COVID-19 Vaccine Hesitancy in Cameroon: The Role of Medical Mistrust and Social Media Use.

Most African countries report low COVID-19 vaccination rates (Msellati et al., 2022; WHO Africa; 2020). This study focuses on factors associated with vaccine hesitancy specifically in the country of Cameroon. Social media use and medical mistrust have been suggested as key variables that may increase vaccine hesitancy. Adopting the information-related perspective guided by the risk information seeking and processing model, the current research explored how social media use and medical mistrust are related to vaccine hesitancy among Cameroonians. Survey results from a sample of 1,000 Cameroonians fielded in early 2022 showed that social media use and medical mistrust were positively associated with belief in misinformation related to the COVID-19 vaccine. Belief in misinformation about the COVID-19 vaccine was negatively associated with perceived information insufficiency. A positive relationship between perceived information insufficiency and information seeking, as well as a negative relationship between information seeking and vaccine hesitancy were also found. Theoretical and practical implications are discussed.

The Roles of Social Media Use and Medical Mistrust in Black Americans' COVID-19 Vaccine Hesitancy: The RISP Model Perspective.

The COVID-19 pandemic has brought unprecedented challenges to healthcare and public health messaging in the United States. One area of focus has been vaccination uptake among Black Americans, who have experienced COVID-19 deaths disproportionate to their share of the United States population, raising questions about the processes involved in vaccination perceptions and behaviors. Guided by the Risk Information Seeking and Processing model, this study explored the roles of medical mistrust and social media as a source of risk information in Black Americans' vaccine hesitancy. Survey results from a YouGov panel sample of Black Americans (n = 1,136; 53.5% female) showed that social media use and medical mistrust were positively associated with belief in misinformation related to the COVID-19 vaccine, which, in turn, was positively related to vaccine hesitancy through perceived information insufficiency and information seeking intentions. Furthermore, we found that belief in misinformation and subjective norms toward anti-vaccination also serially mediated the association between social media use and medical mistrust with vaccine hesitancy. Theoretical and practical implications are discussed.

Temporal frames, temporal focus, and behavioral expectations: The persuasive impact of near and distant threats.

BACKGROUND: Ultraviolet (UV) photography and photoaging visuals make hidden sun damage visible to the naked eye, granting the potential to create messages that vary in temporal dimensionality. As UV photos depict immediate skin damage, the photo communicated that exposure in sun causes invisible damage to the young truck driver (near temporal frame) and visible damage (e.g., wrinkles) to the old truck driver (distant temporal frame). OBJECTIVE: The current study examines the moderating effects of loss/gain frames and temporality variables on the relationship between temporal framing and sun safe behavioral expectations. METHOD: U.S. adults (N = 897) were assigned to a 2 (near/distant temporal frame) × 2 (gain/loss frame) between-participants experiment. RESULTS: The loss frame triggered greater fear compared to the gain frame, this fear forms an indirect path where loss frames increase fear and fear increases changes in sun safe behavioral expectations. Participants exposed to the distant frame had increased behavior expectations if either of the two temporality variables (CFC - future or current focus) were low. Participants with low temporality indicators (i.e., CFC - future, current focus, or future focus) exposed to the gain frame had increased behavior expectations. CONCLUSIONS: The findings demonstrate the potential utility of temporal frames as a tool for designing strategic health messages.

Visual Tailoring and Skin Cancer Prevention: Comparing Personalized, Stock, and Non-Ultraviolet Images.

Past research has demonstrated that ultraviolet (UV) photos - which reveal skin damage as dark patches - can increase preventive behaviors. Emerging camera technology facilitates personalized UV photos for interventions, yet little is known about how personalized photos compare to other visuals and what cognitive or affective mechanism explains their persuasive impact. To engage this research line, the current study compared the impact of personalized UV (PUV), stock UV (SUV), and non-UV (NUV) photos and, to advance theorizing on fear appeals, explored underlying affective mechanisms including physiological fear. A sample of 169 undergraduate students participated in a 3 (Visual conditions: PUV, SUV, NUV) × 2 (Efficacy conditions: No efficacy and Efficacy) between-participants message experiment on a computer equipped with iMotions 6.4 that tracked real-time physiological responses (facial expression and skin conductance). Results demonstrated that PUV skin damage photos produced significantly greater self-reported fear and positive valence (detected by facial expression analysis) than NUV and SUV visuals. Mediation analysis demonstrated that fear had a significant indirect effect on the relationship between exposure to PUV skin damage visuals and behavior expectations.

Developing skin cancer education materials for darker skin populations: crowdsourced design, message targeting, and acral lentiginous melanoma.

Despite decreased susceptibility, darker skin individuals who develop melanoma have worse survival. This disparity in melanoma mortality is the largest for any cancer, and partly driven by a lack of patient education materials targeted to darker skin populations in whom acral lentiginous melanoma (ALM) is the most common subtype. To address this communication disparity, the current study reports a multi-phase design process that leverages crowdsourcing and message testing to develop ALM-focused patient education materials for darker skin populations. Crowdsourced design was utilized to develop a pool of designs (phase 1), the pool was narrowed and thematically analyzed (phase 2), and select designs were evaluated via a message experiment (N = 1877). For darker skin populations, designs that depicted people enhanced knowledge of ALM through message memorability. The current study engages melanoma disparities by providing ALM patient education materials for darker skin populations vetted via a multi-phase process.

Targeted communication and race: explicating perceived message relevance.

Objectives: Targeting is a communication strategy in which a message is designed to address a particular group. It has been postulated that targeting increases message relevance; however, researchers are still explicating relevance and its impact on downline cognitive processes (e.g. message quality, cognitive cost). The current study addresses both gaps by evaluating the impact of targeted materials for White and African American audiences. Design: Adult women (N = 266) aged 18-74 (Mage = 47.12, SD = 1.40) were recruited to participate in a 2 (targeting: multiracial, African American) × 2 (race: White participants, African American participants) × 2 (topic: Hypertension, Environmental Breast Cancer) message experiment. Results: Across both topics, African American participants in the African American condition had reduced cognitive costs, increased message clarity, and increased message relevance. An indirect serial mediation model was supported wherein the relationship between targeting and behavioral intention was mediated by perceived relevance and perceived message quality. Conclusion: Targeting enhances perceived message relevance which, in turn, impacts behavioral intentions via perceived message quality. This model is consistent with the postulates of relevance theory and informs both intervention design and evaluation.

Does it matter if a story character lives or dies?: a message experiment comparing survivor and death narratives.

OBJECTIVE: In narratives, characters often face threats where they either live (survivor narratives) or die (death narratives). Both outcomes have the potential to persuade, and are frequently utilised in mass communication campaigns, yet more research is needed examining the relative effectiveness and underlying mechanisms of each strategy. DESIGN: U.S. adults (N = 1010) were randomly assigned to a 2 (survivor, death) × 2 (non-foreshadowed, foreshadowed) × 2 (within-study replication: narrative 1, narrative 2) between-participants experiment with melanoma stories as stimuli. MAIN OUTCOME MEASURES: Intentions to engage in sun safe behaviour and skin self-examination behaviour were assessed in the pre- and posttest, and then transformed into change scores. RESULTS: Death narratives increased sun safe behaviour intentions. Consistent with the entertainment overcoming resistance model, foreshadowed death narratives were found to increase sun safe behaviour intentions via increased transportation and decreased counterarguing. CONCLUSION: Compared to survivor narratives, death narratives increase intentions to engage in sun safe behaviour. The findings offer support for character death as a key feature of narrative persuasion, and narrative transportation and counterarguing as important mediational pathways.

Applying harm reduction to COVID-19 prevention: The influence of moderation messages and risk infographics.

OBJECTIVE: We propose that harm reduction messages advocating moderation versus abstinence from social interaction will be seen as less threatening and increase intentions to follow COVID-19 guidelines. We also examine two important moderators: the influence of risk framing and willingness to risk infection. METHOD: A 2 × 2 between-participants, randomized experiment (N = 476) varied infographics portraying low-risk behaviors, like going camping, versus high-risk behaviors, like attending a concert, followed by either moderation or abstinence guidelines. Participants in two additional control groups saw an infographic displaying either a full range of risk behaviors or behaviors that pose no risk, each followed by generic guidelines. RESULTS: Regression analyses show moderation messages are less freedom-threatening only when presenting low-risk behaviors. Persons more willing to risk infection found all messages more freedom-threatening; however, for these individuals, moderation messages increased behavioral intentions when risks were presented as high. CONCLUSION: This study suggests harm reduction may be applied effectively in a pandemic, where the behavior of risk-tolerant individuals, at a population level, could have suboptimal effects on curbing virus transmission. PRACTICE IMPLICATIONS: Health educators should communicate harm reduction with certain populations but also test to ensure messaging, including visuals communicating relative risks, are received as intended.

Death Narratives, Negative Emotion, and Counterarguing: Testing Fear, Anger, and Sadness as Mechanisms of Effect.

Narrative messaging research has demonstrated that story outcome (e.g., whether the main character lives or dies) can impact audience behavior, but more research explicating and testing mechanistic pathways is needed. The current study tests fear, anger, and sadness as mechanisms of persuasion, assessing effects on counterarguing, reading flow, and behavioral intention. The current study utilized a 2 (story outcome: death vs. survivor) × 4 (story character: Marla, Erin, Don, and Ray) between-participants experiment (N = 735) to test the effect of story outcome on behavioral intentions via discrete emotion. Death narratives generated greater fear, anger, and sadness. Fear was related to greater behavioral intention and reading flow and diminished counterarguing. Sadness had the opposite effect. Anger produced a mixed persuasive effect, increasing both counterarguing and reading flow. Results have implications for discrete emotions theorizing and underscore the importance of conceptualizing narrative stimuli along multiple affective dimensions rather than single dimensions.

Using Communication Theory of Identity to Evaluate Decision Aids: Focus Group Research with African American Prostate Cancer Survivors.

Prostate cancer remains a significant health concern for U.S. adults, especially African American men, who have higher rates of diagnosis than other racial/ethnic groups. The current study evaluated five prostate cancer decision aids (PCDAs) focused on diagnosis and treatment via seven focus groups with 30 African American survivors. Consistent with the communication theory of identity, three layers of identity were salient in discussing PCDAs: personal, relational, and communal. African American men perceived existing PCDAs positively, evaluating them as accessible, efficacy inducing, and helpful in managing identity threats (personal layer of identity). Participants also found PCDAs to be central to decision making (relational layer of identity). Yet, there were concerns about the perceived lack of representation of African Americans in PCDAs (communal layers of identity). The findings suggest that PCDAs connect to personal and relational layers of identity but do not match expectations of communal identity.

Is News Surveillance related to Cancer Knowledge in Underserved Adults? Testing Three Versions of the Cognitive Mediation Model.

The cognitive mediation model (CMM) proposes indirect paths to news learning such that news surveillance increases news learning through attention to the news and elaboration about the news. But there is a need for additional research that tests key postulates of the CMM especially for media targeting underserved populations. The present study tested three versions of the CMM to model ethnic newspaper learning within a low-income, Spanish-speaking population (N = 150). The original CMM was not supported by the data as elaboration was not related to knowledge; however, a simplified version of the CMM (surveillance → attention → knowledge) was supported. Moreover, a serial mediation model that included a measure of health maven was supported such that news surveillance was positively related to knowledge through maven-ness and attention.

Cancer information overload: Discriminant validity and relationship to sun safe behaviors.

OBJECTIVE: Past research suggests a large number of adults feel overwhelmed by the amount of cancer information - a phenomenon labeled cancer information overload (CIO). The current study examines whether CIO is discriminant from other negative message perceptions (reactance, information avoidance) and related to sun safe behaviors. METHODS: U.S. adults (N = 2,219) completed survey questions assessing CIO, dispositional reactance, defensive/information avoidance, sun safe behavior, and knowledge. RESULTS: The results demonstrated that CIO was discriminant from dispositional reactance, information avoidance, and defensive avoidance, and individuals with higher overload were more likely to tan, less likely to have an annual checkup with a healthcare provider, and less knowledgeable about sun safe protection. Unexpectedly, individuals with higher CIO were more likely to wear wide-brimmed hats. CONCLUSION: CIO is distinct from reactance and avoidance, and related to performance/knowledge of sun safe behaviors, and receiving annual healthcare checkups. PRACTICE IMPLICATIONS: The correlation between CIO and sun safe behavior differs by behavior; a pattern which suggests practitioners might benefit from adapting their communication strategy based on the target population and behavior.