Using User-Centered Design to Facilitate Adherence to Annual Lung Cancer Screening: Protocol for a Mixed Methods Study for Intervention Development

BACKGROUND

Lung cancer is the leading cause of cancer-related death in the United States, with the majority of lung cancer occurrence diagnosed after the disease has already metastasized. Lung cancer screening (LCS) with low-dose computed tomography can diagnose early-stage disease, especially when eligible individuals participate in screening on a yearly basis. Unfortunately, annual adherence has emerged as a challenge for academic and community screening programs, endangering the individual and population health benefits of LCS. Reminder messages have effectively increased adherence rates in breast, colorectal, and cervical cancer screenings but have not been tested with LCS participants who experience unique barriers to screening associated with the stigma of smoking and social determinants of health.

OBJECTIVE

This research aims to use a theory-informed, multiphase, and mixed methods approach with LCS experts and participants to develop a set of clear and engaging reminder messages to support LCS annual adherence.

METHODS

In aim 1, survey data informed by the Cognitive-Social Health Information Processing model will be collected to assess how LCS participants process health information aimed at health protective behavior to develop content for reminder messages and pinpoint options for message targeting and tailoring. Aim 2 focuses on identifying themes for message imagery through a modified photovoice activity that asks participants to identify 3 images that represent LCS and then participate in an interview about the selection, likes, and dislikes of each photo. A pool of candidate messages for multiple delivery platforms will be developed in aim 3, using results from aim 1 for message content and aim 2 for imagery selection. The refinement of message content and imagery combinations will be completed through iterative feedback from LCS experts and participants.

RESULTS

Data collection began in July 2022 and will be completed by May 2023. The final reminder message candidates are expected to be completed by June 2023.

CONCLUSIONS

This project proposes a novel approach to facilitate adherence to annual LCS through the development of reminder messages that embrace content and imagery representative of the target population directly in the design process. Developing effective strategies to increase LCS adherence is instrumental in achieving optimal LCS outcomes at individual and population health levels.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/46657.

Interplay of Message Frame and Reference Point on Recycled Water Acceptance in Green Community: Evidence from an Eye-Tracking Experiment

Public rejection of recycled water hinders the application of recycled water use projects in green communities. An effective information outreach strategy could help to overcome this obstacle. This study used message frames and reference points as control variables to design experimental materials and conduct eye-movement experiments to determine the effect of different information promotion strategies. The results of the study show that: (1) compared with the loss frame, the gain-framed messages are more effective; (2) self-referencing messages are more suitable for recycled water use promotion than other-referencing messages; (3) message frame (gain vs. loss) and reference point (self vs. others) have an interactive effect on the public’s information cognitive behavior; (4) the average duration of fixations for advertising message plays an intermediary role in the path of message frame and reference point jointly influencing the public acceptance. This study provides managerial implications for determining information dissemination strategies for applying recycled water-use projects in green communities.

Do Young Adults Attend to Health Warnings in the First IQOS Advertisement in the U.S.? An Eye-Tracking Approach

INTRODUCTION

In October 2019, a heated tobacco product (HTP) IQOS debuted in the United States. This study examined young adults' attention and cognitions in response to an IQOS ad that carried two mandated textual health warnings (Surgeon General's warning and nicotine warning), and how their vaping and smoking status may interact with attention patterns to affect attitude and intention to use IQOS.

METHODS

In November 2019, college students (N = 164) viewed IQOS' first U.S. magazine ad and two distractor ads. Viewing patterns were recorded with eye-tracking. Masked recall and aided recognition, attitude and intention towards IQOS use were later assessed with self-report. Ordinary Least Squares (OLS) regressions and moderated mediation analyses examined the associations between visual attention and viewers' cognitions about IQOS use.

RESULTS

Promotional content attracted significantly more attention compared to the warnings. Attention to the Surgeon General's warning but not to the nicotine warning was associated with recall and recognition of the warning's content. For ever-vapers, greater attention allocation to the promotional content in the IQOS ad was associated with more favorable attitude toward IQOS use, which was in turn positively associated with intention to use IQOS. Attention allocation to the warnings did not affect attitude or intentions, regardless of tobacco use status.

CONCLUSIONS

The results revealed the effects of IQOS promotional content overshadowed the two health warnings in influencing young people's attitude and intention to use IQOS. Young adults who vaped were more vulnerable to HTP advertising with respect to future use and vaping may be a gateway to HTP use.

IMPLICATIONS

This is the first eye-tracking study examining attention and cognitions associated with the new IQOS ad exposure among young adults. Promotional content in the ad attracted significantly more attention than the two warnings combined. Attention to the Surgeon General's warning but not to the nicotine warning was associated with recall and recognition of the warning's content. Greater attention allocation to the promotional content led to a more favorable attitude toward IQOS use which was associated with increased intention to use IQOS for ever-vapers. However, greater attention allocation to the warnings did not affect attitude or intentions to use IQOS.

A Picture Worth a Thousand Texts? Investigating the Influences of Visual Appeals in a Text Message-Based Health Intervention

Healthy eating among young people may curb obesity and improve health, but strong messaging is needed for healthy eating interventions. In the current work, we evaluated the usefulness of visual appeals in a pilot text message-based healthy eating intervention among college students. A 2 (gain vs. loss) × 2 (image vs. no image) design with pretest and posttest questionnaires (N = 111) revealed text-only messages with loss frames had an influence on affective risk response, while both gain- and loss-framed text messages with visual appeals had positive effects on attitudes and intentions. This pilot study provides evidence to support the feasibility of using visual appeals in text message-based health interventions. The implications of the current study are discussed.

To frame or not to frame? Effects of message framing and risk priming on mouth rinse use and intention in an adult population-based sample

Good dental hygiene is key to public health. To promote dental hygiene behaviours, persuasive messages are key. Message framing is a popular theory that has seen mixed evidence. In this web-based experimental study, interaction effects of message frame, behavioural function, and risk priming were investigated on mouth rinse use and intentions in a representative sample of Dutch adults. Final included sample contained 549 participants (50.1% male, mean age = 47.4, SD = 16.1) and outcomes were immediate mouth rinse product choice, intentions to use mouth rinse, and mouth rinse behaviour at 2-week follow-up. Results demonstrated a theorized significant interaction between message frame and behavioural function were mouth rinse product choice. Two-week follow-up mouth rinse behaviour was affected by an interaction between message frame and risk prime. Message framing can thus be employed to promote dental health, but it requires attention to moderation effects which are inconsistent across behavioural outcomes.

Temporal Consequences, Message Framing, and Consideration of Future Consequences: Persuasion Effects on Adult Fruit Intake Intention and Resolve

Message framing is a persuasive strategy that has seen mixed evidence for promoting fruit intake intentions, potentially because framed messages for fruit intake have not (a) explicitly compared short-term consequences versus long-term consequences, (b) considered individual-level differences in time perspective, and (c) used alternative measures of fruit intake intentions. In the present online study, the effects of persuasive messages created from temporal context (short term vs. long term) and message frame (gain framed vs. loss framed) were investigated on fruit intake intentions and resolve among a sample of Dutch adults who were categorized as either present oriented or future oriented. For intention and resolve, results showed a significant Type of Frame × Type of Temporal Context interaction, such that gain-framed messages were more persuasive when combined with long-term consequences and loss-framed messages were more persuasive when combined with short-term consequences. The effect sizes for these differences were similar for resolve and intention, but only differences for intentions were significant. No other effects were found. These results demonstrate that message framing theory may usefully consider the inclusion of temporal context of outcomes and alternative motivation measures to maximize their persuasive effects.

From the eyes and the heart: a novel eye-gaze metric that predicts video preferences of a large audience

Eye-tracking has been extensively used to quantify audience preferences in the context of marketing and advertising research, primarily in methodologies involving static images or stimuli (i.e., advertising, shelf testing, and website usability). However, these methodologies do not generalize to narrative-based video stimuli where a specific storyline is meant to be communicated to the audience. In this paper, a novel metric based on eye-gaze dispersion (both within and across viewings) that quantifies the impact of narrative-based video stimuli to the preferences of large audiences is presented. The metric is validated in predicting the performance of video advertisements aired during the 2014 Super Bowl final. In particular, the metric is shown to explain 70% of the variance in likeability scores of the 2014 Super Bowl ads as measured by the USA TODAY Ad-Meter. In addition, by comparing the proposed metric with Heart Rate Variability (HRV) indices, we have associated the metric with biological processes relating to attention allocation. The underlying idea behind the proposed metric suggests a shift in perspective when it comes to evaluating narrative-based video stimuli. In particular, it suggests that audience preferences on video are modulated by the level of viewers lack of attention allocation. The proposed metric can be calculated on any narrative-based video stimuli (i.e., movie, narrative content, emotional content, etc.), and thus has the potential to facilitate the use of such stimuli in several contexts: prediction of audience preferences of movies, quantitative assessment of entertainment pieces, prediction of the impact of movie trailers, identification of group, and individual differences in the study of attention-deficit disorders, and the study of desensitization to media violence.

Testing the effects of message framing, kernel state, and exercise guideline adherence on exercise intentions and resolve

OBJECTIVES

To study the effects of framed messages on exercise intention and resolve.

DESIGN

Two (type of frame: gain or loss) × 2 (type of kernel state: desirable or undesirable outcome) post-test study.

METHODS

Participants were recruited online and questioned about their previous exercise behaviour and their exercise risk perception. After this, they were randomly allocated to one of four messages that were different in terms of positive or negative outcomes (type of frame) and in terms of attained or avoided outcomes (type of kernel state). After reading the message, participants indicated their intention and resolve to engage in sufficient exercise.

RESULTS

No effects were found for intention. For resolve, there was a significant interaction between type of frame, type of kernel state, and exercise adherence. Those who did not adhere to the exercise guideline and read the loss-framed message with attained outcomes reported significantly higher resolve than all other participants.

CONCLUSIONS

This study indicates the relevance of including attained outcomes in message framing exercise interventions as well as a focus on exercise resolve.

STATEMENT OF CONTRIBUTION

What is already known on this subject? Message framing is commonly used to increase exercise intentions and behaviour. Meta-analyses do not provide consistent support for this theory. Very little attention has been paid to resolve and message factors on framing effects. What does this study add? Framed messages have an effect on exercise resolve, but not on intention. Loss-framed messages with attained outcomes are most persuasive for those who do not adhere to exercise guidelines. Exercise framing studies should include behavioural resolve next to intention. .