Effects of Message Framing on Influenza Vaccination: Understanding the Role of Risk Disclosure, Perceived Vaccine Efficacy, and Felt Ambivalence

ABSTRACT

The current study examined the effects of framing in promotional health messages on intention to vaccinate against seasonal influenza virus. The findings of an experimental study (N = 86) indicated that exposure to both benefits and side effects of vaccination (gain-framed with risk disclosure message) led to lower intention to receive the flu vaccine. This relationship was mediated by both perceived vaccine efficacy and felt ambivalence in a serial order, revealing the underlying psychological mechanisms important for understanding health-related behaviors. Theoretical implications of constructing sub-framed messages are discussed and the concept of second-order framing is introduced.

KEYWORDS:

• Message framing
• influenza vaccination
• risk disclosure
• perceived vaccine efficacy
• felt ambivalence

Notes

¹ Risk disclosure is conceptualized in our study as disclosure of possible side effects of vaccines in the content of the promotional health message. Another form of risk is addressed by prospect theory, which states that people are generally more risk averse when being exposed to gain-framed messages, and more risk seeking when exposed to loss-frame messages. Stemmed from the prospect theory, risk aversion in our study could be conceptualized as avoiding the risk of getting the flu. Although the same word is used in both risk disclosure and risk aversion, in the former context the term risk addresses the risk of side effects of vaccines and in the latter the risk of getting the flu. The authors acknowledge that the conceptualization of risk might be convoluted in the prospect theory as addressed by some authors (e.g., Van’t Riet et al., 2016) and that the theoretical conceptualization of the term should be further addressed in future studies.

² The discomfort experienced from cognitive dissonance (Festinger, 1957) has sometimes been argued as similar to attitudinal ambivalence, but the two concepts are distinct (for discussion see Newby-Clark, McGregor, & Zanna, 2002; Van Harreveld, Van Der Pligt, & De Liver, 2009). According to Van Harreveld et al. (2009), dissonance is a result of a commitment to behavior that is in conflict with one’s attitude, whereas ambivalent attitude holders have not committed themselves by making a choice between the opposing beliefs. Thus the main difference lies in the level of commitment that can be related to distinction between judgment and choice.

³ In order to further examine the causal order of mediators, an alternative mediation model was tested (message framing → felt ambivalence → perceived vaccine efficacy → vaccination intention). The significance of both models was same (R² = .67, F(4, 81) = 40.22, p < .001). The serial indirect effect in the alternative model was also found significant (point estimate = –.10, SE = .08, 95% CI = [–.296, –.001]). Using PROCESS macro for mediation analysis only provides unstandardized point estimates of indirect effects, thus directly comparing the sizes of indirect effects of two models would not be possible. However, the investigation of each path showed that the path between media exposure and felt ambivalence in the alternative model was not significant. Exposure to gain-framed with risk disclosure message did not lead to felt ambivalence (b = .54, SE = .30, p > .05). Even though the paths between felt ambivalence and perceived vaccine efficacy (b = –.25, SE = .09, p < .01), and between vaccine efficacy and vaccination intention (b = .78, SE = .09, p < .001) respectively were statistically significant in the alternative model, the insignificant path between the independent variable and the first mediator demonstrates that theoretically and statistically the original model used in this study (message framing → perceived vaccine efficacy→ felt ambivalence → vaccination intention) had better explanatory value.