons (aged 55–75 years) received a survey. Information on CRC and screening was provided piece by piece, and per piece its impact on attitudes and intended participation was assessed. All persons received the same information content, but the sequence of information differed per condition: information on the high mortality rate of colorectal cancer was presented in the first or the second piece. Educational levels, the extent people considered future consequences, and value concordance between attitudes and intentions were assessed. Results436 persons (response 71%) completed the survey. Overall most respondents reported positive attitudes towards CRC screening (78%) and intentions to participate in CRC screening (83%), independent of sequence of information provision. Intentions about participation were value concordant in the majority (88%). Results were similar in low educated groups. ConclusionProviding balanced information about CRC screening (also addressing negative effects) did not impede value concordance and high rates of intended participation. Practice implicationsHigh rates of screening intentions are possible without omitting threatening health information in communication materials.

This is your stomach speaking: Anthropomorphized health messages reduce portion size preferences among the powerless

As food portion sizes increase, so too does the amount of energy consumed. The purpose of this study was therefore to determine whether the portion size preferences of individuals could be reduced. Across two experiments, this paper shows that a personally threatening health message that has been endorsed by a digestive system featuring anthropomorphic cues can reduce portion size preferences for energy dense foods and beverages, but only among those who feel powerless. This effect emerges because partially anthropomorphizing an internal body system transforms that system into an agent of social influence. The powerless, who are more sensitive to social influence than the powerful, will consequently be more attuned to threatening health information that has been endorsed by this partially anthropomorphized body system, shaping their behavioral preferences. Anthropomorphizing elements of the self may therefore represent a novel means for motivating behavior change.

Processing of Alcohol-Related Health Threat in At-Risk Drinkers: An Online Study of Gender-Related Self-Affirmation Effects.

Defensiveness in response to threatening health information related to excessive alcohol consumption prevents appropriate behaviour change. Alternatively, self-affirmation may improve cognitive-affective processing of threatening information, thus contributing to successful self-regulation. Effects of an online self-affirmation procedure were examined in at-risk university student drinkers. Participants were randomly assigned to a self-affirmation (writing about personally relevant values) or control task (writing about values relevant to another person) prior to presentation of alcohol-related threatening information. Assessment of prosocial feelings (e.g. 'love') after the task served as a manipulation check. Generic and personalized information regarding the link between alcohol use and cancer was presented, followed by assessment of perceived threat, message avoidance and derogation. Page dwell-times served as indirect indices of message engagement. Alcohol consumption and intention to drink less were assessed during the first online session and at 1-week and 1-month follow-up. Although self-affirmation resulted in higher levels of prosocial feelings immediately after the task, there was no effect on behaviour in the self-affirmation group. Effects on intention were moderated by gender, such that men showed lower intention immediately after self-affirmation, but this increased at 1-week follow-up. Women's intention to reduce consumption in the self-affirmation group reduced over time. Trend-level effects on indices of derogation and message acceptance were in the predicted direction only in men. It is feasible to perform self-affirmation procedures in an online environment with at-risk drinkers. However, use of internet-based procedures with this population may give rise to (gender-dependent) effects that are substantially diluted compared with lab-based experiments.

Information Avoidance Tendencies, Threat Management Resources, and Interest in Genetic Sequencing Feedback.

Information avoidance is a defensive strategy that undermines receipt of potentially beneficial but threatening health information and may especially occur when threat management resources are unavailable. We examined whether individual differences in information avoidance predicted intentions to receive genetic sequencing results for preventable and unpreventable (i.e., more threatening) disease and, secondarily, whether threat management resources of self-affirmation or optimism mitigated any effects. Participants (N = 493) in an NIH study (ClinSeq®) piloting the use of genome sequencing reported intentions to receive (optional) sequencing results and completed individual difference measures of information avoidance, self-affirmation, and optimism. Information avoidance tendencies corresponded with lower intentions to learn results, particularly for unpreventable diseases. The association was weaker among individuals higher in self-affirmation or optimism, but only for results regarding preventable diseases. Information avoidance tendencies may influence decisions to receive threatening health information; threat management resources hold promise for mitigating this association.

Effects of Fear Appeals on Communicating Potential Health Risks of Unregulated Dietary Supplements to College Students

Background: Fear appeals are commonly used in health communication to reduce risk. It is not clear, however, whether familiarity with a health topic can lessen the threat intended. The use of unregulated dietary supplements among young adults is one such area that needs study. Purpose: The study examined the effect of fear appeals on self-protective behavior when college students were informed of the risks of consuming the dietary supplement creatine. It focused on students' responses to fear appeals that varied depending on their familiarity with the product. Methods: Students were assigned to one of 3 groups based on familiarity with creatine. A total of 121 college students viewed advertisements depicting creatine consumption side effects, followed by the main questionnaire including perceived risk, attitudes, and behavioral intention measures. Results: Fear appeal messages were most effective for those least familiar with creatine. Discussion: Familiarity based on previous experience is a factor that must be considered when presenting threatening health information. Translation to Health Education Practice: Health educators and practitioners should inform young adults about risks and proper consumption of dietary supplements before they develop a strong disposition toward the product without accurate knowledge of proper dose and potential side effects.

Sixty years of fear appeal research: current state of the evidence.

Fear arousal is widely used in persuasive campaigns and behavioral change interventions. Yet, experimental evidence argues against the use of threatening health information. The authors reviewed the current state of empirical evidence on the effectiveness of fear appeals. Following a brief overview of the use of fear arousal in health education practice and the structure of effective fear appeals according to two main theoretical frameworks-protection motivation theory and the extended parallel process model-the findings of six meta-analytic studies in the effectiveness of fear appeals are summarized. It is concluded that coping information aimed at increasing perceptions of response effectiveness and especially self-efficacy is more important in promoting protective action than presenting threatening health information aimed at increasing risk perceptions and fear arousal. Alternative behavior change methods than fear appeals should be considered.

Neuroscientific evidence for defensive avoidance of fear appeals.

Previous studies indicate that people respond defensively to threatening health information, especially when the information challenges self-relevant goals. The authors investigated whether reduced acceptance of self-relevant health risk information is already visible in early attention allocation processes. In two experimental studies, participants were watching high- and low-threat health commercials, and at the same time had to pay attention to specific odd auditory stimuli in a sequence of frequent auditory stimuli (odd ball paradigm). The amount of attention allocation was measured by recording event-related brain potentials (i.e., P300 ERPs) and reaction times. Smokers showed larger P300 amplitudes in response to the auditory targets while watching high-threat instead of low-threat anti-smoking commercials. In contrast, non-smokers showed smaller P300 amplitudes during watching high as opposed to low threat anti-smoking commercials. In conclusion, the findings provide further neuroscientific support for the hypothesis that threatening health information causes more avoidance responses among those for whom the health threat is self-relevant.

Reactions to threatening health messages.

BackgroundThreatening health messages that focus on severity are popular, but frequently have no effect or even a counterproductive effect on behavior change. This paradox (i.e. wide application despite low effectiveness) may be partly explained by the intuitive appeal of threatening communication: it may be hard to predict the defensive reactions occurring in response to fear appeals. We examine this hypothesis by using two studies by Brown and colleagues, which provide evidence that threatening health messages in the form of distressing imagery in anti-smoking and anti-alcohol campaigns cause defensive reactions.MethodsWe simulated both Brown et al. experiments, asking participants to estimate the reactions of the original study subjects to the threatening health information (n = 93). Afterwards, we presented the actual original study outcomes. One week later, we assessed whether this knowledge of the actual study outcomes helped participants to more successfully estimate the effectiveness of the threatening health information (n = 72).ResultsResults showed that participants were initially convinced of the effectiveness of threatening health messages and were unable to anticipate the defensive reactions that in fact occurred. Furthermore, these estimates did not improve after participants had been explained the dynamics of threatening communication as well as what the effects of the threatening communication had been in reality.ConclusionsThese findings are consistent with the hypothesis that the effectiveness of threatening health messages is intuitively appealing. What is more, providing empirical evidence against the use of threatening health messages has very little effect on this intuitive appeal.

Eye movement responses to health messages on cigarette packages

BackgroundWhile the majority of the health messages on cigarette packages contain threatening health information, previous studies indicate that risk information can trigger defensive reactions, especially when the information is self-relevant (i.e., smokers). Providing coping information, information that provides help for quitting smoking, might increase attention to health messages instead of triggering defensive reactions.MethodsEye-movement registration can detect attention preferences for different health education messages over a longer period of time during message exposure. In a randomized, experimental study with 23 smoking and 41 non-smoking student volunteers, eye-movements were recorded for sixteen self-created cigarette packages containing health texts that presented either high risk or coping information combined with a high threat or a low threat smoking-related photo.ResultsResults of the eye movement data showed that smokers tend to spend more time looking (i.e., more unique fixations and longer dwell time) at the coping information than at the high risk information irrespective of the content of the smoking-related photo. Non-smokers tend to spend more time looking at the high risk information than at the coping information when the information was presented in combination with a high threat smoking photo. When a low threat photo was presented, non-smokers paid more attention to the coping information than to the high risk information. Results for the smoking photos showed more attention allocation for low threat photos that were presented in combination with high risk information than for low threat photos in combination with coping information. No attention differences were found for the high threat photos.ConclusionsNon-smokers demonstrated an attention preference for high risk information as opposed to coping information, but only when text information was presented in combination with a high threat photo. For smokers, however, our findings suggest more attention allocation for coping information than for health risk information. This preference for coping information is not reflected in current health messages to motivate smokers to quit smoking. Coping information should be more frequently implemented in health message design to increase attention for these messages and thus contribute to effective persuasion.

Endogenous testosterone levels are associated with assessments of unfavourable health information

The purpose of this study was to investigate whether participants’ assessments of unfavourable health information are associated with individual differences in basal testosterone. Testosterone has previously been related to assessments of threat in social and other domains. 52 undergraduate males were tested for a minor, fictitious medical condition thioamine acetylase deficiency (‘TAA deficiency’) in a paradigm that was developed to examine the thoughts and behaviours of individuals who have just received unfavourable medical news. In a variation on the classic paradigm, all participants were told that they had ‘TAA deficiency,’ after which they rated the seriousness and prevalence of that condition as well as 19 other actual conditions. Higher testosterone levels were significantly correlated with lower estimates of both the seriousness and prevalence of TAA deficiency as well as lower median seriousness and prevalence estimates of the 19 actual conditions. Findings are discussed in light of current research in the field of behavioural endocrinology. This study provides preliminary evidence that individual differences in assessments of threatening health information may be associated with neurobiological characteristics.

The effects of culture and self-construal on responses to threatening health information

Objective: The current studies examined if cultural and self-construal differences in self-enhancement extended to defensive responses to health threats. Design: Responses to fictitious medical diagnoses were compared between Asian-Americans and European-North Americans in Experiment 1 and between Canadians primed with an interdependent versus an independent self-construal in Experiment 3. In Experiment 2, the responses of Chinese and Canadians who were either heavy or light soft drink consumers were assessed after reading an article linking soft drink consumption to insulin resistance. Main outcome measure: The primary-dependent measure reflected participants’ defensiveness about threatening versus nonthreatening health information. Results: In Experiment 1, all participants responded more defensively to an unfavourable than a favourable diagnosis; however, Asian-Americans responded less defensively than did European-North Americans. In Experiment 2, all high soft drink consumers were less convinced by the threatening information than were low soft drink consumers; however, among high consumers, Chinese changed their self-reported consumption levels less than did European-Canadians. In Experiment 3, interdependence-primed participants responded less defensively to an unfavourable diagnosis than did independence-primed participants. Conclusion: Defensive reactions to threatening health information were found consistently; however, self-enhancement was more pronounced in individuals with Western cultural backgrounds or independent self-construals.

Increased attention but more efficient disengagement: Neuroscientific evidence for defensive processing of threatening health information.

Previous studies indicate that people respond defensively to threatening health information, especially when the information challenges self-relevant goals. The authors investigated whether reduced acceptance of self-relevant health risk information is already visible in early attention processes, that is, attention disengagement processes. In a randomized, controlled trial with 29 smoking and nonsmoking students, a variant of Posner's cueing task was used in combination with the high-temporal resolution method of event-related brain potentials (ERPs). Reaction times and P300 ERP. Smokers showed lower P300 amplitudes in response to high- as opposed to low-threat invalid trials when moving their attention to a target in the opposite visual field, indicating more efficient attention disengagement processes. Furthermore, both smokers and nonsmokers showed increased P300 amplitudes in response to the presentation of high- as opposed to low-threat valid trials, indicating threat-induced attention-capturing processes. Reaction time measures did not support the ERP data, indicating that the ERP measure can be extremely informative to measure low-level attention biases in health communication. The findings provide the first neuroscientific support for the hypothesis that threatening health information causes more efficient disengagement among those for whom the health threat is self-relevant.

Communication neuroscience as a tool for health psychologists.

Comments on the original article, "Increased attention but more efficient disengagement: Neuroscientific evidence for defensive processing of threatening health information" by L. T. E. Kessels, R. A. C. Ruiter, and B. M. Jansma (see record 2010-14873-005). Kessler et al present an example of Communication Neuroscience as a tool for understanding the mechanisms that lead some health messages to be processed in a way that facilitates impact whereas other messages are ignored. Kessels et al used event-related brain potentials (ERPs), a high temporal resolution method, to monitor neural activity in the moment that messages are presented. They use this technology to provide insight about the low-level attention processes through which individuals at highest risk (in this case, smokers) disengage from self-relevant health messages (threatening and nonthreatening smoking images). The findings of Kessels et al are convergent with prior theory and empirical work demonstrating that high threat messages may not achieve the desired effect if presented in isolation (Brown & Locker, 2009; Leventhal, Safer, & Panagis, 1983; Liberman & Chaiken, 1992). By using the tools of neuroscience, however, Kessels et al elucidate a mechanism that was not apparent through self-report or implicit (reaction time) measures. They demonstrate that high threat messages lead to increased attention capture, but more efficient disengagement when threatening messages are self-relevant; this in turn helps to explain why high threat messages may not have the desired effect, despite successfully capturing people's attention. As such, this study illustrates one benefit of combining the tools of neuroscience with more familiar methods in health psychology.

How self-affirmation reduces defensive processing of threatening health information: Evidence at the implicit level.

Self-affirmation reduces defensive responses to threatening health information, but little is known about the cognitive processes instigated by self-affirmation. This study tested whether self-affirmation increases responsiveness to threatening health information at the implicit level. In an experimental study (N = 84), the authors presented high- (coffee drinkers) and low-relevance (noncoffee drinkers) participants with threatening health information linking caffeine consumption to health problems. Prior to reading this information, the authors manipulated self-affirmation. Participants completed an unobtrusive lexical decision task to measure the accessibility of threat-related cognitions and reported their perceptions of message quality and intentions to take precautions. Among high-relevance participants, self-affirmation increased the accessibility of threat-related cognitions, increased perceptions of message quality, and promoted adaptive behavioral intentions. The findings suggest that self-affirmation can increase implicit responsiveness to threatening health information among a target audience, that is, people for whom the health information is highly relevant.

Don't derogate this message! Self-affirmation promotes online type 2 diabetes risk test taking

The aim of the present study was to examine whether self-affirmation promotes acceptance of threatening type 2 diabetes information and risk-testing behaviour. In an experimental study (N = 84), we manipulated self-affirmation by allowing participants to affirm a value that was either personally important or unimportant to them, and measured participants' risk level prior to reading threatening type 2 diabetes information. As dependent variables, we measured message derogation, intentions to do an online type 2 diabetes risk test and online risk-testing behaviour. Findings showed that self-affirmation decreased message derogation, increased intentions to do an online risk test and promoted online risk test taking among at-risk participants. Among participants not at-risk, self-affirmation decreased intentions and online risk test taking. Therefore, it is concluded, that for an at-risk population self-affirmation can decrease defensive responses to threatening health information and promote (online) risk test taking for diseases.

In the mood to face the facts: When a positive mood promotes systematic processing of self-threatening information

Two experiments tested the hypothesis that a positive mood can increase attendance to, and systematic processing of, threatening health information, particularly when the information is self-relevant. In Study 1, a positive mood increased differentiation between strong and weak arguments in a threatening health message about RSI only for participants who had received false feedback regarding their high vulnerability to RSI. Mood had no effects under conditions of low vulnerability. In Study 2, a positive mood speeded up responses to self-threatening words—compared with neutral words—for smokers who had just read a threatening health message about smoking. The authors conclude that fostering a positive mood may promote attendance to and systematic processing of information that threatens the self, and hence contribute to the success of health campaigns targeted at individuals who are vulnerable to specific health risks.

Information Processing in the Context of Genetic Risk: Implications for Genetic‐Risk Communication

Communicating genetic-risk information is fraught with difficulties, and there are no universally accepted guidelines for clinical practice. In this paper, we suggest that information-processing models may offer some guidance for the communication of genetic risk. The paper reviews selected literature from health and social psychology, including defensive reactions to threatening health information, the Extended Parallel Process Model (EPPM) and Self Affirmation Theory. Ultimately, it presents the Heuristic-Systematic Model (HSM) of information processing as a useful perspective from which to view genetic-risk communication. Through our review of this literature, we identify some of the variables found to influence the systematic or heuristic processing of risk information and note their relevance to genetic counseling contexts. We suggest that systematic information processing is conducive to informed decision-making, as well as improved understanding of risk information. Clinical practice implications derived from our review of these literatures are noted.