An evaluation of the license to save lives program to promote organ, eye, and tissue donation among teenagers.

As the number of designated organ donors continues to lag behind the number of waiting list patients, teenagers remain a promising demographic of potential organ donors. The current study enlisted Michigan and Ohio driver education students to participate in an online digital learning intervention, License to Save Lives (LTSL). Students were randomly assigned to either an interactive or noninteractive LTSL intervention. Across both states, the pretest-posttest design revealed greater knowledge among students following exposure to either the interactive or noninteractive LTSL program. No attitudinal or behavioral differences emerged between the interactive and noninteractive conditions. Michigan (39.82%) and Ohio (58.10%) students registered to be organ donors at a respectable rate. The results are discussed with an emphasis on feasibility and sustainability as well as the promise for digital games to promote organ donation knowledge, attitude, and registration among teenagers.

Can Happiness and Sadness Overcome Organ Donation Barriers Following Exposure to Radio Ads?

Concerns related to bodily integrity, medical mistrust, superstition, and disgust with respect to organ transplantation remain commonly cited barriers among African American, Caucasian, and Hispanic non-donors. The current study examined two narrative strategies for mitigating these barriers by eliciting feelings of happiness or sadness. African American, Caucasian, and Hispanic non-donors (N = 576) were randomly assigned to a radio ad that communicated either a recipient narrative or a waiting list narrative. As expected, the recipient narrative elicited greater feelings of happiness whereas the waiting list narrative aroused greater feelings of sadness. Moderated mediation analyses revealed models in which happiness, not sadness, was the mediator, such that the narrative frame was associated with ad persuasiveness. Additionally, only medical mistrust interacted with happiness to predict ad persuasiveness The results are discussed with an emphasis on message design strategies to employ among reluctant adult African American, Caucasian, and Hispanic potential donors.

Memorable Messages About Mental Health Among International Students in the United States: A Mixed-Method Study.

This study investigated the memorable messages about mental health that international students (N = 199) received from various sources since arriving on campus in the U.S. Utilizing the memorable messages framework, we examined the types of messages (normalizing, strategizing, minimizing) they received and their association with message satisfaction, mental health stigma, and attitude toward help-seeking. The most frequently recalled messages were normalizing messages (49.2%), followed by strategizing messages (31.7%), and minimizing messages (9.5%). Participants who recalled normalizing and strategizing messages reported higher satisfaction and a more favorable attitude toward help-seeking compared to those who recalled minimizing messages. These findings offer theoretical implications for memorable messages and immigrant populations, as well as practical implications for campaign messaging and design. These results can guide university officials in tailoring their efforts to meet the mental health needs of this vulnerable population.

Leveraging Dynamic Norms to Reduce College Student Alcohol Use: A Test of Four Mediators.

Social norms are common in persuasive messaging. For norms trending in a positive direction, it may be beneficial to emphasize change (i.e. dynamic norm) rather than the status quo (i.e. static norm). To test this proposition, we examined college students' responses to social norm messages encouraging moderate alcohol use. Undergraduates (N = 842) were randomly assigned to view a dynamic norm ("More college students drinking in moderation"), a static descriptive norm ("Most college students drink in moderation"), or a no message control. Four mechanisms were examined as potential mediators, three of which have been examined in previous work (preconformity, perceived importance, self-efficacy) and one of which was novel (psychological reactance). Results revealed that exposure to either social norm message (dynamic or static descriptive) was associated with more favorable attitude relative to a no message control. Attitude did not differ between the dynamic norm and static descriptive norm conditions. Only psychological reactance mediated the relationship between message condition (dynamic vs. static descriptive norm) and favorable attitude. Implications and future directions are discussed.

An examination of teenagers' beliefs toward organ donor registration.

Teenagers represent a promising target population for organ donor registration efforts, as in the US teenagers age 15-17 may register their intent for organ donation, which later translates to consent at age 18. However, teenagers constitute a relatively understudied population in the organ donation literature. A sample of teenagers (N = 466) ranging in age from 13 to 19 was recruited from driver's education schools in Ohio and Michigan in order to learn more about their perceived reasons for and against registering as an organ donor. A coding scheme was developed, and responses were coded by two trained coders. In line with previous work in adult samples, our results revealed the three most common reasons for registering were prosocial benefits, rational arguments, and personal experience. In contrast to previous work among adults, the two most common reasons for not registering were bodily integrity and religious reasons. Several novel beliefs among teenagers that were both supportive and non-supportive of organ donor registration were identified. Findings from the current study are discussed with an emphasis on implications for practitioners working to promote organ donor registration among teenage audiences.

The Impact of Mortality Salience on Organ Donation Attitude, Beliefs, and Behavior.

The current study examines the relationship between mortality salience and attitude, beliefs, and behavior toward organ donor registration. Participants (N = 484) completed a laboratory study in a 2 (mortality salience vs. control) x 2 (processing: distal vs. proximal) between-subjects factorial design. Dependent variables included death thought accessibility, attitude, information seeking, and organ donation beliefs (bodily integrity, ick, jinx, and medical mistrust). Differences between conditions were examined with independent samples t-tests and χ2 analyses. Participants in the mortality salience condition reported greater death thought accessibility than those in the control; however, no difference in attitude nor information seeking (non-donors only) was found between the two conditions. No difference in attitude nor information seeking (non-donors only) was observed between participants engaging in distal versus proximal defensive processing. Participants in the mortality salience condition reported higher medical mistrust and bodily integrity than those in the control condition; no difference between ick or jinx was found between the two conditions. Theoretical and practical implications are discussed.

Message Fatigue to Bystander Intervention Messages: Examining Pathways of Resistance among College Men.

Bystander intervention programs are a feature on college campuses; however, the effectiveness of these programs among certain subsets of men has recently been questioned. The current study examines college men's resistance to bystander intervention efforts by investigating message fatigue as a theoretical explanation for how bystander intervention programs may fail among college men. Specifically, the current study examined both active (i.e., reactance) and passive (i.e., inattention) resistance to bystander intervention messages among a sample of college men (N = 518). Results were consistent with reactance as a mediating mechanism explaining message failure among fatigued audiences. The mediating role of inattention was not supported. Theoretical and practical implications of the current study are discussed.

What's at Stake: Evaluating a Run-Hide-Fight® Intervention Video through the Lens of Vested Interest Theory.

The Department of Homeland Security and the Federal Bureau of Investigation have encouraged colleges and universities to create emergency preparedness interventions that prepare students, faculty, and staff for any conceivable campus crisis. In this investigation, we tested the efficacy of a professionally produced Run-Hide-Fight® video to accomplish such a goal with a convenience sample of college students. Drawing on Vested Interest Theory (VIT) to guide our evaluation, we observed significant gains in stake, salience, and self-efficacy for students exposed to the emergency preparedness video compared to those not exposed to the video. We find evidence not only for short-term gains immediately after message exposure but also persisting effects two weeks after exposure. In addition, greater perceptions of stake and salience in response to the video predicted more favorable attitudes toward emergency preparedness over time. These findings demonstrate the potential for brief messages shown in university classrooms to encourage students to feel vested in emergency preparedness on campus. They also shed light on promising messaging strategies to foster favorable attitudes toward emergency preparedness.

An evaluation of a motor vehicle facility campaign with an established statewide donor registry: A test of sustainable, evidence-based intervention strategies.

Increasing organ donor registration enrollment inside motor vehicle facilities (MVF) is a common approach in the United States. From this research, a formula for what works has emerged within the literature including the presence of an interpersonal component, video messages, and point-of-decision materials. These intervention components have demonstrated effectiveness at increasing registrations in relatively new statewide registries; however, their effectiveness in MVFs with a mature registry remains understudied. The current study examined the effectiveness of an online MVF clerk intervention and the other examined the effectiveness of a multi-message, phase MVF intervention aimed at increasing organ donation registrations. The results revealed that MVF clerks garnered increased knowledge and greater comfort in communicating about organ donation with patrons after the intervention. Moreover, the intervention revealed that clerk talk effectiveness was positively associated with organ donation registration among MVF customers. Against expectations, recall of video messages was negatively associated with new registrations. Exposure to the brochure, counter mat, and poster donation messages was not associated with organ donation registration. An emphasis on the strengths and shortcomings of using MVFs as intervention sites for organ donation registration promotion are discussed.

An Application of the Reasoned Action Approach to Bystander Intervention for Sexual Assault.

The high prevalence of sexual assault in US college campuses has led to a widespread implementation of bystander intervention programs aimed at preventing sexual assault. The current study examines predictors of college students' intentions to engage in bystander intervention through the theoretical lens of the reasoned action approach. An online survey with college students (N = 186) was conducted at a large Midwestern university. Our results indicated experiential attitudes, instrumental attitudes, descriptive norms, autonomy, and capacity, each positively associated with participants' intentions to intervene to stop a sexual assault. Against expectations, injunctive norms were unrelated to bystander intervention intentions. Finally, in addition to these main effects, an experiential attitude by autonomy interaction was also observed. The results are discussed with a focus on the theoretical and practical implications of our findings.

Examining Mechanisms Underlying Fear-Control in the Extended Parallel Process Model.

This investigation sought to advance the extended parallel process model in important ways by testing associations among the strengths of efficacy and threat appeals with fear as well as two outcomes of fear-control processing, psychological reactance and message minimization. Within the context of print ads admonishing against noise-induced hearing loss (NIHL) and the fictitious Trepidosis virus, partial support was found for the additive model with no support for the multiplicative model. High efficacy appeals mitigated freedom threat perceptions across both contexts. Fear was positively associated with both freedom threat perceptions within the NIHL context and favorable attitudes for both NIHL and Trepidosis virus contexts. In line with psychological reactance theory, a freedom threat was positively associated with psychological reactance. Reactance, in turn, was positively associated with message minimization. The models supported reactance preceding message minimization across both message contexts. Both the theoretical and practical implications are discussed with an emphasis on future research opportunities within the fear-appeal literature.

A Department of Motor Vehicle-Based Intervention to Promote Organ Donor Registrations in New York State.

CONTEXT: Examination of efficacy of motor vehicle representative educational training and dissemination of promotional materials as a means to promote organ donation enrollments in New York State. OBJECTIVE: To increase the number of New York State residents who consent to donation through the department of motor vehicle transactions during project period. SETTING: County-run motor vehicle offices across New York State. PARTICIPANTS: Customers who present to New York Department of Motor Vehicle offices and the representative who work at designated bureaus. INTERVENTIONS: point-of-decision materials including promotional posters, brochures, website, and the motor vehicle representative training sessions. MAIN OUTCOME MEASURES: Reasons for enrollment decision, knowledge/experience with donation, monthly consent rates, enrollment in state organ, and tissue registry. RESULTS: Customers who elected not to register reported no reason or uncertainty surrounding enrollment. The representatives reported experience with donation, discussion with customers, and need for additional education on organ donation. Enrollment cards were mailed to 799 project staff; counties where offices participated in intervention did not indicate significantly higher monthly enrollments when comparing pre- to postenrollment rates. CONCLUSIONS: Use of point-of-decision materials and enrollment cards proved inexpensive method to register customers with a 3.6% return rate. Customers report low (27%) enrollment rate and reticence to consent to donation. Educational training sessions with representatives did not yield significant enrollment increases when evaluating data at county-level enrollment.

An investigation into mature adults' attitudinal reluctance to register as organ donors.

BACKGROUND: Mature adults (age 50-64) make up a large proportion of organ transplant recipients, and waiting list candidates yet are underrepresented in terms of actual donors. Understanding the reasons why mature adults fail to register as deceased organ donors is critical in achieving the goal of increasing the actionable supply of organs available for transplant. Conceptual models propose certain factors such as bodily integrity, ick (i.e., disgust), jinx (i.e., superstition), medical mistrust, salience, self-efficacy, and stake are associated with organ donation registration attitudes. Moreover, the age myth, or the belief that one's age prevents them from becoming an organ donor, was examined among mature adults between the ages of 50-64. METHOD: An online survey was disseminated to mature adults (N=709). RESULTS: Results indicated jinx, salience, self-efficacy, and stake each predicted organ donation attitudes among mature adults. Moreover, results indicated that age myth accounted for attitudes toward registering as an organ donor among non-registered mature adults after controlling for non-cognitive and vested interest constructs. CONCLUSION: This study demonstrates the age myth is negatively associated with attitudes toward registering as organ donors. The results are discussed with an emphasis on both the theoretical and practical implications of study findings.

Does Donor Status, Race, and Biological Sex Predict Organ Donor Registration Barriers?

PURPOSE: The purpose of the current study was to examine differences among bodily integrity, disgust, medical mistrust, and superstition among African Americans, Caucasians, and Latinos; females and males; and registered organ donors and non-registered potential donors. METHODS: A random digit dialing phone survey was utilized to garner information pertaining to organ donation beliefs among African American (n = 200), Caucasian (n = 200), and Latino (n = 200) Chicago residents. More specifically, participants responded to measures of bodily integrity, disgust, medical mistrust, and superstition, organ donor registration status, among others. RESULTS: The results indicated that African American and Latino participants were less likely to be registered organ donors than Caucasians (p < .001). In general, females maintained fewer barriers than males with respect to bodily integrity (p < .05), disgust (p = .01), and superstition (p = .01). With respect to organ donation barriers, bodily integrity (p < .0001) emerged as a central concern among those surveyed. CONCLUSION: This study highlights the significance of audience segmentation when promoting posthumous organ and tissue donation. Specifically, the results stress the importance of constructing distinct messages to non-registered potential donors compared to messages delivered to registered donors. Moreover, different barriers surfaced among females and males as well as among African American, Caucasian, and Latino residents. It is clear that a one size fits all approach will likely not work when promoting organ and tissue donation.

Source and Message Framing Considerations for Recruiting Mature Adults as Organ Donors Through Direct Mail Campaigns.

CONTEXT: Mature adults represent an important audience segment for organ donation practitioners. Despite their potential impact as organ donors, compared to other age demographics, their registration rates are much lower. OBJECTIVE: The objective of the current campaign was to determine the most effective source and message strategy to promote organ and tissue donation among mature adults. METHODS: A 2 (states: Illinois and Iowa) by 2 (sources: government agency and organ procurement organization [OPO]) by 3 (taglines: Any age is the right age to share the gift of life, Don't rule yourself out, and Don't rule yourself out: Any age is the right age to share the gift of life) between-subjects design was used to test the effectiveness of direct mailings promoting organ donation to mature adults. RESULTS: Across both Illinois and Iowa, the results revealed that greater organ donation registration rates emerged following exposure to direct mail authored by a state official such as the Illinois Secretary of State or the Iowa Department of Public Health compared to local OPOs. CONCLUSIONS: Overall, the findings speak to the effectiveness of direct mail marketing campaign's ability to register potential organ donors. Moreover, the results reveal that it is more important who sends the message as opposed to what the message states.

Examining the Principles of Influence on Safer Sex Communication During Casual and Committed Sexual Encounters.

Teens and young people are at risk for contracting sexually transmitted infections. Understanding how relationship context may moderate the effectiveness of safer sex communication strategies among this demographic is important information for practitioners striving to promote safer sex behaviors. In this study, focus groups (N = 9) with college students were conducted and analyzed to examine the relation between 6 principles of influence (authority, consistency, liking, reciprocity, scarcity, and social proof) and safer sex communication during committed and casual sexual encounters. Results revealed that with the exceptions of social proof and consistency, the principles of influence were endorsed more frequently for casual than committed sexual encounters. For casual sexual encounters, the principles of authority, reciprocity, and scarcity arose as influential principles. For committed sexual encounters, the principles of consistency, liking, and reciprocity arose as influential principles. These results are discussed with an emphasis on the theoretical and practical implications.

Reasons for (not) signing the state registry: surveying Department of Motor Vehicles customers in New York state.

CONTEXT: Prior research examining rationales for enrolling as an organ donor is biased because of its reliance on college student samples and retrospective recall. OBJECTIVE: To characterize New York state residents' registry enrollment decisions in close proximity to a registration opportunity. DESIGN: -Surveys were conducted with customers exiting Department of Motor Vehicle offices. PARTICIPANTS: A total of 1325 customers were surveyed upon exiting 1 of 18 Department of Motor Vehicle offices spanning 9 counties. MAIN OUTCOME MEASURE: Customers making donation-relevant transactions (ie, license renewal/registration) reported whether they had registered as a donor that day, and all other customers reported whether they had registered as a donor in the past. Customers reported reasons to justify their enrollment decision through short interview questions. RESULTS: Among current donation-relevant transactions (n = 299), 27% reported enrolling in the registry. Of remaining customers, 39% reported enrolling in the state registry in the past. For those who elected not to enroll, many failed to communicate a reason for their decision, or reported a lack of opportunity to sign or decisional uncertainty. Among enrollees, reasons for registration included the altruistic benefits of donation, prior registration, personal experience with donation, and rational arguments for donation. CONCLUSION: The value of point-of-decision survey data are discussed in relation to strategic efforts to promote organ donor registration.

The Utility of Choice-Enhancing Language in Emergency Preparedness Messages: An Application of Psychological Reactance Theory.

OBJECTIVE: This study uses psychological reactance theory as a framework for designing effective emergency preparedness messages. Psychological reactance is the motivational state that occurs when individuals perceive their freedom to be threatened. From the standpoint of persuasive message design, reactance is an undesirable outcome that should be avoided whenever possible. METHODS: Participants (N = 174) were randomly assigned to view 1 of 2 emergency preparedness messages (choice-enhancing language ["the choice is yours"] vs choice-restricting language ["you must"]) in a between-subjects-posttest-only online survey experiment. RESULTS: Structural equation modeling revealed that choice-restricting language resulted in greater freedom threat and subsequent reactance. Reactance resulted in a diminished attitude and subsequent intention to prepare an emergency kit. CONCLUSION: Public health practitioners would benefit from the inclusion of choice-enhancing language in their public communications, alongside the exclusion of choice-restricting language. Pretesting of messages is recommended to avoid eliciting reactance and subsequent boomerang effects.

Message Fatigue and Resistance to Anti-Binge Drinking Messages: Examining the Mediating Roles of Inattention and Reactance.

OBJECTIVE: The current study examined message fatigue as a theoretical explanation for college students' resistance to anti-binge drinking messaging. Specifically, inattention and psychological reactance were examined as mediators bridging the message fatigue and perceived message effectiveness relationship. METHOD: University students (N = 783, 60% female) were recruited by the university's SONA sampling system to participate in an online Qualtrics survey where they read a message discouraging binge drinking. RESULTS: In line with our predictions, structural equation modeling revealed that message fatigue was positively associated with both inattention and reactance (as mediated by freedom threat). In turn, inattention, but not reactance, was negatively associated with perceived message effectiveness. CONCLUSIONS: The current findings suggest that there may be deleterious consequences of message fatigue when discouraging binge drinking. The current results also highlight the importance of pilot testing anti-binge drinking messages for message fatigue during formative research to avoid triggering maladaptive outcomes.

An Examination of Nursing Students' Knowledge About Organ Donation.

BACKGROUND: Nurses play an important role in educating the public about organ donation, but only if they themselves are knowledgeable on the topic. This study examined nursing students' knowledge of common myths and misconceptions related to organ donation. METHOD: Nursing students (N = 232) completed an anonymous online survey. Eight true/false questions assessed nursing students' knowledge of organ donation. RESULTS: Overall, nursing students were knowledgeable about organ donation, correctly answering on average 5.55 of 8 questions. Nursing students were least likely to believe the myths that medical providers are untrustworthy and that organ donors are unable to have an open casket funeral, but they were most likely to believe the myth that there is a black market for organ donation in the United States. CONCLUSION: The results provide useful data to nurse educators seeking to prepare the next generation of nurses to be knowledgeable and competent communicators on the topic of organ donation. [J Nurs Educ. 2020;59(7):388-391.].