Using Short-Form Videos to Get Clinical Trial Newcomers to Sign Up: Message-Testing Experiment.

BACKGROUND: Recruiting participants for clinical trials poses challenges. Major barriers to participation include psychological factors (eg, fear and mistrust) and logistical constraints (eg, transportation, cost, and scheduling). The strategic design of clinical trial messaging can help overcome these barriers. While strategic communication can be done through various channels (eg, recruitment advertisements), health care providers on the internet have been found to be key sources for communicating clinical trial information to US adults in the social media era. OBJECTIVE: This study aims to examine how communication source (ie, medical doctors and peers) and message framing of TikTok videos (ie, psychological and logistical framing) influence clinical trial-related attitudes, perceptions, and sign-up behaviors under the guidance of the integrated behavioral model. METHODS: This study used a 2 (source: doctor vs peer) × 2 (framing: psychological vs logistical) between-participant factorial design web-based experiment targeting adults in the United States who had never participated in clinical trials (ie, newcomers). A Qualtrics panel was used to recruit and compensate the study respondents (n=561). Participants viewed short-form videos with doctors or peers, using psychological or logistical framing. The main outcome measures included perceived source credibility, self-efficacy, attitude toward clinical trial participation, behavioral intention, and sign-up behavior. Structural equation modeling was used to analyze the direct and indirect effects of message factors on the outcome variables. Source (doctor=1; peer=0) and framing (psychological=1; logistical=0) were dummy-coded. RESULTS: Doctor-featured messages led to greater perceived source credibility (ß=.31, P<.001), leading to greater self-efficacy (95% CI 0.13-0.30), which in turn enhanced behavioral intention (95% CI 0.12-0.29) and clinical trial sign-up behavior (95% CI 0.02-0.04). Logistical barrier-framed messages led to greater self-efficacy (ß=-.09, P=.02), resulting in higher intention to participate in clinical trials (95% CI -0.38 to -0.03) and improved sign-up behavior (95% CI -0.06 to -0.004). Logistical barrier-framed messages were also directly associated with an increased likelihood of signing up for a clinical trial (ß=-.08, P=.03). The model accounted for 21% of the variance in clinical trial sign-up behavior. Attitude did not significantly affect behavioral intention in this study (ß=.08, P=.14), and psychological and logistical barrier-framed messages did not significantly differ in attitudes toward clinical trial participation (ß=-.04, P=.09). CONCLUSIONS: These findings advance our understanding of how people process popular message characteristics in short-form videos and lend practical guidance for communicators. We encourage medical professionals to consider short-form video sites (eg, TikTok and Instagram Reels) as effective tools for discussing clinical trials and participation opportunities. Specifically, featuring doctors discussing efforts to reduce logistical barriers is recommended. Our measuring of actual behavior as an outcome is a rare and noteworthy contribution to this research.

"Trust Me, I'm a Doctor." How TikTok Videos from Different Sources Influence Clinical Trial Participation.

This study experiments with TikTok videos to promote clinical trial participation. More specifically, it examines how short-form video sources (doctors vs. prior volunteers for clinical trials) influence perceived source credibility, self-efficacy, and behavioral intention to participate in clinical trials. Findings from this online experiment (N = 396) showed that doctor sources led to greater behavioral intention through enhancing source credibility compared to prior volunteer sources. Alternatively, prior volunteer sources increased behavioral intention via enhanced self-efficacy for participants with low trust in doctors. These findings contribute to the understanding of how short-form video sources act as heuristic cues, leading to persuasion outcomes. Overall, we recommend featuring doctors when using video-based messages to promote clinical trial participation. Also, this study emphasizes the need for health communication practitioners to consider prior volunteers as spokespersons when targeting populations with low baseline trust in doctors.

Exploring the Strategic Use of TikTok for Clinical Trial Recruitment: How audiences' Prior Short-Form Video Usage Influences Persuasive Effects.

Guided by the elaboration likelihood model and framing theory, this study explores the potential of short-form video platforms (e.g. TikTok), for targeted clinical trial recruitment. An online experiment compared doctor vs. peer-led videos addressing logistical or psychological barriers to participation, mimicking common TikTok communication tactics. Results indicate that high (vs. low) TikTok users are more persuaded by recruitment messages, and they exhibit stronger intentions to participate in clinical trials. Although doctor-sourced messages generate greater credibility and a more favorable message attitude, peer-sourced messages may be more effective in increasing participation intention. Lastly, doctor-sourced videos that address logistical barriers and peer-sourced videos that discuss psychological barriers result in higher self-efficacy for clinical trial participation. This study contributes to the growing body of research on new media's role in health communication and provides insights into how to strategically utilize TikTok and other short-form video platforms for clinical trial recruitment.

COVID-19 vaccination communication: Effects of vaccine conspiracy beliefs and message framing among black and white participants.

BACKGROUND: The importance of vaccination in combating the COVID-19 pandemic is widely acknowledged. The aim of this study was (1) to understand how one's vaccine conspiracy beliefs would influence their public health news processing, (2) to examine how specific public health news features (i.e., news frame) would influence message processing, and (3) to examine if there were any differences between Black and White participants in their message processing. METHODS: A nationwide online experiment (N = 821) with a 3 (vaccine conspiracy beliefs: high vs. moderate vs. low) × 2 (participants' race: Black vs. White) × 2 (news frames: gain vs. loss) mixed-factorial design was conducted in the United States. RESULTS: Participants' level of vaccine conspiracy beliefs was predictive of their responses to outcome measures. Additionally, Black participants reported higher perceived message effectiveness, more favorable attitudes toward the message, and higher vaccination intentions than White participants. Furthermore, health news that emphasized vaccination benefits produced more favorable attitudes than those emphasizing losses associated with non-vaccination, especially for White participants. Lastly, participants reported more favorable attitudes toward gain-framed health news regardless of their vaccine conspiracy beliefs. CONCLUSION: It is crucial for health officials to work to find effective media message strategies to combat COVID-19 vaccine conspiracy theories and misinformation. Furthermore, this study supports the significance of health organizations' ongoing efforts to tailor public health messaging to specific racial groups, as evidenced by considerable variations in perceptions among Black and White Americans.

Overcoming Black Americans' Psychological and Cognitive Barriers to Clinical Trial Participation: Effects of News Framing and Exemplars.

This study examines how news features (framing and the use of exemplars) can help overcome two common barriers (psychological and cognitive) impeding Black American participation in clinical trials. In an online experiment, Black participants (N = 390) viewed social media news posts varying in framing (focus on psychological vs. cognitive barriers) and use of an exemplar (present vs. absent and White vs. Black) and then responded to outcome measures including perceived message effectiveness, message attitudes, and intention to participate in clinical trials. The findings illustrate that including a racially matched (i.e. Black) exemplar improves attitudes toward clinical trial messages. Most notably, featuring a race-matched exemplar increases intention to participate in a trial when the messages discuss psychological barriers. These findings enhance our understanding of how messages can be better designed to increase Black American participation in clinical trials, thereby contributing to reducing health inequities and improving health outcomes.

Improving rural White men's attitudes toward clinical trial messaging and participation: effects of framing, exemplars and trust.

This study examined whether framing, exemplar presence and exemplar race in social media news posts influence rural White men's perceptions, attitudes and behavioral intentions toward clinical trial participation, and if so, how individual trust in doctors moderates the effects of these three factors. An experiment with a 2 within (framing: cognitive versus psychological barriers) × 2 within (exemplar: present versus absent) × 2 between (exemplar race: White versus Black) subjects mixed factorial design was conducted among rural White men (N = 208). Twelve social media news posts about clinical trial participation were created for the experiment. Results revealed that respondents had greater behavioral intentions to participate in clinical trials after seeing posts with exemplars present (versus absent). When news posts addressed cognitive barriers (e.g. lacking knowledge about the value of clinical trials), the presence of exemplars enhanced perceived self-efficacy to participate in clinical trials. Participants with lower trust in doctors reported more favorable attitudes to posts with exemplars, and the posts with Black exemplars were perceived as more effective (approaching statistical significance). When communicating about clinical trials to rural White men, health professionals should consider including exemplars and addressing cognitive barriers to participation.

An informed approach to the development of primary care pediatric firearm safety messages.

BACKGROUND: Firearm ownership is prevalent in the US and many children spend time in areas where firearms are not stored safely. The AAP recommends firearm safety counseling at pediatric well-visits. METHODS: We developed and tested six contextual messages to promote safe firearm storage based on: absence of harm, collective appeal to understanding child behavior, pediatrician's authority, evidence-based, fear appeal, and general safety considerations. One hundred four parents who keep firearms at home were recruited from Amazon Mechanical Turk Prime and viewed video messages and reported behavioral intentions and emotional reactions following each message. RESULTS: All six contextual messages were perceived as important and believable and increased parents' intentions to follow safety advice provided, but also elicited negative emotions. The authority message elicited more negative emotions and resulted in lower intentions to follow safe storage advice. CONCLUSIONS: Including firearm messages with other child safety advice merits further evaluation. Authority messages should be avoided.

The Impact of Retransmission and Modality on Communicating Health Research Findings via Social Media.

Social media is an increasingly popular tool for disseminating health research findings to members of the general public and may contribute to improving the effectiveness of science communication. This study was designed to investigate how retransmission (i.e., social media content shared by a familiar, credible organization) and modality (i.e., how the message is delivered) influence the effectiveness of communicating health research findings via social media. The findings from a 2 (source) X 3 (modality) X 2 (topic) mixed factorial design experiment (N= 517) indicated that source had a significant effect, such that posts that were retransmitted by a credible organization resulted in greater perceived source credibility, greater perceived message effectiveness, and greater likelihood of an individual to engage with the post on Facebook. Modality significantly increased perceived source credibility and perceived message effectiveness when posts were retransmitted by a credible source, indicating that modality made a difference when messages were elaborated as a function of the retransmission. Also, the topic of the post had a significant impact on the study's dependent variables of interest. Overall, the findings illustrate the potential of retransmission and modality as message features that can improve communication of health research findings on social media. Theoretical and practical implications are discussed.

The Third Rail of Pediatric Communication: Discussing Firearm Risk and Safety in Well-Child Exams.

This research endeavors to understand how pediatricians and parents discuss - or do not discuss - firearm risks for children during well-child visits. Through individual semi-structured interviews with 16 pediatric providers and 20 parents, the research explores discursive barriers to open conversation, perspectives on anticipatory guidance, and new ideas for culturally competent messaging. The research focuses particularly on how parents' and providers' perspectives on firearm risk communication are tied to cultural norms and expectations. One salient theme that emerged is that the American Academy of Pediatrics recommendation that pediatricians ask parents about ownership status is deemed undesirable by pediatricians and parents because of the delicate intercultural setting. Born out of pediatric and parent experiences, and mindful of culturally salient barriers, this study offers alternative strategies for discussing firearm risk in well-child exams.

Constructing and influencing perceived authenticity in science communication: Experimenting with narrative.

This study develops a measure of perceived authenticity in science communication and then explores communication strategies to improve the perceived authenticity of a scientific message. The findings are consistent with literature around trust and credibility, but indicate that authenticity-the perception that the scientist is a unique individual with qualities beyond institutional affiliations or a role in the production of the research-may add a potentially important dimension to accepted categories of integrity and benevolence.

How Journalists Characterize Health Inequalities and Redefine Solutions for Native American Audiences.

Many Native American communities experience severe health inequalities, including shorter average lifespan and higher rates of chronic illnesses. Journalism that serves Native Americans is a promising channel for heath communication, but only if scholars first understand the particular cultural contexts of indigenous communities. This research contributes to that goal by investigating how journalists serving Native American communities characterize health and the issues they identify with covering determinants of health. In in-depth interviews (N = 24), journalists contrasted how they cover health issues as embedded in cultural context with shallow, more negative coverage by non-Native media organizations. Interviews also revealed a tension between "medical" and "cultural" models of health, contributing to the oversaturation of certain issues, like diabetes, while other health topics are underrepresented. The journalists also expressed how social determinants and histories of oppression shape health inequalities, illuminating the roles of historical trauma and the destruction of indigenous health beliefs and behaviors. Failure to recognize these issues could stymie efforts to communicate about health issues facing Native American audiences.

What Is the Story with Narratives? How Using Narratives in Journalism Changes Health Behavior.

Health journalists frequently use narratives to bring news stories to life, with little understanding about how this influences the health behavior of readers. This study was designed to examine the effect of a New York Times health news article about a person who developed a life-threatening illness after using ibuprofen on readers' future use of ibuprofen. We recruited an Internet sample (N = 405) to participate in a longitudinal study examining ibuprofen use before, immediately following, and two weeks after reading the story. Ibuprofen use two-weeks after reading the heath news article was significantly lower than baseline use. Furthermore, intentions to use ibuprofen were also significantly reduced suggesting that the observed behavior change may persist beyond the two-week period studied. Health journalists should be cautious in their use of stories about health outcomes, particularly when those stories deviate from data about objective risks.

False Balance in Public Health Reporting? Michele Bachmann, the HPV Vaccine, and "Mental Retardation".

This content analysis of media coverage of Michele Bachmann's erroneous comments that the HPV vaccine causes mental retardation explores the relationship between truth-telling (the presentation of accurate information) and balance (presenting opposing perspectives of an issue equally and legitimately) in public health reporting. Of 200 articles analyzed, about 50% provided correction and about 40% provided a counterpoint. We also found that health reporters tended to engage in truth-telling and balance more than political reporters. Implications for theory and practice are discussed.

Social Representation of Cyberbullying and Adolescent Suicide: A Mixed-Method Analysis of News Stories.

Cyberbullying has provoked public concern after well-publicized suicides of adolescents. This mixed-methods study investigates the social representation of these suicides. A content analysis of 184 U.S. newspaper articles on death by suicide associated with cyberbullying or aggression found that few articles adhered to guidelines suggested by the World Health Organization and the American Foundation for Suicide Prevention to protect against suicidal behavioral contagion. Few articles made reference to suicide or bullying prevention resources, and most suggested that the suicide had a single cause. Thematic analysis of a subset of articles found that individual deaths by suicide were used as cautionary tales to prompt attention to cyberbullying. This research suggests that newspaper coverage of these events veers from evidence-based guidelines and that more work is needed to determine how best to engage with journalists about the potential consequences of cyberbullying and suicide coverage.

Stigmatizing Images in Obesity Health Campaign Messages and Healthy Behavioral Intentions.

Background Antiobesity campaigns blaming individual behaviors for obesity have sparked concern that an emphasis on individual behavior may lead to stigmatization of overweight or obese people. Past studies have shown that perpetuating stigma is not effective for influencing behavior. Purpose This study examined whether stigmatizing or nonstigmatizing images and text in antiobesity advertisements led to differences in health-related behavioral intentions. Method Participants in this experiment were 161 American adults. Measures included self-reported body mass index, weight satisfaction, antifat attitudes, and intention to increase healthy behaviors. Results Images in particular prompted intention to increase healthy behavior, but only among participants who were not overweight or obese. Conclusion Images and text emphasizing individual responsibility for obesity may influence behavioral intention among those who are not overweight, but they do not seem to be effective at altering behavioral intentions among overweight people, the target audience for many antiobesity messages. Images in antiobesity messages intended to alter behavior are influential and should be selected carefully.

Individual and social determinants of obesity in strategic health messages: Interaction with political ideology.

Antiobesity health communication campaigns often target individual behavior, but these ads might inflate the role of individual responsibility at the expense of other health determinants. In a 2 × 2 full-factorial, randomized, online experiment, 162 American adults viewed antiobesity advertisements that varied in emphasizing social or individual causation for obesity through text and images. Locus for attribution of responsibility for obesity causes and solutions was measured, as was how these responses were moderated by political ideology. Participants who viewed text emphasizing individual responsibility were less likely to agree that genetic factors caused obesity. Conservative participants who viewed images of overweight individuals were less likely than liberal participants to agree that social factors were responsible for causing obesity. In addition, among conservative participants who viewed images of fast food versus images of overweight individuals, agreement that the food industry bore some responsibility mediated support for policy solutions to obesity. These findings, among others, demonstrate that awareness of multilevel determinants of health outcomes can be a precursor of support for policy solutions to obesity among those not politically inclined to support antiobesity policy. In addition, stigmatizing images of overweight individuals in antiobesity campaigns might overemphasize the role of individual behavior in obesity at the expense of other factors.

JOURNALISTIC USE OF EXEMPLARS TO HUMANIZE HEALTH NEWS.

Health journalists often use personal stories to put a "face" on a health issue. This research uses a sociology-of-news approach, based on data collected from 42 in-depth interviews and three surveys with health journalists and editors [national (N = 774), state (N = 55), and purposive (N = 180)], to provide a first look at how important journalists think exemplars are to their stories. Results show journalists select exemplars to inform, inspire, and/or sensationalize a health issue. Some of the strategies journalists use to locate exemplars pose ethical concerns. Further, journalists rank the use of exemplars lower in aiding audience understanding compared with the use of experts, data and statistics, and definitions of technical terms.

Are health journalists' practices tied to their perceptions of audience? An attribution and expectancy-value approach.

This study examines a national survey of U.S. health journalists (N = 774) to ascertain how journalists' perceptions of audience use of health news shapes their journalistic practices. We establish a framework through attribution theory and expectancy-value theory for how journalists choose to fulfill their roles as providers of health information. Using these theoretical lenses, we look at whether health journalists' audience orientation is associated with their use of accessibility-oriented or credibility-focused practices. Our findings show that, overall, journalists believe readers are individually responsible for their health outcomes and that journalists focus on providing accessibility-oriented information when they feel their audience's ability to understand information may be compromised. Journalists' beliefs about audience behavior are associated with their attitudes toward communication practices.

What makes African American health disparities newsworthy? An experiment among journalists about story framing.

News stories reporting race-specific health information commonly emphasize disparities between racial groups. But recent research suggests this focus on disparities has unintended effects on African American audiences, generating negative emotions and less interest in preventive behaviors (Nicholson RA, Kreuter MW, Lapka C et al. Unintended effects of emphasizing disparities in cancer communication to African-Americans. Cancer Epidemiol Biomarkers Prev 2008; 17: 2946-52). They found that black adults are more interested in cancer screening after reading about the progress African Americans have made in fighting cancer than after reading stories emphasizing disparities between blacks and whites. This study builds on past findings by (i) examining how health journalists judge the newsworthiness of stories that report race-specific health information by emphasizing disparities versus progress and (ii) determining whether these judgments can be changed by informing journalists of audience reactions to disparity versus progress framing. In a double-blind-randomized experiment, 175 health journalists read either a disparity- or progress-framed story on colon cancer, preceded by either an inoculation about audience effects of such framing or an unrelated (i.e. control) information stimuli. Journalists rated the disparity-frame story more favorably than the progress-frame story in every category of news values. However, the inoculation significantly increased positive reactions to the progress-frame story. Informing journalists of audience reactions to race-specific health information could influence how health news stories are framed.