Extending the explanatory utility of the EPPM beyond fear-based persuasion

The Media-Mediated Model of Information Seeking Behavior: A Proposed Framework in the Chinese Culture During the COVID Pandemic

This study aims to unravel the key determinants of individuals' information seeking behavior during health crises. It challenges conventional perspectives that solely emphasize individual experiences. It also undermines frameworks that draw direct parallels between individual experiences and media factors, disregarding the mediating role of media. Models like the Comprehensive Model of Information Seeking (CMIS) also have limitations as they prioritize media mediation over recognizing the direct impacts of individual experiences on information seeking behaviors. We hereby propose a framework, the Media-Mediated Model of Information Seeking Behavior, that sheds light on the interplay between individual and media experiences. Analysis of survey data involving 5,469 participants in three Chinese societies, including mainland China (n = 2,067), Hong Kong (n = 1,913), and Taiwan (n = 1,489), reveals that individual experiences have both direct and indirect effects on information seeking, mediated by media utility. Experience of symptoms and risk perception depend on people's perceptions of the utility of media, while efficacy and media trust directly influence information seeking behaviors. These findings contribute to theoretical understanding and offer practical guidelines. Public institutions and health promoters can leverage media platforms to shape people's perceptions of health issues and encourage active information behaviors. It is also crucial to prioritize cultivating public trust in media and efficacy during crises.

Do comparative judgements affect the perceived relevance of mobile phone road safety campaigns?

OBJECTIVE

Given the prevalence of illegal mobile phone use while driving and reliance upon messaging campaigns in deterring the behavior, there is a need to explore to what extent comparative judgements may influence desired outcomes of such campaigns. This exploratory study investigated (a) the perceived relevance and influence of different mobile phone road safety campaigns within a sample of Queensland motorists who reported using their mobile phone while driving and (b) if these varied depending on whether participants believed that their crash risk whilst using a phone was higher (comparative pessimism), lower (comparative optimism) or similar to the same-age and sex driver.

METHODS

A total of 350 licensed drivers residing within Queensland (Australia) were included in this study, of which 200 reported using their hand-held phone on some occasion. Participation involved completing a 20-25 min online anonymous survey, which included viewing three mobile phone road safety campaigns (injury-based, sanction-based and humor) and responding to questions about the perceived relevance and impact of each campaign.

RESULTS

A total of 64 (32%) participants displayed comparative optimism, 50 displayed similar judgements (25%) and 86 (43%) exhibited comparative pessimism. First, it was found that the injury-based campaign was perceived to be significantly more relevant than the humor campaign. Second, whilst the relevance of each campaign did not vary as a function of group membership, the campaigns were significantly less relevant to those displaying comparative optimism relative to those with similar judgements and comparative pessimism. Finally, the injury-based campaign was perceived to be significantly more influential than the other campaigns. However, overall, participants displaying comparative optimism believed that they would be less influenced by the campaigns compared to those with comparative pessimism.

CONCLUSIONS

Although preliminary, these findings suggest that low perceptions of risk may dilute or extinguish the desired behavioral outcomes of mobile phone road safety campaigns. Nonetheless, experimental research is needed to examine these effects directly.

Understanding the Design of Fear Appeals by Applying the Extended Parallel Process Model: A Qualitative Analysis of COVID-19 Public Service Announcements

PURPOSE

Identify how early COVID-19 public health messages incorporated in the tenets of the extended parallel process model (EPPM).

SETTING

YouTube videos developed by governmental departments, medical institutions, news organizations, and non-profit organizations in the United States were aggregated.

METHOD

This qualitative study conducted a keyword search to identify public service announcements (PSAs). The sample was further refined after searching PSAs that contained fear appeals. A thematic analysis was performed by using the constant comparative method.

SAMPLE

A total of forty-three videos was included in the final analysis.

RESULT

Two themes emerged regarding messages aimed at arousing the perceived severity of threat. These themes include emphasizing the consequences of being infected and utilizing personal narratives. Perceived susceptibility of threat was aroused by emphasizing that some groups have higher risks than others. Two themes emerged around arousing perceived response efficacy: (1) the authority of professionals; and (2) altruism and personal responsibility. One way was identified to arouse perceived self-efficacy, which is informing the protective measures.

CONCLUSION

Multiple strategies were used in PSAs about COVID-19 to arouse fear during the early stages of the pandemic. The utilization of self-efficacy was oversimplified, by not providing details about the rationale for the recommended behavior.

Targeting young driver emotions can reduce their cellphone distractions

OBJECTIVE

This study sought to evaluate the relationship between young drivers' intention to engage in cellphone distractions while driving and their emotions towards the associated risks. First, we assessed whether the emotions of guilt, shame, and fear are associated with young drivers' intention to engage in cellphone distractions, through an extended Theory of Planned Behavior (TPB) model. Second, we evaluated whether road signs that may evoke these negative emotions reduce cellphone use intentions among young drivers.

METHODS

An online survey was conducted with young drivers (18 to 25 years old) from Ontario, Canada. 403 responses were collected, of which, 99 responses were used to evaluate the first objective and all 403 responses were used to evaluate the second objective.

RESULTS

Anticipating feelings of guilt, shame, and fear negatively predicted the intention to engage in cellphone distractions, above and beyond the standard TPB constructs (i.e., attitudes, subjective norms, and perceived behavioral control). When prompted with potentially emotion-evoking road signs (children crossing, my mom/dad works here), an increase in anticipated feelings of these emotions corresponded with lower intention to engage in cellphone distractions.

CONCLUSION

Countermeasures that target young driver emotions toward distracted driving risks may be effective in reducing their distraction engagement. Future studies in more controlled environments can investigate causal relationships between emotions and distracted driving among young drivers.

Narrative versus statistical messages: The interplay of perceived susceptibility and misperceptions on vaccine intention

Although there is enough scientific evidence to show the benefits and safety of vaccines, vaccine rates are low, while misperceptions about vaccines are on the rise. The main purposes of the current study are to 1) examine the effects of narrative vs. statistical messages on vaccine intention, 2) test the mediating role of perceived expectancies, and 3) examine the moderating roles of perceived susceptibility and misperceptions on vaccine intention. Data were collected with an online experiment through Amazon Mturk. The online experiment was conducted via Qualtrics once the study was considered exempt by the Institutional Research Board of a large University in the U.S. A total of 300 participants aged 18 and above completed the survey. Findings show that perceived expectancies mediate the relationship between message manipulation and vaccine intention. Our findings also show a three-way interaction which indicates that among individuals with high misperceptions, statistical messages are more persuasive for individuals with high perceived susceptibility, while narrative messages are more influential for individuals with low perceived susceptibility.

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

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

Framing Effects on US Adults’ Reactions to COVID-19 Public Health Messages: Moderating Role of Source Trust

Increasing politicization of health guidance and fluctuating trust in public health institutions have challenged effective coronavirus disease 2019 (COVID-19) public health communication in the United States. Applying the extended parallel process model, this research reports findings from two online survey experiments conducted at different points in the pandemic regarding two advocated risk reduction behaviors. Analyses test US adults’ emotional and argument strength reactions to experimental tweets attributed to the Centers for Disease Control (CDC) and Prevention which vary with regards to advocated behavior (social distancing; vaccination), emotional appeal, wellbeing orientation (individual vs. collective), and content frame (health vs. economic outcomes). Trust in the CDC is treated as a potential moderator. Results of path analyses indicated that emotional appeal and content frame had little impact on emotional or cognitive responses to the social distancing tweets, though unvaccinated adults with low trust in the CDC experienced greater hope and fear responses to tweets emphasizing collective benefits of vaccination. Hope reactions in both studies predicted greater perceived response efficacy for the advocated behavior, particularly among those with low CDC trust, while message annoyance undermined efficacy among low trust participants. Particularly among adults with low trust in the CDC, fear reactions led to reduced efficacy. Perceived efficacy of vaccination predicted greater intention to receive a COVID-19 vaccine, controlling for prior intention. Messages which inspire hope with regards to risk reduction behaviors and include sound arguments may be more motivating than fear-appeal messages, particularly among individuals with low levels of trust in public health institutions.

Motivating cascade testing for familial hypercholesterolemia: applying the extended parallel process model for clinician communication

Motivating at-risk relatives to undergo cascade testing for familial hypercholesterolemia (FH) is critical for diagnosis and lifesaving treatment. As credible sources of information, clinicians can assist in family communication about FH and motivate cascade testing uptake. However, there are no guidelines regarding how clinicians should effectively communicate with probands (the first person diagnosed in the family) and at-risk relatives. Individuals and families with FH can inform our understanding of the most effective communications to promote cascade testing. Guided by the extended parallel process model (EPPM), we analyzed the perspectives of individuals and families with FH for effective messaging clinicians can use to promote cascade testing uptake. We analyzed narrative data from interviews and surveys collected as part of a larger mixed-methods study. The EPPM was used to identify message features recommended by individuals and families with FH that focus on four key constructs (severity, susceptibility, response efficacy, self-efficacy) to promote cascade testing. Participants included 22 individuals from 11 dyadic interviews and 98 survey respondents. Participants described prioritizing multiple messages that address each EPPM construct to alert relatives about their risk. They illustrated strategies clinicians could use within each EPPM construct to communicate to at-risk relatives about the importance of pursuing diagnosis via cascade testing and subsequent treatment for high cholesterol due to FH. Findings provide guidance on effective messaging to motivate cascade testing uptake for FH and demonstrates how the EPPM may guide communication with at-risk relatives about genetic risk and motivate cascade testing broadly.

Desensitization to Fear-Inducing COVID-19 Health News on Twitter: Observational Study

Background

As of May 9, 2021, the United States had 32.7 million confirmed cases of COVID-19 (20.7% of confirmed cases worldwide) and 580,000 deaths (17.7% of deaths worldwide). Early on in the pandemic, widespread social, financial, and mental insecurities led to extreme and irrational coping behaviors, such as panic buying. However, despite the consistent spread of COVID-19 transmission, the public began to violate public safety measures as the pandemic got worse.

Objective

In this work, we examine the effect of fear-inducing news articles on people’s expression of anxiety on Twitter. Additionally, we investigate desensitization to fear-inducing health news over time, despite the steadily rising COVID-19 death toll.

Methods

This study examined the anxiety levels in news articles (n=1465) and corresponding user tweets containing “COVID,” “COVID-19,” “pandemic,” and “coronavirus” over 11 months, then correlated that information with the death toll of COVID-19 in the United States.

Results

Overall, tweets that shared links to anxious articles were more likely to be anxious (odds ratio [OR] 2.65, 95% CI 1.58-4.43, P<.001). These odds decreased (OR 0.41, 95% CI 0.2-0.83, P=.01) when the death toll reached the third quartile and fourth quartile (OR 0.42, 95% CI 0.21-0.85, P=.01). However, user tweet anxiety rose rapidly with articles when the death toll was low and then decreased in the third quartile of deaths (OR 0.61, 95% CI 0.37-1.01, P=.06). As predicted, in addition to the increasing death toll being matched by a lower level of article anxiety, the extent to which article anxiety elicited user tweet anxiety decreased when the death count reached the second quartile.

Conclusions

The level of anxiety in users’ tweets increased sharply in response to article anxiety early on in the COVID-19 pandemic, but as the casualty count climbed, news articles seemingly lost their ability to elicit anxiety among readers. Desensitization offers an explanation for why the increased threat is not eliciting widespread behavioral compliance with guidance from public health officials. This work investigated how individuals' emotional reactions to news of the COVID-19 pandemic manifest as the death toll increases. Findings suggest individuals became desensitized to the increased COVID-19 threat and their emotional responses were blunted over time.

Socio-Cognitive Factors Associated With Lifestyle Changes in Response to the COVID-19 Epidemic in the General Population: Results From a Cross-Sectional Study in France

BACKGROUND

The aims of the present study were to assess changes in lifestyles in the general population in response to coronavirus disease 2019 (COVID-19) lockdown and the influence of COVID-19 perceptions, as assessed by the Extended Parallel Process Model (EPPM), on these changes.

METHODS

Data were collected from 4005 individuals through an online survey conducted 3-4 weeks after the nationwide lockdown implementation in France. Participants were asked whether they practiced five behaviors (i.e., screen watching, snacking, eating fruits and vegetables, exercising, and walking) less often, as often as, or more often than prior to the lockdown. Beliefs and expectations toward the COVID-19 epidemic were also assessed using an adapted version of Witte's EPPM, together with sociodemographic and environmental variables. Among the respondents consuming regularly alcohol and tobacco, logistic regressions were performed to estimate the Odds ratios (ORs) of increase (yes/no) and decrease (yes/no) in drinking and smoking since the lockdown.

RESULTS

More than 8 in 10 respondents reported unhealthy changes in lifestyle since the lockdown, mostly in relation to physical activity. The unhealthy changes were positively associated with male sex (RR = 1.17; confidence interval [95% CI] = 1.10-1.24), living urban density, having a garden (RR = 1.16 [1.07-1.26]), financial difficulties because of COVID-19 (RR = 1.09 [1.02-1.18]), and lack of fear control (RR = 1.04 [1.01-1.09]) and negatively with cognitive avoidance (RR = 0.92 [0.89-0.95]). Less than 4 in 10 respondents reported healthy changes over the same period, mostly in relation to better eating habits. They were positively associated with living with more than two persons (RR = 1.22 [1.02-1.45]), having a terrace (RR = 1.14 [1.02-1.29], and perceived efficacy (RR = 1.11 [1.04-1.08]) and negatively with being aged 40 or higher. Alcohol consumption overall declined in regular drinkers, while a slight increase in tobacco use was observed in regular smokers.

DISCUSSION

The COVID-19 pandemic and lockdown resulted in frequent and mostly unhealthy changes in lifestyle among the general population. These changes were related to individual and environmental characteristics but also to EPPM appraisals in the wake of fear appeal from COVID-19 campaigns. Communication and preventive measures should include messages and initiatives toward the maintenance of healthy lifestyles during pandemics such as the adaptation of physical activity and eating guidelines to the particular contexts of mobility restriction and infection control.

Personal and Media Factors Related to Citizens' Pro-environmental Behavioral Intention against Haze in China: A Moderating Analysis of TPB

This study extends the theory of planned behavior by taking communication factors into account to examine the determinants of pro-environmental behavioral intention in haze mitigation. Unlike other theory of planned behavior (TPB) extension studies, we shift the focus of inquiry from examining the mediating role of TPB variables to investigating the moderating role in promoting pro-environmental behavior. Using an online survey in China, the results indicated that attitude, subjective norms, perceived behavioral control, and attention to haze-related efficacy messages were positively associated with pro-environmental behavioral intention. Notably, attention to haze-related threat messages had no significant relationship with behavioral intention. Moreover, moderation analyses revealed that the interaction effects between attention to efficacy messages and attention to threat messages on behavioral intention vary among people with different attitude, subjective norms, and perceived behavioral control. Theoretically, this study contributes to the literature of the TPB by analyzing its moderating role in promoting behavior change. Findings from this study suggest the importance of disseminating distinctive media messages to audiences with different personality traits, which is beneficial for practitioners to tailor specific messages in environmental campaigns.

The Effects of Fear Appeals and Message Format on Promoting Skin Cancer Prevention Behaviors among College Students

This study tested the Extended Parallel Process Model (EPPM) by examining how fear mediated the effects of threat on individuals’ assessment of risk, which was neglected in many fear appeal studies. Second, this study treated efficacy as an existing perception, and explored the effects of varying levels of threat and efficacy on individuals’ behavioral intention. Furthermore, this study examined whether message format, such as narratives, played a role on individuals’ behavioral intention. Implications for the EPPM and health message development were discussed.

You Mad? Using Anger Appeals to Promote Activism Intentions and Policy Support in the Context of Sugary Drink Marketing to Kids

One proposed solution to address childhood obesity is to limit children's exposure to advertising for sugar-sweetened beverages. Might persuasive appeals be able to channel anger toward the soda industry in order to promote support for marketing regulations and increase intentions to engage in activism around this issue? This study sought to answer this question by drawing on research in communication and psychology about the relationships between anger, persuasion, and activism-related outcomes. Participants (N = 551) were randomly assigned to read one of four messages about sugary drink marketing to kids, following a 2 (anger: high vs. low) × 2 (efficacy: high vs. low) design, or to a no-exposure control group. There was a main effect of the anger manipulation on policy support, which was driven by support for punitively oriented policies. Although no main effects were observed for activism intentions, mediation analyses indicated indirect effects of the anger and efficacy appeals on intentions by way of evoked anger and perceived efficacy, respectively. Contrary to expectations, messaging effects did not differ for pro-attitudinal and counter-attitudinal groups. Implications for public health advocacy and persuasion research are discussed.

Randomized Evaluation of the National Collegiate Athletic Association's Concussion Education Fact Sheet for Coaches

Background. Concussion education for coaches is being increasingly recommended by leading sports organizations, yet the effectiveness of available materials has not often been assessed. This study evaluated the impact of the National Collegiate Athletic Association's (2017) publication: "Concussion safety: What coaches need to know" (the "NCAA Fact Sheet for Coaches") on participants' concussion knowledge and safety supportive intentions. Method. NCAA head coaches (n = 779) were randomized to view the NCAA Fact Sheet for Coaches either before (intervention condition) or after (control condition) responding to questions assessing concussion knowledge and intentions to engage in three behaviors (talk to team about concussion safety; allow symptomatic athlete to continue play; encourage medical staff to return athlete as quickly as possible). Results. Knowledge scores were significantly higher among coaches in the intervention condition as compared to the control condition, largely driven by differences in knowledge about the consequences of continued play postconcussion (injury, reaction time, possible death). Fewer coaches in the intervention condition expected that they would allow an athlete with a suspected concussion continue to participate in a game or practice or that they would encourage medical staff to return athletes to play as quickly as possible. Discussion. The present study provides evidence that educational content, like that contained in the NCAA Fact Sheet for Coaches, may have a positive short-term impact on concussion knowledge and behavioral intentions of coaches. In light of these findings, sports organizations should consider providing similar educational materials to coaches, evaluating whether the information is impactful in their population.

An educational intervention based on the extended parallel process model to improve attitude, behavioral intention, and early breast cancer diagnosis: a randomized trial

BACKGROUND

Breast cancer is an important public health problem worldwide. This study aimed to assess the effectiveness of an educational intervention based on fear appeals using the extended parallel process model (EPPM) to improve attitudes, intention, and early breast cancer diagnosis in Iranian women.

METHODS

This was a cluster-randomized trial conducted in Tehran, Iran. A sample of women 40 years old and above was recruited and assigned either to intervention group or to control group. The intervention group received two pamphlets containing fear appeals specially designed for this study using the EPPM. The control group received nothing. The primary outcomes were changes in attitude, behavioral intention, and early breast cancer diagnosis. Participants responded to a questionnaire before intervention and at 3 months follow-up assessments. Independent t-tests and paired t-tests were used for comparison.

RESULT

In all, 600 women were entered into the study (277 in the intervention group and 323 in the control group). Of these, 162 were lost to follow-up assessment. Thus, the analysis was restricted to those for whom both baseline and follow-up information was available (n=438). The mean age of participants was 53.2 (SD=9.45) years, and the mean year education of participants was 9.4 (SD=4.12) years. There were no significant differences between two groups regarding demographic variables. However, comparing outcome variables (attitude, intention, and early breast cancer diagnosis) at baseline and follow-up assessments, we found that the intervention group showed significant improvements in attitude and intention (P=0.01 and P=0.001, respectively), but no significant improvement was observed for early breast cancer diagnosis (P=0.78). The control group did not show any changes.

CONCLUSION

The findings showed that fear appeals could not influence early breast cancer diagnosis among women. However, significant changes were observed for attitude and behavioral intention.

The Effect of Personal Characteristics, Perceived Threat, Efficacy and Breast Cancer Anxiety on Breast Cancer Screening Activation

In order to activate women to participate in breast cancer screening programs, a good understanding is needed of the personal characteristics that influence how women can be activated to search for more information, consult friends and doctors, and participate in breast cancer screening programs. In the current study, we investigate the effect of six personal characteristics that have in previous research been identified as important triggers of health behavior on breast cancer screening activation: Health awareness, Need for Cognition, Affect Intensity, Breast cancer knowledge, Topic involvement, and the Perceived breast cancer risk. We test the effect of these factors on four activation variables: intention of future information seeking, forwarding the message to a friend, talking to a doctor, and actual breast cancer screening attendance. Additionally, we try to unravel the process by means of which the antecedents (the six personal characteristics) lead to activation. To that end, we test the mediating role of perceived breast cancer threat, perceived efficacy of screening, and the evoked breast cancer anxiety as mediators in this process. The data were collected by means of a cross-sectional survey in a sample of 700 Flemish (Belgium) women who were invited to the free-of-charge breast cancer population screening. Screening attendance of this sample was provided by the government agency in charge of the organisation of the screening. Health awareness, affects intensity, topic involvement, and perceived risk have the strongest influence on activation. Breast cancer anxiety and perceived breast cancer threat have a substantial mediation effect on these effects. Efficacy perceptions are less important in the activation process. Increased health awareness and a higher level of perceived risk lead to less participation in the free of charge population based breast screening program. Implications for theory and practice are offered. The limitation of the study is that only a standard invitation message was used. In future research, other types of awareness and activation messages should be tested. Additionally, the analysis could be refined by investigating the potentially different activation process in different subgroups of women.

It's no laughing matter: An exploratory study of the use of ironic versus sarcastic humor in health-related advertising messages

We examined the persuasive effects of ironic and sarcastic versus no humor appeals in health messages and the potential differential effects of ironic versus sarcastic humor. Findings of a controlled experiment (N = 303) suggested that sarcastic messages, as compared to no humor messages, resulted in less negative affect, more counterarguing, and decreased perceived argument strength. Ironic messages led to more counterarguing than no humor messages. Significant differences in counterarguing, perceived argument strength, and attitudes toward the risky behavior were detected between the two humor types. Counterarguing mediated the indirect effect of message type on attitudes toward the risky behavior.

Evaluating public education messages aimed at monitoring and responding to social interactive technology on smartphones among young drivers

Young drivers are more likely than any other age group to access social interactive technology (e.g., Facebook, E-mail) on a smartphone while driving. The current study formed part of a larger investigation and was guided by The Step Approach to Message Design and Testing (SatMDT) to evaluate the relative effectiveness of three different public education messages aimed at reducing smartphone use among young drivers. The messages were each adapted to the specific behaviours of monitoring/reading and responding to social interactive technology on smartphones. Participants (n=288; 199F, 89M) were drivers aged 17-25 years who resided in the Australian state of Queensland. Message acceptance (i.e., intention and effectiveness) and message rejection were both assessed using a self-report survey. Multivariate analyses found that, overall, the messages targeting monitoring/reading behaviour were considered more effective than those targeting responding behaviour. The message that challenged the underlying motivation that believing you are a good driver makes it easier to monitor/read social interactive technology while driving was considered particularly effective by young male drivers.

The behavioural constellation of deprivation: Causes and consequences

Socioeconomic differences in behaviour are pervasive and well documented, but their causes are not yet well understood. Here, we make the case that a cluster of behaviours is associated with lower socioeconomic status (SES), which we call “the behavioural constellation of deprivation.” We propose that the relatively limited control associated with lower SES curtails the extent to which people can expect to realise deferred rewards, leading to more present-oriented behaviour in a range of domains. We illustrate this idea using the specific factor of extrinsic mortality risk, an important factor in evolutionary theoretical models. We emphasise the idea that the present-oriented behaviours of the constellation are a contextually appropriate response to structural and ecological factors rather than a pathology or a failure of willpower. We highlight some principles from evolutionary theoretical models that can deepen our understanding of how socioeconomic inequalities can become amplified and embedded. These principles are that (1) small initial disparities can lead to larger eventual inequalities, (2) feedback loops can embed early-life circumstances, (3) constraints can breed further constraints, and (4) feedback loops can operate over generations. We discuss some of the mechanisms by which SES may influence behaviour. We then review how the contextually appropriate response perspective that we have outlined fits with other findings about control and temporal discounting. Finally, we discuss the implications of this interpretation for research and policy.

The Step approach to Message Design and Testing (SatMDT): A conceptual framework to guide the development and evaluation of persuasive health messages

This paper provides an important and timely overview of a conceptual framework designed to assist with the development of message content, as well as the evaluation, of persuasive health messages. While an earlier version of this framework was presented in a prior publication by the authors in 2009, important refinements to the framework have seen it evolve in recent years, warranting the need for an updated review. This paper outlines the Step approach to Message Design and Testing (or SatMDT) in accordance with the theoretical evidence which underpins, as well as empirical evidence which demonstrates the relevance and feasibility of, each of the framework's steps. The development and testing of the framework have thus far been based exclusively within the road safety advertising context; however, the view expressed herein is that the framework may have broader appeal and application to the health persuasion context.

Young drivers' engagement with social interactive technology on their smartphone: Critical beliefs to target in public education messages

The current study forms part of a larger study based on the Step Approach to Message Design and Testing (SatMDT), a new and innovative framework designed to guide the development and evaluation of health communication messages, including road safety messages. This four step framework is based on several theories, including the Theory of Planned Behaviour. The current study followed steps one and two of the SatMDT framework and utilised a quantitative survey to validate salient beliefs (behavioural, normative, and control) about initiating, monitoring/reading, and responding to social interactive technology on smartphones by N=114 (88F, 26M) young drivers aged 17-25 years. These beliefs had been elicited in a prior in-depth qualitative study. A subsequent critical beliefs analysis identified seven beliefs as potential targets for public education messages, including, 'slow-moving traffic' (control belief - facilitator) for both monitoring/reading and responding behaviours; 'feeling at ease that you had received an expected communication' (behavioural belief -advantage) for monitoring/reading behaviour; and 'friends/peers more likely to approve' (normative belief) for responding behaviour. Potential message content targeting these seven critical beliefs is discussed in accordance with the SatMDT.

Judged effectiveness of threat and coping appraisal anti-speeding messages

PURPOSE

Using a young driver sample, this experimental study sought to identify which combinations of threat-appraisal (TA) and coping-appraisal (CA) messages derived from protection motivation theory (PMT) participants would judge as most effective for themselves, and for other drivers.

METHOD

The criterion variable was reported intention to drive within a signed speed limit. All possible TA/CA combinations of 18 previously highly-rated anti-speeding messages were presented both simultaneously and sequentially. These represented PMT's three TA components: severity, vulnerability, and rewards, and three CA components: self-efficacy, response efficacy, and response costs. Eighty-eight young drivers (34 males) each rated 54 messages for perceived effectiveness for self and other drivers.

RESULTS

Messages derived from the TA severity component were judged the most effective. Response cost messages were most effective for females. Reverse third-person effects were found for both females and males, which suggested that combining TA and CA components may increase the perceived relevance of anti-speeding messages for males.

DISCUSSION

The findings have potential value for creating effective roadside anti-speeding messages, meriting further investigation in field studies.

Threat appeals in health communication: messages that elicit fear and enhance perceived efficacy positively impact on young male drivers

Background

Health communications often present graphic, threat-based representations of the potential consequences of health-risk behaviours. These ‘threat appeals’ feature prominently in public health campaigns, but their use is controversial, with studies investigating their efficacy reporting inconsistent, and often negative, findings. This research examined the impact of a threat-based road safety advertisement on the driving behaviour of young male drivers.

Methods

To address limitations of previous research, we first identified a road safety advertisement that objectively and subjectively elicited fear using physiological and subjective measures. Study 1 (n = 62) examined the effect of this advertisement, combined with a manipulation designed to increase perceived efficacy, on speed choice. Study 2 (n = 81) investigated whether a state emotion, anger, impacts on the effectiveness of the advertisement in changing four distinct driving behaviours. Both studies examined short-term effects only.

Results

Study 1 findings indicated that a high threat message, when combined with high perceived efficacy, can lead to a decrease in speed choice. Study 2 results suggested that increased levels of state anger may counteract the potential value of combining fear-arousing threats and efficacy-building messages.

Conclusions

Findings suggest that threat-based road safety communications that target affective (fear) and cognitive (perceived efficacy) mechanisms can positively affect driving behaviours. State emotions, such as anger, may negatively impact on the effectiveness of the message. Taken together, these findings provide additional support for the use of efficacy-building messages in threat-based communications, but highlight the need for further research into the complex array of affective influences on driving.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3227-2) contains supplementary material, which is available to authorized users.

A Systematic Review of Intervening to Prevent Driving While Intoxicated: The Problem of Driving While Intoxicated (DWI)

BACKGROUND

Driving while intoxicated (DWI) is a significant public health issue. The likelihood someone will intervene to prevent DWI is affected by the characteristics of the individuals and the context of the potential driving scenario. Understanding such contexts may help tailor public health messages to promote intervening from those who are nearby to an intoxicated driver.

OBJECTIVE

This systematic review investigates the behavior of those close to an intoxicated driver and factors associated with increasing the likelihood they will intervene in situations where driving while impaired may be likely. The review of the literature is guided by an orienting framework, namely the classic social psychology theory of decision-making proposed by Latané and Darley.

RESULTS

Drawing upon this framework, the review examines the extent to which research has focused on factors which influence whether or not an individual identifies a need to intervene and identifies a seriously dangerous situation. In addition, consideration is given to perceived personal responsibility. The final two components of the model are then discussed; the perceived skill an individual who may intervene has (in their ability to intervene) and their actual enactment of the intervening behavior. Conclusions and Importance: Drawing upon such a well-considered theoretical framework, this review provides guidance on key components likely to assist in the development of targeted, more effective public education messages and campaigns that dissuade individuals from drinking and then driving.

Use of the Persuasive Health Message framework in the development of a community-based mammography promotion campaign

PURPOSE

We describe how the Persuasive Health Message (PHM) framework was used to guide the formative evaluation informing development of messages and materials used in a community-based multi-media campaign intended to motivate low-income African American women to obtain low- or no-cost mammograms through the CDC's National Breast and Cervical Cancer Early Detection Program.

METHODS

Seventy-eight African American women were recruited for eight focus groups that discussed breast cancer screening. The moderator guide was developed in accordance with the PHM framework and solicited information on perceived threat and efficacy, cues, salient beliefs and referents, and barriers to self-efficacy.

RESULTS

We created persuasive messages to emphasize that African American women are susceptible to the threat of breast cancer, but that their personal action in obtaining regular mammograms may lead to early detection, subsequent treatment, and reduced cancer mortality. The messages addressed concerns of self-efficacy by emphasizing that uninsured women can also obtain high-quality low- or no-cost mammograms. In an attempt to combat the sentiment that breast cancer is a death sentence, the messages indicated that breast cancer can be successfully treated, especially when detected early.

CONCLUSIONS

The PHM framework consists of three steps: (1) determine information about threat and efficacy; (2) develop an audience profile; and (3) construct a persuasive message. It offered our team easy-to-follow, flexible steps to create a persuasive and effective campaign promoting awareness and use of mammogram screening among low-income African American women.

Out of control mortality matters: the effect of perceived uncontrollable mortality risk on a health-related decision

Prior evidence from the public health literature suggests that both control beliefs and perceived threats to life are important for health behaviour. Our previously presented theoretical model generated the more specific hypothesis that uncontrollable, but not controllable, personal mortality risk should alter the payoff from investment in health protection behaviours. We carried out three experiments to test whether altering the perceived controllability of mortality risk would affect a health-related decision. Experiment 1 demonstrated that a mortality prime could be used to alter a health-related decision: the choice between a healthier food reward (fruit) and an unhealthy alternative (chocolate). Experiment 2 demonstrated that it is the controllability of the mortality risk being primed that generates the effect, rather than mortality risk per se. Experiment 3 showed that the effect could be seen in a surreptitious experiment that was not explicitly health related. Our results suggest that perceptions about the controllability of mortality risk may be an important factor in people's health-related decisions. Thus, techniques for adjusting perceptions about mortality risk could be important tools for use in health interventions. More importantly, tackling those sources of mortality that people perceive to be uncontrollable could have a dual purpose: making neighbourhoods and workplaces safer would have the primary benefit of reducing uncontrollable mortality risk, which could lead to a secondary benefit from improved health behaviours.

Aligning HIV/AIDS communication with the oral tradition of Africans: a theory-based content analysis of songs' potential in prevention efforts

Despite a growing recognition of songs as a useful HIV/AIDS campaign strategy, little research has investigated their potential and/or actual impact. In this study, through a theory-based content analysis, we have assessed the prevention domains covered and the health-relevant constructs promoted by 23 AIDS songs widely used to aid prevention efforts in Ethiopia. To identify the health-relevant constructs and reveal their potential to facilitate or inhibit positive changes, the Extended Parallel Process Model (EPPM) has been used. The findings revealed that the songs cover most of the prevention domains that constitute the current agenda of behavior change communication in Sub-Saharan Africa. However, although all the EPPM variables have been found in almost every song, there were significantly more efficacy messages than threat messages. This suggests that although the songs may lead to positive changes in HIV/AIDS-related outcomes among audiences who have already perceived the threat posed by HIV/AIDS, they are less likely to motivate and thereby generate responses from audiences who have less or no threat perceptions. It is argued that given their potential as a culturally appropriate strategy in Sub-Saharan Africa where oral channels of communication play significant roles, songs could be harnessed for better outcomes through a theory-based design.

Modifying behaviour to reduce over-speeding in work-related drivers: an objective approach

The goal of this study was to utilise an objective measurement tool, via an on-board Diagnostic tool (OBDII), to explore the effectiveness of a behaviour modification intervention designed to reduce over-speed violations in a group of work-related drivers. It was predicted that over-speed violations would be decreased following participation in a behaviour modification intervention where drivers received weekly feedback on their speeding performance and goal setting exercises. The final analysis included the on-road behaviour of 16 drivers, all of whom completed each stage of the intervention programme. As predicted, over-speed violations significantly decreased from pre-test to post-test, after controlling for kilometres driven. These findings offer practical guidance for industry in developing interventions designed to improve work-related driving behaviour.