When Risk Communication Backfires: Randomized Controlled Trial on Self-Affirmation and Reactance to Personalized Risk Feedback in High-Risk Individuals

Centre of Research Excellence for Chronic Respiratory Disease.
Health Psychology (Impact Factor: 3.59). 05/2013; 32(5):561-70. DOI: 10.1037/a0029887
Source: PubMed


Health promotion often faces the problem that populations with high behavioral risk profiles respond defensively to health promotion messages by negating risk or reactant behavior. Self-affirmation theory proposes that defensive reactions are an attempt of the self-system to maintain integrity. In this article, we examine whether a self-affirmation manipulation can mitigate defensive responses to personalized visual risk feedback in the skin cancer prevention context (ultraviolet [UV] photography), and whether the effects pertain to individuals with high behavioral risk status (high personal relevance of tanning).

We conducted a full-factorial randomized controlled trial (N = 292; age 11-71) following a 2 * 2 design (UV photo yes/no, self-affirmation yes/no). Follow-up period was 2 weeks. Subsequent tanning behavior, sun avoidance intentions, and risk perception.

A multivariate analysis of variance (MANOVA) revealed a three-way interaction between risk feedback, the self-affirmation manipulation, and risk status for the three outcome measures. Follow-up analyses of variance (ANOVAs) indicated that high-risk individuals receiving only the risk feedback intervention reacted defensively and reported higher exposure. A self-affirmation manipulation mitigates this reactance effect both on the level of cognitions and behavior.

Self-affirmation has influential implications not only for Social Psychology but also for health prevention measures. The findings support the effectiveness of self-affirmation in reducing reactant and defensive reactions to personalized visual risk feedback. Interactions with health risk status indicate that self-affirmation might increase the effectiveness of health promotion messages in high-risk populations.

Download full-text


Available from: Benjamin Schüz, May 05, 2014
  • Source
    • "People exhibit greater reactance when they perceive less ability to choose their own actions (Miller et al., 2007). Other defensive reactions such as derogating risk information and downplaying personal vulnerability can also occur in response to communications about health threats (Harris et al., 2007; Erceg-Hurn and Steed, 2011; McQueen et al., 2013; Schüz et al., 2013). It may benefit public health to understand and, if possible, to avoid such " boomerang " effects in the implementation of smoke-free laws. "
    [Show abstract] [Hide abstract]
    ABSTRACT: In addition to their primary goal of protecting nonsmokers from secondhand smoke, smoke-free air laws may also encourage intentions to quit smoking, quit attempts, and cessation among smokers. However, laws may not encourage quitting if smokers feel threatened by them and react defensively. This study examined whether spontaneous self-affirmation - the extent to which people think about their values or strengths when they feel threatened - may reduce smokers' reactance to smoke-free laws, enhancing the ability of the laws to encourage quitting. We linked state-level information on the comprehensiveness of U.S. smoke-free laws (compiled in January, 2013 by the American Lung Association) with data from a U.S. health survey (Health Information National Trends Survey) collected from September-December, 2013 (N = 345 current smokers; 587 former smokers). Smoke-free laws interacted with self-affirmation to predict quit attempts in the past year and intentions to quit in the next six months: Smokers higher in self-affirmation reported more quit attempts and quit intentions if they lived in states with more comprehensive smoke-free laws. There was some evidence of a "boomerang" effect (i.e., less likelihood of making a quit attempt) among smokers low in self-affirmation if living in states with more comprehensive smoke-free laws, but this effect was significant only among smokers extremely low in self-affirmation. For quit intentions, there was no evidence for a boomerang effect of smoke-free laws even among smokers extremely low in self-affirmation. More comprehensive smoke-free laws were not associated with smoking status (former vs. current smoker) or average amount smoked per day, nor did they interact with self-affirmation to predict these outcomes. The impact of smoke-free policies on quit attempts and quit intentions may be moderated by psychological characteristics such as the tendency to spontaneously self-affirm. Follow-ups should experimentally manipulate self-affirmation and examine effects of smoke-free laws in controlled contexts. Copyright © 2015. Published by Elsevier Ltd.
    Full-text · Article · Jul 2015 · Social Science [?] Medicine
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Aims: This study tests whether enhancing alcohol risk messages with self-affirmation, the process of focusing on cherished aspects of oneself, increases intentions to reduce alcohol consumption and reduces actual alcohol consumption. It was also examined whether these effects differed by risk status as indicated by standard drinks consumed in an average week. Methods: Participants (n = 121) were randomly allocated to a self-affirmation or matched control condition before viewing emotive graphic alcohol warning posters in a questionnaire-based study. Results: There were significant increases in intentions to reduce alcohol consumption in self-affirmed participants, and these effects were stronger in participants with higher behavioural risk. Intentions in turn significantly predicted a reduction in self-reported alcohol consumption. Conclusions: These findings support the use of self-affirmation to enhance alcohol awareness campaigns, particularly in individuals with high behavioural risk.
    Full-text · Article · Mar 2013 · Alcohol and Alcoholism
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Social, personality, and health psychologists have a long tradition of active and productive collaborations that have advanced the development of intervention strategies that promote health and well-being and the specification of the theoretical principles that underlie those strategies. This special issue is designed to continue this tradition of collaboration and to highlight areas of research and investigative strategies that offer opportunities for innovation. This concluding paper examines how investigators construe the interface between theory and practice and, with that lens, considers several themes that have emerged across the papers that comprise this special issue. As evidenced by the papers in this special issue, investigators are well-positioned to leverage advances in understanding of human health and well-being. However, to capitalize on this opportunity, investigators need to commit to cultivating a culture of scientific activity that prioritizes the engagement of theory and practice-the pursuit of both understanding and use. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Full-text · Article · May 2013 · Health Psychology
Show more