The Antecedents and Consequences of Interpersonal Communication during a School-based Health Intervention.

School-based health interventions often have limited and inconsistent effects. Although interpersonal communication likely is important, hardly any studies have investigated interpersonal communication of students with their friends, classmates, and parents about the health programs and health behaviors in school-based health interventions. In a two-wave prospective study of 389 adolescents focusing on three health behaviors (i.e., alcohol use, snack intake, and exercise), we addressed two aims. Our first aim was to investigate how student evaluations of a school-based health intervention influenced interpersonal communication about health behaviors (i.e., valence and frequency of conversations). Findings showed that positively evaluating a school-based health intervention increased how often students talked about the intervention with friends, classmates, and parents, as well as how they discussed the three health behaviors. Our second aim was to investigate the influence of interpersonal communication with friends, classmates, and parents on predictors of health behaviors. We found for conversational frequency that frequently discussing health behaviors resulted in healthier (more positive) predictors of exercise, but also in unhealthier (more positive) predictors of snacking and drinking. Furthermore, findings showed that positively discussing exercising, and negatively discussing snacking and drinking, resulted in healthier predictors of these behaviors. Our findings show that it is important to understand the impact of post-intervention communication and that post-intervention communication with peers and parents about health behaviors are predictors of health behavior.

Smoking Education for Low-Educated Adolescents: Comparing Print and Audiovisual Messages.

This study aims to provide insight into which modality is most effective for educating low-educated adolescents about smoking. It compares the persuasive effects of print and audiovisual smoking education materials. We conducted a field experiment with two conditions (print vs. video) and three measurement times (Time 1, Time 2, and Time 3). A total of 221 high school students in the second year of the lowest levels of education in the Netherlands participated at all three time points of the study. Results showed that participants in both conditions had more negative beliefs about smoking after being exposed to the smoking education than before, but there were no differences between the print and video version in this effect. However, the video version did make the attitude toward smoking more negative at Time 3 compared to baseline, whereas the text version did not, which suggests that the video version was more effective for educating low-educated adolescents about smoking.

The effects of narrative versus non-narrative information in school health education about alcohol drinking for low educated adolescents.

BACKGROUND: Traditionally most health education materials are written in an expository non-narrative format. Scholars have argued that the effectiveness of materials may increase when these texts are replaced by narrative texts, and that the non-narrative texts should be replaced by narrative texts. However, no previous studies have tested these claims in the context of school health education for low educated adolescents. This study aims to do so for an existing preventive health education intervention about alcohol for low educated adolescents. Based on the empirical findings of previous studies, it is expected that the claims about narratives being more effective than non-narrative texts are not true for effects on knowledge. Instead non-narrative texts are expected to have a stronger impact on this outcome variable. For attitude towards alcohol and intention to drink alcohol the claims are expected to be true, because participants are expected to be less aware of the persuasive intent of the narrative texts, which would make them less resistant. As a result, narrative texts are expected to have a stronger effect on attitude and intention. METHODS: This study compares the effects on knowledge, attitude towards alcohol, and intention to drink alcohol of both information formats in a two-condition (non-narrative vs. narrative information) experiment with repeated measures (pre-measurement, immediate post-measurement, and delayed post-measurement). The experiment was conducted amongst 296 students of the two lowest levels of the Dutch secondary education system. RESULTS: The results showed immediate effects on knowledge and attitude towards alcohol, which did not differ between conditions and school levels. These effects did not persist over time. There were no effects on intention to drink alcohol. CONCLUSION: It is concluded non-narrative and narrative information are equally effective in the context of school health education, suggesting the claims that scholars have made about the superior effects of narrative texts are not true. Given the fact that narrative texts are more expensive to develop, policy makers may not be advised to prefer these types of texts over the traditionally used non-narrative texts.

The differential impact of statistical and narrative evidence on beliefs, attitude, and intention: a meta-analysis.

Although "evidence" is often used as an important argument in persuasive health campaigns, it remains unclear what type of evidence has the strongest impact on particular outcome variables. We conducted a meta-analysis in which the effects of statistical and narrative evidence on beliefs, attitude, and intention were separately compared. Statistical evidence was found to have a stronger influence than narrative evidence on beliefs and attitude, whereas narrative evidence had a stronger influence on intention. We explain these findings in terms of the match between the specific characteristics of the two types of evidence and those of the outcome variables. Statistical evidence, beliefs, and attitude all relate primarily to cognitive responses, whereas both narrative evidence and intention relate more specifically to affective responses. We conclude that communication professionals developing health campaigns should match the type of evidence to the main communication objectives.

The effects of integrating instrumental and affective arguments in rhetorical and testimonial health messages.

Recent research highlights the superior influence of affect over cognition in health decision making. The present study examined the independent and combined effects of 2 message characteristics that are thought to tap into the cognition-affect distinction: message format (rhetorical vs. testimonial) and argument type (instrumental vs. affective). In this 2 × 2 experiment, 81 college students were randomly assigned to 1 of 4 health messages discouraging binge drinking. The results indicated that messages containing affective arguments were judged more positively and perceived as more effective than were messages containing instrumental arguments. The results further revealed an interaction effect between message format and argument type. Testimonials were more persuasive when they contained affective arguments than when they contained instrumental arguments. Type of arguments did not influence the efficacy of rhetorical messages. Mediation analyses revealed that instrumental arguments reduce the efficacy of testimonials because they prevent individuals from being transported into the story, and increase psychological reactance. In conclusion, testimonial messages more effectively discourage binge drinking among college students when they contain affective, as opposed to instrumental, arguments.

The role of affect and cognition in health decision making.

Both affective and cognitive evaluations of behaviours have been allocated various positions in theoretical models of decision making. Most often, they have been studied as direct determinants of either intention or overall evaluation, but these two possible positions have never been compared. The aim of this study was to determine whether affective and cognitive evaluations influence intention directly, or whether their influence is mediated by overall evaluation. A sample of 300 university students filled in questionnaires on their affective, cognitive, and overall evaluations in respect of 20 health behaviours. The data were interpreted using mediation analyses with the application of path modelling. Both affective and cognitive evaluations were found to have significantly predicted intention. The influence of affective evaluation was largely direct for each of the behaviours studied, whereas that of cognitive evaluation was partially direct and partially mediated by overall evaluation. These results indicate that decisions regarding the content of persuasive communication (affective vs. cognitive) are highly dependent on the theoretical model chosen. It is suggested that affective evaluation should be included as a direct determinant of intention in theories of decision making when predicting health behaviours.

The effectiveness of narrative versus informational smoking education on smoking beliefs, attitudes and intentions of low-educated adolescents.

OBJECTIVE: This study tests the effectiveness of narrative versus informational smoking education on smoking beliefs, attitudes and intentions of low-educated adolescents. DESIGN: A field experiment with three waves of data collection was conducted. Participants (N = 256) were students who attend lower secondary education. At the first and third waves, they completed a questionnaire. At the second wave, 50.8% of the participants read a smoking education booklet in narrative form and 49.2% read a booklet in informational form. After reading, all participants also completed a questionnaire at wave 2. MAIN OUTCOME MEASURES: Beliefs about negative consequences of smoking, attitudes towards smoking and intentions to smoke were measured. RESULTS: Repeated measures analyses with time as a within-subjects factor and condition as a between-subjects factor showed that beliefs about smoking were more negative at Wave 2 compared to Wave 1, irrespective of condition. However, attitudes towards smoking were more positive at Wave 3 compared to Wave 1 when participants had read the narrative version. CONCLUSION: These results show that narrative smoking education is not more effective than informational smoking education for low-educated adolescents and can even have an unintended effect for this target group by making attitudes towards smoking more positive.

The temporal stability and predictive validity of affect-based and cognition-based intentions.

Recent research has revealed individual differences in the extent to which people base their intentions on affect and cognition. Two studies are presented that assess whether such differences predict the strength of individuals' intention-behaviour relationships. Participants completed measures of affect, cognition, intention, and behaviour regarding a range of health behaviours. Study 1 (N = 300) found that the strength of the intention-behaviour relationship was significantly related to the extent to which individuals based their intentions on affect, but not to the extent they based them on cognition. Study 2 (N = 387) replicated the findings of the first study. In addition, Study 2 revealed that intention stability mediated the relationship between the degree people based their intentions on affect and the strength of the intention-behaviour relationship. Thus, individuals who base their intentions strongly on affect have more stable intentions, and are therefore more likely to enact them.

The influence of affective and cognitive arguments on message judgement and attitude change: The moderating effects of meta-bases and structural bases.

This study investigated whether the efficacy of affective vs. cognitive persuasive messages was moderated by (1) individuals' subjective assessments of whether their attitudes were based on affect or cognition (i.e. meta-bases) and (2) the degree individuals' attitudes were correlated with affect and cognition (i.e. structural bases). Participants (N = 97) were randomly exposed to a message containing either affective or cognitive arguments discouraging binge drinking. The results demonstrated that meta-bases and not structural bases moderated the influence of argument type on message judgement. Affective (cognitive) messages were judged more positively when individuals' meta-bases were more affective (cognitive). In contrast, structural bases and not meta-bases moderated the influence of argument type on attitude and intention change following exposure to the message. Surprisingly, change was greater among individuals who read a message that mismatched their structural attitude base. Affective messages were more effective as attitudes were more cognition-based, and vice versa. Thus, although individuals prefer messages that match their meta-base, attitude and intention change regarding binge drinking are best established by mismatching their structural base.

The interplay between affect and theory of planned behavior variables.

OBJECTIVES: To assess whether affective evaluations of health behaviors moderate or mediate the influence of theory of planned behavior (TPB) variables on intention. METHODS: For each of 20 health behaviors, respondents (N=300) completed questionnaire measures of affective evaluation, attitude, subjective norm, perceived behavioral control, and intention. RESULTS: Analyses using path modeling revealed that affective evaluation of the behaviors did not moderate the influence of the TPB variables on intention, but it partially mediated the influence of attitude and perceived behavioral control on intention. CONCLUSIONS: These results emphasize the importance of affective evaluation as a target for health communication.