Persuasive Narratives About Osteoporosis: Effects of Protagonist Competence, Narrator Point of View, and Subjective Risk.

Narratives have been widely acknowledged as a powerful persuasion tool in health promotion and education. Recently, great efforts have been devoted to identifying message components and causal pathways that maximize a narrative's persuasion power. Specifically, we investigated how narrator point of view and readers' subjective relative risk moderate the effects of protagonist competence on intentions to adopt osteoporosis-prevention behaviors, and proposed identification with the protagonist, self-referencing, and fear arousal as three mediators explaining the effect. Women aged 35 to 55, still young enough to reduce osteoporosis risk, read a narrative in which the 60-year-old female character reflects on either taking actions to prevent osteoporosis (competent protagonist) or failing to do so, resulting in osteoporosis (incompetent protagonist) (N = 563). The narratives were told from either the first- or third-person point of view. We found that women who perceived themselves to be at lower risk for developing osteoporosis relative to their peers identified more with the competent protagonist. For women at higher perceived risk, the competent and incompetent protagonists elicited similar levels of identification. Identification was higher when the protagonist's story was told from the first-person perspective, but only for the incompetent protagonist narrative. Identification, self-referencing, and fear arousal played important mediating roles. Implications for theory development and practice are examined.

Parental COVID-19 Vaccine Hesitancy in the United States.

OBJECTIVE: Little is known about parents' willingness to vaccinate their children against COVID-19. We assessed the prevalence of vaccine hesitancy among parents with a child or adolescent aged 12-15 years, examined predictors of parents' COVID-19 vaccine hesitancy, their reasons for resisting a pediatric COVID-19 vaccine, and the correlation between parents' intentions to vaccinate their child and the acceptance of a vaccine for themselves. METHODS: We conducted a national online survey of 637 parents of a child or adolescent aged 12-15 years in March 2021, before COVID-19 vaccines had been approved for this age group. We assessed univariate predictors of vaccine hesitancy, and we used logistic regression analysis to assess independent effects of variables on vaccine hesitancy. RESULTS: Nearly one-third (28.9%; 95% CI, 25.5%-32.5%) of respondents reported pediatric vaccine hesitancy. Vaccine-hesitant parents were less knowledgeable about vaccines, more accepting of vaccine conspiracies, and less worried about COVID-19 risks to their child's health than vaccine-accepting parents were. Vaccine hesitancy was higher among female (vs male), single (vs married/living as married), older (vs younger), low income (vs high income), non-college graduates (vs college graduates), and Republican (vs Democrat) parents. The primary concerns expressed by vaccine-hesitant parents pertained to vaccine safety rather than vaccine effectiveness. One-quarter of vaccine-hesitant parents preferred that their child obtain immunity through infection rather than vaccination. Non-vaccine-hesitant parents' reasons for vaccinating focused on protecting the health of their child and others. Childhood COVID-19 vaccine acceptance was strongly associated with parents' intentions to get the vaccine for themselves. CONCLUSION: A messaging strategy for effective public health interventions that includes educating the public about vaccination, countering misinformation about vaccine development and safety, and stressing the safety of approved COVID-19 vaccines may boost vaccine acceptance among vaccine-hesitant parents.

Conservative Media Use and Childhood COVID-19 Vaccine Information: A Test of the Contradictory Health Information Processing Model.

The Contradictory Health Information Processing (CHIP) model explains individuals' processing of conflicting health claims. Tests of the model, while highly supportive, have been experimental and have relied upon low-familiar topics. Accordingly, a survey of parents with a child aged <12 years (N = 510) was conducted to test the application of the CHIP model to the controversial issue of childhood COVID-19 vaccination; such a vaccine had not yet been approved for this age group at the time of the survey. As hypothesized, reliance upon conservative news was associated with the perception that media information contradicted official guidance to vaccinate children, which led to issue uncertainty. Issue uncertainty prompted negative appraisals and decision uncertainty. Specifically, decision uncertainty partially mediated the effect of issue uncertainty on negative appraisals of vaccination, which in turn aroused threat emotions. However, threat emotions did not predict information-seeking, as specified in the model. This result may have been due to respondents having already decided to vaccinate their child, or not - a reflection of the partisan nature of the topic and the extensive coverage it had received. Theoretical and practical implications are discussed.

A meta-analysis of the impact of point of view on narrative processing and persuasion in health messaging.

OBJECTIVE: To synthesize experimental research on the impact of narrative point of view (POV) on message processing and persuasion outcomes in health promotion. Moderators examined included characteristics of study design, participants, and experimental stimuli. DESIGN AND MAIN OUTCOME MEASURES: Random effects model meta-analysis of 16 health promotion experiments, using the metafor package in R. Studies included compared the effects of first- and third-person POV on risk perceptions, attitudes, behavioral intention, identification and transportation. RESULTS: There was no evidence of publication bias. Narratives told in the first-person POV led to higher levels of perceived susceptibility (d = 0.10, 95% CI [0.01, 0.20]) and identification feelings (d = 0.10, 95% CI [0.10, 0.21]) than third-person narratives. The effects of first-person POV narratives were significantly stronger for stories that were written in the past-tense and that depicted the protagonist as being similar to message recipients. CONCLUSION: Findings support a theoretical model of POV impact in which a first-person perspective increases identification with the character, thereby leading to higher levels of perceived susceptibility to the health threat. The practical implication is that the effectiveness of narrative persuasion is enhanced by using the first-person point of view, emphasizing target audience-protagonist similarities, and telling stories in the past tense.

When Media Health Stories Conflict: Test of the Contradictory Health Information Processing (CHIP) Model.

Guided by Uncertainty Management Theory, UMT, we tested a model that explicates how uncertainty arising from contradictory health information is managed through information seeking. In an online experiment, 763 U.S. adults were randomly assigned to one of three message conditions: contradictory, non-contradictory, or control. Participants in the contradictory and non-contradictory conditions answered questions about their perceptions of contradiction, issue and decision uncertainty, negative appraisals and emotions, and information-seeking intentions. They also completed measures of several moderator variables, including information overload, intolerance for uncertainty, and health self-efficacy. Baseline levels of issue and decision uncertainty were measured in the control condition. Model tenets were confirmed: perceptions of contradiction led to issue uncertainty which, in turn, prompted cognitive appraisals directly, and indirectly through increased decision uncertainty. The effects of issue and decision uncertainty on information-seeking intentions were mediated by negative appraisals and threat emotions. Individuals with high health self-efficacy and positive outcome expectations of information search were more likely to manage uncertainty through information seeking. These results support the use of the CHIP model when perceptions of contradiction and decision uncertainty need to be accounted for, while also validating UMT for its original purposes. Model refinements and implications are discussed.

Narratives of Prevention and Affliction in Type 2 Diabetes: Mechanisms of Influence in a Sample of Middle-aged Women.

Research suggests that readers identify more with a competent protagonist who acts to prevent diabetes than with a less competent protagonist whose inaction leads to disease. We sought a better understanding of the mediators of this protagonist competence effect. Middle-aged women (45-55) read a prevention narrative depicting a protagonist at risk for type 2 diabetes (T2D) who prevents diabetes through lifestyle changes or an affliction narrative in which protagonist inaction leads to disease (N = 315). The prevention narrative elicited more identification than the affliction narrative for participants at low risk of T2D, but less identification for higher risk participants. Identification's impact on intentions to adopt self-protective behaviors was partially mediated by self-referencing. Protagonist competence did not affect transportation, but transportation had a direct effect on behavioral intentions and an indirect effect on intentions mediated by self-referencing. Fear arousal predicted behavioral intentions and was highest among those who read the affliction narrative and rated self as at risk for T2D. Protagonist competence had an indirect effect on intentions mediated by attributions of trustworthiness in response to the affliction narrative. This study contributes to our understanding of how narratives work and underscores the importance of tailoring narratives to the risk profile of individuals.

Predictors of intention to vaccinate against COVID-19: Results of a nationwide survey.

BACKGROUND: Public polling indicates that vaccine uptake will be suboptimal when COVID-19 vaccines become available. Formative research seeking an understanding of weak vaccination intentions is urgently needed. METHODS: Nationwide online survey of 804 U.S. English-speaking adults. Compensated participants were recruited from the U.S. through an internet survey panel of 2.5 million residents developed by a commercial survey firm. Recruitment was based on quota sampling to produce a U.S. Census-matched sample representative of the nation with regard to region of residence, sex, and age. RESULTS: COVID-19 vaccination intentions were weak, with 14.8% of respondents being unlikely to get vaccinated and another 23.0% unsure. Intent to vaccinate was highest for men, older people, individuals who identified as white and non-Hispanic, the affluent and college-educated, Democrats, those who were married or partnered, people with pre-existing medical conditions, and those vaccinated against influenza during the 2019-2020 flu season. In a multiple linear regression, significant predictors of vaccination intent were general vaccine knowledge (ß = 0.311, p < .001), rejection of vaccine conspiracies (ß = -0.117, p = .003), perceived severity of COVID-19 (ß = 0.273, p < .001), influenza vaccine uptake (ß = 0.178, p < .001), having ≥ 5 pre-existing conditions (ß = 0.098, p = .003), being male (ß = 0.119, p < .001), household income of ≥ $120,000 (ß = 0.110, p = .004), identifying as a Democrat (ß = 0.075, p < .029), and not relying upon social media for virus information (ß = -0.090, p ã€ˆ002). Intent to vaccinate was lower for Fox News (57.3%) than CNN/MSNBC viewers (76.4%) (χ2(1) = 12.68, p < .001). Political party differences in threat appraisals and vaccine conspiracy beliefs are described. CONCLUSIONS: Demographic characteristics, vaccine knowledge, perceived vulnerability to COVID-19, risk factors for COVID-19, and politics likely contribute to vaccination hesitancy.

From Network Positions to Language Use: Understanding the Effects of Brokerage and Closure Structures from a Linguistic Perspective.

We investigated cancer survivors' interactions on an online breast cancer support forum, focusing on how the network structures of brokerage and closure relate to the types of support received and to the language used in posts. Data came through the extraction of 1,443 forum members' online networks. Automated linguistic analysis was carried out on the 27,248 threads these survivors made and the 336,151 replies they received. Survivors' brokerage and closure levels were positively correlated with the use of positive affective words in their posts, a linguistic marker of well-being. Different network positions fostered different types of support in the community. Specifically, people bridging unconnected users (the broker role) were more likely to receive informational support whereas people in closely knit groups (the closure role) were more likely to receive emotional support. Theoretical, methodological, and practical implications are examined.

The ONETEP linear-scaling density functional theory program.

We present an overview of the onetep program for linear-scaling density functional theory (DFT) calculations with large basis set (plane-wave) accuracy on parallel computers. The DFT energy is computed from the density matrix, which is constructed from spatially localized orbitals we call Non-orthogonal Generalized Wannier Functions (NGWFs), expressed in terms of periodic sinc (psinc) functions. During the calculation, both the density matrix and the NGWFs are optimized with localization constraints. By taking advantage of localization, onetep is able to perform calculations including thousands of atoms with computational effort, which scales linearly with the number or atoms. The code has a large and diverse range of capabilities, explored in this paper, including different boundary conditions, various exchange-correlation functionals (with and without exact exchange), finite electronic temperature methods for metallic systems, methods for strongly correlated systems, molecular dynamics, vibrational calculations, time-dependent DFT, electronic transport, core loss spectroscopy, implicit solvation, quantum mechanical (QM)/molecular mechanical and QM-in-QM embedding, density of states calculations, distributed multipole analysis, and methods for partitioning charges and interactions between fragments. Calculations with onetep provide unique insights into large and complex systems that require an accurate atomic-level description, ranging from biomolecular to chemical, to materials, and to physical problems, as we show with a small selection of illustrative examples. onetep has always aimed to be at the cutting edge of method and software developments, and it serves as a platform for developing new methods of electronic structure simulation. We therefore conclude by describing some of the challenges and directions for its future developments and applications.

Effects of public versus media responsibility messages on stigmatization of people with schizophrenia in an American adult sample.

PURPOSE: People with mental illness suffer from the consequences of stigma. Interventions to reduce stigma should focus on alternative approaches that target false beliefs toward mental disorders. The effectiveness of two messages to reduce stigma toward schizophrenia was tested: a traditional public responsibility message that attributes stigma to public misunderstandings, and an alternative media responsibility message that attributes stigma to bias in media representations. METHODS: An experiment with Americans (N = 448) randomly assigned to a public responsibility message, a media responsibility message, or a control condition. Participants in the two message conditions completed measures of guilt and reactance toward the media. Perceptions of personal responsibility and dangerousness, and social rejection intentions were assessed for all participants. RESULTS: Both messages lowered perceptions of dangerousness and social rejection intentions, relative to control. The media responsibility generated more reactance toward the media than the public responsibility approach, but not more guilt. Reactance did not mediate message effects. Perceptions of personal responsibility were reduced after exposure to the public responsibility message, but only for participants with no prior contact with mental illness. CONCLUSIONS: Both approaches reduced perceptions of dangerousness and social rejection intentions. Stigma reduction campaigns might segment the audience based on prior contact.

Communication interventions to promote the public's awareness of antibiotics: a systematic review.

BACKGROUND: Inappropriate antibiotic use is implicated in antibiotic resistance and resultant morbidity and mortality. Overuse is particularly prevalent for outpatient respiratory infections, and perceived patient expectations likely contribute. Thus, various educational programs have been implemented to educate the public. METHODS: We systematically identified public-directed interventions to promote antibiotic awareness in the United States. PubMed, Google Scholar, Embase, CINAHL, and Scopus were queried for articles published from January 1996 through January 2016. Two investigators independently assessed titles and abstracts of retrieved articles for subsequent full-text review. References of selected articles and three review articles were likewise screened for inclusion. Identified educational interventions were coded for target audience, content, distribution site, communication method, and major outcomes. RESULTS: Our search yielded 1,106 articles; 34 met inclusion criteria. Due to overlap in interventions studied, 29 distinct educational interventions were identified. Messages were primarily delivered in outpatient clinics (N = 24, 83%) and community sites (N = 12, 41%). The majority included clinician education. Antibiotic prescription rates were assessed for 22 interventions (76%). Patient knowledge, attitudes, and beliefs (KAB) were assessed for 10 interventions (34%). Similar rates of success between antibiotic prescription rates and patient KAB were reported (73 and 70%, respectively). Patient interventions that did not include clinician education were successful to increase KAB but were not shown to decrease antibiotic prescribing. Three interventions targeted reductions in Streptococcus pneumoniae resistance; none were successful. CONCLUSIONS: Messaging programs varied in their designs, and many were multifaceted in their approach. These interventions can change patient perspectives regarding antibiotic use, though it is unclear if clinician education is also necessary to reduce antibiotic prescribing. Further investigations are needed to determine the relative influence of interventions focusing on patients and physicians and to determine whether these changes can influence rates of antibiotic resistance long-term.

Opposition to Nonprescription Naloxone Access: Measurement and Psychosocial Predictors.

Background: Access of naloxone has been increased in recent years, yet opposition to unrestricted availability persists. Objectives: To validate a measure of opposition to the policy of nonprescription naloxone and foster a better understanding of the characteristics of individuals who oppose such a policy. Methods: Respondents from a crowdsource platform (N = 621) responded to an instrument developed to assess opposition to nonprescription naloxone. Construct validity was assessed by examining the relationship of the opposition scale with measures of social distance, belief in a just world, right wing authoritarianism, social dominance orientation (SDO), perceptions of the degree of threat to the nation presented by opioid users, past exposure to opioid misuse, and conservative political ideology. Results: A 9-item measure of opposition emerged (α=.96). Opposition to nonprescription naloxone was generally associated with construct validation variables as expected. In a regression analysis that adjusted for demographic characteristics, opposition was most strongly related to authoritarianism, the perception that opioid users present a threat to our nation, the belief that we live in a just world, social dominance orientation, greater perceived social distance between self and opioid users, and past experiences with users. Opposition scores differentiated those who supported versus opposed specific policies regarding naloxone access and were particularly high among Republicans. Most respondents did not oppose policies on nonprescription naloxone access. Conclusions/Importance: The instrument developed provides a reliable and valid tool that enables future investigations into understanding and overcoming the psychological, social, and political foundations of opposition to expanded naloxone access.

Relationship of people's sources of health information and political ideology with acceptance of conspiratorial beliefs about vaccines.

BACKGROUND: Conspiracies about vaccination are prevalent. We assessed how the health information sources people rely upon and their political ideologies are associated with acceptance of vaccine conspiracies. METHODS: Online survey (N = 599) on Amazon's Mechanical Turk crowdsource platform. Hypotheses were tested via structural equation modeling. RESULTS: Acceptance of vaccine conspiracy beliefs was associated positively with greater reliance on social media for health information (coef. = 0.42, p < .001), inversely related to use of medical websites (coef. = -0.21, p < .001), and not significantly related to use of providers for health information (coef. = -0.13, p = .061). In addition, liberal political orientation was negatively associated with acceptance of vaccine conspiracies (coef. = -0.29, p < .001). CONCLUSIONS: An understanding of vaccine conspiracy acceptance requires a consideration of people's health information sources. The greater susceptibility of political conservatives to conspiracy beliefs extends to the topic of vaccination.

Communication about chronic pain and opioids in primary care: impact on patient and physician visit experience.

Patients and physicians report that communication about chronic pain and opioids is often challenging, but there is little empirical research on whether patient-physician communication about pain affects patient and physician visit experience. This study video recorded 86 primary care visits involving 49 physicians and 86 patients taking long-term opioids for chronic musculoskeletal pain, systematically coded all pain-related utterances during these visits using a custom-designed coding system, and administered previsit and postvisit questionnaires. Multiple regression was used to identify communication behaviors and patient characteristics associated with patients' ratings of their visit experience, physicians' ratings of visit difficulty, or both. After adjusting for covariates, 2 communication variables-patient-physician disagreement and patient requests for opioid dose increases-were each significantly associated with both worse ratings of patient experience and greater physician-reported visit difficulty. Patient desire for increased pain medicine was also significantly positively associated with both worse ratings of patient experience and greater physician-reported visit difficulty. Greater pain severity and more patient questions were each significantly associated with greater physician-reported visit difficulty, but not with patient experience. The association between patient requests for opioids and patient experience ratings was wholly driven by 2 visits involving intense conflict with patients demanding opioids. Patient-physician communication during visits is associated with patient and physician ratings of visit experience. Training programs focused on imparting communication skills that assist physicians in negotiating disagreements about pain management, including responding to patient requests for more opioids, likely have potential to improve visit experience ratings for both patients and physicians.

Increasing confidence and changing behaviors in primary care providers engaged in genetic counselling.

BACKGROUND: Screening and counseling for genetic conditions is an increasingly important part of primary care practice, particularly given the paucity of genetic counselors in the United States. However, primary care physicians (PCPs) often have an inadequate understanding of evidence-based screening; communication approaches that encourage shared decision-making; ethical, legal, and social implication (ELSI) issues related to screening for genetic mutations; and the basics of clinical genetics. This study explored whether an interactive, web-based genetics curriculum directed at PCPs in non-academic primary care settings was superior at changing practice knowledge, attitudes, and behaviors when compared to a traditional educational approach, particularly when discussing common genetic conditions. METHODS: One hundred twenty one PCPs in California and Pennsylvania physician practices were randomized to either an Intervention Group (IG) or Control Group (CG). IG physicians completed a 6 h interactive web-based curriculum covering communication skills, basics of genetic testing, risk assessment, ELSI issues and practice behaviors. CG physicians were provided with a traditional approach to Continuing Medical Education (CME) (clinical review articles) offering equivalent information. RESULTS: PCPs in the Intervention Group showed greater increases in knowledge compared to the Control Group. Intervention PCPs were also more satisfied with the educational materials, and more confident in their genetics knowledge and skills compared to those receiving traditional CME materials. Intervention PCPs felt that the web-based curriculum covered medical management, genetics, and ELSI issues significantly better than did the Control Group, and in comparison with traditional curricula. The Intervention Group felt the online tools offered several advantages, and engaged in better shared decision making with standardized patients, however, there was no difference in behavior change between groups with regard to increases in ELSI discussions between PCPs and patients. CONCLUSION: While our intervention was deemed more enjoyable, demonstrated significant factual learning and retention, and increased shared decision making practices, there were few differences in behavior changes around ELSI discussions. Unfortunately, barriers to implementing behavior change in clinical genetics is not unique to our intervention. Perhaps the missing element is that busy physicians need systems-level support to engage in meaningful discussions around genetics issues. The next step in promoting active engagement between doctors and patients may be to put into place the tools needed for PCPs to easily access the materials they need at the point-of-care to engage in joint discussions around clinical genetics.

Persuasive Effects of Point of View, Protagonist Competence, and Similarity in a Health Narrative About Type 2 Diabetes.

We examined the persuasive effects of three narrative features in a message about type 2 diabetes: narrative point of view (first- vs. third-person perspective), protagonist competence (positive role model who prevents diabetes vs. negative role model who develops diabetes), and protagonist-reader similarity (demographically similar vs. dissimilar). We posited that a first-person point of view would elevate people's identification levels more than a third-person point of view, especially when the protagonist was depicted as a positive role model. We also expected a similar protagonist to foster greater levels of identification than a dissimilar one. In addition, the positive effect of a competent role model on identification was expected to be enhanced under the condition of reader-protagonist similarity. Finally, we hypothesized that the effects of identification on persuasion would be mediated by self-referencing. Participants 30 years of age or younger (N = 489) were randomly assigned to read a story about a person with a family history of type 2 diabetes that was altered with regard to the experimental factors. Thereafter they completed a questionnaire incorporating measures of study variables. Greater levels of identification were found to foster self-referencing, leading to persuasion. Identification was strongest with a first-person point of view and when the narrator was a positive role model. The effect of identification on persuasion was mediated by self-referencing. Contrary to expectations, protagonist-reader demographic similarity did not affect identification or self-referencing. There was no support for the two moderation hypotheses.

Goals of Chronic Pain Management: Do Patients and Primary Care Physicians Agree and Does it Matter?

OBJECTIVE: Assess patient-physician agreement on management goals for chronic musculoskeletal pain and its associations with patient and physician visit experiences. MATERIALS AND METHODS: Pre-visit and post-visit questionnaires for 87 primary care visits that involved patients taking opioids for chronic musculoskeletal pain and primary care resident physicians. After each visit, patients and physicians independently ranked 5 pain treatment goals from most to least important. RESULTS: In total, 48% of patients ranked reducing pain intensity as their top priority, whereas 22% ranked finding a diagnosis as most important. Physicians ranked improving function as the top priority for 41% of patients, and ranked reducing medication side effects as most important for 26%. The greatest difference between patient and physician rankings was for reducing pain intensity. In regression analyses, neither overall agreement on goals (ie, the physician's first or second priority included the patient's top priority) nor difference in patient versus physician ranking of pain intensity was significantly associated with patient-reported visit experience (ß for overall agreement, -0.08; 95% confidence interval [CI], -0.45 to 0.30; P=0.69; ß for intensity, -0.06; 95% CI, -0.17 to 0.04; P=0.24) or physician-reported visit difficulty (ß for overall agreement, 1.92; 95% CI, -2.70 to 6.55; P=0.41; ß for intensity, 0.42; 95% CI, -0.87 to 1.71; P=0.53). DISCUSSION: Patients and physicians prioritize substantially different goals for chronic pain management, but there is no evidence that agreement predicts patient experience or physician-reported visit difficulty. Primary care physicians may have adapted to new recommendations that emphasize functional goals and avoidance of long-term opioid therapy, whereas patients continue to focus on reducing pain intensity.

Characterizing internet health information seeking strategies by socioeconomic status: a mixed methods approach.

BACKGROUND: The Internet is valuable for those with limited access to health care services because of its low cost and wealth of information. Our objectives were to investigate how the Internet is used to obtain health-related information and how individuals with differing socioeconomic resources navigate it when presented with a health decision. METHODS: Study participants were recruited from public settings and social service agencies. Participants listened to one of two clinical scenarios - consistent with influenza or bacterial meningitis - and then conducted an Internet search. Screen-capture video software captured the Internet search. Participant Internet search strategies were analyzed and coded for pre- and post-Internet search guess at diagnosis and information seeking patterns. Individuals who did not have a college degree and were recruited from locations offering social services were categorized as "lower socioeconomic status" (SES); the remainder was categorized as "higher SES." Participants were 78 Internet health information seekers, ranging from 21-35 years of age, who experienced barriers to accessing health care services. RESULTS: Lower-SES individuals were more likely to use an intuitive, rather than deliberative, approach to Internet health information seeking. Lower- and higher-SES participants did not differ in the tendency to make diagnostic guesses based on Internet searches. Lower-SES participants were more likely than their higher-SES counterparts to narrow the scope of their search. CONCLUSIONS: Our findings suggest that individuals with different levels of socioeconomic status vary in the heuristics and search patterns they rely upon to direct their searches. The influence and use of credible information in the process of making a decision is associated with education and prior experiences with healthcare services. Those with limited resources may be disadvantaged when turning to the Internet to make a health decision.

Narrator Point of View and Persuasion in Health Narratives: The Role of Protagonist-Reader Similarity, Identification, and Self-Referencing.

Narratives are often used in messages about health threats. We posited that a 1st-person point of view (POV) narrative would have a greater effect than a 3rd-person POV on the mediators identification and self-referencing-an effect moderated by protagonist-reader similarity. Higher levels of identification and self-referencing were expected to elevate susceptibility and severity perceptions, leading to persuasion. Participants ages ≤30 years were recruited from a crowdsource website and randomly assigned to read one version of a faux magazine article about caffeine overdose. Article versions were defined by a 2 (1st- or 3rd-person POV) × 2 (similar or dissimilar protagonist) design. To manipulate similarity, we had respondents read an article in which the protagonist was also young (24 years of age) and of the same sex or much older (54 years of age) and of the opposite sex. Participants then completed a questionnaire measuring study variables. Contrary to expectations, POV did not affect identification or self-referencing. However, similarity directly impacted identification, which in turn influenced severity perceptions. Self-referencing was not affected by the experimental manipulations but had a direct effect on susceptibility and also mediated the identification → susceptibility relationship. Susceptibility and severity perceptions were associated with greater levels of persuasion. Implications for message design are discussed.

Targeting Type 2: Linguistic Agency Assignment in Diabetes Prevention Policy Messaging.

We explored the effects of linguistic agency assignment on the persuasive impact of a fictitious medical journal editorial about Type 2 diabetes. Participants (N = 422) read 1 of 4 versions of an editorial that differed in the language used to describe the health threat posed by the disease (threat agency) and to outline a program for preventing it (prevention agency). Threat agency was assigned either to the disease (e.g., diabetes puts individuals' lives at risk) or to humans (e.g., individuals who acquire diabetes put their lives at risk). Prevention agency was assigned either to the recommended prevention behaviors (e.g., a healthy diet and regular exercise protect children from Type 2) or to humans (e.g., children who eat a healthy diet and exercise regularly protect themselves from Type 2). Respondents' perceptions of disease severity were higher when threat agency was assigned to diabetes rather than humans. However, attitudes toward the proposed prevention program were higher when prevention agency was assigned to humans rather than to the recommended behaviors. The latter finding contrasts with agency effects observed in previous research on a viral threat, suggesting that the optimal pattern of agency assignment in prevention messaging may be different for acute and chronic lifestyle diseases.