Effects of Message Framing and Narrative Format on Promoting Persuasive Conversations with Others About the Flu Vaccine

"Findings support the use of persuasive messages to motivate interpersonal conversation to promote vaccination."



Influenza vaccination rates in Israel are still lower than recommended. Concerns about the flu vaccine have been linked to low levels of public trust in pharmaceutical companies, in government health agencies that promote vaccination, and/or in physicians, as well as lower levels of health literacy and increased exposure to vaccine misinformation and conspiracy theories (e.g., on social media). This study examines the effects of message framing (loss vs. gain) and format (narrative vs. expository) on intentions to discuss flu vaccination with a close referent (close friend or family member). A central hypothesis is that messages will have stronger effects on (a) discussion intentions and (b) behaviour (i.e., interpersonal discussion about the vaccine) when participants feel greater concern for the health of the referent if they do not get vaccinated.



This approach conceptualises interpersonal communication not just as information delivery but as a consequential means of influencing behaviour. The idea is that interpersonal communication can be particularly effective as it can be personal and tailored to the person being addressed, enhancing perceptions of personal relevance. Interpersonal communication can also reinforce social support, which is linked to positive health outcomes, and it can increase knowledge and decrease uncertainty about the subject.



The researchers test the effects of video messages using a two-wave web-based randomised experiment among adults in Israel (baseline: N = 429, one-month follow-up: N = 241). First, they developed four scripts for a 3-minute video featuring the same protagonist - "Alon" (a pseudonym). Message content was uniform across conditions (besides manipulated factors). Two videos emphasised the benefits of having the flu vaccine for the other person (gain framing), while two videos emphasised the risks to the other person of not being vaccinated (loss framing), using an approach based on prior research. Within each of the framing message conditions, one video was written in a first-person narrative format, while the other presented the same information in an expository format. The messages were scripted in English, then translated to Hebrew, and narrated by the actor in Hebrew (his native language), with Hebrew language subtitles to enhance audience comprehension. The researchers asked participants to report whether they had discussed the flu vaccine with a close family member or friend in the last month, though they did not directly measure this behaviour.



A binary logistic regression model to test the effects of message framing and message format (H2b) on vaccine conversations at follow-up showed a significant positive lagged effect of loss-framed messages (vs. gain-framed) on discussion likelihood: Participants exposed to loss-framed messages were 2.7 times more likely to report discussing the flu vaccine with a close referent, compared with participants exposed to gain-framed messages. Furthermore, participants who viewed narrative format messages reported greater intention to have a conversation with their close referent about flu vaccination if they felt greater concern for their health, compared with participants who expressed less concern. However, there was no significant effect of message format (narrative) on the likelihood of reported conversation at follow-up.



Thus, if the objective of the message is to influence behavior and to generate long-term effects, results suggest that it would be most effective to use a loss-framed message (in any format). The results show that audiences may evaluate loss-framed messages according to their risk perceptions when greater concern for the health risk motivates action - not only for one's own health but for another person's health.



"One explanation for these results may be that loss-framed messages and narrative format messages promoting vaccination discussions may only motivate audiences to hold these discussions when the risk to the close others' health is salient to them. Interpersonal relationships are based on a delicate exchange of information, support, and mutual trust, particularly with regard to discussing sensitive topics such as health risks for the other person. For vaccination promotion messages, results suggest group targeting audiences whose family members or close social contacts are in a high-risk group may be advisable. For example, a vaccination promotion campaign might target parents with young children in high-risk groups, pregnant women, or (middle-aged) children of older adults who would be at high risk of flu severity or even death if they were to catch the flu without being vaccinated. Encouraging the audience to discuss flu vaccination with their family members, relatives, parent/s, or close friends could be an effective strategy."



Per the researchers, the study findings can help inform message design to motivate interpersonal conversations to promote flu vaccination. Conversations can take place through face-to-face interactions but also via online channels, across a variety of modalities that allow for asynchronous dialogue and the incorporation of elements from other channels. Research on interpersonal conversation as a campaign outcome suggests that the most effective approach is to boost the audience's perceived efficacy to hold the conversation, empower them with information, and explain the benefits of the conversation for the person who will be receiving the appeal.



As suggested here, future research should consider the valence and nature of the reported discussion that was motivated by message exposure and its impact on both parties. For example, when discussing the flu vaccine, the unvaccinated referent may raise arguments against the vaccine or express a lack of normative support for vaccination that may adversely influence the message recipients' own vaccination beliefs and intentions. Broadly: "More research is needed to understand how interpersonal influence can be targeted as a campaign outcome to influence vaccine-related uptake through social influence."



In conclusion: "Results contribute to theory on risk-framing by showing that audiences may evaluate loss-framed messages according to their risk perceptions, when greater concern for health risks motivate action, not only for one's own health but for another person's health."