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The Relationship between Users’ Receptiveness to Health Messages and Social Cognitive Beliefs in Persuasive Health Communication
Event Type
Poster Presentation
TimeThursday, April 152:36pm - 2:38pm EDT
LocationDigital Health
DescriptionINTRODUCTION
People react to different types of health messages in persuasive health communication aimed at motivating behavior change. Hence, in human factors (HF) design, there is a need to tailor health applications to different user groups rather than changing the human characteristics and conditions. However, in the domain of fitness app design, there is limited research on the relationship between users’ receptiveness to health messages and their social-cognitive beliefs about health behavior, and how this relationship is moderated by gender. Knowledge of the gender difference will help in tailoring fitness apps to male and females.

OBJECTIVES
The first objective of our paper is to uncover the relationships between users’ receptiveness to different types of health messages and their social cognitive beliefs. The second objective is to uncover users’ receptiveness to different types of health messages. The third objective is to uncover how gender moderates their receptiveness to the different types of health messages and its relationship with their social-cognitive beliefs about bodyweight exercise modeled in a fitness app.

BACKGROUND
Social Cognitive Theory: The SCT posits that cognition, environment and behavior interact reciprocally to define and shape behaviors. Common cognitive factors proposed by Bandura include self-efficacy, self-regulation and outcome expectation. These cognitive factors interact with environmental factors such as human, social and technological systems to shape behavior. Behavior modeling is an example of a technological system in which, in the context of social learning, an expert demonstrates to an observer how to correctly perform a given behavior. Research shows that it is a persuasive technique that has the potential of changing behavior.

Persuasive Messages: Persuasion is a process by which people use messages to influence the behaviors of others. Persuasive messages are communicated to users through certain channels with the aim of eliciting certain behaviors. Typical channels for persuasive health communication include radio, television, newspapers, mobile apps, social media, website, etc.

METHOD
We used a qualitative approach to address the objectives of our study. Our research questions are as follows:

RQ1. Is there a relationship between users’ receptiveness to health messages and social-cognitive determinants of physical activity?
RQ2. Are the relationships between their receptiveness to health messages and social-cognitive beliefs moderated by gender?
RQ3. Does users’ receptiveness to health messages vary across type and gender?

To contextualize the study, we developed a mocked-up fitness app in which an expert demonstrates to the user (the observer) how to correctly perform a bodyweight exercise such as push-up, squat, wall-sit, etc. Then we asked participants questions on different types of rational health messages and social-cognitive-belief constructs. The rational health messages questions, which are drawn from the literature, include the following. The scale ranges from “does not motivate me to start or continue exercising (1) to completely motivates me to start or continue exercising (7).”

1. Financial Cost Related: “‘Physical inactivity costs Canadian taxpayers $6.8 billion a year’ (Source: CBCNews).”
2. Obesity Related: “‘One in four Canadian adults has clinical obesity’ (Source: Canadian Institute for Health Information).”
3. Death Related: “‘6% of the world's death is caused by physical inactivity’ (Source: World Health Organization).”
4. Illness Related: “‘Those who do not find time for exercise will have to find time for Illness’ (Source: Edward Stanley).”
5. Social Stigma Related: “‘The stigma against people with obesity is comparable to that of racial discrimination’ (Source: Canadian Obesity Network).”

In addition, we asked participants questions about their social-cognitive beliefs about the bodyweight exercise modeled in the fitness app. Two questions from each of three social cognitive construct include the following:

1. Perceived Self-Efficacy [0 – Not Confident to 100 - Confident]: How confident are you that you can complete at home the proposed weekly number of push-ups for the next three months.
a. Even if you feel depressed?
b. Even when you feel tense?

2. Perceived Self-Regulation [1 – Strongly Disagree to 5 – Strongly Agree]: To achieve my proposed weekly average number of push-ups....
a. I will set a goal.
b. I will keep track of my progress in meeting my goal.

3. Outcome Expectation [1 – Strongly Disagree to 5 – Strongly Agree]: The [name of exercise] will...
a. Improve my overall body functioning.
b. Strengthen my bones.

A total of 669 participants took part in the study, 517 and 152 of whom were whites and black/brown, respectively. Each participant was remunerated with US $0.6.

RESULTS
We conducted two types of analysis: path modeling of the relationship between health message and social-cognitive beliefs, and analysis of variance (ANOVA) on users’ susceptibility to the different message types.

Path Modeling: Overall, the path model of the relationships between the message types and each of the social-cognitive-belief constructs has a goodness of fit ranging from 28 to 36%, indicating that the overall validation of the model is medium. Secondly, message types in our path models account for between 11 and 22% of the variance of the social-cognitive-belief constructs, with illness-, followed by death- and stigma-related messages being more consistent in accounting for the variance. For example, regarding self-regulation, illness-related message (beta = 0.15, p < 0.01), and death-related message (beta = 0.24, p < 0.001) have a significant relationship with self-regulation-belief construct, but financial-cost-, obesity- and stigma-related messages have no significant effect. These relationships are not moderated by gender. Regarding self-efficacy, only illness-related message (beta = 0.12, p < 0.05) has a significant relationship with self-efficacy-belief construct in the overall model. Moreover, in the gender-based models, social-stigma-related message is significant in the female model (beta = 0.17, p < 0.05) but non-significant in the male model (beta = 0.02, p > 0.05), with the difference being statistically significant (p < 0.05). Finally, regarding outcome expectation, only illness-related message (beta = 0.11, p < 0.05) and stigma-related-message (beta = 0.11, p < 0.05) have a significant relationship with outcome-expectation construct in the overall model. Moreover, just as in the case of self-efficacy, in the gender-based models, social-stigma-related message is significant in the female model (beta = 0.14, p < 0.01) but non-significant in the male model (beta = 0.08, p > 0.05), with the difference being statistically significant (p < 0.05).

ANOVA for Message Types: We carried out a two-way analysis of variance to uncover the effect of gender and message type on users’ receptiveness to health messages. Our results showed that there is a main effect of gender (F (1, 3335) = 12.30, p < 0.001) and message type (F (4, 3335) = 12.30, p < 0.001), but no interaction (F (4, 3335) = 1.16, p > 0.5) between both variables. Overall, males (M = 4.19) are significantly more receptive (p < 0.01) to the health messages than females (M = 3.93). Moreover, users were significantly more receptive to illness-related message (M = 4.84) and death-related message (M = 4.69) than financial-cost-related message (M = 3.70), obesity-related message (M = 3.50) and stigma-related message (M = 3.48).

CONCLUSION
We found that, regardless of gender, users are more likely to be receptive to illness- and death-related messages compared with financial-cost-, obesity- and social-stigma-related messages. Moreover, we found a significant relationship between users’ receptiveness to illness- and death-related messages and their self-regulation beliefs. We also found a significant relationship between users’ receptiveness to illness-related messages and their outcome expectations and self-efficacy beliefs. In particular, we found a significant relationship between female users’ receptiveness to social-stigma-related messages and their outcome expectations and self-efficacy beliefs, but none for male users. The findings indicate that illness and death-related messages are most likely to be effective in driving behavior change in the physical activity domain.