Modality of Communication and Recall of Health-related Information

Abstract

A health warning was presented to 89 female and 19 male students aged 17-36 years via three modalities or channels of communication: a 'talking head' (video), an audiotape recording (audio) or a printed transcript (print). The verbal content of the message was identical in all three conditions. Participants' free recall, cued recall (recognition) and global recall of the message were then measured. On two separate dependent measures and a combined measure, recall was significantly (p < .005) better in both the audio and print conditions than in the video condition. No significant differences in recall were found between the audio and print conditions. These results, and those of earlier studies of modality effects on recall of information, are discussed in terms of self-pacing and distraction theories.

Full text

Modality of Communication 1
Corston, R., & Colman, A. M. (1997). Modality of communication and recall of health-related information.
Journal of Health Psychology, 2, 185-194.
Modality of Communication and Recall of Health-Related Information
Rod Corston and Andrew M. Colman
University of Leicester
Abstract
A health warning was presented to 89 female and 19 male students aged 17-36 years via three modalities or
channels of communication: a “talking head” (video), an audiotape recording (audio), or a printed transcript
(print). The verbal content of the message was identical in all three conditions. Participants’ free recall, cued
recall (recognition), and global recall of the message was then measured. On two separate dependent measures
and a combined measure, recall was significantly (p < .005) better in both the audio and print conditions than in
the video condition. No significant differences in recall were found between the audio and print conditions.
These results, and those of earlier studies of modality effects on recall of information, are discussed in terms of
self-pacing and distraction theories.
Key words: channel of communication, context effects, distraction theory, modality of communication, self-
pacing
Health warnings designed to alert members of the general public to new diseases such as
AIDS, or to encourage health-related behaviours such as having one’s blood pressure
checked or avoiding cigarette smoking, are often issued in the form of short public
information or public service announcements, which are broadcast on television or radio,
published as newspaper or magazine advertisements, or issued as separate leaflets (Rice &
Paisley, 1981). Although the usefulness of such communications is often taken for granted
(e.g., Brawley, 1983; Sprafkin, Swift, & Hess, 1983), the published evidence regarding their
effectiveness is equivocal (Department of Health, 1992; Marks, 1994; McGuire, 1985;
Murphy, 1980; Schmeling & Wotring, 1980; Tyler, 1984; Warner, 1977; Winett, King, &
Altman, 1989). In a review of some 400 studies, McCarthy, Finnegan, Krumm-Scott, and
McCarthy (1984) concluded that the research had failed to establish the efficacy of public
information announcements in influencing the behaviour of their recipients. One reason for
the relative inconclusiveness of the evidence is that the specific efficacy of a public
information message tends to be obscured when – as is usually the case – it is issued as part
of a broader publicity campaign involving multiple awareness-increasing initiatives
implemented simultaneously (Hanneman, McEwan, & Coyne, 1973).
A variety of modalities or channels of communication may be used to transmit health
warnings to the public, and the particular communication modalities that are chosen may
have significant effects on the recipients’ responses to the information. Television or video
(an audiovisual modality) is generally more engrossing or involving than radio (audio) or
print (visual), inasmuch as it is perceived as more salient, commands more attention, is
generally better liked, and is regarded as more credible by the majority of recipients
(Andreoli & Worchel, 1978; Chaiken & Eagly, 1983). Furthermore, people tend to report that
they obtain more information from television than from the other mass media (Lichty, 1982;
Roper Organization, 1975, 1979), whereas objective evidence suggests that attitudes are in
fact more strongly influenced by information in the print media (Barrows, 1981; Patterson,
1980), and research has shown that written presentation generally results in greater

Modality of Communication 2
assimilation of information than audio or video presentation (Barlow & Wogalter, 1993;
Pezdek, Lehrer, & Simon, 1984; Wilson, 1974).
Experimental evidence suggests that the greater assimilation of information presented in
print than in the audio or video modalities applies only to long-term memory for information
that is relatively complex or difficult to absorb. For short-term memory, a large number of
studies have consistently shown audio presentation to be superior to visual presentation,
although the effect is restricted to terminal items (see Penny, 1975, 1989a, for reviews). For
long-term memory, audio presentation is sometimes found to be inferior (e.g., Penny, 1989b)
and sometimes superior (e.g., Conway & Gathercole, 1987; Gathercole & Conway, 1988).
There is reason to suspect that modality effects in long-term memory may be mediated partly
by message complexity. In an influential investigation, Chaiken and Eagly (1976) presented
messages of varying complexity in terms of sentence structure and vocabulary in all three
modalities. There were no significant differences in how well the simple message was
understood or remembered in the three modalities, but the complex message was significantly
better understood and recalled when it was presented in print than in the audio or video
modalities.
The superior recall of complex material presented via print than video appears counter-
intuitive. One might expect an audiovisual medium to have a greater capacity to convey
information because it involves both ‘showing’ and ‘telling’ the information to the recipients,
but the recall superiority of the print modality for complex material has been replicated many
times (e.g., Barlow & Wogalter, 1993; Browne, 1978; Furnham, Benson, & Gunter, 1987;
Furnham & Gunter, 1985, 1987; Furnham, Gunter, & Green, 1990; Gunter, Furnham, &
Gietson, 1984; Pezdek, Lehrer, & Simon, 1984; Wilson, 1974; Wold, 1977).
The evidence is not entirely consistent, however. Several decades ago Williams, Paul, and
Ogilvie (1957) reported significantly better recall for abstract material presented via video
than audio, and via audio than print. More recently Stauffer, Frost, and Rybolt (1981) failed
to find any superiority of print over video in the recall of news stories, although they did find
that both print and video presentation led to significantly better recall than audio. In a later
study, Wogalter and Young (1991) reported two laboratory experiments and a field
experiment in all of which safety warnings were more effective in achieving compliance
when delivered in the audio than the print modality, with audio plus print most effective of
all. More recently still, Ogloff and Vidmar (1994) found that pre-trial publicity surrounding
an actual case involving child sex abuse had a significantly greater prejudicial influence on
potential jurors when it was presented on television than in print. None of the above three
studies manipulated message complexity, however, and this provides a possible clue to their
apparently anomalous findings. The material used by Williams et al., though abstract, dealt
with ideas that were not difficult to grasp, used simple vocabulary and sentence structure, and
was not very complex in the sense of requiring deep processing for memory encoding, and
the same can probably be said of the everyday news stories used by Stauffer et al., the very
simple safety warnings used by Wogalter and Young, and certainly the pretrial publicity
investigated by Ogloff and Vidmar, which the authors themselves described as ‘very
comprehensible’ (p. 513). The memory superiority of the print modality over video and audio
apparent applies only to material that is difficult to assimilate or to encode in memory.
The mediating effect of message complexity becomes clear in the light of various
explanations that have been offered for the superior recall of some types of material
presented in print compared to other modalities, especially video or television. Some
researchers (e.g., Furnham, Gunter, & Green, 1990) have drawn attention to various aspects
of the presentation of printed information, such as paragraphing, punctuation, and general
layout, that may help recipients to ‘chunk’ the information in a manner that has been shown

Modality of Communication 3
to facilitate learning of information that is not inherently easy to grasp (Baddeley, 1982, pp.
152-154). Another learning advantage of print, and to some extent of audio information also,
is that the recipients create their own mental images rather than having them provided ready-
made, and this in turn promotes greater depth of processing, which is known to lead to
enhanced memory (Craik & Lockhart, 1972). Evidence in support of this explanation has
emerged from research with children (Meringoff, 1980), although some commentators (e.g.,
Baddeley, 1978) have argued that the concept of depth of processing is circular inasmuch as
it is difficult to define it independently of the memorial consequences of a processing task. A
learning disadvantage of video arises from the finding that pictures may enhance memory
only when they are strikingly relevant and may actively impair memory by distracting
attention from the content of the message in other circumstances (Chu & Schramm, 1967;
Gunter, 1979). In the production of news programs, pictures of doubtful relevance are often
used to accompany stories that have to be covered because of their importance but for which
no useful visual material is available. In the audio modality, paralinguistic (that is, non-verbal
vocal) information may similarly function as a distraction and may impair memory encoding
of the verbal content of the message, although the effect is probably weaker in this case,
because research in the field of non-verbal communication has shown that paralinguistic cues
generally have less impact than visual cues (Knapp, 1992; Mehrabian, 1972).
Most important, according to some authorities (e.g., O’Keefe, 1990, pp. 184-185), is the
fact that reading is self-paced, whereas information presented in the audio and video
modalities is not. The significance of this difference is that when identical messages are
presented in different modalities of communication for experimental comparisons, with
exposure times equalized between treatment conditions for control of the extraneous variable
of learning duration, most participants who receive written messages have time to read and to
re-read the whole or part of the text, but in the other conditions the recipients have no control
over the pace of presentation and therefore do not have the advantage of repetition.
Furthermore, it is only in the print modality that the reader has some control over the order of
presentation of information, and there is evidence that the order of presentation of
information has a greater effect on recall in the audio than the print modality (Unnava,
Burnkrant, & Erevelles, 1994). The self-pacing and rearrangement properties of the print
modality may explain the learning superiority of complex material presented in print, and
they may also explain why this superiority is not apparent for simple material (Chaiken &
Eagly, 1976), because simple information can presumably be assimilated easily without
repetition or rearrangement. This explanation may also account for the apparently
contradictory findings of Williams, Paul, and Ogilvie (1957), Stauffer, Frost, and Rybolt
(1981), Wogalter and Young (1991), and Ogloff and Vidmar (1994), because the messages
used in those studies appear to have been relatively simple and easy to assimilate.
In the case of certain types of health warnings, notably those providing information about
newly discovered health risks and how to avoid them, the primary objective is to educate
people rather than to persuade them, and the proximate goal is therefore is to communicate
information that will be remembered by the recipients. Health warnings are often
unavoidably complex and relatively difficult to assimilate (McCarthy et al., 1984; Murphy,
1980; Rice & Paisley, 1981) and, in the light of the research outlined above, the modality of
communication may therefore be of prime importance in determining their effectiveness.
The study reported below was designed to examine the recall of a fictitious but realistic
health warning presented in the video, audio, and print modalities. In order to avoid some of
the problems that have arisen in earlier research in this area, the health warning contained
information that was rather complex and not easily assimilable, and the distracting effects of
irrelevant visual material were minimized in the video condition by using a specially

Modality of Communication 4
prepared audio-visual presentation in the form of a ‘talking head’ without extraneous
pictures. The effects of paralinguistic cues were equalized between the video and audio
modalities by using the same soundtrack in both conditions. Previous studies in this area have
been criticized for assessing memory using recognition measures only, which may obscure
the learning advantage of the print modality because reading requires more cognitive effort
and leads to greater depth of information processing than television viewing (Furnham,
Benson, & Gunter 1987, p. 106). In the study reported below, therefore, memory for the
information viewed, heard, or read was assessed by both free recall and cued recall
(recognition) measures. It was hypothesized in the light of earlier research and theorizing that
participants in the print condition would remember most about the health warning and that
participants in the video condition would remember least.
Method
Design
In a single-factor randomized design, participants were assigned to three treatment
conditions in which a realistic health warning regarding a fictitious new disease was
presented to them in one of three different modalities of communication: a video ‘talking
head’, an audio message taken from the soundtrack of the video version, and a print message
transcribed from the video and audio versions. The verbal content of the message was thus
identical in all three treatment conditions, and the paralinguistic information was identical in
the video and audio conditions. After exposure to the health warning, the participants
responded to a questionnaire designed to measure their free recall and cued recall
(recognition) of the health warning.
Participants
The sample consisted of 89 male and 19 female undergraduate students aged between 17
and 36 years who volunteered to participate. Volunteers were assigned to treatment
conditions quasi-randomly, the constraints being the volunteers’ availability for the
scheduled testing sessions and a requirement to include the same number of participants in
each treatment condition. Participants were naive as to the aims of the research but were told
that there was some form of information delivery and a questionnaire involved.
Materials
The 446-word health warning began with a statement that ‘the Department of Health has
issued the following warning against the disorder caused by a wheat mite (ANDRENIS 1B)
found in white bread’ and continued with a brief history of the disorder, a list of its main
symptoms, a summary of preventive measures, and finally an outline of treatment following
infection. The printed version was presented as a two-page document headed ‘A Health
Warning’; the video version, which lasted 4 minutes and 15 seconds, showed an actor (a
head-and-shoulders shot of a slightly balding 48-year-old man in a sports jacket and tie)
speaking directly to camera with no visual cues other than the ‘talking head’; and the audio
version was simply the soundtrack of the video version. To ensure parity of exposure time in
all three treatment conditions, participants in the print condition were allowed four minutes
and 15 seconds to read the printed version.
The dependent variable measures were incorporated into a two-part questionnaire
distributed to participants immediately after they had viewed, heard, or read the health
warning. The first part, which was designed to measure participants’ free recall of the health
warning, was simply a ruled page with the following heading: ‘In the space provided below,
write down as much of the health message as you can recall’. One point was scored for each

Modality of Communication 5
correct item of information recalled.
The second part of the questionnaire consisted of 10 multiple-choice questions designed
to measure cued recall (recognition) of the health warning. Examples of the cued recall items
are as follows: ‘The message presented to you described a type of mite. Was it (a) a white
mite, (b) a wet mite, (c) a wheat mite, (c) a bread mite? (Choose one answer)’; ‘Which five of
the following are main symptoms of the disorder: (a) nausea, (b) headache, (c) indigestion,
(d) loss of appetite, (e) blurred vision, (f) dizziness, (g) aching limbs, (h) fatigue, (i)
flatulence, (j) skin rash, (k) bloated abdomen? (Choose five answers)’. The cued recall items
were selected and modified on the basis of pilot testing to ensure that none was too easy or
too difficult to provide a wide range of scores among a student sample. One point was scored
for each correct answer, and the maximum possible cued recall score was 18.
Procedure
Participants were tested in groups ranging in size from 6 to 15. Participants were told that
they were about to be exposed to a short health warning and (depending on the treatment
condition) that it would be on video, audio, or in the form of printed text. In the video and
audio conditions, the health warning was delivered to the group as a whole, that is, the
videocassette or audiocassette was played to the group. In the print condition, participants
were given individual copies of the printed version of the health warning.
Once the message had been delivered, the tape was turned off (or in the print condition
after four minutes and 15 seconds the printed sheets were collected) and copies of the
questionnaire were distributed face downward. The instructions on the questionnaire were
read aloud to the group, and questions about procedure were answered. The participants were
then asked to turn over the first lined page and to fold the body of the questionnaire behind it.
This prevented them from seeing any later cued recall questions, which contained clues that
could have helped them in the free recall section of the questionnaire. Participants were given
five minutes to write down, in their own words, as much as they could recall of the health
message. At the end of the five minutes, they were asked to complete the remaining ten cued
recall questions in their own time.
After responding to questionnaire, participants were debriefed and thanked for taking part
in the research.
Results
Preliminary Checks
The free recall measure yielded a range of scores from zero to 22 (M = 10.37, SD = 3.90),
and the cued recall scores ranged from 4 to 17 (M = 12.66, SD = 2.05). These ranges, means,
and standard deviations turned out to be broadly comparable between the free recall and cued
recall scores, and it was therefore considered justifiable to calculate an aggregate measure of
global recall by simply summing the free recall and cued recall scores. The global recall
score is equivalent, as far as statistical results are concerned, to an unweighted mean.
Effects of Communication Modality
One-way analyses of variance were applied to test for any significant differences in free
recall, cued recall, and global recall across treatment conditions. Cell means and standard
deviations are shown in Table 1.
Table 1. Mean Recall Scores Across Communication Modality

Modality of Communication 6
Modality
Recall Video (n = 36) Audio (n = 36) Print (n = 36)
Free 8.06 (3.92) 11.22 (3.65) 11.83 (4.13)
Cued 11.61 (2.80) 13.22 (1.55) 13.17 (1.81)
Global 19.67 (6.11) 24.44 (3.97) 25.00 (5.08)
Note. Figures in parentheses in the body of the table are standard deviations.
Free recall. A significant effect due to modality of communication on free recall of the
health warning was found: F(2, 105) = 9.71, p < .001, effect size η2 = .15. Tukey-HSD
multiple comparisons (p < .05) showed that free recall of the health warning was significantly
better in both the audio and print modalities than in the video modality but that there was no
significant difference between the audio and print modalities.
Cued Recall. A similar significant though slightly smaller effect due to modality of
communication on cued recall was found: F(2, 105) = 6.67, p < .002, effect size η2 = .11.
Tukey-HSD multiple comparisons (p < .05) showed the same pattern of differences as with
free recall: cued recall of the health warning was significantly better for both audio and print
than for video, and there was no significant difference between audio and print.
Global Recall. Global recall differed significantly across treatment conditions: F(2, 105)
= 11.75, p < .001, with a modest though substantial effect size η2 = .18. Once again, Tukey-
HSD tests (p < .05) showed that there was no significant difference in global recall between
the audio and print modalities, but global recall of the health warning was significantly better
in both the audio and print modalities than in the video modality. This is hardly surprising in
view of the fact that this dependent variable is merely the sum of the other two, but global
recall in the audio and print modalities may nevertheless have turned out to be significantly
different in spite of its component elements failing to be significantly different
independently; in the even this did not happen, and the pattern of significant differences was
entirely consistent across all three dependent measures.
Discussion
Modality of communication had a significant effect on free recall, cued recall
(recognition), and global recall of the health warning. Almost one-fifth of the variance in
global recall of the health warning was explained by differences in the modality through
which it was presented to the participants (effect size η2 = .18). These results confirm in
general terms the findings of several earlier investigations that recall of a complex message is
substantially affected by the modality through which it is presented, and they confirm that
this applies to a health warning of the type similar to some that are issued as public
information or public service announcements in the press and broadcasting media, although it
should be borne in mind that this conclusion is based on a single assessment immediately
following presentation of the health warning and that other factors may influence cognitive
processing over longer time periods following exposure.
The results reported above only partly confirm our hypotheses, however. In the light of
previous research and theorizing, we hypothesized that participants in the print condition
would remember most about the health warning and that participants in the video condition

Modality of Communication 7
would remember least. On each of the three dependent measures used in this study, the only
significant difference was between the video presentation, which yielded relatively low recall
scores, and the audio and print presentations, which both yielded significantly higher recall
scores. In other words, both audio and print modalities were associated with significantly
higher recall scores than video but, contrary to expectations, print did not yield significantly
higher recall scores than audio. In fact, mean recall scores for print and audio barely differed
from each other: on global recall, which provided the most general measure and also the
widest range of scores, the mean score for print (M = 25.00, SD = 5.08) was less than one
point higher than the mean for audio (M = 24.44, SD = 3.97).
The results of this investigation therefore only partly replicate those of Chaiken and
Eagly (1976), who found that their complex message was significantly better recalled when it
was presented in print than in the audio or video modalities but did not differ significantly
between the audio and video modalities. Our results confirm those of Chaiken and Eagly in
showing superior recall in the print than the video modality but fail to confirm Chaiken and
Eagly’s finding of superior recall in the print than the audio modality, and in addition our
results also show significantly higher recall in the audio than the video modality, which were
not significantly different in Chaiken and Eagly’s study.
The superior recall of complex material presented in the print modality compared to
video, on which our findings agree with those of Chaiken and Eagly (1976), has been
reported many times (e.g., Barlow & Wogalter, 1993; Browne, 1978; Furnham, Benson, &
Gunter, 1987; Furnham & Gunter, 1985, 1987; Furnham, Gunter, & Green, 1990; Gunter,
Furnham, & Gietson, 1984; Pezdek, Lehrer, & Simon, 1984; Wilson, 1974; Wold, 1977).
There is less agreement in the literature over the comparative effects of audio and video
presentations, on which our findings do not correspond with Chaiken and Eagly’s. In
particular, in two separate studies, Furnham and Gunter (1985, 1987) found significantly
higher recall scores for audio than video presentations, which is in line with the findings
reported in this article, and some other studies have reported the opposite effect, namely
significantly higher recall scores for video than audio presentations (e.g., Furnham, Benson,
& Gunter, 1987; Furnham, Gunter, & Green, 1990; Gunter, Furnham, & Leese, 1986). It
seems reasonable to conclude that the comparative effects on recall of audio and video
presentations are variable and poorly understood.
A tentative explanation is nevertheless possible. In a discussion of the effect of
communicator salience on persuasion, Chaiken and Eagly (1983) pointed out that the
presentation of a message in the video or audio modalities has the effect of drawing the
recipients’ attention to the communicator and away from the message itself, thereby
enhancing the effects of the communicator’s personal characteristics, which may be positive
or negative. The contradictory findings in the literature regarding the relative effects on recall
of video and audio presentations are explicable if we make the reasonable assumption that
communicators differ from one another in the degrees to which their visual and paralinguistic
characteristics tend to distract attention from what they say and interfere with memory
encoding of the content of their messages. Perhaps some communicators have especially
distracting forms of vocal delivery, so that recall of their audio messages is significantly
impaired relative to print (as in Chaiken and Eagly, 1976) or in some cases even relative to
video (as in some other studies cited above), whereas other communicators have styles of
vocal delivery that are not significantly more distracting than print presentation (as in the
study reported in this article and some others discussed earlier). Of course, the extent to
which a communicator’s paralinguistic behaviour is distracting depends on the particular
recipients of the communication: a strong Australian accent, for example, may be distracting
to a British or American audience but not to an Australian or New Zealand audience. In any

Modality of Communication 8
case, because of the well-established ‘visual dominance’ effect in information processing
(Posner, Nissen, & Klein, 1976), the effects of the paralinguistic cues are likely to be
swamped by those of the visual cues in the video modality.
This interpretation tends to support the distraction theory of modality effects, according
to which recall of a complex message is better following print than video presentation
because pictures, unless strikingly relevant, can actively impair memory encoding by
distracting attention from the content of the message (Chu & Schramm, 1967; Gunter, 1979).
What is required to explain the entire spectrum of findings is an additional assumption that
paralinguistic cues can have a similar distracting effect, but that this effect is variable
depending on the communicator’s vocal idiosyncrasies (and how these interact with the
audience) and is likely to be weaker than the visual distraction effect, because of visual
dominance and the fact that paralinguistic cues generally have been shown to have less
impact than visual cues (Knapp, 1992; Mehrabian, 1972).
This analysis, and indeed the empirical findings reported in this article, do not support the
most plausible explanations of modality effects, according to which it is because of the
opportunity for self-pacing or rearrangement of the contents of the message that recall of
complex material presented in this modality tends to be superior (O’Keefe, 1990, pp. 184-
185; Unnava, Burnkrant, & Erevelles, 1994). This type of explanation fails to account for the
significant recall differences between audio and video presentations reported in this article
and in a number of other studies, because neither audio nor video presentations offer any
opportunities for self-pacing or rearrangement of message content. The self-pacing and
rearrangement theories may be valid as far as they go, in fact some such mechanism is almost
bound to operate, but they do not appear to provide a complete explanation of all the
observed modality effects. Additional psychological processes are evidently at work, and the
distraction theory, suitably modified to accommodate paralinguistic effects and inter-
communicator differences, enables the variable recall differences found between audio and
video presentations to be understood.
It is worth commenting, finally, on the practical implications of research in this area.
There is persuasive evidence in the literature that a message that is complex or difficult to
assimilate is generally better recalled if it is presented in print rather than on video or
television, and the findings reported in this article confirm that conclusion strongly in the
special case of a complex public health warning. This does not mean, however, that ‘difficult’
public health warnings and other complex messages should necessarily be disseminated via
newspapers, magazines, and leaflets to the exclusion of television. The experimental findings
apply to recipients who are given equal exposure to messages presented in different
modalities and are constrained to pay attention to them, but it remains true that television is
more involving and attention-grabbing than any of the print media, and in naturalistic
conditions people may be more likely to pay heed to information presented on television
(Andreoli & Worchel, 1978; Chaiken & Eagly, 1983).
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Author Note
Rod Corston (now at Department of Psychology, Peterborough Regional College),
Department of Psychology; Andrew M. Colman, Department of Psychology.
This research was supported in part by Grant No. M71 from BEM Research. We are
grateful to Mallory Wober and Geoff Lowe for comments on an earlier version of the article.
Correspondence concerning this article should be addressed to Andrew M. Colman,
Department of Psychology, University of Leicester, Leicester LE1 7RH, UK. Electronic mail
may be sent via the Internet to amc@leicester.ac.uk.