Attitude certainty: Antecedents, consequences, and new directions

Optimizing an adaptive digital oral health intervention for promoting oral self-care behaviors: Micro-randomized trial protocol

Dental disease continues to be one of the most prevalent chronic diseases in the United States. Although oral self-care behaviors (OSCB), involving systematic twice-a-day tooth brushing, can prevent dental disease, this basic behavior is not sufficiently practiced. Recent advances in digital technology offer tremendous potential for promoting OSCB by delivering Just-In-Time Adaptive Interventions (JITAIs)- interventions that leverage dynamic information about the person's state and context to effectively prompt them to engage in a desired behavior in real-time, real-world settings. However, limited research attention has been given to systematically investigating how to best prompt individuals to engage in OSCB in daily life, and under what conditions prompting would be most beneficial. This paper describes the protocol for a Micro-Randomized Trial (MRT) to inform the development of a JITAI for promoting ideal OSCB, namely, brushing twice daily, for two minutes each time, in all four dental quadrants (i.e., 2x2x4). Sensors within an electric toothbrush (eBrush) will be used to track OSCB and a matching mobile app (Oralytics) will deliver on-demand feedback and educational information. The MRT will micro-randomize participants twice daily (morning and evening) to either (a) a prompt (push notification) containing one of several theoretically grounded engagement strategies or (b) no prompt. The goal is to investigate whether, what type of, and under what conditions prompting increases engagement in ideal OSCB. The results will build the empirical foundation necessary to develop an optimized JITAI that will be evaluated relative to a suitable control in a future randomized controlled trial.

Uncertain Facts or Uncertain Values? Testing the Distinction Between Empirical and Normative Uncertainty in Moral Judgments

People can be uncertain in their moral judgments. Philosophers have argued that such uncertainty can either refer to the underlying empirical facts (empirical uncertainty) or to the normative evaluation of these facts itself (normative uncertainty). Psychological investigations of this distinction, however, are rare. In this paper, we combined factor-analytical and experimental approaches to show that empirical and normative uncertainty describe two related but different psychological states. In Study 1, we asked N = 265 participants to describe a case of moral uncertainty and to rate different aspects of their uncertainty about this case. Across this wide range of moral scenarios, our items loaded onto three reliable factors: lack of information, unclear consequences, and normative uncertainty. In Study 2, we confirmed this factor structure using predefined stimulus material. N = 402 participants each rated eight scenarios that systematically varied in their degree of uncertainty regarding the consequences of the described actions and in the value conflict that was inherent to them. The empirical uncertainty factors were mainly affected by the introduction of uncertainty regarding consequences, and the normative uncertainty factor was mainly affected by the introduction of value conflict. Our studies provide evidence that the distinction between empirical and normative uncertainty accurately describes a psychological reality. We discuss the relevance of our findings for research on moral judgments and decision-making, and folk metaethics.

Does Intention Strength Moderate the Intention-Health Behavior Relationship for Covid-19 Protection Behaviors?

BACKGROUND AND PURPOSE

The present research tests whether intention strength moderates intention-health behavior relations and the extent to which this is accounted for by the moderating effects of intention stability, goal priority, and goal conflict.

METHODS

In a prospective multi-behavior study, a representative sample of UK adults (N = 503) completed measures of past behavior, intention, intention strength, goal priority, and goal conflict in relation to eight Covid-19 protection behaviors at time 1. Intention and self-reported behavior were assessed at time 2 (2 months later). Intention stability was assessed over 2 months.

RESULTS

Intention strength was a significant moderator of the intention-behavior relationship (controlling for past behavior). Controlling for the moderating effects of intention stability attenuated the moderating effect of intention strength, while also controlling for the moderating effects of goal priority and goal conflict reduced the moderating effects of intention strength to nonsignificance.

CONCLUSIONS

The present findings indicate that intention strength is a significant moderator of the intention-health behavior relationship. They also suggest that the moderating effect of intention strength is explained by effects on intention stability, goal priority, and goal conflict. Tests of interventions to manipulate intention strength as a means to strengthen intention stability and intention-behavior relations are warranted.

Drivers of social acceptance of natural-resource management: A comparison of the public and professionals in California

The social impacts of natural resource management are challenging to evaluate because their perceived benefits and costs vary across stakeholder groups. Nevertheless, ensuring social acceptance is essential to building public support for adaptive measures required for the sustainable management of ecosystems in a warming climate. Based on surveys with both members of the public and natural-resource professionals in California, we applied structural-equation modeling to examine how psychological factors impact individuals' attitudes toward management's capacity to reduce the impacts of disturbance events, including wildfires, smoke from wildfires, drought, water shortages, tree mortality, and utility failure. We found the members of the public more optimistic than natural-resource professionals, perceiving management capacity to be on average 3.04 points higher (of 10) and displaying higher levels of trust of the government on both the state (Δ = 11%) and federal levels (Δ = 19%). Personal experience with natural-resource events had a positive effect on perceived management in both the public (1.26) and the professional samples (5.05), whereas perceived future risk had a negative effect within both samples (professional = -0.91, public = -0.45). In addition, higher trust and perceived management effectiveness were also linked with higher perceptions of management capacity in the public sample (1.81 versus 1.24), which could affect the acceptance of management actions. Continued social acceptance in a period of increasing risk may depend on managers sharing personal experiences and risk perception when communicating with the public. The contemporary shift toward multibenefit aims is an important part of that message.

Psychological reactance and vaccine uptake: a longitudinal study

OBJECTIVE

In most countries, vaccine uptake is a voluntary decision. If people experience threats to this freedom, for example, by pro-vaccination media campaigns or government pressure, psychological reactance may be induced. To regain freedom, the opposite behaviour (vaccine refusal) may become more attractive, forming a vaccination barrier. It remains unclear how state reactance fluctuates and how it relates to vaccination intention versus behaviour. Therefore, this pre-registered longitudinal study aimed to gain insight in the changes in state reactance during a COVID-19 vaccination programme and its relationship with vaccine uptake.

METHODS

A representative sample of Dutch adults under 60 completed questionnaires before being eligible for vaccination, shortly before they were invited for vaccination, and after the opportunity for vaccination.

RESULTS

Data were analysed using regression analyses (N = 1411). Reactance did not change as hypothesised, but remained stable over time. As hypothesised, reactance predicted lower subsequent vaccination intention. Controlling for intentions, however, reactance did not predict vaccine uptake. Furthermore, reactance predicted lower decision confidence about vaccination, except for people who strongly opposed vaccination.

CONCLUSION

Reactance has a sustained role in anticipation of a vaccination decision. Although reactance seems to affect the process towards the decision, this does not determine the final choice.

Strengthening the Link between Vaccine Predispositions and Vaccine Advocacy through Certainty

Background. Instruments designed to assess individual differences in predispositions towards vaccination are useful in predicting vaccination-related outcomes. Despite their importance, there is relatively little evidence regarding the conditions under which these instruments are more predictive. The current research was designed to improve the ability of these kinds of instruments to predict vaccination advocacy by considering the certainty associated with the responses to vaccination scales. Method. Across two studies, participants completed the Beliefs about Medicines Questionnaire BMQ scale (Study 1) or the Vaccination Attitudes Examination (VAX) scale (Study 2). The certainty participants had in their responses to each scale was either measured (Study 1) or manipulated (Study 2). Intentions to advocate in favor of vaccination served as the criterion measure in both studies. Results. As expected, the scales significantly predicted vaccination advocacy, contributing to enhancing the predictive validity of the instruments used in the studies. Most relevant, certainty moderated the extent to which these scales predicted vaccination advocacy, with greater consistency between the initial scores and the subsequent advocacy willingness obtained for those with higher certainty. Conclusions. Certainty can be useful to predict when the relationship between vaccination-related cognitions (i.e., beliefs or attitudes) and advocacy willingness is likely to be stronger.

Promoting a hand sanitizer by persuasive messages: moving bottle and background color as approach and avoidance cues

In message-based health interventions, peripheral cues such as motion and color capture exogenous attention. These cues may elicit approach and avoidance motivation and the core ingredients of persuasion (argument framing, source of the message, and persuasion knowledge). In two studies, we presented participants with persuasive messages about a hand sanitizer. Messages varied by the framing of the arguments (gain vs. loss) and by the source of the message (healthcare industry vs. public health agency). In Study 1 (N = 137), the forward apparent motion of the hand sanitizer bottle compared to a backward apparent motion increased a positive attitude toward the hand sanitizer, the intention to buy it, and ease of judgment. In Study 2 (N = 280), a small main positive effect of a green background was observed for attractiveness of the hand sanitizer, but only when a green background followed a red one. Green (vs. red) background increased willingness to buy the hand sanitizer. We observed no main effects of argument framing or source of the message. The discussion emphasizes approach and avoidance motivation as a common framework for understanding the respective contribution of peripheral cues and core ingredients of messages to the persuasion process.

A study of college students' intention to use metaverse technology for basketball learning based on UTAUT2

Recent advancements in virtual reality technology have attracted increasing attention from enterprises and scholars, and many new related products have been launched. Due to the current COVID-19 epidemic, the non-face-to-face teaching environment will seriously affect students' basketball learning. We therefore combined basketball learning with metaverse technology, discussed basketball teaching in a virtual reality environment, and examined the influencing factors of college students' intentions to use metaverse technology. In the light of UTAUT2, a new research model was proposed, and quantitative research was carried out. The results of a survey of 1074 valid samples revealed that habits and attitudes are crucial factors in the success of basketball learning using a metaverse. The findings also indicate that grade and gender are moderator variables.

Understanding the intention-behavior gap: The role of intention strength

This manuscript overviews recent research on the intention-behavior gap, focusing on moderators of the intention-behavior relationship. The manuscript draws on the concept of intention strength to make two important points. First, strong intentions provide better predictions of behavior, thereby reducing the intention-behavior gap. However, strong intentions have the additional features of being more stable over time, less pliable in the face of interventions to change them, and more likely to bias information processing about engaging in the behavior. These four features of intention strength are not independent. For example, stable intentions are likely to provide better predictions of behavior. Second, various predictors of strength (e.g., importance, certainty, extremity) may also constitute important, but little studied, moderators of the intention-behavior relationship. Moreover, the effects of these moderators of the intention-behavior relationship may be mediated through intention stability (and perhaps other features of intention strength). Future research on the intention-behavior gap would benefit from a more systematic consideration of a broad range of moderators of the intention-behavior relationship both individually and in combination. In addition, future research could usefully explore how these moderating effects might be explained. Such a systematic approach may further our understanding of the intention-behavior gap in relation to physical activity and other behaviors.

Excluding numeric side-effect information produces lower vaccine intentions

Encouraging vaccine uptake is important to reducing the impact of infectious disease. However, negative attitudes and vaccine hesitancy, due in part to worry about side effects, are obstacles to achieving high vaccination rates. Provided vaccine information sheets typically include a list of side effects without numeric information about their likelihoods, but providing such numbers may yield benefits. We investigated the effect of providing numeric information about side-effect likelihood (e.g., "1%") and verbal labels (e.g., "uncommon") on intentions to get a hypothetical vaccine, reasons for the vaccination decision, and risk overestimation. In a diverse, online, convenience sample (N = 595), providing numeric information increased vaccine intentions-70% of those who received numeric information were predicted to be moderately or extremely likely to vaccinate compared to only 54% of those who did not receive numeric information (p<.001), controlling for age, gender, race, education, and political ideology. Participants receiving numeric information also were less likely to overestimate side-effect likelihood. Verbal labels had additional benefits when included with numeric information, particularly among the vaccine hesitant. For these participants, verbal labels increased vaccine intentions when included with numeric information (but not in its absence). Among the vaccine-hesitant, 43% of those provided numeric information and verbal labels were predicted to be moderately or extremely likely to get vaccinated vs. only 24% of those given a list of side effects (p<.001). We conclude that the standard practice of not providing numeric information about side-effect likelihood leads to a less-informed public who is less likely to vaccinate.

Nudge with interface designs of online product review systems – Effects of online product review system designs on purchase behavior

Purpose

Although considerable evidence shows that online product reviews (OPRs) can greatly affect consumers, how interface designs of OPR systems (i.e. websites where consumers read and write OPRs) impact online buying behavior has not yet been well investigated. Using research on confidence in judgment and the Stimulus-Organism-Response (SOR) framework, this study aims to develop a model of the effects of OPR system design on consumer purchase behavior.

Design/methodology/approach

A study using a two by two by two factorial experimental design was conducted. The structural model with AMOS 23 based on 319 useable data points was tested.

Findings

Findings are very interesting. First, designs that manipulate positions of reviews impact perceived value but surprisingly have no effects on confidence in judgment. Second, designs using default display order based on helpfulness votes rather than on recency of reviews increase confidence to a higher level. Third, although unstructured organization methods are used by many major OPR systems, they are inferior in enhancing consumers’ emotional reactions to structured ones.

Research limitations/implications

This paper highlights the need for more academic research on how interface designs of online product review systems impact purchase behavior. Additionally, this study emphasizes the need for examining how confidence in judgment is impacted in the online environment.

Practical implications

For practitioners, this research provides them with design implications on how to increase consumer purchase behavior.

Originality/value

This research enhances the understanding of the effects of OPR system interface design on purchase behavior. In addition, the current paper sheds light on how confidence in judgment, given its importance in reducing online consumer’s hesitance to buy, is impacted by various interface designs of OPR systems. Furthermore, this study applies the SOR framework to the context of OPR system designs.

Factors influencing poor medication adherence amongst patients with chronic disease in low-and-middle-income countries: A systematic scoping review

Background

Poor medication adherence among patients with Chronic Diseases is one of the significant health problems globally. Despite this, evidence on chronic medication adherence in low and middle-income countries is unclear.

Objective

This scoping review aimed to identify factors influencing poor medication adherence amongst patients with chronic diseases in low and middle-income countries.

Methods

We searched studies exploring factors influencing poor medication adherence amongst patients in low and middle-income countries across the following databases published between 2008 to 2018: Public or publisher Medline, Google scholar, Cumulated Index to Nursing and Allied Health Literature, Health Source, and Medline with full text via Elton B. Stephen's Company host. Methodological quality assessment of the primary studies was done as recommended by Levac, Colquhoun, and O'Brien (2010) review using a Mixed-Method Appraisal Tool 2018. We reported the results following the Preferred Reporting Item for Systematic reviews and Meta-Analyses extension for Scoping Review guidelines.

Results

From the initial 154 records screened, we identified six (6) eligible studies that presented evidence on factors influencing poor medication adherence amongst patients in low and middle-income countries. Studies included were from the following countries: Jordan, South Africa, Guatemala, Ethiopia, Indonesia, India, and Palestine. Kappa agreement of the full article screening shows that there was 76.92% agreement versus 58.12% expected by chance which constitutes a considerably good agreement between screeners (Kappa statistic = 0.45 and p-value <0.05). Of the six included studies that underwent methodological quality, five scored 100%, which is regarded as the highest score the remaining one scored between 50-75%, indicating a moderate to low risk bias overall. All included studies presented evidence on medication adherence as being in either knowledge of the diseases, attitudes towards medication taking, beliefs that a patient holds about the treatment or disease, and quality control amongst chronic diseases patients.

Conclusions

Our scoping review provides evidence that poor medication adherence in LMICs is influenced by a lack of knowledge, negative attitudes, and negative beliefs, leading to poor quality of life. There is limited research evidence on the effect of patients' beliefs and perceptions on medication adherence in low and middle-income countries. We call upon further research on beliefs, perceptions, and effectiveness of interventions towards chronic medication adherence in low and middle-income countries.

The burden of being certain: National identity certainty predicts support for COVID-Related restrictive measures and outgroup conspiracy beliefs

In dealing with the COVID-19 pandemic, government officials often encounter two concurrent concerns: they have to enforce necessary public health and safety measures to manage COVID-19. Meanwhile, they also have to mitigate conspiracy beliefs about COVID-19. To shed light on these issues, we conducted two studies to investigate national identity certainty (i.e., the extent to which people are certain about their national identity) as a predictor of (a) support for restrictive measures to curtail COVID-19 and (b) conspiracy beliefs about an outgroup as the culprit of COVID-19. Study 1 was a three-week longitudinal study (N = 301) where we investigated the relationships both on a between-person level (differences between individuals) and on a within-person level (week-by-week fluctuations of the same individual). We found that individual differences in national identity certainty predicted increased support for restrictive measures and increased outgroup conspiracy beliefs. These relationships emerged, even when we controlled for national identity positivity, that is, the extent to which people see their national identity in positive light. In Study 2 (N = 316), we used a cross-sectional correlational design and replicated the findings of Study 1. Moreover, we found that the relationships were explained by distinct threat perceptions: realistic threat explained the increased support for restrictive measures, whereas symbolic threat explained the increased outgroup conspiracy beliefs. Overall, our findings suggest that support for restrictive measures and outgroup conspiracy beliefs can be seen as attempts of people high in national identity certainty to address the distinct threats of COVID-19.

The interactive effects of ambivalence and certainty on political opinion stability

Some political attitudes and opinions shift and fluctuate over time whereas others remain fairly stable. Prior research on attitude strength has documented several features of attitudes that predict their temporal stability. The present analysis focuses on two of them: attitudinal ambivalence and certainty. Each of these variables has received mixed support for its relationship with attitude stability. A recent set of studies, however, has addressed this link by showing that ambivalence and certainty interact to predict stability. Because those studies relied exclusively on college student samples and considered issues that may have been especially likely to evince change over time, the present analysis aimed to replicate the original findings in a sample of registered Florida voters with an important politically relevant issue: abortion. Results of these analyses replicated the previous findings and support the generalizability of the ambivalence × certainty interaction on attitude stability to a sample of registered voters reporting their attitudes toward abortion. Implications for public opinion and the psychology of political attitudes are discussed.

Change Appeals: How Referencing Change Boosts Curiosity and Promotes Persuasion

Does merely referencing that an object or entity has changed affect people's attitudes and intentions toward it? This research investigates the possibility that change references spark curiosity and information seeking, which can have a positive or negative effect on people's evaluations of a target stimulus, depending on the information environment. Seven experiments reveal that referencing that an object or entity has changed decreases perceptions of its longevity, but also sparks curiosity about it-a desire to learn more. This curiosity motivates people to seek information about the object or entity, which can enhance or depress their evaluations depending on whether that information search leads to favorable or unfavorable information. When further information is unavailable, change references appear to have a negative impact on people's evaluations, consistent with well-established longevity biases. This research suggests that change references have an important and generalizable impact on persuasive outcomes and pinpoints the conditions surrounding and processes driving this effect.

Perceived relative harm of using e-cigarettes predicts future product switching among US adult cigarette and e-cigarette dual users

BACKGROUND AND AIMS

People's perceptions of the harmfulness of e-cigarettes, compared with cigarettes, may influence their product use decisions. We tested if perceiving e-cigarettes as less harmful than cigarettes predicted whether cigarette and e-cigarette dual users switched their product use status 1 year later, becoming exclusive e-cigarette users, exclusive cigarette smokers, or non-users of both product types.

DESIGN

Longitudinal analyses of waves 2 (2014-15) and 3 (2015-16) of the prospective, national Population Assessment of Tobacco and Health (PATH) Study.

SETTING

United States.

PARTICIPANTS

Adults who reported using both cigarettes and e-cigarettes within the past 30 days at wave 2 reported their perceptions of e-cigarette harm at wave 2, and reported whether they used cigarettes and e-cigarettes within the past 30 days at wave 3 (n = 2211).

MEASUREMENTS

The key predictor was wave 2 perceptions of e-cigarette harm compared with cigarettes ('less harmful,' 'about the same', 'more harmful' or 'don't know'). The key outcome was wave 3 past 30-day use of e-cigarettes and cigarettes, classified into four categories: exclusive e-cigarette use (i.e. use of e-cigarettes but not cigarettes), exclusive cigarette smoking (i.e. use of cigarettes but not e-cigarettes), dual use of both product types and non-use of both product types.

FINDINGS

At wave 2, 59.4% of dual users perceived e-cigarettes as less harmful than cigarettes [95% confidence interval (CI) = 56.9, 61.9]. Compared with those with other perceptions of e-cigarette harm, dual users who perceived e-cigarettes as less harmful than cigarettes were more likely to become exclusive e-cigarette users 1 year later [7.5 versus 2.7%; adjusted odds ratio (aOR) = 2.9, 95% CI = 1.7-4.8], more likely to remain dual users (39.6 versus 29.9%; aOR = 1.5, 95% CI = 1.2-1.8), less likely to become exclusive cigarette smokers (44.8 versus 59.4%; aOR = 0.6, 95% CI = 0.5-0.7) and similarly likely to become non-users of both product types (8.2 versus 8.0%; aOR = 1.1, 95% CI = 0.7-1.7).

CONCLUSIONS

US adult dual users of e-cigarettes and cigarettes who perceive e-cigarettes as less harmful than cigarettes appear to be more likely to switch to exclusive e-cigarette use, more likely to remain dual users and less likely to switch to exclusive cigarette use 1 year later than dual users with other perceptions of e-cigarette harm.

The impacts of evaluation duration and product types on review extremity

Purpose

Extreme online reviews can have great impacts on consumers’ purchase decisions. The purpose of this paper is to investigate when users are more likely to provide extreme ratings. The study draws inference from attitude certainty theory and proposes that review extremity is influenced by the interaction of evaluation duration and product/service types: for hedonic products/services, shorter evaluation duration can foster attitude certainty, leading to higher review extremity; in contrast, for utilitarian products/services, longer evaluation duration can increase attitude certainty, resulting in more extreme reviews.

Design/methodology/approach

Three studies were conducted to test the hypotheses: Study 1 is an empirical analysis of 3,000 reviews from an online retailing website; Studies 2 and 3 are two between-subject experiments.

Findings

Results from three studies confirm the hypotheses. Study 1 provides preliminary evidence on how review extremity varies in evaluations of different durations and product/service types. Results from Studies 2 and 3 show that for hedonic products/services, the shorter the evaluation duration, the more likely users are to give extreme ratings; however, for utilitarian products/service, the longer the evaluation duration, the more likely users are to give extreme reviews; and attitude certainty plays a mediating role between evaluation duration and review extremity.

Originality/value

Findings from this study provide understandings on when a fast rather than a slow evaluation can lead to more extreme reviews. The results also highlight the role of users’ attitude certainty in the underlying mechanism.