“Did you know you could save a life?”:
A study on the effects of cultural identity on attitudes, subjective
norms, perceived behavioural control, and intentions
towards stem cell donation registration
Darya Danesh 10841679 Master’s Thesis Graduate School of Communication Master’s programme (Persuasive) Communication Science prof. dr. S.J.H.M. (Bas) van den Putte 09 April 2019 Word count (excl. tables and footnotes): 7,495
Table of Contents
Abstract ... 3
Introduction ... 4
Stem Cell Donation Registration ... 6
Theoretical Background ... 7
Cultural Identity ... 7
Theory of Planned Behaviour ... 8
Cultural Consistency ... 12 Personal Relevance ... 13 Method ... 14 Design ... 14 Stimulus Materials ... 15 Pilot Study... 16 Data Collection ... 17 Procedure ... 17 Participants ... 18 Measures ... 18 Moderator. ... 18 Dependent variables... 18 RQ variable... 20 Analyses ... 20 Results ... 21 Hypothesis testing ... 21 Conclusion ... 27 Discussion... 28
Limitations and Further Research ... 29
References ... 31
Appendix A ... 37
Abstract
There is a global need for registered stem cell donors given the low probability of finding a match for patients who require stem cell transplantation. The majority of research into the impact of cultural identity on attitudes, subjective norms, perceived behavioural control, and intentions focuses on stem cell donation as a concept, rather than the step that comes before: registration. The current study aims to determine the effect of cultural identity on these variables in the context of stem cell donation registration. Building on the
assumptions of the theory of planned behaviour, cultural identity, and cultural consistency, the central research question is as follows: To what extent does exposure to a persuasive message predict an individual’s attitude, subjective norms, perceived behavioural control, and intentions towards stem cell donation registration, and is this relationship moderated by an individual’s cultural identity? In this context, both persuasive message and cultural identity are differentiated between Hofstede’s (1983) cultural dimensions of individualism (i.e., importance of the individual) and collectivism (i.e., importance of the in-group).
The current study uses an online-embedded experiment distributed via social media and a crowd-sourcing tool. Participants were randomly assigned to an experimental condition where they were asked to consider a fictional advertorial pamphlet about stem cell donation registration. Participants were asked to report on items about their personal cultural identity, as well as the aforementioned determinants of the theory of planned behaviour. Results indicate null or negative effects of cultural identity, contrary to prior literature on the same or similar topics. Based on these results, the researcher recommends further research into the cultural framing of health messages.
Keywords: theory of planned behaviour, cultural identity, cultural consistency, health communication, stem cell donation registration.
Introduction
Nearly one million individuals are diagnosed with blood cancer (i.e., leukemia, lymphoma, and multiple myeloma) every year (Bray et al., 2018). For most of these individuals, the only hope for treatment lies within the process of a stem cell transplantation. Yet, there is only a 20-30% chance of an individual having a matched, full-blood, sibling donor. Those 70-80% without a sibling match are forced to search the global donor registries (e.g., through the World Marrow Donor Association (WMDA)). There are over 33 million registered donors worldwide, however, due to the complexity of the donor matching process, the search is often disappointing, with only 10% finding a donor match. (Kolb & Holler, 1997; World Marrow Donor Association, 2018). In order to increase the possibility of matching those in need with suitable donors, there is a clear requirement for more registered donors. Similar to other forms of (tissue and organ) donation, there are many variables which contribute to the decision to register as a stem cell donor.
The theory of planned behaviour is often used in communication research
investigating the determinants which lead people to behave a certain way. The determinants of this theory, which inform how an individual might engage in a target behaviour, are attitudes, subjective norms, perceived behavioural control, and intentions. The present research theorizes that these determinants are at the root of behavioural intentions towards registering as stem cell donor.
In order to test this theory, the current research’s basis is in persuasive
communication. It is based upon the premise that advertising is where people generally get information about stem cell donation registration (SCDR). This is because in a general sense, people tend to get their information about donation, and subsequently the need for registered donors and the SCDR process, through the mass media (Feeley & Servoss, 2005). However, for those who are past the registration step and are in the process of providing a stem cell
donation, the majority of the information is given by the haematologists who are part of the procedure (Pillay et al., 2012). The concepts of SCDR and the stem cell donation process are not mutually exclusive, however, the current research focuses on SCDR. Central to this project is cultural identity (CI), be it individualist or collectivist—a concept borrowed from Hofstede’s (1983) cultural dimensions: masculinity vs. femininity, power distance index, uncertainty avoidance index, and individualism vs. collectivism. The researcher aims to look at how CI may affect attitude, subjective norms, perceived behavioural control, and intentions towards SCDR. By looking at the way in which an individual identifies culturally as either individualistic (cf. American culture) or collectivist (cf. Central and East Asian cultures), insights can be derived on how culturally relevant communication affects said individuals (Hofstede, 1980; Han & Shavitt, 1994). Health communication research has shown that a persuasive message which is culturally consistent with the individual exposed to it has been found to be more effective in persuading individuals towards a certain goal (Ko & Kim, 2010; Kreuter, Lukwago, Bucholtz, Clark, & Sanders-Thompson, 2003; Sherman, Uskul, & Updegraff, 2011; Uskul & Oyserman, 2010). Research has also found that when a message is culturally consistent with the receiver of a health message, results show favourable attitudes, subjective norms, perceived behavioural control, and intentions, in comparison to when they are culturally inconsistent (e.g., Boiarsky, Rouner, & Long, 2013; Galanis, Sparos,
Katostaras, Velonakis, & Kalokerinou, 2008; Han & Shavitt, 1994; Studts, Ruberg,
McGuffin, & Roetzer, 2009; Uskul & Oyserman, 2010). It is arguable that including cultural identity as a moderator in the relationship between a culturally (in)consistent persuasive message and attitude, subjective norms, perceived behavioural control, and intentions
towards SCDR will lead to a better understanding of underlying factors which may influence SCDR.
Thus, the overarching research question for the current research is as follows: To what extent does exposure to a persuasive message (individualistic vs. collectivist) predict an individual’s attitude, subjective norms, perceived behavioural control, and intentions towards SCDR, and is this relationship moderated by an individual’s CI (individualistic vs.
collectivist)?
Stem Cell Donation Registration
Societally, people are more familiar with the terms bone marrow (BM) donation and transplant as a treatment for malignant blood diseases such as leukemia and lymphoma. This is due to the fact that in the past, BM donations were the norm (Cancer.NET, 2013). While this process sometimes still occurs, peripheral blood (PB) stem cell donation and transplant has been the commonplace procedure since its induction to the field of hematology in 1986 (Korbling & Freireich, 2011). Where a BM donation requires a surgical procedure under anesthesia to remove stem cells from marrow in the hip bone, the process of PB stem cell collection requires no surgery (Pillay et al., 2012).
Before delving into the determinants of the theory of planned behaviour in relation to SCDR, it is important to delineate the process of registering as a stem cell donor. The
registration process for donation registries is relatively simple. The first step is to obtain and read the relevant information. This is generally available through the website of a registry (such as on matchis.nl, blood.ca, or dkms.org.uk) or via advertorial materials which can be acquired in hospitals, doctor’s offices, etc. Next, a potential registrant must complete a health screening questionnaire, to see if they are in generally good health. When they are past this initial screening process, they are asked to accept the terms and conditions of their agreement to register. Then, a swab kit is sent to the potential registrant via post. The swab kit consists of a cotton swab which the potential registrant must wipe on the inside of their cheek to collect a saliva sample: there is enough DNA in this sample for the preliminary matching
process. Once completed, the kit is to be sent back to the registry from it was received. Once registered, the individual is put on an international list. If their saliva sample tests as a likely match with a patient in need, they will be contacted. If they agree to donate, which they can decline at any time, they will be invited to undergo a number of blood tests and, if matched, the process of donation. While this process is seemingly simple, and many people are already registered worldwide, the probability of finding a genetic match between a registered donor to a patient is still quite low. The probability of a donor matching with a patient is relatively low because the genetic matching required is quite complex and often ethnically dependent. There are thousands of possible match combinations, and even then, there is no certainty that a so-called good match will make its way from match to transplant (Kolb & Holler, 1997). Moreover, the probability for finding a match for minority or mixed ethnicities is particularly low contrary to that of Europeans of white descent1 (Gragert et al., 2014).
Theoretical Background Cultural Identity
Before delving into the theory of planned behaviour, it is important to delineate the context in which it is important for the current research. That is, in terms of cultural identity. Hofstede defines a number of psychological aspects upon which social systems (i.e., cultures) are based, referred to as cross-cultural dimensions (1983). Commonly used in cultural and (health) communication science research is the individualism versus collectivism dimension (e.g., Han & Shavitt, 1994; Ko & Kim, 2010; Sherman et al., 2011; Uskul & Oyserman, 2010). Individualism refers to situations where people tend to see themselves as most important. When looking at stem cell donors, traits such as feeling good about the self or feeling special for helping, feeling adventurous, or feeling like a role model for others can be
1
75% for white Europeans, 46% for Middle Eastern or North African of white descent, 27-52% for Hispanics, Asians, Pacific Islanders, and Native Americans, 16-19% for black Americans of all backgrounds.
attributed as individualistic traits (Simmons, Schimmel, & Butterworth, 1993). Collectivism refers to situations where people are part of an in-group to which they are fiercely loyal (Hofstede, 1983; Markus & Kitayama, 1991). More specifically, in the context of stem cell donors, wanting to help their greater community, religiosity and wanting to help those in their religious in-group, feeling a bond that stem cell donors fit into a new in-group can be
attributed as collectivist traits (Simmons et al., 1993). Often the differentiation is defined as the distinction between one’s feeling as either an “I” or a “we” (Hofstede & Bond, 1988). These definitions of individualism and collectivism, along with their rapport with to the determinants of the theory of planned behaviour in relation to stem cell donorship and SCDR, are at the core of the current research
Theory of Planned Behaviour
The theory of planned behaviour (TPB) is a model often used to establish the underlying determinants which lead an individual to make a decision (Ajzen, 1991). According to the TPB, there are three main factors—attitudes, subjective norms, and
perceived behavioural control—which lead to a person’s intention (i.e., motivation) to apply a target behaviour.
Attitudes are defined as a way of thinking about an issue, which can be either
evaluative (i.e., based on one’s affect) or cognitive (i.e., based on one’s rationale). Generally speaking, there is a mix of attitudes in the context of SCDR. A recent survey study explored factors including knowledge, barriers to donation registration, and attitudes in relation to SCDR intentions. Results showed that positive attitudes towards donation was a significant indicator for participants’ intentions to register as a stem cell donor (Abdrbo, Hassanein, Albajhan, & Alsabi, 2017). In a study conducted with African American individuals, which tend to be culturally considered as collectivists, positive attitudes about helpfulness and negative attitudes about fear and trust about resources were attributed to positive and negative
intentions, respectively (Glasgow & Bello, 2007). One study showed that positive attitudes in collectivists were attributed to those who had individualistic traits (Simmons et al., 1993). Another study found that when looking at an individual’s in-group, collectivists had more positive attitudes than individualists. This finding is in line with expectations of collectivists and their in-groups. In relation to all other groups (i.e., different variations of strangers), individualists had more positive attitudes than collectivists. This, too, is in line with expectations of individualists and strangers (Bagozzi, Lee, & Van Loo, 2001)2. These culturally detailed findings conclude that the general propensity is for individualist and collectivist attitudes to be in line with what is expected from them. However, because (1) there is not much research to prove these expectations, (2) some of the findings prove to be confounding, and (3) prior research does not focus on SCDR, it is important to further explore attitudes in this context.
Subjective norms are defined as the opinions of (i.e., injunctive norms) and the perception of the behaviours of (i.e., descriptive norms) one’s important others. About stem cell donors in general, Glasgow and Bello (2007) uncovered that for donors, positive injunctive norms tend to lead to positive intentions, and negative descriptive norms tend to lead to negative intentions. Individuals seen as collectivists were more likely to be affected by subjective norms in relation to their immediate family and close relatives (i.e., in-group) compared to individualists (Switzer et al., 2013)3. Comparison within the collectivist identity found that those seen as more collectivist had stronger subjective norms than those seen as less collectivist. However, individualists were privier to being affected by subjective norms than collectivists (Bagozzi et al., 2001). These results confirm the general propensity of
2 NB: Individuals were grouped culturally based on their ethnic background rather than using
a measurement tool.
3 NB: Individuals were grouped culturally based on their ethnic background rather than using
strong subjective norms leading to positive intentions. However, much like with attitudes, it has not yet been focused towards the context of SCDR.
Perceived behavioural control (PBC) is defined as an individual’s self-perceived ability to apply the target behaviour (i.e., self-efficacy) and their ability to control the difficulties related to applying it (i.e., perceived controllability). Research about SCDR and stem cell donation has found results to confirm the importance of PBC in stem cell donation. In their study on anticipated guilt associated with stem cell donation, Massi Lindsey (2005) found that the self-efficacy aspect of PBC positively influenced intention to register as a donor. Similarly, another study found that low PBC was associated with a lack of knowledge about SCDR–as well as a lack of control over the spread of resources–which corresponded to negative intentions (Glasgow & Bello, 2007). Bringing CI into the mix, individualists who were exposed to health messages about the relational consequences of sexually transmitted infections (STIs), thus messages collectivist in nature, had more positive PBC than when exposed to health messages about the personal consequences, thus messages individualistic in nature, of STIs. And, interestingly, no difference was found for collectivists when exposed to either collectivist or individualist messages (Ko & Kim, 2010). With that said, there is no research to date which explores PBC in relation to SCDR.
It is theorized that one’s intention to apply a target behaviour is the strongest predictor of its application (Ajzen, 1991). Because it is impossible to gauge whether or not an
individual will apply a target behaviour in the future, it is thus more plausible to measure their intention to do so. For the purpose of this research, SCDR intentions will be measured on the same level as the TPB determinants, as a fourth dependent variable (See Figure 1). As previously mentioned, Glasgow and Bello’s (2007) research found that (potential) stem cell donors have either positive intentions or negative intentions, which are causally related to
attitudes and subjective norms, matching their respective directions4. Ko and Kim (2010) found that individuals who were exposed to collectivist health messages had more positive intentions than when exposed to individualistic messages, but found no relationship for collectivists. Bagozzi, Lee, and van Loo (2001) found a number of interesting results when looking at specifically identified cultural subgroups, namely more and less collectivist and more and less individualistic, and their proximal relationships. They found that for immediate family members, more collective collectivists had more positive intentions than all
individualists; for close relatives and total strangers, less individualist individualists had more positive intentions than more collective collectivists; for ethnic strangers, more individual individualists had more positive intentions than more collective collectivists; and for total strangers, more individual individualists had more positive intentions than less collective collectivists. However, since these results were based upon cultural groupings made by the researchers and not a measurement tool, the cultural findings reflect stereotypical standards rather than personal cultural identity.
The aforementioned results from previous research show that there is no one way to look at attitudes, subjective norms, perceived behavioural control, and intentions. It is now clear that all four determinants of the TPB are rarely tested all together, especially not in the context of SCDR. That being said, the persuasive goal of the message in the current study is to determine how people with personally reported CIs score on the TPB determinants in relation to SCDR, with the following expectation:
H1: Individualists will score more positively than collectivists on (a) attitudes, (b) subjective norms, (c) perceived behavioural control, and (d) intentions towards SCDR, regardless of message exposure.
4 E.g., Positive attitudes and subjective norms leading to positive intentions, negative
A study on the self-image of registered donors found that some people who identified as individualistic (via being helpful) believed that registering as a stem cell donor is a good way to set an example for others (Simmons et al., 1993). This finding is in line with the aforementioned studies about identity (cf. Switzer et al., 2013; Bagozzi, Lee & van Loo, 2001). In their study, Simmons and colleagues (1993) also found that some collectivists reported that their general choice to donate was directly related to their religiosity, a known collectivist trait. This finding is contradictory to previous studies which found that
collectivists are less likely to donate to strangers who are not part of their in-group (cf. Switzer et al., 2013; Bagozzi, Lee & van Loo, 2001). These findings lead to the assumption that in general, individuals’ choices are dependent upon their CI rather than (mere) exposure.
H2: Individuals exposed to the individual message condition will have the same results as those exposed to the collectivist message, in that there will be no difference in (a) attitudes, (b) subjective norms, (c) perceived behavioural control or (d)
intentions towards SCDR Cultural Consistency
One of the many ways a person can relate with an issue is based upon consistency between an individual’s CI and the contextual cues in a (health) message. Han and Shavitt (1994) tested this concept in consumer research to show that cultural consistency between an individual and an advertisement would lead to the message’s intended persuasion. They found that consumer attitudes towards a product were more favourable when the product type matched the CI (i.e., individualistic or collectivist) of the consumer, as opposed to when they did not match. They also found that both individualists and collectivists were more persuaded by advertorial messages which were culturally consistent, respectively (Han & Shavitt, 1994). This concept has also been tested in the realm of health communication. Uskul and Oyserman (2010) found that for both individualists and collectivists, cultural consistency
increased persuasiveness of a health message, specifically when CI is primed before exposure to the message. In line with this finding, Uskul and Hynie (2010, in Sherman et al., 2011) found that both individualists and collectivists were more likely to engage with and be persuaded by culturally consistent health information rather culturally inconsistent
information. Ko and Kim (2010) also found this relationship to be true of individualists and cultural congruency, but not of collectivists. Thus, the current research aims to (dis)prove the cultural (in)consistency phenomenon, with the following assumptions:
H3: There is an interaction between cultural identity and persuasive message, that is: (i) Individualistic people exposed to an individualistic persuasive message will score higher on (a) attitudes, (b) subjective norms, (c) perceived behavioural control, and (d) intentions towards SCDR than when exposed to a collectivist persuasive message. (ii) Collectivist people exposed to a collectivist persuasive message will score lower on (a) attitudes, (b) subjective norms, (c) perceived behavioural control, and (d) intentions towards SCDR than when exposed to an individualistic persuasive message.
Personal Relevance
As previously defined, one’s intention to apply a target behaviour is synonymous with their motivation to do so. A possible influencing factor for motivation might be personal relevance. Research has found that, for instance, people who have had cancer affect someone close to them (i.e., a close family member or friend), are more likely to be open to SCDR. This is because the personal relevance of cancer as an issue stimulates people to want to do anything they can to help any others affected by cancer (Simmons et al., 1993, Studts, Ruberg, McGuffin, & Roetzer, 2010). Similarly, research has also shown that people who knew of someone who was in need of stem cell transplantation were more likely to register as donors themselves (Galanis et al., 2008). However, none of these studies focused specifically
on the determinants of the TPB, leaving a gap in the scientific knowledge about its importance, or, perhaps, lack thereof. For the purpose of this research, the concept of personal relevance is thus two-fold: the extent to which cancer and/or SCDR are relevant in an individuals’ personal circumstances.
RQ1: What is the role of personal relevance, with (i) cancer and (ii) SCDR, in relation (a) attitudes, (b) subjective norms, (c) perceived behavioural control, and (d)
intentions towards SCDR?
Figure 1. Conceptual model.
Method Design
The direct and moderating role of CI on a persuasive message’s effect on the TPB variables was tested through an online survey-embedded experiment. The research followed a two (persuasive message: individualistic vs collectivist) by two (CI: individualistic vs
collectivist) between-subjects design, with attitudes, subjective norms, perceived behavioural control, and intention towards SCDR as the dependent variables. This is considered to be a
combined design as CI is a quasi-experimental variable which cannot be manipulated. The experiment consisted of four experimental conditions, where the independent variable persuasive message was coded as dichotomous, and the moderating variable and the four dependent variables were measured as continuous.
Stimulus Materials
Communication research has shown that source is an important factor in the dissemination of health information (Betsch et al., 2015). Information associated with a website elicits higher intentions than when the source is more informal, given that organisation websites are more likely to have an editor monitoring/gatekeeping the
information provided (Hu & Sundar, 2010). Thus, the two stimuli used for this research both consisted of a pamphlet-style poster by a fictional SCDR organization with an image
accompanied by text. The poster depicted a fictional SCDR organization in order to mitigate knowledge bias.
The pamphlet-style posters for the fictional organisations were largely identical in order to mitigate possible confounding effects of context cues (See Appendix A for full posters). Both pamphlets followed the same five-part outline: (1) title, (2) red text asking the reader if they are aware of the possibility of joining the stem cell registry, (3) explanation that stem cell donation registration can lead to benefiting patients who are very and/or terminally ill, (4) a five-step explanation of the stem cell registration process, and (5) final sentences about confirmation of registration and who can benefit from the act. The text about steps for SCDR was written based off of information from Dutch, British, and Canadian SCDR organizations. This choice reflected the European and North American contexts in which participants were recruited.
Subtle differences were included to make a differentiation between individualistic directed and collectivist directed language. The poster created for the individualistic
condition used language in a way to make the reader feel like their selfless act would be the solution for saving anyone. This is based on research that showed individualists are more likely to help complete strangers (Bagozzi et al., 2001).The text described that the choice to register as a stem cell donor would make them ‘a hero’, using sentences like “By registering as a stem cell donor, you could be the hero match to save someone’s life” and emphasizing “Hero Squad” in red. The premise behind using a hero-complex was based upon the idea that individualistic people tend to want to do good for others while getting some sort of
recognition and good feeling about themselves in return (Garcia et al., 2013). The poster created for the collectivist condition used language in a way to make the reader feel like their selfless act would benefit their community, because collectivist’s biggest differentiator is that they care deeply about helping their in-group (Markus & Kitayama, 1991). By using prompts such as “A member of your community could be affected by one of these diseases and
require a stem cell transplant” and emphasizing “your community” in red, the text is meant to connect to collectivist individuals. These subtle but important differences were intended to elicit cultural consistency between the persuasive message and its reader, because cultural consistency has led to higher scores for individualists and lower scores for collectivists on the determinants of the TPB.
Pilot Study
To ensure that the text on the posters adequately represented their intended
manipulation, the researcher conducted a pilot study with 10 participants. Half of the pilot study participants were Communication Science students at the University of Amsterdam in order to have a communication science perspective on the persuasive nature of the composed text. The other half of the pre-test participants were chosen by convenience to the researcher. In the pilot study, participants were asked (1) to evaluate the quality of the poster as a source of information about SCDR and (2) to give any suggestions about the wording of the items of
the questionnaire. Subsequently, they were asked to share their perceptions of the informative nature and degree of accessibility of the language used on the poster. Finally, they were asked to offer any insights on how to improve the persuasive text and/or questionnaire. The final stimulus materials were edited accordingly and can be seen in Appendix A. The text was not evaluated to ensure the differentiation between the dimensions of CI in the pilot study, which will be further discussed in the limitations section of this paper.
Data Collection
Participants were recruited through Facebook, Twitter, and Amazon Mechanical Turk (MTurk). The researcher posted a call for participants on their personal Facebook and Twitter profiles, to recruit as many participants as possible. The call requested completion by anyone who was willing, as the interest of the research was to gain an overall perspective, regardless of age, gender, or country of residence. The research also asked friends and followers on respective social networking sites to share the call, in hopes of creating a snowball effect for participant recruitment. The researcher also created a batch request on MTurk to recruit participants, with a short description of the research project.
Procedure
The experiment was created in Qualtrics. First, participants were prompted to read and agree with the informed consent form. Once agreed, participants moved onto a series of questions intended to measure their CI, and knowledge about stem cell donation and SCDR, in order to prime the concept of CI and knowledge about the topics. They were then
randomly assigned to one of the experimental conditions. Each condition consisted of a short explanation of the poster being presented and asked to pay close attention while reading the informational pamphlet in the window that would follow. Following consideration of the stimulus, participants were asked to report on items measuring: personal relevance, attitudes, subjective norms, and intentions all in relation to SCDR. Finally, participants were asked to
report on baseline items, namely to record their age, gender, and country of residence. Finally, as a manipulation check, participants were asked whether they saw a poster talking about Hero Match and the Hero Squad, or a general poster talking about community and Stem Cell Donors. See Appendix B for full questionnaire.
Participants
Through the two recruitment methods, 161 participants were recruited through social media, and 39 participants through Amazon MTurk, a total of 200 participants. Participants who did not fully complete the experiment (n = 24) were omitted from the analysis. This left a final sample of 176 participants used for analysis, of which 122 (69.3%) were female. The age range of the final sample was 19-70 (M = 34.97, SD = 11.61).
Participants were randomly assigned to one of the experimental conditions, of which 86 (48.9%)were exposed to the individualistic condition (MAge = 34, SDAge = 10.32), and the
remaining participants to the collectivist condition (MAge = 36, SDAge = 12.67).
Measures
Moderator. Cultural identity was measured using 15 items from Triandis and Gelfand’s (1998) validated measurement tool on a 5-point bipolar scale, with 1 = definitely
no and 5 = definitely yes (cf Cozma, 2011). Eight of the items measured individualism, with
statements such as “I rely on myself most of the time, I rarely rely on others”. The remaining seven items measured collectivism, with statements such as “It is my duty to take care of my family, even when I have to sacrifice what I want”. The seven collectivism items were reverse coded in order to create an accurate variable to measure a dichotomous CI. A mean score was calculated for 15 items (α = .68, M = 2.96, SD = 0.44) with lower scores indicating a more collectivist identity, and higher scores indicating a more individualistic identity.
Dependent variables. Each of the dependent variables was based upon the determinants of the TPB, and adapted to match the SCDR topic. To be consistent with
Fishbein and Ajzen's (2010) indication of measurements, each item included action, context, target, and a specified time frame.
Subjective norms were measured using a 5-point disapproval-approval semantic
differential scale, with four referents (friends, someone in my family, acquaintances, and
strangers). To indicate injunctive norms, respondents were asked to indicate whether the
aforementioned referents would (dis)approve of them registering as a stem cell donor (α = .82, M = 2.91, SD = .87). To indicate descriptive norms, respondents were asked to indicate whether they thought the aforementioned referents are currently registered as stem cell donors (α = .78, M = 4.06, SD = .73). Because the purpose of this research is to look at a general sense of subjective norms, an overarching subjective norms variable was computed. A mean score was then calculated for subjective norms (α = .77, M = 3.48, SD = .63), where a higher score represented a greater importance of subjective norms for the participant.
Attitudes were measured through ten 5-point semantic differential items, five of which
measured affective attitudes (e.g., unenjoyable-enjoyable; α = .91, M = 3.67, SD = .94), and the remaining five measured cognitive attitudes (e.g., punishing-rewarding; α = .90, M = 4.26, SD = .78). Items were presented in a random order, with the following self-referential instruction: “For me, personally, registering as a stem cell donor in the next month can be described as: (indicate the answer which corresponds most accurately with your attitude)”. Items were coded accordingly and, because the purpose of this research is to look at a general sense of attitudes, an overarching attitudes variable was computed. A mean score was then calculated for attitudes (α = .93, M = 3.95, SD = 0.79), a higher score indicated a more positive attitude towards SCDR.
Intention was measured by asking participants their likeliness to become a registered
stem cell donor in the coming, using a 5-point very unlikely-very likely differential scale where a higher score indicated a higher intention towards SCDR (M = 3.64, SD = 1.33).
Perceived behavioural control was measured through two 5-point semantic
differential items, which measured self-efficacy (“I am able to go the registry’s website and sign up” (cf. Massi Lindsey, 2005)) and perceived controllability (“I am in control of my decision to register as a stem cell donor” (cf. Kushner, Riggs, Foa, & Miller, 1993). A mean score was calculated (α = .78, M = 4.52, SD = 0.74), where a higher score indicated a higher sense of PBC towards SCDR.
RQ variable. Personal relevance was measured by asking about the degree to which cancer, and subsequently SCDR, were considered to be personally relevant. To do so,
participants were asked whether they or someone they know has/had cancer and whether they or someone they know is registered as a stem cell donor, if not, “This does not apply to me” was offered as an alternative answer option.
The control variables included age, gender, and country of residence.
Analyses
To test H1 and H2, four simple regressions will be conducted to see the effects of persuasive message (H1) and cultural identity (H2) on attitudes, subjective norms, perceived behavioural control, and intentions towards SCDR.
Before testing for H3i and H3ii explicitly, four multiple regressions will be conducted to see the interaction effects of persuasive message x cultural identity on attitudes, subjective norms, perceived behavioural control, and intentions towards SCDR on the entire sample. If any significant effects are found, a median split of the file on the CI variable will be
conducted. Then, simple slope analyses will be conducted in order to test explicitly for H3i and H3ii.
To explore the effects of personal relevance of cancer (RQ1i) and personal relevance of SCDR (RQ1ii) on attitudes, subjective norms, perceived behavioural control, and
intentions towards SCDR, four simple regressions will be conducted.
Results
A One-Way ANOVA was conducted with the conditions as the independent variable and CI as the dependent variable to check for randomization. Results indicated no significant difference for the conditions, F(1, 174) = 0.31, p = .579, on CI. Thus, randomization of participants into the two experimental conditions was successful. To check for differences between experimental conditions on age, gender, and country of residence, Chi-square tests and t-tests were conducted. Chi-square tests revealed no significant differences between the two conditions for gender, X2 (1, N = 176) = 0.21, p = .650, and country of residence, X2 (13, N 176) = 11.40, p = .577. This indicates equal distributions between conditions. An
independent sample t-test was conducted for age, t(174)= 1.427, p = .060, 95% CI [-.95, 5.94], indicating that there was no significant differences between groups; collectivist condition (M = 39.16, SD = 12.66) and individidualist condition (M = 33.70, SD = 10.32). Because there were no significant differences between groups for any of the control
variables, they were taken into consideration for hypothesis testing. To check if respondents correctly recognised the content of the stimulus materials, a Chi-square test for the conditions was conducted with the manipulation check variable. That this manipulation check reached significance, X2 (2, N = 176) = 50.26, p < .001, suggests respondents were able to
acknowledge the fictional organization in the stimulus material. Hypothesis testing
To test H1, CI was included as the independent variable for analysis. As seen in Table 1, results showed a significant negative effect of CI on attitudes, b* = -.173, and intentions,
b* = -.201. No significant effect was found for subjective norms, b* = -.121, or perceived
behavioural control, b* = -.067. Thus, people who are more individualistic scored more negatively on attitudes and intentions, refuting H1.
T abl e 1 St andar di ze d r egr es si on c oe ff ic ie nt s w it h c onf ide nc e i nt er val s e st im at ing t he e ff ec t of c ul tur al ide nt it y on at ti tude s, s ubj ec ti ve nor m s, pe rc ei ve d be hav iour al c ont rol , and i nt ent ions to w ar ds S C D R (H 1). T abl e 2 St andar di ze d r egr es si on c oe ff ic ie nt s w it h c onf ide nc e i nt er val s e st im at ing t he e ff ec t of pe rs uas iv e m es sage on at ti tude s, s ubj ec ti ve nor m s, pe rc ei ve d be hav iour al c ont rol , and i nt ent ions to w ar ds S C D R (H 2). P re d ic to r v a ri a b le D e p e n d e n t v a ri a b le s A tt it u d e s ( A tt ) S u b je c ti v e N o rm s ( S N ) P e rc e iv e d B e h a v io u ra l C o n tr o l (P B C ) In te n ti o n s ( IN T ) b * C I (9 5 % ) p b * C I (9 5 % ) p b * C I (9 5 % ) p b * C I (9 5 % ) p C u lt u ra l Id e n ti ty -. 1 7 3 -. 3 2 0 ,-.0 2 5 .0 2 2 -. 1 2 1 -. 2 7 0 ,. 0 2 7 .1 0 9 -. 0 6 7 -. 2 1 6 ,. 0 8 2 .3 7 8 -. 2 0 1 -. 3 4 8 ,-.0 5 5 .0 0 7 N o te : M o d e l S u m m a ri e s – A tt : R 2 = . 0 3 0 , F (1 ,1 7 4 ) = 5 .3 3 9 , p = . 0 2 2 ; S N : R 2 = . 0 1 5 , F (1 ,1 7 4 ) = 2 .6 0 1 , p = . 1 0 9 ; P B C : R 2 = . 0 0 4 , F (1 ,1 7 4 ) = . 7 8 3 , p = . 3 7 8 , IN T : R 2 = .0 4 0 , F (1 ,1 7 4 ) = 7 .3 3 5 , p = . 0 0 7 . P re d ic to r v a ri a b le D e p e n d e n t v a ri a b le s A tt it u d e s ( A tt ) S u b je c ti v e N o rm s ( S N ) P e rc e iv e d B e h a v io u ra l C o n tr o l (P B C ) In te n ti o n s ( IN T ) b * C I (9 5 % ) p b * C I (9 5 % ) p b * C I (9 5 % ) p b * C I (9 5 % ) p P e rs u a s iv e M e s s a g e -. 0 8 3 -. 2 3 2 ,. 0 6 6 .2 7 1 -. 1 4 9 -. 2 9 7 ,-.0 0 1 .0 4 8 -. 0 2 3 -.1 7 2 ,. 1 2 7 .7 6 3 -. 0 8 8 -. 2 3 7 ,. 0 6 1 .2 4 8 N o te : M o d e l S u m m a ri e s – A tt : R 2 = . 0 0 7 , F (1 ,1 7 4 ) = 1 .2 1 8 , p = . 2 7 1 ; S N : R 2 = . 0 2 2 , F (1 ,1 7 4 ) = 3 .9 7 2 , p = . 0 4 8 ; P B C : R 2 = . 0 0 1 , F (1 ,1 7 4 ) = . 0 9 1 , p = .7 6 3 , IN T : R 2 = . 0 0 8 , F (1 ,1 7 4 ) = 1 .3 4 6 , p = . 2 4 8 .
To test H2, the experimental conditions were included as the independent variable for analysis. As seen in Table 2, a significant effect of condition on subjective norms, b* = -.149, was found. No significant effect was found for attitudes, b* = -.083, perceived behavioural control, b* = -.023, or intentions, b* = -.088. Thus, H2 is partially supported; where there is no difference in scores between groups exposed to individualistic and collectivist messages on attitudes and intentions, those exposed to the individualistic condition scored more negatively on subjective norms.
To test for the interaction effect, four multiple regressions were conducted (See Table 3). Results showed a significant interaction effect on perceived behavioural control, b* = .191, and a marginally significant interaction effect on attitudes, b* = .142. No significant effects were found for subjective norms, b* = -.013, or intentions, b* = .089. This means that when looking at the sample as a whole, an interaction effect exists for perceived behavioural control, and a marginally significant interaction effect exists for attitudes.
In order to further investigate H3i and H3ii, first a median split (Mdn = 0.00) was conducted on CI where values below the median represented collectivists and values above it represented individualists. Then, to explore the (marginally) significant interaction effects, a simple slope analysis was conducted for each of the hypotheses. When looking at
individualists, no significant effects were found for attitudes5, b* = -.061, p = .583, 95% CI [-.30,.17], or perceived behavioural control6, b* = .112, p = .316, 95% CI [-.11,.34], refuting H3i. When looking at collectivists, no significant effects were found for attitudes7, b* = -.092, p = .376, 95% CI [-.27,-10], or perceived behavioural control8, b* = -.135, p = .194,
95% CI [-.34,.07], refuting H3ii. 5 R2 = .004, F(1,80) = .303, p = .583. 6 R2 = .013, F(1,80) = 1.018, p = .316. 7 R2 = .009, F(1,92) = .791, p = .376. 8 R2 = .018, F(1,92) = 1,710, p = .194.
T abl e 3 St andar di ze d r egr es si on c oe ff ic ie nt s w it h c onf ide nc e i nt er val s e st im at ing t he int er ac ti on e ffe ct of pe rs uas iv e m es sage and c ul tur al ide nt ity on at ti tude s, s ubj ec ti ve nor m s, pe rc ei ve d be hav iour al c ont rol , and i nt ent ions to w ar ds S C D R . P re d ic to r v a ri a b le D e p e n d e n t v a ri a b le s A tt it u d e s ( A tt ) S u b je c ti v e N o rm s ( S N ) P e rc e iv e d B e h a v io u ra l C o n tr o l (P B C ) In te n ti o n s ( IN T ) b * C I (9 5 % ) p b * C I (9 5 % ) p b * C I (9 5 % ) p b * C I (9 5 % ) P P e rs u a s iv e M e s s a g e (P M ) -. 0 7 5 -. 2 2 2 ,. 0 7 1 .3 1 3 -. 1 4 5 -. 2 9 3 ,. 0 0 3 .0 5 5 -. 0 1 9 -. 1 6 6 ,. 1 2 9 .8 0 4 -. 0 7 9 -. 2 2 5 ,. -0 6 8 .2 9 1 C u lt u ra l Id e n ti ty ( C I) -. 2 0 2 -. 3 5 2 ,-.0 5 1 .0 0 9 -. 1 2 2 -. 2 6 4 ,. 0 4 0 .1 4 6 -. 1 1 0 -. 2 6 2 ,. 0 4 2 .1 5 4 -. 2 1 8 -. 3 6 9 ,-.0 6 8 .0 0 5 P M x C I .1 4 2 -. 0 0 8 ,. 2 9 2 .0 6 4 -. 0 1 3 -. 1 6 5 ,. 1 3 9 .8 6 8 .1 9 1 .0 4 0 ,. 3 4 3 .0 1 4 .0 8 9 -. 0 6 2 ,. 2 3 9 .2 4 5 N o te : M o d e l S u m m a ri e s – A tt : R 2 = . 0 5 5 , F (3 ,1 7 2 ) = 3 .3 1 6 , p = . 8 2 1 ; S N : R 2 = . 0 1 9 , F (3 ,1 7 2 ) = 2 .1 2 5 , p = . 0 9 9 ; P B C : R 2 = . 0 2 3 , F (3 ,1 7 2 ) = 2 .3 5 6 , p = . 0 7 4 ; IN T : R 2 = . 0 5 4 , F (3 ,1 7 2 ) = 3 .2 8 5 , p = . 0 2 2 .
Because the interaction analysis showed significance for perceived behavioural control and marginal significance for attitudes, additional analyses were conducted to explore root of these results: the file was split by experimental condition (i.e., persuasive message, either individualistic or collectivist), and another simple slope analysis was conducted for attitudes and perceived behavioural control. When looking at the collectivist experimental condition, results showed significant negative effects on attitudes9, b* = -.290, p = .006, 95%
CI [-.58,-.10], and perceived behavioural control10, b* = -.276, p = .008, 95% CI [-.51,-.08].
When looking at the individualistic experimental condition, results showed no significant effects on attitudes11, b* = -.060, p = .543, 95% CI [-.24,.13], , or perceived behavioural control12, b* = .089, p = .415, 95% CI [-.12,.29]. These results signify that: (1) collectivists have more positive attitudes and higher perceived behavioural control when exposed to a collectivist message, compared to individualists exposed to a collectivist message, and (2) there is no difference in attitudes or perceived behavioural control between individualists and collectivists when exposed to an individualistic message.
To explore RQ1i, personal relevance of cancer was included as the independent variable for analysis. Results showed a significant negative effect on attitudes, b* = -.164, and subjective norms, b* = -.172. No significant effect was found for perceived behavioural
control, b* = -.141, or intentions, b* = -.124. This means that people to whom cancer is personally relevant are less likely to have favourable attitudes and subjective norms in relation to cancer. To explore RQ1ii, personal relevance of SCDR was included as the independent variable for analysis. Results showed that subjective norms, b* = -.218, and intentions, b* = -.175, were negatively related to personal relevance of SCDR.
9 R2 = .084, F(1,88) = 8.066, p = .006. 10 R2 = .076, F(1,88) = 7.268, p = .008. 11 R2 = .004, F(1,84) = .373, p = .543. 12 R2 = .008, F(1,84) = .671, p = .418.
T abl e 4 St andar di ze d r egr es si on c oe ff ic ie nt s w it h c onf ide nc e i nt er val s f or the e ffe ct of pe rs onal r el ev anc e of c anc er (R Q 1i ) an d pe rs onal r el ev anc e of SC D R (R Q 1i i) on a tt it ude s, s ubj ec ti ve nor m s, pe rc ei ve d be hav iour al c ont rol , and i nt ent ions tow ar ds S C D R . P re d ic to r v a ri a b le D e p e n d e n t v a ri a b le s A tt it u d e s ( A tt ) S u b je c ti v e N o rm s ( S N ) P e rc e iv e d B e h a v io u ra l C o n tr o l (P B C ) In te n ti o n s ( IN T ) b * C I (9 5 % ) p b * C I (9 5 % ) p b * C I (9 5 % ) p b * C I (9 5 % ) P R Q 1 i P e rs o n a l re le v a n c e o f c a n c e r -. 1 6 4 -. 3 1 1 ,-.0 1 6 .0 3 0 -. 1 7 2 -. 3 1 9 ,-.0 2 4 .0 2 3 -. 1 4 1 -. 2 9 0 ,. 0 0 7 .0 6 1 -. 1 2 4 -. 2 7 2 ,. 0 2 5 .1 0 2 R Q 1 ii P e rs o n a l re le v a n c e o f S C D R -. 1 2 2 -. 2 7 1 ,. 0 2 6 .1 0 6 -. 2 1 8 -. 3 6 4 ,-.0 7 2 .0 0 4 .0 1 7 -. 1 3 3 ,. 1 6 7 .8 2 3 -. 1 7 5 -. 3 2 2 ,-.0 2 8 .0 2 0 N o te : M o d e l S u m m a ri e s R Q 1 i – A tt : R 2 = . 0 2 7 , F (1 ,1 7 4 ) = 4 .7 9 3 , p = . 0 3 0 ; S N : R 2 = . 0 3 0 , F (1 ,1 7 4 ) = 5 .2 9 8 , p = . 0 2 3 ; P B C : R 2 = . 0 2 0 , F (1 ,1 7 4 ) = 3 .5 5 2 , p = .0 6 1 , IN T : R 2 = . 0 1 5 , F (1 ,1 7 4 ) = 2 .6 9 6 , p = . 1 0 2 ; M o d e l S u m m a ri e s R Q 1 ii – A tt : R 2 = . 0 1 5 , F (1 ,1 7 4 ) = 2 .6 3 9 , p = . 1 0 6 ; S N : R 2 = . 0 4 8 , F (1 ,1 7 4 ) = 8 .6 9 2 , p = . 0 0 4 ; P B C : R 2 = . 0 0 0 , F (1 ,1 7 4 ) = . 0 5 0 , p = . 8 2 3 , IN T : R 2 = . 0 3 1 , F (1 ,1 7 4 ) = 5 .4 9 1 , p = . 0 2 0 .
There was no significant effect for attitudes, b* = -.122, or perceived behavioural control, b* = .017. This means that people to whom SCDR is personally relevant are less likely to have favourable subjective norms and intentions towards SCDR. Full results for RQ1i and RQ1ii can be seen in Table 4.
Conclusion
The aim of the present study is to explore the extent to which exposure to an
individualistic or collectivist persuasive message affects attitudes, subjective norms, perceived behavioural control, and intentions in relation to SCDR, and to see if the relationship is
moderated by an individual’s self-reported CI, be it individualistic or collectivist. The present research, where participants were exposed to either and individualistic or collectivist message, leads to a number of conclusions. Contrary to the hypotheses, those exposed to the
individualistic message score more negatively on attitudes (H1a) and intentions (H1d) than those exposed to the collectivist message, and there are no differences in subjective norms (H1b) and perceived behavioural control (H1c) between those exposed to either of the stimuli. There is partial support for H2: no difference between individualists and collectivists are found on attitudes (H2a), perceived behavioural control (H2c), and intentions (H2d), however, individualists score more negatively on subjective norms (H2b) than collectivists. On the whole, an interaction effect exists for attitudes and perceived behavioural control, but not for subjective norms or intentions. Further exploration into attitudes (H3i-a, H3ii-a) and
perceived behavioural control (H3i-c, H3ii-c) reveals that the hypotheses are refuted.
Exploration into the causal relationship of personal relevance of cancer shows negative effects on attitudes (RQ1i-a) and subjective norms (RQ1i-b), and no effect on perceived behavioural control (RQ1i-c) or intentions (RQ1i-d). Exploration into the causal relationship of personal relevance of SCDR shows negative effects on subjective norms (RQ1ii-b) and intentions (RQ1ii-d), and no effect on attitudes (RQ1ii-a) or perceived behavioural control (RQ1ii-c).
Discussion
The unexpected finding that individualistic people have more negative attitudes and intentions, and no differences in subjective norms and perceived behavioural control is inconsistent with literature aboutSCDR (Bagozzi et al., 2001; Switzer et al., 2013). A
possible explanation for these inconsistent finding is the generalized use of the concept of CI. Triandis, Bontempo, Villareal, Asai and Lucca's (1988) research shows that individualism and collectivism can each be divided into two categories (i.e., horizontal and vertical). Their research suggests that while the cultural identities indeed share concepts, these sub-concepts are understood differently across the CI. An example given is that of being self-reliant: for individualists it means an individual competitiveness, for collectivists it means not being a burden to their in-group (Triandis et al., 1988). And it could be that individualism in one country is experienced differently than in another (e.g., Canadian individualism may differ from Dutch individualism on certain sub-concepts).
Interestingly, people exposed to a persuasive message, be it individualistic or collectivist, report negative subjective norms towards SCDR. Glasgow and Bello (2007) mention that some registered donors report negative subjective norms when they are asked about it in a salient context. This could mean that participants in the present study feel
negatively about social and moral obligations and/or desirability within the context of SCDR, similar to the findings about already registered donors.
The expected culturally (in)consistent relationship between a persuasive message and an individual does not occur in the participants of the current study. Instead, results reveal that (1) collectivists have more positive attitudes and higher perceived behavioural control when exposed to a collectivist message, compared to individualists exposed to a collectivist message, and (2) there is no difference in attitudes or perceived behavioural control between individualists and collectivists when exposed to an individualistic message. This unexpected
outcome could be due to a suboptimal manipulation of the stimulus materials. Pilot study participants were asked to focus on the accessibility of the language used in the stimulus materials rather than the differentiation between language geared towards an individualist or collectivist culture.
The exploratory results for the impact of personal relevance of cancer on the
determinants of the TPB are inconsistent with literature about personal relevance and helping the cancer community (Simmons et al., 1993; Studts et al., 2009). A possible explanation is that people who have a personal or family history of cancer may feel confronted when dealing with information about cancer, especially if the outcomes of a diagnosis or treatment were not favourable.
Exploratory results for the negative impact of personal relevance of SCDR for subjective norms and intentions, and the lack of impact for attitudes and perceived behavioural control, are contrary to the assumptions of the TPB. Theory suggests that if a topic is important to someone, they are more likely to score more favourably on the
determinants of the TPB (Ajzen, 1991). These results might be explained by the personal, and possibly negative, experiences of friends and/or acquaintances who are registered as stem cell donors – such as never being called to donate due to low probability of matching, or an uncomfortable donation experience.
Limitations and Further Research
There are many limitations to the conduction of the present study. It is important to note that due to the large majority of respondents being recruited through convenience
sampling, it is impossible to consider what these results might mean to the general population. It is also important to note that respondents were not asked about their socioeconomic status. Research has shown that socioeconomic status can play a role in the decision to register as a tissue donor, namely that people from lower socioeconomic classes tend not to trust that
resources (i.e., the stem cell donation) will be allotted fairly (Switzer et al., 2013). Thus, including items about socioeconomic status (e.g., level of education) could be beneficial in gaining a deeper understanding of participants’ expectations.
Next, it would be useful to replicate this study with more rigorously tested stimulus materials. It would be wise to first create a version including the communication style of the manipulation target based upon Hall’s (1976) low- and high- context communication. Low-context communication uses explicit statements, and is the predominant choice for Western, individualistic cultures; high-context communication focuses more on a global, implicit understanding of a concept, and is more commonly used in Eastern, collectivist cultures (Adler & Elmhorst, 2008). It would then be beneficial to ask pre-test participants if the language and message of the stimulus material was clear. Creating texts which are culturally distinguishable would be beneficial for the dissemination of the message to the target
audiences (individualists and collectivists). This suggested benefit is consistent with findings about the benefits of linguistic and sociocultural strategies in health communication (Kreuter & McClure, 2004). Furthermore, tailoring a more detailed (health) questionnaire and analysis based on different aspects CI (cf. Singelis, Triandis, Bhawuk, & Gelfand, 1995) could lead to deeper insight on attitudes, subjective norms, perceived behavioural control, and intentions towards SCDR.
Finally, future experimental research could yield more meaningful conclusions by exploring whether participants are living in a country whose cultural norms are consistent with the country or culture with which they identify. Health research about anti-smoking websites in Korea and the United States has concluded that this can indeed be a factor in people’s choice for health-related information. Paek, Yu, and Bae (2009) found that in Korea, Koreans were more likely to go to Korean websites for anti-smoking information rather than going to American sites. The same tendency was found for Americans and choosing sites in
the United States rather than in Korea. This implies that cultural consistency does not only matter between the reader and the message, but also between the reader and their country of residence. It could be beneficial to then lend these insights to the creation of SCDR
advertisements for (inter)national campaigns.
The current study indicates that the expected null effect of a persuasive message exists for attitudes, perceived behavioural control, and intentions (H2a, H2c, H2d). Yet, contrary to prior research and hypothetical expectations, results indicate that the effects of a persuasive message, cultural identity, and the interaction between the two in the context of stem cell donation registration is either null (H1b, H1c, H3i-b, H31-d, H3ii-b, H3ii-d) or negative (H1a, H1d, H2b). Interestingly, results indicate a significant negative interaction effect of persuasive message and cultural identity on attitudes and perceived behavioural control, thus refuting the expected results (H3i-a, H3i-c, H3ii-a, H3ii-c). Conversely, this result does not imply
differences between different cultural identities, but rather differences within one cultural identity. Moreover, the negative (a, b, RQ1ii-b, RQ1ii-d) and null (c, RQ1i-d, RQ1ii-a, RQ1ii-c) effects for personal relevance warrant further research. Future studies may benefit from a more in-depth look at these discovered differences.
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Appendix A Stimulus Materials
