Greater benefit of self-affirmation for prevention-focused individuals prior to threatening health messages

Abstract

Objective

Individuals are often defensive toward health messages that suggest they are putting their health at risk because such messages threaten their self-competence and integrity. Although self-affirmation can facilitate prevention behaviors in response to health messages, effects are variable. We examined whether disease prevention focus might strengthen self-affirmation’s effects in response to disease prevention messages, given that prevention-focused individuals are likeliest to be persuaded by those messages after self-affirmation attenuates defensiveness.

Design

In Study 1, participants were self-affirmed before a message about sexually transmitted infections. In Studies 2 and 3, individuals were self-affirmed prior to a message about alcohol and cancer risk.

Main Outcome Measures

Studies assessed intentions to use condoms, intentions to reduce alcohol, and willingness to drink alcohol in specific scenarios.

Results

In Study 1, self-affirmation facilitated condom use intentions among those higher in prevention focus. In Studies 2 and 3, self-affirmation facilitated lower willingness to consume alcohol among those high in prevention focus. A meta-analysis across the three studies indicated that self-affirmation improved intentions and willingness under high, but not low, prevention focus (d = 0.20, p = .003).

Conclusion

These findings demonstrate that health prevention-focus can strengthen self-affirmation’s effects, thereby improving responsiveness to health communications about behaviors that increase disease risk.

Keywords:

• Self-affirmation
• prevention focus
• health messages
• health behavior

Acknowledgement

We thank Kathryn Cornelius and Joanna Sterling for assistance in collecting the data for Study 1.

Disclosure statement

No potential conflict of interest was reported by the authors.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Notes

1 Approximately one week later, participants were emailed to ask whether they had engaged in sex in the past week. If so, they indicated whether they used a condom never, some of the time, or all of the time. The study was not powered to obtain significant effects on behavior, but inclusion of this measure permitted an effect size assessment. Study 1 also assessed perceived barriers and behavior change plans (open-ended, coded by two reviewers). Perceived barriers ranged from 0 to 5 (M = 1.36, SD = 1.23), with high interrater reliability (κ = .96–.98) and plans ranged from 1 to 5 (M = 1.32, SD = 1.25; κ = .95–.99). Self-affirmation and prevention focus interacted to predict barriers (B = −.420, 95%CI = −.783, −.056, p = .024, d = .27) such that self-affirmation reduced barriers when prevention focus was higher. No other effects were significant (ps > .05). For the purposes of testing separate (unpublished) hypotheses unrelated to this manuscript, participants also completed measures of message acceptance, risk perception, and condom knowledge; the full questionnaire is available from the first author.

2 The pattern and significance of results remained unchanged when the control variable was not included.

3 Sexual activity (past 6 months) did not interact with self-affirmation, B = 0.52, 95% CI = −0.11, 1.14, p = .103, or prevention focus, B = 0.04, 95% CI = −0.37, 0.44, p = .858, nor was the three-way interaction significant, B = 0.18, 95% CI = −0.64, 0.99, p = .673. Sexual activity (between the affirmation follow-up) did not interact with self-affirmation, B = 0.32, 95% CI = −0.68, 1.31, p = .532, or prevention focus, B = −0.30, 95% CI = −1.65, 1.04, p = .658, nor was the three-way interaction significant, B = 0.11, 95% CI = −1.55, 1.76, p = .901.

4 At follow-up, 29 sexually-active-at-baseline participants reported engaging in sexual activity during the course of the study. The interaction of self-affirmation and prevention focus yielded a large effect size (OR = 32.3, 95% CI = 0.53, 1958.03, p = .098; d = 1.91, see Table 2), though not statistically significant, presumably due to low power. Self-affirmation among those higher in prevention focus yielded greater condom use. However, there were no statistically significant transition points within the observed range of prevention focus. Of note, including the three participants who had their sexual debut during the follow-up period increased the p-level (OR = 11.01, 95% CI = 0.51, 235.50, p = .125), although the effect size remained large (d = .1.32).

5 Study 1 also found tentative evidence of behavioral differences at a one-week follow-up (also presented in a footnote): self-affirmed individuals higher in health prevention focus were more likely to use condoms (although the interaction was not statistically significant at p < .05, the study was underpowered for this outcome and the effect size was high. However, given the small number of participants in this analyses, any further interpretation would be speculative.