Message framing in health communication : the role of temporal framing, persuasion knowledge and reactance

Master Thesis

Message Framing in Health Communication:

The role of Temporal Framing, Persuasion Knowledge and Reactance

Master’s programme Communication Science --

Date: 26th of June 2015 --

Name: May Meppe Student number: 10003981

--

Abstract

To increase smoking cessation rates, every year new anti-smoking campaigns are created. But these campaigns have not provided the wanted results yet (Zhu, Lee, Gamst & Wolfson, 2012).

The problem of the health consequences of smoking is and has been here for decades and the search for effective communication strategies still continues. This research focuses on the use of

message framing and the moderating influence of temporal framing on attitude towards the message, attitude towards quitting smoking and intention to quit smoking. This research also

focuses on the influence of persuasion knowledge in this relationship and the mediating role of

reactance. An online experiment (N = 213) found no main-effect for message framing on the

dependent variables. It also found that temporal framing and persuasion knowledge had no significant influence on this relationship. Results also show that the relationship between

message framing and smoking cessation intentions and attitudes was not mediated by reactance.

Introduction

It is common knowledge that smoking is unhealthy and can lead to several deadly diseases (U.S. Department of Health and Human Services, 2014). However, after many governmental

restrictions and worldwide regulations there are still 5 million people who die from the health consequences of smoking each year and there are for example in the United States every day 2.100 young adults who become daily cigarette smokers (U.S. Department of Health and Human Services, 2014). To decrease the number of smokers, new anti-smoking campaigns are created every year. These anti-smoking campaigns. however, often do not provide the wanted results (Zhu, Lee, Gamst, & Wolfson, 2012). Zhu and colleagues reviewed literature on smoking cessation interventions, with the focus on the last twenty years (from 1991 to 2010). They found that in those years there was a big development of cessation interventions, but that the results of these interventions indicated that there was no trend of an increase in the smoking cessation rates in the population of the United States in these two decades. The problem is still severe and therefore communication professionals are searching for effective communication strategies to increase smoking cessation rates. This research focusses on these messages.

Messages can be framed in different ways. This research focusses on two different types of message framing: gain-frame versus loss-frame and short-term consequences frame versus long-term consequences frame. When a gain-frame is used, the advantages when complying with the advised behavior (quitting smoking) are emphasized (Rothman & Salovey, 1997). When a loss-frame is used, the disadvantages of not complying (not quitting smoking) with the advised behavior are emphasized. When a short-term consequences frame is used, the

advantages/disadvantages of the behavior are emphasized on the short-term (Chandran & Menon, 2004). When a long-term consequences frame is used, the advantages or disadvantages

of the behavior are emphasized on the long-term. The use of gain- versus loss-frames will be referred to as message framing in this research, the use of a short-term or long-term

consequences frame will be referred to as temporal framing in this research.

In the past, researchers have investigated the effects of the use of different message frames on different variables related to smoking behavior, intentions and attitudes. Previous research repeatedly found that for prevention behavior (quitting smoking) the use of a gain-frame will be the most effective (Rothman & Salovay, 1997; O’Keefe & Jensen, 2009; Gallagher & Updegraff, 2011). But, recent research on the use of both message framing and temporal framing on cigarette warning labels (Nan, Zhoa, Yang, & Iles, 2015), found that the use of loss-frames caused significantly higher perceived effectiveness of the message, argument strength and liking than gain-framed messages. In this research they found no effects of temporal framing. These results differ from what has been researched before, one possible explanation for that could be that Nan et al. (2015) focused on nonsmokers, instead of smokers. They state that because their target group consisted of nonsmokers only, the use of a short-term and long-term frame could possibly not have any effects because the consequences are simply not that relevant to

nonsmokers. They state that the difference in frames might matter more for actual smokers, who are more susceptible to the consequences and are maybe more sensitive to how these

consequences are framed. Because of that this research will continue this work, by focusing on analyzing actual smokers and thereby researching if the main effect of message framing is influenced by the difference in temporal frame.

Nan et al. (2015) further suggest that the use of framing could work but that there could possibly be a rise of reactance that has an influence on the relationship between message

‘reactance’ (Brehm, 1966). This theory states that people believe that they have the freedom to make their own choices and to act as they wish. When this freedom is attacked, by for example a persuasive or forcing message, the person feels as if their freedom is threatened and this person will want to restore its freedom. To restore this freedom the individual will rebel against the message and act in the opposite way. Previous research has found that the use of a gain-frame resulted in more favorable reactions to a message and that it caused for a lower psychological

reactance when focused on organ donation (Reinhart, Marshall, Feeley & Tutzauer, 2007). They

also found that reactance caused negative attitudes and lowered the intention to donate (Reinhart et al., 2007). Reinhart et al. (2007) therefore theorize that using a loss-framed message could possibly lead to a higher reactance to the message because a person feels that he is being persuaded and feels threatened in his freedom of choice. Previous research also found these effects of reactance for messages about sun safety (Cho & Sands, 2011) and excessive alcohol consumption among college students (Quick & Bates, 2010). Erceg-Hurn and Steed (2011) researched reactance after exposure to cigarette warning labels, they found that when a warning label was framed in a loss-frame this caused for a higher reactance, in comparison to a gain-frame. The results of these studies highlight the importance of studying this phenomenon, so that future smoke cessation interventions can be improved on causing the least reactance. Where Erceg-Hurn and Steed (2011) focused on warnings on packages, this research will focus on the messages only. This is because these messages are used in a broader way than just cigarette warning labels and can target the behavior even before purchase of a package.

Last, the possible moderating effect of persuasion knowledge is studied because previous research found that persuasion knowledge, the knowledge a person has about being persuaded (Friestad & Wright, 1994), could be influencing the cognitive processes that lead to reactance to

a persuasive message (Henrie & Taylor, 2009; Fabrigar et al, 2006; Friestad & Wright, 1999). Persuasion knowledge in relationship to message framing has never been researched; therefore this study will aim to provide new scientific information on which further research can be build and smoking interventions can be created.

In summary, this study aims to provide more scientific understanding of the effects

message framing in messages focused on increasing smoking cessation rates on the attitude towards the message, the attitude towards quitting smoking and the intention to quit smoking.

This study also examines the possible mediating role of reactance and the moderating role of

persuasion knowledge and temporal framing. The findings of this study can be applied in the

practical field as guidelines for construing anti-smoking campaign messages. The goal of this study is to answer the following research question(s):

What is the impact of the type of message framing (gain vs. loss) on the attitude towards the message, the attitude towards quitting smoking and the intention to quit smoking? Is this relationship mediated by reactance? And do persuasion knowledge and temporal framing have an effect on this relationship?

Theoretical background

Message framing

The use of different frames results in people making different choices, even though the information that is given is essentially the same (Rothman & Salovey, 1997). This research focuses on two types of message framing: gain- versus loss-framing and short-term versus long-term framing.

A gain-framed message describes the positive outcomes of performing the recommended behavior or the negative outcomes that will not happen when performing the behavior (e.g. “If you quit smoking, your chances of developing lung cancer will be reduced), whereas a loss-framed message describes the negative outcomes when the behavior is not performed (e.g. “If you do not quit smoking, your chances of developing cancer will be increased) (Rothman & Salovey, 1997). The theory of framing can be explained by the prospect theory of Tversky and Kahneman (1979). This theory proposes that when a choice is expressed in terms of gains, people will be more risk-averse and prefer the less risky choice, and when a choice is expressed in terms of losses, people are willing to take more risk and will prefer the riskier option (Tversky & Kahneman, 1979). In health communication, Rothman and Salovey (1997) make a distinction between prevention behavior and detection behavior. An example of prevention behavior is using a condom to prevent getting an STD. An example of detection behavior is to perform an STD test, to find possible illnesses. This research focuses on smoking cessation, which is prevention behavior. Previous research has repeatedly shown that for prevention behavior using a gain-frame will be the most persuasive (Rothman & Salovey, 1997; O’Keefe & Jensen, 2009; Gallagher & Updegraff, 2011). This can be explained through the fact that prevention behavior comes with a relatively small risk (Tversky & Kahneman, 1979). When a person quits smoking, the chances of a negative outcome are very small and the chances of a positive outcome are big. The analysis of Latimer (2007) confirms this advantage for gain-frames in comparison with loss-frames when it concerns the promotion of smoking cessation, as did Gallagher and Updegraff (2011). It is therefore theorized that when a health campaign is framed in terms of gains the message will be more persuasive in comparison to a loss-framed message (O’Keefe & Jensen, 2009), which leads to the first hypothesis:

H1: The use of a gain-frame in a health message focused on smoking cessation will be more effective, in comparison to a loss-frame, in increasing the attitude towards the message, the attitude towards quitting smoking and the intention to quit smoking.

Message framing and temporal framing

A message can also be framed in terms of time. In this research the second focus lies on temporal

framing, as a possible moderating variable. A temporal frame describes the actual distance

between one reference point (today) and one point in the future (e.g. tomorrow or next year). The Construal Level Theory (Liberman & Trope, 1998) suggests that people have certain

psychological reactions which differ because of the temporal distance. This theory explains why there is a difference when using a short-term frame in comparison to a long-term frame. When a short-term frame is used, the frame focusses on the outcomes of the behavior on short-term (e.g. tomorrow). When a long-term frame is used, the frame focusses on the outcomes of the behavior on the long-term (e.g. next year). The Construal Level Theory suggests that events in the distant future are seen as less concrete and more abstract.

A message that is framed in terms of gains and losses, can at the same time be framed in terms of time. When this is the case, the threat of the possible outcomes (of complying or not complying with the recommended behavior) will be closer (short-term frame) or more distant (long-term frame). Nan et al. (2015) recently researched, the effects of temporal framing and

message framing when looking at cigarette warning labels. They did find a main-effect of a

loss-frame on argument strength, liking and perceived effectiveness of the message, but they found no significant effects of the use of different temporal frames. The findings of a main-effect of a loss-frame are remarkable because this is not in line with previous research, which repeatedly

found a main effect of gain-frames when researching smoking cessation (Rothman & Salovey, 1997; O’Keefe & Jensen, 2009; Gallagher & Updegraff, 2011).

Only Chandran and Menon (2004) also researched the effects of message framing and

temporal framing before, they did find significant results. First, they found a main-effect of temporal framing; the use of an ‘every day’ frame made the risk seem more proximal and more

concrete than the use of an ‘every year’ frame, which confirms the Construal Level Theory. This resulted in increased intentions to comply with the behavior, increased self-risk perceptions and increased effectiveness of the risk communication. The researchers also found a moderating effect of outcome valence (gain versus loss) on the relationship between temporal framing, risk perception, attitudes, behavioral intentions and effectiveness of risk communication. When a message emphasized the negative outcomes (loss-frame), a day frame made the message more concrete and dreadful and this was more persuasive in comparison to the year frame. In the condition with the positive outcome (gain-frame) the effects were reversed. A gain-frame message combined with a day frame let the targeted behavior seem less of a threat, in

comparison with the year frame. They found these results for messages about preventing the risk of mononucleosis, heart disease and cell phone radiation. Because the researched behaviors are also preventive behaviors, similar results are expected for messages focused on smoking cessation. It is expected that the main effect of a gain-frame on the dependent variables will be influenced by the use of different temporal frames. The following hypothesis is therefore constructed:

H2: The effect of a gain-frame on the attitude towards the message, the attitude towards quitting smoking and the intention to quit smoking is larger when the message uses a long-term frame than when the message uses a short-term frame. These effects will be reversed when a loss-frame is used.

Message framing and reactance

The theory of psychological reactance (Brehm, 1966) might explain why persuasive messages sometimes do not work (Witte & Allen, 2000). The reactance theory states that when a

persuasive message is perceived as a threat to freedom, the receiver of the message will try to act in the opposite way than the persuasive message intended (Brehm, 1966). This is because

individuals believe that they are free to make their own choices and that they are free to act the way they wish. When the individual perceives a threat to his or her freedom, by a forcing or persuasive message, the individual feels as if his or her freedom has been threatened. To ‘get’ this freedom back, the individual will rebel against the force and behave in the opposite way.

It has also been found that health warnings cause reactance and that these messages sometimes do more harm than good (Robinson & Killen, 1997). Dillard and Shen (2005)

theorize that the differences in the perceived threat to freedom might be caused by different types of message framing. Several researches has since been conducted to find out what differences in messages cause for this reactance, but no researches have been conducted for messages focused on smoking cessation.

Cho and Sands (2011) found that, for messages concerning sun-safety, when a loss-frame was used, in comparison to a gain-frame, this produced a higher perceived threat to freedom. Other previous research also found that loss-frames produced greater reactance (Reinhart et al., 2007), which caused for negative attitudes towards organ donation and lowered intentions to

donate. Quick and Bates (2010) researched the effects of message framing on reactance when focusing on excessive alcohol consumption among students, but they did not found that a

message framing was associated with reactance. They state that because of their weak

manipulation, they manipulated one third of the text with frames, the results might have been compromised. Erceg-Hurn and Steed (2011) also researched the effects of message framing on reactance, when focusing on cigarette warning labels. Their study also support the finding that a loss-frame caused for higher reactance, in comparison to a gain-frame. They found that when a warning consisted of text only reactance was little, but when smokers were exposed to graphic warnings 80% of the smokers experienced reactance. Because of these findings it is expected that the use of message framing will have an influence on reactance and that this will have an influence on the dependent variables. The following hypothesis is constructed:

H3: The main effect of a gain frame on attitude towards the message, attitude towards quitting smoking and the intention to quit smoking can be explained by the mediating role of reactance.

Persuasion knowledge and reactance

Persuasion knowledge is the personal knowledge an individual has about tactics and “tricks” that can be used by an influence agent to persuade them (Friestad & Wright, 1994). The Persuasion Knowledge Model states that persuasion knowledge develops through time and experience. The persuasion knowledge also differs and develops through different cultures and generations. Individuals learn about persuasion from social interactions with for example friends and family, they also learn by observing marketers and media. A consequence of the growth of this

knowledge is that it can effect certain attitudes and behavior, because their knowledge changes the way they respond.

In this research it is expected that persuasion knowledge might influence the relationship between message framing and reactance (Kivetz, 2005). Because when the persuasion

knowledge of an individual is developed, it makes the individual aware of persuasive attempts and the attempts to force them to act in a certain way. When this forcefulness is recognized by the target, reactance can occur and the target will try to rebel against the message (Friestad & Wright, 1994). Smokers in general will be more sensitive to a persuasive message promoting smoking cessation, because they know that they are being persuaded to act against their own behavior (Miller, Burgoon, Granpre & Alvaro, 2006). Because of this, it is expected that

reactance will be positively influenced by the degree of persuasion knowledge. An individual

who scores high on the persuasion knowledge scale, is expected to also score high on the scale of

reactance. This leads to the last hypothesis:

H4: The effect of a gain frame on the attitude towards the message, the attitude towards quitting smoking and the intention to quit smoking is reduced when the persuasion knowledge about the message is high, in comparison to when the persuasion knowledge about the message is low.

Figure 1. Conceptual model

Methods

Research design

In this research the effectivity of two different types of framing was tested in a message focused on smoking cessation. The design of this research was a 2 (gain vs. loss) x 2 (long vs. short) factorial between-subjects design. The participants were randomly assigned to one of the four conditions (Table 1).

Table 1. Research design: conditions

Two types of framing Short (48 hours) Long (One year)

Gain gain x short (condition 1) gain x long (condition 2) Loss loss x short (condition 3) loss x long (condition 4)

Participants

The participants in this research must be 18 years or older. Only people who smoke, or are occasional smokers could participate in this research. The participants were searched in the

researcher's own social environment and were contacted through email or Facebook. The

experiment was conducted in the Netherlands. In a short message the participant was asked if he or she wanted to participate in a research. In this message it became clear that the research was for a master thesis and that the research would take about 10 minutes of their time. When the participant wanted to contribute to the research he or she had to click on a hyperlink, which would lead the participant to the research in Qualtrics.

Procedure

All the participants completed the experiment online. On the first page in Qualtrics there was an information sheet (Appendix A) describing that the research was about ‘construction of texts in health communication’. After this page the participant saw the informed consent form (Appendix B). The informed consent form stated that the research about constructing texts in health

communication would take 10 minutes of their time, that they first would answer questions about themselves and about their smoking behavior, after which they read a text and thereafter they received some final questions about the text. The informed consent form also stated that it was very important that the participants answered the questions honestly, that the participation in this research was entirely anonymous and that the participant could fill in his or her e-mail address to get the results later. When the participant provided informed consent, the next page appeared, which consisted of questions concerning their demographic information (e.g. age, gender) and current smoking behavior (for complete questionnaire see appendix D). After the questions the participant would see one of the four manipulated texts (Appendix C). The participant was asked to read the text thoroughly and on the next page there would be a questionnaire with questions, first concerning the mediator (reactance), then the dependent variables (attitude towards the message, attitude towards smoking, intention to quit smoking) and last the moderator (persuasion

knowledge). The last two questions regarded two manipulation checks and then in the end the participant was thanked for participating in the experiment.

Measurements

Demographic information and current smoking behavior

First the participants filled in a couple of questions regarding their demographic information and current smoking behavior. The questions concerning their smoking behavior were constructed according to the work of Mudde, Willemsen, Kremers and De Vries (2006).

Independent variables

The participants each saw one of the four manipulated messages, which consisted of information about either the advantages of quitting smoking (gain-frame) or the disadvantages of not quitting smoking (loss-frame). The texts both also had one sentence regarding the different temporal frames (short- versus long-term). The following subjects were discussed: overall health, physical condition, smell, stress and fertility. For a short summary of the content of the conditions see Table 2. For the four different texts in the four conditions see Appendix C.

Table 2. Short summary of content of the conditions

Type of frame Gain Loss

Title of text The advantages of quitting smoking

The disadvantages of not quitting smoking

Features in text (Message frame)

Health

Overall better health and reduced chances of getting cancer.

Physical condition

More oxygen in your lungs,

Health

Overall bad health and increased chances of getting cancer.

Physical condition

which causes a better physical condition.

Smell

There’s no more smell around you and in your house.

Stress

Your body is not nicotine dependent anymore, which reduces stress.

Fertility

Fertility is high, you have a higher chance of having children.

which causes a bad physical condition.

Smell

There’s always a smell

around you and in your house.

Stress

Your body is nicotine dependent, which increases stress.

Fertility

Fertility is low, you have a lower chance of having children.

Temporal frame Short

48 hours after you quit smoking your taste and smell senses come back.

Long

After one year of quitting smoking your chances of getting a heart attack are reduced by half.

Short

48 hours after you smoked a cigarette your smell and taste senses are reduced.

Long

After one year of smoking your chances of getting a heart attack are doubled.

Dependent variables

After seeing the stimulus material the participant filled in the final questionnaire regarding the variables in the following order: reactance, attitude towards the message, attitude towards

smoking, intention to quit smoking and persuasion knowledge.

Attitude towards the message. The attitude towards the message was measured with five 7-point semantic scales, adopted from the methodological considerations of Ajzen (1990). Participants answered the following statement: “the message I just read is in my opinion...”. The scales varied from harmful-beneficial, pleasant-unpleasant, good-bad, worthless-valuable,

Attitude towards quitting smoking. The attitude towards quitting smoking was measured with one statement, which could be answered on five 7-point semantic scales. The participant answered the following statement: “for me, quitting smoking is...”. The scales were constructed by the teachings of Ajzen (2002) and consisted of pleasant-unpleasant,

harmful-beneficial, enjoyable-unenjoyable, good-bad, worthless-valuable.

Intention to quit smoking. Intention to quit smoking was measured with three

statements, which were previously used in the study of Capella and Wong (2009). Participants were asked to answer the following questions: “how likely is it that you will: a) quit smoking permanently and completely, (b) reduce the total numbers of cigarettes you smoke per day, and (c) talk to someone about quitting smoking?”. Participants could answer these three questions on a 7-point scale, where 1 is “definitely not” and 7 is “definitely will”.

Reactance. The measurement of state reactance consisted of four items (angry, irritated,

aggravated and annoyed) that were answered on a 4-point scale (1 = I have none of this feeling,

and 4 = I have a great deal of this feeling) (Dillard & Peck, 2001).

Persuasion Knowledge. To measure the construct of persuasion knowledge the

participants had to answer the statement “I think the message about smoking is...” on five 7-point semantic scales based on the research of Ohanian (1990): not credible, trustworthy, honest,

convincing, biased.

Manipulation check

To check if the manipulation of the four conditions worked, the participants each had to fill in two questions regarding the difference in message framing (gain versus loss) and the difference in temporal framing (short-term versus long-term).

The participants in condition 1 and 2, who read the text in a gain-frame, had to answer the following manipulation check regarding the difference in message framing: “To what extent did the text emphasize the advantages of quitting smoking?”. This question could be answered on a 7-point semantic scale (1 = negative and 7 = positive). If the participants in condition 1 and 2 answered this question on a score of 4 or higher, the manipulation worked for these conditions.

The participants in condition 3 and 4, who saw the text in a loss-frame, answered the following manipulation check: “To what extend did the text emphasize the disadvantages of not quitting smoking?”. This question was also answered on a 7-point semantic scale (1 = positive and 7 = negative). If the participants of conditions 3 and 4 answered this question on the negative side of the scale (score = 4 or lower), the manipulation worked.

The manipulation check question about the difference in temporal framing was as followed: “To what extent were the consequences emphasized on a short-term or on a long-term?” This question could be answered on a 7-point scale (1 = short and 7 = long). The question on the temporal distance was the same for all the conditions. When participants in condition 1 and 3 answered the question on scores 1 to 4, and participants in condition 2 and 4 on scores 4 to 7, the manipulation was accepted as successful.

Sample & scale construction

Sample

A total of 314 participants took part in the online experiment. The dropout rate was 17% which resulted in a total of 260 participants who finished the experiment. 47 of the participants said they never smoked, so they were also excluded from the experiment, which resulted in a total of 213 participants who were included in the analyses. The group consisted of 104 (48.8 percent) men and 109 women (51.2 percent), with the mean age of 25.46 (SD = 6.58). The aged varied

from 18 till 61. From the total sample 84 participants (39.4 percent) said to smoke every day, 78 participants (36.6 percent) smoked occasionally and 51 participants (23.9 percent) previously smoked but had now quit. It was chosen to also include the participants who had now quit in the analyses.

Scale construction

To test the reliability of the scales for message attitude, attitude towards quitting smoking,

intention to quit smoking, state reactance and persuasion knowledge the Cronbach’s Alpha was

used.

The construct of message attitude had a Cronbach’s Alpha of .14, which is not reliable. By deleting the item ‘enjoyable-unenjoyable’ the Cronbach’s Alpha became .67, so this item was deleted. It was not possible to make the scale more reliable by deleting another item. The scale for attitude towards quitting smoking had a Cronbach’s Alpha of .80 and deleting an item would not make it more reliable. The Cronbach’s Alpha for the scale intention to quit smoking was .50, which is not reliable, deleting an item would not make the scale more reliable.

The scale of state reactance measured the immediate reactance towards the message, after the message was shown. The Cronbach’s Alpha for this scale was .90, which is considered very reliable. It was not possible to increase the reliability by deleting an item.

The scale for persuasion knowledge had a Cronbach’s Alpha of .75. When the item ‘biased-unbiased’ was deleted, the scale had a Cronbach’s Alpha of .80, so this item was deleted.

Plan of Analyses

Demographic information

The sample was analyzed by age, gender, current smoking behavior and quit attempt.

Participants who are under the age of 18 were excluded from the experiment. Participants who never smoked were also excluded.

Randomization, covariates and manipulation check

To check if the randomization worked and that there were no differences between groups two different analyses were conducted. A Chi-Square analysis was conducted for the variables

gender and quit attempt and an Independent Samples T-test for age and education.

Next was analyzed whether there were variables that correlated with the dependent variables. The following variables were analyzed as possible covariates: age, gender, education and current attempt to quit. After the analysis for the control variables, a Spearman’s correlation was conducted for gender and quit attempt, and a Pearson's’ correlation for age and education. A manipulation check was conducted to see if the manipulation in the experiment

worked. There were two different manipulation checks, one regarding the gain versus loss frame condition and one regarding the temporal frame condition. The participants, who answered both manipulation checks right, were included in the final dataset.

Hypotheses

First the variables message framing and temporal framing were made into two dummy variables (message framing: 0 = loss and 1 = gain, temporal framing: 0 = short and 1 = long).

To test for the first hypothesis (main effect of gain-frames) three separate ANCOVA’s were conducted with the message framing as the independent variable and the attitude towards

the message, the attitude towards quitting smoking and the intention to quit smoking as

dependent variables. Significant correlating variables were included as covariates, this was the case for all the analyses.

To test for the second hypothesis, regarding the interaction effect between the use of a gain- versus loss-frame and the use of a long- versus short-term frame three separate

ANCOVA’s were conducted. In these three analyses message framing and temporal framing were the independent variables and attitude towards the message, attitude towards quitting

smoking and intention to quit smoking were the three separate dependent variables.

The third hypothesis, regarding the mediating role of state reactance in the relationship between the use of message framing (gain versus loss) and the dependent variables was tested with the use of the methods of Hayes (2012). For these analyses Model 4 in the program PROCESS by Hayes was used. The dummy variable of message framing was used in these analyses, where Step A was to confirm the significant relationship between the independent variable and the dependent variable (XY). Step B was to confirm the significant relationship between the independent variable and the mediator (XM). Step C was to confirm the

significant relationship between the mediator and the dependent variable, when in the presence of the independent variable (M|XY), and Step C’ was to confirm the insignificance of the relationship of the independent variable and the dependent variable, when in the presence of the mediator (X|MY). Because there were three dependent variables, these four steps were followed three times.

To test for the fourth hypothesis, regarding the moderating role of persuasion knowledge, in the relationship between the use of message framing (gain versus loss) on the variable

analysis, with the dummy conditions (message framing) as independent variable, persuasion

knowledge as moderator and reactance as dependent variable. When the results showed a

significant interaction between the conditions and the moderator, it could be concluded that there was a moderating effect of persuasion knowledge.

Results

Randomization check

The results of a Chi-Square test showed no significant differences between groups for gender (χ² (1) = .10, p = .757) and quit attempt (χ² (1) = 1.56, p = .214) and two Independent Samples T-tests showed no significant differences between groups for age (t(188) =.26, p = .807) and

education (t(188) = -.76, p = .482), equal variances assumed.

Correlation analysis

To control if there were any significant differences across conditions regarding: age, gender, educational level and the presence of an attempt to quit a Pearson’s correlations analysis and a Spearman’s correlation analysis were conducted. The correlation analysis found significant correlations between attitude towards the message and age, persuasion knowledge and age,

intention to quit smoking and gender, intention to quit smoking and the presence of a quit

attempt, and last a correlation between persuasion knowledge and quit attempt. The strength and

direction of the correlations can be found in Table 3. Because of these correlations gender, age and quit attempt were taken into account as covariates in further analyses.

Table 3. Correlations

Pearson’s correlation analysis Spearman’s correlation analysis

Age Education Gender Quit attempt

Attitude towards the message -.150* -.024 .029 -.016 Attitude towards quitting smoking .020 .023 .019 -.094 Intention to quit smoking .086 -.035 -.161* -.199**

Reactance -.106 -.006 -.159 -.113

Persuasion knowledge .121* -.033 .052 .161*

* Correlation is significant at the 0.05 level (2-tailed). ** Correlation is significant at the 0.01 level (2-tailed).

Manipulation check

From the first manipulation check (gain versus loss), 23 people (10 percent of the total sample) were excluded, because they answered the question on wrong side of the scale. This resulted in a total sample of 190 participants. The results of the second manipulation check are displayed in Table 4. The manipulation failed, only about half (N = 39) of the participants who saw the condition with the short-term consequences (N = 78) answered the question on answer 1 to 4 on the scale. From the participants who saw the text with the long-term consequences 72 out of 94 answered the question on the ‘right’ side of the scale. Because of this it was concluded that the manipulation of the temporal framing failed, but because of the big reduction of the sample it was decided not to delete these participants and continue with the analyses.

Table 4. Manipulation check for temporal framing

Short-term or long-term? (1=short, 7=long)

Condition 1 2 3 4 5 6 7 Total

Short 5 11 11 16 13 12 10 78

Long 4 9 9 23 24 15 10 94

Total 9 20 20 39 37 27 20 172

Hypothesis testing

Main effect of a gain-frame

There were no significant variances across all groups. Three separate ANCOVA’s did not find any significant effects of message framing on attitude towards the message (F(1, 173) = 3.04, p = .083), attitude towards quitting smoking (F(1, 173) = .23, p = .632) and intention to quit

smoking (F(1, 172) = .05, p = .829). This means that the first hypothesis was rejected. There was

no main effect found of the use of a gain-frame in comparison to a loss-frame on the dependent variables.

Interaction effect message framing and temporal framing

An ANCOVA showed there was no significant interaction found between the use of a message

frame in combination with a temporal frame on the attitude towards the message (F(1, 171) =

2.69, p = 0.107) on the attitude towards quitting smoking (F(1, 171) = 2.39, p = .124) and on the

intention to quit smoking (F(1, 170) = .12, p = .729). This means that hypothesis 2 was rejected,

the effect of gain-frame on attitude towards the message, attitude towards quitting smoking and

intention to quit smoking was not larger when the message uses a long-term frame in comparison

Mediating role of reactance

The analyses for the possible moderating role of reactance showed no significant effects. From these analyses the conclusion was that the main effect of a gain-frame cannot be explained by

reactance as a mediator. The steps and complete results of the analyses can be found in Table 5.

This means that Hypothesis 3 was be rejected. The main effect of gain-frame on intention to quit

smoking, the attitude towards quitting smoking and the attitude towards the message, cannot be

explained by the mediating role of reactance.

Moderating role of persuasion knowledge

The analysis found no significant interaction effect between the message framing, persuasion

knowledge and reactance. The results of the analyses can be found in Table 6. Because of this

results it was concluded that there was no moderating effect of persuasion knowledge. The effect of a gain-frame on the dependent variables was not reduced when persuasion knowledge was high, in comparison to when persuasion knowledge was low. Therefore, hypothesis 4 was rejected.

Table 5. Results for mediation analysis

Step A Step B Step C Step C’ Bootstrap results for indirect effects

B SE T p B SE T p B SE T p B SE T p ab SE LL 95CI UL 95 CI Message attitude .04 .07 -.63 .532 .11 .10 1.20 .235 -.14 .08 -1.77 .078 .11 .09 1.19 .23 -.13 .07 -.28 .09 Smoking attitude .04 .07 -.63 .532 -.21 .16 -1.33 .186 .06 .13 .46 .646 .05 .12 .39 .692 .05 .12 -.20 .30 Quit intention .04 .07 -.63 .532 -.05 .11 -.43 .666 -.01 .10 -.02 .981 -.05 .11 -.43 .666 -.01 .09 -.18 .18

Note. B = unstandardized regression coefficient, SE = standard error, T = t-value, LL 95 CI = lower limit of 95% confidence interval, UL 95 CI = upper limit of 95% confidence interval, p > .05 = (n.s.) = not significant.

Table 6. Results for moderation analysis

Interaction with reactance

B SE T p LL 95CI UL 95CI

Persuasion Knowledge .26 .09 2.39 .018 (n.s.) .04 .42

Note. B = unstandardized regression coefficient, SE = standard error, T = t-value, LL 95 CI = lower limit of 95% confidence interval, UL 95 CI = upper limit of 95% confidence interval, (n.s.) = not significant

Conclusion & discussion

In this research the effects were examined of the use of message framing on the attitude towards

the message, the attitude towards quitting smoking and the intention to quit smoking. The goal of

this research was also to study the possible the mediating role of reactance and the possible moderating role of temporal framing and persuasion knowledge in this relationship.

The expectation of this research was that there would be a main effect of a gain-frame, in comparison to a loss-frame on the dependent variables. It was expected that the main effect of a gain-frame could be explained by the mediating role of reactance. It was also hypothesized that the use of temporal framing would have an effect on the relationship between message framing and reactance. Finally it was expected that the main effect of a gain-frame would be reduced when persuasion knowledge was high and therefore expecting persuasion knowledge to be a possible moderator in this relationship. The findings of this research will be further discussed in order of the four hypotheses.

The first hypothesis regarded the main effect of a gain-frame in comparison to a loss-frame. The results of this research showed no significant effects of the use of a gain-frame in comparison to a loss-frame on the dependent variables, H1 was therefore refuted. This was notable because, previous research found that for prevention behavior, which quitting smoking is, the use of a gain-frame was the most effective (Rothman & Salovey, 1997), and many other researchers have found similar results (Latimer, 2007; O’Keefe & Jensen, 2009). A possible explanation for not finding these results could be that the manipulation was relatively small, the manipulated text did not look like a brochure or campaign message. The sentences were short and the experiment was conducted in the online environment of the University of Amsterdam. A

recommendation for further research would be to manipulate the texts as if they were truly from an anti-smoking campaign or brochure.

The second hypothesis stated that the main effect of a gain-frame would be more

effective when used in combination with a long-term frame, in comparison to a short-term frame. The results of this research showed no significant differences between the use of a gain-frame in combination with a long-term frame in comparison to a short-term frame, H2 was therefore rejected. A possible reason for not finding significant results highlight a very important

discussion point: the failed manipulation of temporal framing. The manipulation check showed that the participants did not understand the short-term or long-term consequences sentence correctly and even though the manipulation failed, it was still chosen to continue with the analyses. A possible reason for this failed manipulation could be that the frame was manipulated with only one sentence in every manipulated text. A recommendation for further research would be to manipulate the texts completely to a short-term framed text and a long-term framed text.

The third hypothesis stated that the main effect of a gain-frame on the dependent

variables could be explained by the mediating role of reactance. Results of the analyses showed no significant results for this hypothesis, therefore H3 was also rejected. The role of reactance has been studied before on messages focused on sun-safety (Cho & Sands, 2011), excessive drinking among college students (Quick & Bates, 2010) and cigarette warning labels (Erceg-Hurn & Steed, 2011). They all found that a loss-frame caused higher reactance than a gain-frame. This research could not find similar significant results, a possible explanation for that could be that the sample of this research consisted for 36.6 percent of occasional smokers and for 23.9 percent of participants who once smoked but have now quit. It could be that there was

already less reactance against smoking cessation messages, because these participants did not smoke. For future research it is recommended that the sample consists only of regular smokers.

The last hypothesis regarded the possible moderating effect of persuasion knowledge on the relationship between message framing and reactance. It was hypothesized that the effects of a gain-frame on the dependent variables would be reduced when persuasion knowledge was high, in comparison to when persuasion knowledge was low. The results of this research found no significant proof for this hypothesis, therefore the last hypothesis (4) was also rejected. A possible explanation for finding these different results could be that persuasion knowledge was measured with a construct that did not accurately measured persuasion knowledge. Persuasion knowledge develops through time and experience (Friestad & Wright, 1994), for further research it is important to measure this in more detail.

In this research it was tried to answer the following research question: “What is the

impact of the type of message framing (gain vs. loss) on the attitude towards the message, the attitude towards quitting smoking and the intention to quit smoking? Is this relationship mediated by reactance? And do persuasion knowledge and temporal framing have an effect on this relationship? From the results of the analyses it can be concluded that there was no

significant effect on the type of message framing on the attitude towards the message, the attitude towards quitting smoking and the intention to quit smoking. This relationship was not significantly mediated by reactance. Finally, persuasion knowledge and temporal framing played no significant moderating role on this relationship.

Next to the already discussed points and recommendations for further research, it is also recommended for further research to select the sample with more detail. The final sample of this study consisted of 213 participants, from whom 51 (23.9 percent) were previous smokers but did

not smoke anymore. It was chosen to include these non-smokers in the analyses, because they once smoked, but including these participants could possibly have affected the results. The attitudes and intentions of participants who already stopped smoking before conducting the experiment were already different than those of the smokers.

Finally, it has to be noted that some of the constructs in this research were found to be unreliable. The scales for the dependent variables attitude towards the message and intention to

quit smoking, had respectively a Cronbach’s Alpha of .67 and .50, but were chosen to be

included in the analyses. For future research it is important to construct these scales with more attention.

This is one of the first researches that focuses on the effects of framing smoking cessation messages on resistance and the role of persuasion knowledge in this relationship. This research is the starting point, for a movement that is not only looking at the message characteristics but also at other possible variables that have an effect on attitudes, intentions and behaviors. The results of this research show no significant effects of these variables, and because of that it can be concluded that temporal framing, persuasion knowledge and reactance are variables that have no influence on these attitudes, intentions and behaviors concerning smoking cessation. With this in mind further research can be conducted to find other possible variables that influence this

relationship. Therefore this research contributes to the already existing research on smoking cessation by possibly eliminating variables and giving recommendations for further research.

Communication professionals can now choose not focus on temporal framing in their messages. They can also take this research as a starting point for further research on the construction of health communication texts.

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Appendix A - Information sheet (NL)

Je bent uitgenodigd deel te nemen aan een onderzoek dat wordt uitgevoerd onder verantwoordelijkheid van ASCoR, onderdeel van de Universiteit van Amsterdam. Het onderzoek waarvoor ik je medewerking heb gevraagd, is getiteld ‘Tekstvorming in gezondheidscommunicatie’. Doel van het onderzoek is om meer inzicht te krijgen in hoe gezondheidscommunicatie, met betrekking tot roken, het beste kan worden vormgegeven. Aan dit onderzoek kun je alleen deelnemen wanneer je ouder bent dan 18 en wel eens hebt gerookt. Tijdens dit onderzoek zul je eerst wat algemene vragen krijgen, vervolgens zul je een tekst lezen en tot slot krijg je nog wat vragen over deze tekst. Het onderzoek duurt ongeveer 10 minuten. Onder alle deelnemers worden 3 bonnen voor Bol.com, ter waarde van €15, verloot.

Omdat dit onderzoek wordt uitgevoerd onder de verantwoordelijkheid van ASCoR, Universiteit van Amsterdam, heb je de garantie dat:

1. Jouw anonimiteit is gewaarborgd en dat jouw antwoorden of gegevens onder geen enkele voorwaarde aan derden zullen worden verstrekt, tenzij je hiervoor van tevoren

uitdrukkelijke toestemming hebt verleend.

2. Je zonder opgaaf van redenen kunt weigeren mee te doen aan het onderzoek of je deelname voortijdig kunt afbreken. Ook kun je achteraf (binnen 24 uur na deelname) jouw toestemming intrekken voor het gebruik van jouw antwoorden of gegevens voor het onderzoek.

3. Deelname aan het onderzoek geen noemenswaardige risico’s of ongemakken voor je met zich meebrengt, geen moedwillige misleiding plaatsvindt, en je niet met expliciet

aanstootgevend materiaal zult worden geconfronteerd.

4. Je uiterlijk 5 maanden na afloop van het onderzoek de beschikking over een

onderzoeksrapportage kunt krijgen waarin de algemene resultaten van het onderzoek worden toegelicht.

Voor meer informatie over dit onderzoek en de uitnodiging tot deelname kun je te allen tijde contact opnemen met de projectleider May Meppe; may.meppe@student.uva.nl

Mochten er naar aanleiding van jouw deelname aan dit onderzoek bij jou klachten of

opmerkingen zijn, dan kunt je contact opnemen met het lid van de Commissie Ethiek van de afdeling Communicatiewetenschap, per adres: ASCoR secretariaat, Commissie Ethiek,

ascor.secr-fmg@uva.nl. Een vertrouwelijke behandeling van jouw klacht of opmerking is daarbij gewaarborgd.

Ik hoop je hiermee voldoende te hebben geïnformeerd en dank je bij voorbaat hartelijk voor je deelname aan dit onderzoek dat voor mij van grote waarde is.

Met vriendelijke groet, May Meppe

Appendix B - Informed consent form (NL)

Welkom bij dit online experiment. Je kunt dit experiment op een computer uitvoeren, maar ook op je smartphone. Wanneer je mee doet aan het experiment op je telefoon is het handiger je telefoon in de breedte te houden (landscape).

Het experiment zal ongeveer 10 minuten duren. Eerst zul je een paar algemene vragen

beantwoorden. Daarna zul je een bericht te zien krijgen en vraag ik jou deze door te lezen. Tot slot zul je een aantal vragen krijgen over deze tekst. Het is erg belangrijk dat je alle vragen eerlijk beantwoordt.

Door mee te doen aan dit experiment geef je mij toestemming gebruik te maken van jouw antwoorden voor enkel en alleen wetenschappelijk onderzoek. De informatie die jij geeft is volledig anoniem en zal nooit gedeeld worden met derden. Ik zal je niet vragen om je naam of andere informatie die jou persoonlijk zou kunnen identificeren.

Mocht je nu of later nog vragen hebben, dan mag je altijd contact opnemen met de projectleider van dit onderzoek – May Meppe – door te mailen naar may.meppe@student.uva.nl . Mocht je klachten hebben over dit onderzoek, dan kun je contact opnemen met een lid van het Ethische Committee van de ASCoR, door een brief of mail te sturen naar het volgende adres: ASCoR secretariaat, Ethische Committee, Universiteit van Amsterdam, Postbus 15793, 1001 NG Amsterdam, 020- 525 3680; ascor-secr-fmg@uva.nl

Alvast bedankt voor het meedoen!

Ik heb de bovenstaande tekst gelezen en begrepen en bevestig hierbij mijn deelname aan dit onderzoek

· Ja · Nee

Appendix C - Stimulus material

De voordelen van stoppen met roken!

Wanneer je stopt met roken zal je al snel merken dat je gezondheid verbetert.

Je algemene gezondheid gaat vooruit en jouw kans op het krijgen van kanker vermindert. Omdat je meer zuurstof kunt opnemen in je longen, zal je ook een betere conditie krijgen. Je zal ook merken dat je lichaam niet meer verslaafd is aan nicotine, wat zorgt voor veel minder stress. Door te stoppen met roken zal je vruchtbaarder worden, en daardoor meer kans hebben om kinderen te krijgen.

Ook zal er rond om jou en in jouw huis geen vieze geur van tabak meer hangen. Daarbij komt dat al na 48 uur jouw smaak verbetert en je beter zal kunnen ruiken.

Kortom, stoppen met roken heeft veel voordelen!

2. Condition 2: gain + long

De voordelen van stoppen met roken!

Wanneer je stopt met roken zal je al snel merken dat je gezondheid verbetert.

Je algemene gezondheid gaat vooruit en jouw kans op het krijgen van kanker vermindert. Omdat je meer zuurstof kunt opnemen in je longen, zal je ook een betere conditie krijgen. Je zal ook merken dat je lichaam niet meer verslaafd is aan nicotine, wat zorgt voor veel minder stress. Daarbij komt dat wanneer jij een jaar bent gestopt met roken, jouw kansen op een hartaanval met de helft is verminderd.

Door te stoppen met roken zal je vruchtbaarder worden, en daardoor meer kans hebben om kinderen te krijgen.

Ook zal er rond om jou en in jouw huis geen vieze geur van tabak meer hangen. Kortom, stoppen met roken heeft veel voordelen!

3. Condition 3: loss + short De nadelen van roken!

Wanneer je rookt zal je al snel merken dat je gezondheid verslechterd.

Je algemene gezondheid gaat achteruit en jouw kans op het krijgen van kanker vergroot. Omdat je minder zuurstof kunt opnemen in je longen, zal je ook een slechtere conditie krijgen. Je zal ook merken dat je lichaam verslaafd is aan nicotine, wat zorgt voor veel stress.

Door te roken zal je minder vruchtbaar worden, en daardoor minder kans hebben kinderen te krijgen.

Ook zal er rond om jou en in jouw huis een vieze geur van tabak hangen. Daarbij komt dat al na 48 uur jouw smaak vermindert en je minder goed zal kunnen ruiken.

Kortom, roken heeft veel nadelen!

4. Condition 4: loss + long De nadelen van roken!

Wanneer je rookt zal je al snel merken dat je gezondheid verslechterd.

Je algemene gezondheid gaat achteruit en jouw kans op het krijgen van kanker vergroot. Omdat je minder zuurstof kunt opnemen in je longen, zal je ook een slechtere conditie krijgen. Je zal ook merken dat je lichaam verslaafd is aan nicotine, wat zorgt voor veel stress. Daarbij komt dat wanneer jij een jaar hebt gerookt, je kans om een hartaanval te krijgen is verdubbeld.

Door te roken zal je minder vruchtbaar worden, en daardoor minder kans hebben kinderen te krijgen.

Ook zal er rond om jou en in jouw huis een vieze geur van tabak hangen. Kortom, roken heeft veel nadelen!

Appendix D - Questionnaire

3. Wat is je hoogst afgeronde / huidige opleidingsniveau? ❏ VMBO ❏ HAVO ❏ VWO ❏ MBO ❏ HBO ❏ WO ❏ Anders, namelijk... ❏ Geen

4. Rook je wel eens? ❑ Ja, dagelijks ❑ Ja, af en toe

❑ Mee, helemaal niet

5. Welke en hoeveel van de volgende tabakproducten rook je gemiddeld per dag? … sigaretten per dag

… shagjes per dag … sigaren per dag … pijp per dag

6. Welk van de volgende uitspraken past het beste bij jou? (je mag maar één hokje aankruisen) ❑ Ik rook tenminste één keer per dag

❑ Ik rook niet dagelijks, maar tenminste één keer per week ❑ Ik rook niet wekelijks, maar tenminste één keer per maand ❑ Ik rook minder dan één keer per maand

❑ Ik probeer roken af en toe uit

❑ Ik ben gestopt nadat ik een tijd minstens één keer per week heb gerookt ❑ Ik ben gestopt, ik rookte altijd minder dan één keer per week

7. Onderneem je op dit moment een stoppoging? ❑ ja

❑ nee

[STIMULUS MATERIAAL]

Questions after seeing the stimulus material

De volgende vragen gaan over de tekst die je zojuist hebt gelezen, het is belangrijk dat je de vragen eerlijk beantwoord.

State reactance 1.

Geef bij onderstaande woorden aan in hoeverre jij ze hebt gevoeld na het lezen van het vorige bericht:

Boos

Ik heb dit niet gevoeld ❑ ❑ ❑ ❑ Ik heb dit gevoeld Geïrriteerd

Ik heb dit niet gevoeld ❑ ❑ ❑ ❑ Ik heb dit gevoeld Verontwaardigd

Ik heb dit niet gevoeld ❑ ❑ ❑ ❑ Ik heb dit gevoeld Geërgerd

Ik heb dit niet gevoeld ❑ ❑ ❑ ❑ Ik heb dit gevoeld

Attitude towards the message.

Het bericht wat ik zojuist heb gelezen vind ik...

Schadelijk ❑ ❑ ❑ ❑ ❑ ❑ ❑ Onschadelijk Plezierig ❑ ❑ ❑ ❑ ❑ ❑ ❑ Onplezierig

Slecht ❑ ❑ ❑ ❑ ❑ ❑ ❑ Goed

Waardeloos ❑ ❑ ❑ ❑ ❑ ❑ ❑ Waardevol Aangenaam ❑ ❑ ❑ ❑ ❑ ❑ ❑ Onaangenaam

Attitude towards quitting smoking.

Voor mij is stoppen met roken...

Nadelig ❑ ❑ ❑ ❑ ❑ ❑ ❑ Voordelig