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.

Facts Tell, Stories Sell? Assessing the Availability Heuristic and Resistance as Cognitive Mechanisms Underlying the Persuasive Effects of Vaccination Narratives

Online vaccine-critical sentiments are often expressed in appealing personal narratives, whereas vaccine-supporting information is often presented in a non-narrative, expository mode describing scientific facts. In two experiments, we empirically test whether and how these different formats impact the way in which readers process and retrieve information about childhood vaccination, and how this may impact their perceptions regarding vaccination. We assess two psychological mechanisms that are hypothesized to underlie the persuasive nature of vaccination narratives: the availability heuristic (experiment 1, N = 418) and cognitive resistance (experiment 2, N = 403). The results of experiment 1 showed no empirical evidence for the availability heuristic, but exploratory analyses did indicate that an anti-vaccination narrative (vs. expository) might reduce cognitive resistance, decrease vaccination attitudes and reduce attitude certainty in a generally pro-vaccination sample, especially for those who were more vaccine hesitant. Preregistered experiment 2 formally tested this and showed that not narrative format, but prior vaccine hesitancy predicts cognitive resistance and post-reading attitudes. Hesitant participants showed less resistance toward an anti-vaccine text than vaccine-supporting participants, as well as less positive post-reading attitudes and attitude certainty. These findings demonstrate belief consistency effects rather than narrative persuasion, which has implications for scientific research as well as public health policy.

Consuming media, consuming food: investigating concurrent TV viewing and eating using a 7-d time use diary survey

OBJECTIVE

One explanation for the relationship between TV viewing and obesity is that people may (over)eat while watching TV. The current study investigated associations between TV viewing and the time spent on (concurrent) eating in a naturalistic setting among a general population sample.

DESIGN

Preregistered secondary data analyses were performed of a diary survey in which respondents reported their time use in 10-min blocks for 7 d.

SETTING

Concurrent TV viewing and eating was operationalised as all blocks in which TV viewing and eating occurred simultaneously. Furthermore, the TV content respondents watched was coded as food-related (i.e. culinary content) or non-food related.

PARTICIPANTS

The sample composed of 2292 adults (58·9 % female) in the Netherlands, aged ≥ 20 years, from all educational levels (18·1 % low, 29·8 % middle and 51·4 % high).

RESULTS

More than half of the respondents (51·3 %) reported concurrent TV viewing and eating at least once during the 7-d diary period. The average eating occasion was longer in duration while watching TV (v. without media use), and the total time spent on eating was longer on days of concurrent TV viewing and eating (v. days of eating without media use). The percentage of TV viewing time spent on concurrent eating did not differ between food-related and non-food-related TV content.

CONCLUSIONS

Eating while watching TV was related to an increased time spent on eating. Even though energy intake was not assessed, these findings from a naturalistic setting provide further evidence that concurrent TV viewing and eating may contribute to overeating.

See the cake and have it too? Investigating the effect of watching a TV cooking show on unhealthy food choices

This study tested whether exposure to food-related (vs. non-food related) TV content would increase unhealthy food choices in unsuccessful restrained eaters (i.e., chronic dieters with low perceived self-regulatory success; PSRS), decrease unhealthy food choices in successful restrained eaters (i.e., chronic dieters with high PSRS), and would not affect food choices in unrestrained eaters (i.e., non-dieters). As such, we attempted to (1) explain previous mixed findings on behavioral effects of exposure to food-related TV content, and (2) generalize previous findings on successful and unsuccessful restrained and unrestrained eaters' differential reactivity to isolated food cues (e.g., food words) to food cues embedded in TV content. In a one-factorial between-subjects experiment, participants viewed a cooking segment in which high-calorie cakes were prepared (n = 50) or a non-food segment (n = 62) of a TV show. The percentage of unhealthy (vs. healthy) food choices in a computerized choice task served as dependent variable. Eating restraint and PSRS were measured afterwards. In contrast to the hypothesis, no three-way interaction between TV content, eating restraint, and PSRS on the percentage of unhealthy food choices was found. However, it was found that overall, people with lower levels of PSRS made a higher percentage of unhealthy food choices compared to people with higher levels of PSRS. Contrasting findings from previous research using isolated food cues, this study showed no evidence of unsuccessful restrained eaters' heightened susceptibility to food cues in TV content, possibly explained by a lower salience of or attention to food cues.

"I was Right about Vaccination": Confirmation Bias and Health Literacy in Online Health Information Seeking

When looking for health information, many people turn to the Internet. Searching for online health information (OHI), however, also involves the risk of confirmation bias by means of selective exposure to information that confirms one's existing beliefs and a biased evaluation of this information. This study tests whether biased selection and biased evaluation of OHI occur in the context of early-childhood vaccination and whether people's health literacy (HL) level either prevents or facilitates these processes. Vaccination beliefs were measured for 480 parents of young children (aged 0-4 years) using an online survey, after which they were exposed to a list of ten vaccine-related message headers. People were asked to select those headers that interested them most. They also had to evaluate two texts which discussed vaccination positively and negatively for credibility, usefulness, and convincingness. The results showed that people select more belief-consistent information compared to belief-inconsistent information and perceived belief-confirming information as being more credible, useful, and convincing. Biased selection and biased perceptions of message convincingness were more prevalent among people with higher HL, and health communication professionals should be aware of this finding in their practice.

Framing in Entertainment-Education: Effects on Processes of Narrative Persuasion

Nowadays, entertainment-education (E-E) is often used as a persuasive strategy to stimulate prosocial behavior. Although E-E is mostly regarded as a persuasive strategy in itself, in an increasing number of E-E programs several persuasive strategies are used to communicate the educational message to the audience. This study investigates the effects of a strategy widely used in health communication, but not previously studied in the field of E-E: framing. To this means we examined the effect of two different ways an E-E message can be framed: by emphasizing either the losses of not performing the behavior in question or the gains of performing this behavior. A serial multiple mediation model showed that framing affected intention to refrain from drunk cycling via counterarguing and attitude toward drunk cycling; the use of a gain frame decreased counterarguing, which decreased the attitude toward drunk cycling. This subsequently resulted in a higher intention to refrain from this behavior. Implications of these results are discussed.

Effects of Disclosing Sponsored Content in Blogs: How the Use of Resistance Strategies Mediates Effects on Persuasion

This article presents two studies examining the effects of disclosing online native advertising (i.e., sponsored content in blogs) on people's brand attitude and purchase intentions. To investigate the mechanisms underlying these effects, we integrated resistance theories with the persuasion knowledge model. We theorize that disclosures activate people's persuasion knowledge, which in turn evokes resistance strategies that people use to cope with the persuasion attempt made in the blog. We tested our predications with two experiments (N = 118 and N = 134). We found that participants indeed activated persuasion knowledge in response to disclosures, after which they used both cognitive (counterarguing) and affective (negative affect) resistance strategies to decrease persuasion. The obtained insights do not only advance our theoretical understanding of how disclosures of sponsored blogs affect persuasion but also provide valuable insights for legislators, advertisers, and bloggers.

Embodied Resistance to Persuasion in Advertising

From the literature on resistance to persuasion in advertising, much is known about how people can resist advertising by adopting resistance strategies, such as avoidance, counter-arguing, and selective attention (e.g., Fransen et al., 2015b). However, the role of emotion regulation and bodily expression in resisting persuasion is so far underexplored. This is a surprising observation if one considers that at least 40% of advertisements use positive emotions (i.e., happiness) to persuade people to like the ad, brand, and product (Weinberger et al., 1995). In this article we present a framework in which we apply previous knowledge and theories on emotion regulation and embodiment to the process of resistance to persuasion. In doing so, we specifically address the role of facial expression in the course of resistance. The literature and findings from our own research lead us to propose that people can resist persuasion by controlling their facial expression of emotion when exposed to an advertisement. Controlling the expression of emotions elicited by an ad (for example refusing to smile) might be a fruitful way to resist the ad’s persuasive potential. Moreover, we argue that co-viewers can affect embodied resistance to persuasion. Showing the viability of embodied resistance to persuasion is relevant in view of the fact that ads trying to persuade us by addressing our positive emotions are ubiquitous. Embodied resistance might help people to cope with these induced positive emotions in order to resist advertisements and might therefore work as a novel and effective strategy to resist persuasion.

Strategies and motives for resistance to persuasion: an integrative framework

Persuasion is an important element of human communication. But in many situations, we resist rather than embrace persuasive attempts. Resistance to persuasion has been studied in many different disciplines, including communication science, psychology, and marketing. The present paper reviews and connects these diverse literatures, and provides an organizing framework for understanding and studying resistance. Four clusters of resistance strategies are defined (avoidance, contesting, biased processing, and empowerment), and these clusters are related to different motivations for resisting persuasion (threat to freedom, reluctance to change, and concerns of deception). We propose that, while avoidance strategies may be triggered by any of these motivations, contesting strategies are linked primarily to concerns of deception, while empowerment and biased processing strategies are most common when people are reluctant to change.

Educational storylines in entertainment television: audience reactions toward persuasive strategies in medical dramas

Medical television drama series provide an important source of health information. This form of entertainment-education (E-E) can be used to influence knowledge, attitudes, and behaviors toward health-related issues. In the literature, E-E is generally regarded as a persuasive strategy in itself, whereas in an increasing number of E-E programs, several different persuasive strategies are used. An important question is how the audience ethically evaluates these strategies. The aim of the present study is to examine viewers' ethical judgments toward the use of three persuasive strategies in E-E: product placement, framing, and persuasion toward a controversial position. A survey among 525 viewers of 5 popular medical dramas demonstrates that viewers evaluate the use of the currently investigated attitudinal statements about potential persuasive strategies in E-E as being immoral and that viewers prefer neutral storylines. Adopting a strategy that viewers find inappropriate may interfere with the intended prosocial effects of E-E. A broader understanding of the appropriate and inappropriate uses of persuasive strategies in E-E is indispensable for effective E-E productions.