The sound of silence: The importance of bystander support for confronters in the prevention of norm erosion.

Observing deviant behaviour can lead to 'norm erosion', where a norm is no longer seen as relevant and compliance with it is reduced. Previous research argues that social confrontations can mitigate norm erosion. However, this work has not considered the impact of bystanders to confrontations, who might influence the outcome by supporting-or failing to support-the person confronting a social rule breaker. We examine the effect of bystanders' reactions on preventing norm erosion across three experimental studies. We examined how supportive and non-supportive bystander reactions to a confronter impacted the perceived strength of a prosocial norm among participants and their behavioural intentions. We find that when bystanders explicitly supported the confronter against the rule breaker, the norm was perceived as stronger-and sometimes, compliance intentions were higher-than when bystanders did not respond to the confronter. A mini meta-analysis across the three studies reveals that the effect of bystander support on perceived norm strength is large and robust. Our work demonstrates that for the prevention of norm erosion, confrontations benefit greatly from being explicitly supported by bystanders.

The effect of moral appeals on influenza vaccination uptake and support for a vaccination mandate among health care workers.

OBJECTIVE: Influenza vaccination uptake among health care workers (HCWs) protects patients and staff. Still, many health institutions' coverage rates are unsatisfactory. We aimed to test the effect of communicating moral appeals in increasing vaccination uptake in a real life setting. METHOD: In three field experiments among HCWs, a moral appeal highlighting morally relevant consequences of influenza vaccination was manipulated. The outcome variables were vaccination intention right after exposure to the moral appeal (Study 1; N = 569 US and UK HCWs from various institutions) and vaccination uptake in subsequent weeks for those respondents who consented in sharing this data during the survey (Studies 2 and 3, respectively N = 121 and N = 770 Dutch hospital employees). RESULTS: Studies 1 and 3 showed that moral appeal enhanced vaccination intention and uptake (vaccination uptake increased by 11%), due to increased awareness that vaccination is a moral decision. In Study 2, moral appeal had no effect, probably because people with more outspoken vaccination attitudes had responded to the call to fill in the survey. Moreover, moral appeal increased support for an influenza vaccination mandate. Furthermore, the results suggest that moral appeal was especially effective among HCWs with no history of influenza vaccination. CONCLUSION: These results indicate that moral appeal can be a useful tool for increasing both vaccination uptake and mandate support within health care institutions.

The predictive values of a deliberative and a paternalistic attitude towards two situations of moral conflict: A study among Dutch nurse practitioners and physician assistants.

BACKGROUND: In this study, we examined the predictive values of a moral deliberate and paternalistic attitude on the propensity of yielding to pressure. In these hypothesised positive and negative relationships, we further sought to ascertain whether moral disengagement plays a pivotal role when individuals deviate from ethical standards, rules and regulations when yielding to pressure. AIM(S): This study's primary aim was to assess the predictive value of a moral deliberative and paternalistic attitude for yielding to pressure when physician assistants (PAs) and nurse practitioners (NPs) face moral conflicts. METHOD: This validation study was cross-sectional and based on a convenience sample of Dutch PAs and NPs. The MSQ-DELIB and MSQ-PATER scales indicate a moral deliberate or paternalistic attitude. These scales were assumed to have a predictive value towards the degree of yielding to pressure by PAs and NPs. Yielding to pressure was measured by two vignettes in which respondents faced a moral conflict (vignette 1: prescribing unindicated antibiotics and vignette 2: discharging a difficult patient from the hospital). RESULTS: Only moral deliberation was a significant predictor of yielding to pressure. That is, we found a positive effect in vignette 1 (in which the pressure came from the patient). In contrast, we found a negative relationship in vignette 2 (in which pressure went from the working environment). Paternalism did not affect yielding to pressure in either vignette. CONCLUSION: This study suggests that PAs and NPs having a moral deliberative attitude makes them receptive to pressure exerted by patients to break moral standards. On the other hand, they are more resilient against doing so when this pressure comes from different sources than the patient. Further research is needed to find more conclusive evidence for this differential effect.

Facilitating and motivating factors for reporting reprehensible conduct in care: A study among nurse practitioners and physician assistants in the Netherlands.

RATIONALE, AIMS AND OBJECTIVES: The aims of this study are as follows: (a) to establish whether a relationship exists between the importance that healthcare professionals attach to ethics in care and their likelihood to report reprehensible conduct committed by colleagues, and (b) to assess whether this relationship is moderated by behavioural control targeted at preventing harm. METHOD: In this cross-sectional study, which was based on a convenience sample (n = 155) of nurse practitioners (NPs) and physician assistants (PAs) in the Netherlands, we measured ethics advocacy (EA) as a motivating factor (reflecting the importance that healthcare professionals attach to ethics and care) and "behavioral control targeted at preventing harm" (BCPH) as a facilitating factor. "Reporting reprehensible conduct" (RRC) was measured as a context-specific indicator of whistleblowing intentions, consisting of two vignettes describing morally questionable behaviour committed by colleagues. RESULTS: The propensity to report reprehensible conduct was a function of the interaction between EA and BCPH. The only group for which EA predicted RRC consisted of individuals with above-average levels of perceived BCPH. CONCLUSION: The results suggest that the importance that healthcare professionals attach to ethical aspects in care is not sufficient to ensure that they will report reprehensible conduct. Such importance does not induce reporting behaviour unless the professionals also perceive themselves as having a high level of BCPH. We suggest that these insights could be helpful in training healthcare providers to cope with ethical dilemmas that they are likely to encounter in their work.

Re-assessing the validity of the Moral Sensitivity Questionnaire (MSQ): Two new scales for moral deliberation and paternalism.

RATIONALE, AIMS, AND OBJECTIVES: The current study and previous research have called the six-component model of Lützen's 30-item Moral Sensitivity Questionnaire (MSQ) into question. For this reason, we re-examined the construct validity of this instrument. METHODS: In this cross-sectional study, which was based on a convenience sample of Dutch nurse practitioners (NPs) and physician assistants (PAs), we tested the validity of MSQ items using exploratory and confirmatory factor analyses (EFA and CFA, respectively). RESULTS: The EFA revealed a two-component model, which was then tested as a target model with CFA and was found to have good model fit. Some items were correlated with two uncorrelated latent constructs, which we labelled as "paternalistic" and "deliberate" attitudes towards patients. CONCLUSIONS: As in previous studies, the analyses in the current study, which was conducted among PAs and NPs, did not reveal six dimensions for the 30 items. Two new latent dimensions of moral sensitivity were psychometrically tested and confirmed. These two components relate to studies investigating ethical behaviour, and they can be used to describe the moral climate in healthcare organizations. The scales are indicators of the extent to which health professionals behave in a deliberate (sensitive) or paternalistic (insensitive) manner towards the opinions of patients within the context of medical decision-making.

Moral Rationalization Contributes More Strongly to Escalation of Unethical Behavior Among Low Moral Identifiers Than Among High Moral Identifiers.

Occasional acts of immorality are commonplace. One way in which people deal with their own prior immoral acts, is to rationalize why their acts are morally acceptable. It has been argued that such post hoc moral rationalizations may contribute to continuation or escalation of immoral behavior. This paper experimentally tests this causal influence of post hoc moral argumentation on escalation of immoral behavior and also tests how this depends on people's level of moral identity. In three experiments we asked participants to generate moral arguments for their past behaviors. The results show that engaging in moral rationalization causes subsequent continuation and escalation of previous immoral behavior, but more so for low moral identifiers than for high moral identifiers.

Moral reasoning explained by personality traits and moral disengagement: A study among Dutch nurse practitioners and physician assistants.

AIM: To explore the direct and indirect effect of the personality meta-traits 'Stability' and 'Plasticity' on moral reasoning among nurse practitioners (NPs) and physician assistants (PAs). BACKGROUND: Moral reasoning is influenced by being prone to moral disengagement and personality traits. Moral disengagement is observed among professionals in many fields, including healthcare providers. Moral disengagement is known to be provoked by environmental stressors and influenced by certain personality traits. DESIGN: A cross-sectional approach was used including self-report questionnaires. METHODS: A convenience sample of Dutch NPs (N = 67) and PAs (N = 88) was surveyed via online questionnaires between January and March 2015, using (a) the Defining Issues Test; (b) the BIG five inventory; and (c) the Moral Disengagement Scale. Structural equation modelling (SEM) was employed for estimating the construct validity of two meta-traits of personality and to test unidirectional influences on moral reasoning. RESULTS: Only the Stability trait was a direct predictor of moral reasoning whereas both Stability and Plasticity were precursors of moral disengagement. Both personality meta-traits had statistically significant indirect effects on moral reasoning through a low level of moral disengagement. The influence of both personality traits on the level of moral reasoning was increased by strong self-censure on entering into morally disengaged interactions. CONCLUSION: The personality meta-trait 'Stability' is an indicator of moral reasoning and is explained by a lower propensity to morally disengage among highly stable people. Although the meta-trait Plasticity exerts an indirect effect through moral disengagement on moral reasoning, it is not a direct indicator of moral reasoning.

The Impact of Workplace Health Promotion Programs Emphasizing Individual Responsibility on Weight Stigma and Discrimination.

Over time, there has been a steady increase of workplace health promotion programs that aim to promote employees' health and fitness. Previous research has focused on such program's effectiveness, cost-savings, and barriers to engaging in workplace health promotion. The present research focuses on a downside of workplace health promotion programs that to date has not been examined before, namely the possibility that they, due to a focus on individual responsibility for one's health, inadvertently facilitate stigmatization and discrimination of people with overweight in the workplace. Study 1 shows that the presence of workplace health promotion programs is associated with increased attributions of weight controllability. Study 2 experimentally demonstrates that workplace health promotion programs emphasizing individual rather than organizational responsibility elicit weight stigma. Study 3, which was pre-registered, showed that workplace health promotion programs emphasizing individual responsibility induced weight-based discrimination in the context of promotion decisions in the workplace. Moreover, focusing on people with obesity who frequently experience weight stigma and discrimination, Study 3 showed that workplace health promotion programs highlighting individual responsibility induced employees with obesity to feel individually responsible for their health, but at the same time made them perceive weight as less controllable. Together, our research identifies workplace health promotion programs as potent catalysts of weight stigma and weight-based discrimination, especially when they emphasize individual responsibility for health outcomes. As such, we offer valuable insights for organizations who aim to design and implement workplace health promotion programs in an inclusive, non-discriminatory way that benefits all employees.

Making snacking less sinful: (counter-)moralising obesity in the public discourse differentially affects food choices of individuals with high and low perceived body mass.

OBJECTIVE: As public discourse surrounding obesity highlights the societal costs of obesity and individual's own responsibility for their weight, being overweight is often framed as immoral. Such 'moralizing' messages about being overweight may be a psychological threat for those with high body mass. Attempting to counter-moralise the public discourse (i.e. actively arguing that there is nothing 'immoral' about being overweight) may relieve this threat, inducing people, especially those with higher (perceived) weight, to engage in healthier behaviours. METHOD: Two experiments were performed among Dutch and US participants. (Counter-)moralisation was manipulated. Body mass and weight-related self-perceptions were measured. The dependent variable was healthy vs. unhealthy snack choice. RESULTS: (Counter-)moralisation and (perceived) overweight jointly predicted snack choice: counter-moralising messages induced healthy snacking, but only among those who regarded themselves to have a high body mass. CONCLUSIONS: The effects of moralising vs. counter-moralising obesity depended on one's (perceived) overweight. This suggests that, for people with relatively high weight, the current moralising public discourse on obesity works in counterproductive ways. Campaigns that 'counter-moralize' obesity (i.e. that refute moralising messages) are more productive, although they should be tailored to those who see themselves as being overweight.

Reward, punishment, and cooperation: a meta-analysis.

How effective are rewards (for cooperation) and punishment (for noncooperation) as tools to promote cooperation in social dilemmas or situations when immediate self-interest and longer term collective interest conflict? What variables can promote the impact of these incentives? Although such questions have been examined, social and behavioral scientists provide different answers. To date, there is no theoretical and/or quantitative review of rewards and punishments as incentives for cooperation in social dilemmas. Using a novel interdependence-theoretic framework, we propose that rewards and punishments should both promote cooperation, and we identify 2 variables­cost of incentives and source of incentives­that are predicted to magnify the effectiveness of these incentives in promoting cooperation.A meta-analysis involving 187 effect sizes revealed that rewards and punishments exhibited a statistically equivalent positive effect on cooperation (d =0.51 and 0.70, respectively). The effectiveness of incentives was stronger when the incentives were costly to administer, compared to free. Centralization of incentives did not moderate the effect size. Punishments were also more effective during iterated dilemmas when participants continued to interact in the same group, compared to both (a) iterated dilemmas with reassignment to a new group after each trial and (b) one-shot dilemmas. We also examine several other potential moderators, such as iterations, partner matching, group size, country, and participant payment. We discuss broad conclusions, consider implications for theory, and suggest directions for future research on rewards and punishment in social dilemmas.

When sanctions fail to increase cooperation in social dilemmas: considering the presence of an alternative option to defect.

Previous social dilemma research has shown that sanctioning defection may enhance cooperation. The authors argue that this finding may have resulted from restricting participants to two behaviors (cooperation and defection). In this article, the authors introduce the concept of a "social trilemma" (a social dilemma in which an alternative option to defect is present) and tested the effect of a sanction. The authors show that a sanction only increased cooperation and collective interests in the traditional social dilemma. In a social trilemma, the sanction failed because it caused some people to choose the alternative option to defect. Moreover, the results indicate that this was especially the case when people did not expect fellow group members to cooperate. In this case, the sanction even worked counterproductive because it decreased collective interests. It is concluded that allowing individuals to consider alternative options to defect can reveal the potential detrimental effects of sanctioning systems for the collective.