The Influence of Family Communication Patterns and Identity Frames on Perceived Collective Psychological Ownership and Intentions to Share Health Information

ABSTRACT

An experimental study exposed participants (N = 299) to different message frames to investigate whether Family Communication Patterns (FCP) and message characteristics influenced willingness to communicate about Family Health History (FHH). Message frames were either collective (our), individual (mine), or control (no pronouns). Afterward, participants were asked about their perceived collective psychological ownership of health information, attitudes, subjective norms, and FHH communication intentions. Although the message frames had no impact on perceived collective psychological ownership of health information, conversation orientation and conformity orientation (respecting parental authority) were positively associated with perceived collective psychological ownership of health information. Additionally, perceived collective psychological ownership, attitudes, and subjective norms were found to have indirect effects between FCP and FHH communication intentions. These findings provide further support that FCP influences how health message appeals are processed and suggest interventions could be tailored to FCP orientations for effective FHH behaviors.

Collecting and maintaining a family health history (FHH) allows individuals to understand what diseases run in their family (Centers for Disease Control and Prevention, 2017), which informs disease risks and decisions to engage in prevention behaviors. Only 40% of individuals report having collected this information despite overwhelming acknowledgment about the importance of FHH (Welch et al., 2015). Although health campaigns have encouraged families to talk about FHH, it remains unclear what characteristics of message appeals are most effective for communication.

As families are a specific type of group, it follows that the norms and attitudes of one’s group or family might inform whether messages encouraging FHH are effective. The purpose of this study is to investigate associations between family communication patterns and message frames (individual versus collective identity) on perceptions of collectively-owned health information (i.e., FHH). We also examine the psychological mechanisms that underpin the persuasive impacts of these message appeals on FHH behavior, including the indirect effects of family communication patterns (Koerner & Fitzpatrick, 2006; Ritchie, 1991) on individual decisions to disclose health information to family members.

Family communication patterns

Koerner and Fitzpatrick (2006) family communication patterns theory (FCP) suggests family communication schemata are defined by conversation and conformity orientations; as such, FCP provides a useful framework for understanding whether individuals disclose health information. Conversation orientation refers to how freely family members express ideas while conversation orientation refers to homogeneity of beliefs and attitudes held within the family (Koerner & Fitzpatrick, 2002). FCP proposes four family types including consensual (high conversation and conformity), laissez-faire (low conversation and conformity), protective (low conversation and high conformity), and pluralistic (high conversation and low conformity) families.

FCP are believed to influence how individual family members process messages (Schrodt et al., 2008), as well as behaviors and attitudes resulting from message exposure. For example, individuals with high conversation or conformity orientation who experienced greater psychological reactance following exposure to a persuasive message about organ donation were less willing to discuss organ donation with family members (Scott & Quick, 2012). Experiencing greater parental control (a dimension of conformity) was also shown to increase the likelihood of systematic processing that, in turn, increased attitudes and intentions for collecting FHH (Hovick et al., 2021); thus, individuals with a strong sense of adhering to parental control may be more likely to critically evaluate and be persuaded by messages.

An important caveat to studying FCP is the evolvement of conformity and conversation orientation conceptualization. Although family types were proposed to result from the interaction of orientations, little empirical evidence supports this assumption (Hays et al., 2017). Despite numerous definitions and measurements of these two constructs (Schrodt et al., 2008), researchers have struggled with capturing conformity orientation. Recent reconceptualization by Horstman et al. (2018) aims to incorporate positive elements of conformity, because homogeneity of ideas and beliefs are not necessarily indicative of negative traits (i.e., overbearing) and may elicit positive traits (i.e., togetherness) within the family. For example, those who conform to the viewpoint that health information is “family information” may be more likely to share health information with family members.

Despite what we know about conformity and conversation orientation, we still know little about the role of FCP on health behavior change, and specifically in the FHH context. Some have proposed that FCP acts as distal variables, indirectly influencing behaviors via health-related cognitions (Hovick et al., 2021). This is a key tenet of the integrative model of behavioral prediction (IMBP, Fishbein, 2009), which posits health behavioral intentions are a function of one’s attitudes, self-efficacy, and norms that are shaped by distal variables (e.g., culture, gender, personality traits, individual attributes) and may predict how an individual views the world and appropriate behaviors. However, despite the placement of FCP as a distal predictor of FHH behavior, more research is needed on mechanisms that explain the effects of conformity and conversation orientation on persuasive outcomes (i.e., perceptions of health information ownership).

Identity and information management

FHH information management

Although decisions to disclose health information may be shaped by FCP, some may not view FHH as inherently family information. Indeed, communication privacy management (CPM, Petronio, 2002) postulates decisional criteria for maintaining confidential information, such as revealing health information to family members. CPM describes a permeable boundary in which information is shared and becomes part of a collective, where others are involved in keeping information private. Thus, when information is shared with others, recipients and the individual who disclosed the information become co-owners of the information where rules are formed around the personal information.

Embedded within CPM’s notion of boundary setting is the framework of identity and sense of self (Petronio & Caughlin, 2006). Put simply, information begins as personal (mine) and becomes collective (ours) through disclosure to others. Whereas CPM approaches privacy management from an individual perspective, FCP theorizes communication patterns emerge from intragroup socialization (Bridge & Schrodt, 2013). Thus, group identity theories and related research may provide a better understanding of how intragroup socialization influences individual choices regarding information privacy boundary setting. More specifically, stronger (vs. weaker) family identity may influence communication regarding health information. For example, Xu et al. (2020) found that familism mediated intentions to practice safe sex among Chinese immigrant women in the United States, which suggests that connectedness to one’s family may have compelled women to speak up about safe sex with their partners.

Family connectedness likely factors into perceptions of family and personal identity. Scabini and Manzi (2011) believe that access to and internationalization of family heritage (including genetic information and relational schemas and behaviors), which is shaped by parent-child interaction and transmission, ultimately impacts individual identity within the family. Research supports the assertion that family schemas may be socially learned and transmitted across generations. Rauscher et al. (2020) found that grandparents, parents, and children share similar conversation and conformity orientations. Specifically, grandparent conversation and conformity orientations predicted parent FCP orientations that, in turn, predicted adult children’s FCP orientations. Because the transmission of generational FCP patterns appears to be an enduring trait that influences how one approaches communication, it follows that FCP may influence whether an individual views health information as something to be shared or held confidential.

A construct that might account for differences in the disclosure of FHH information within families is perceived psychological ownership (Pierce et al., 2003). Derived from organizational communication research, it refers to the perceived ownership of an idea or thought (Pierce & Jussila, 2010). Moreover, psychological ownership may be perceived as personal (mine) or collective (ours); thus, Pierce and Jussila (2010) define perceived collective psychological ownership as a shared mind-set by a group of individuals who consider themselves an “us.” To our knowledge, the relationship between FCP and perceived collective psychological ownership of health information has not been tested, although a relationship is likely.

We expect that FCP orientations (i.e., conformity and conversation orientation) will influence intentions to communicate health information via perceived collective psychological ownership. Research has demonstrated that relationships exist between conversation orientation and self-concept (Schrodt et al., 2008), as well as conversation orientation and self-disclosure; those from higher conversation-oriented families were more willing to disclose information (Huang, 1999). Because disclosing health information may lead to perceptions of co-owned information, we expect greater conversation orientation will increase the likelihood that FHH is viewed as collectively-owned amongst family members (see Figure in https://osf.io/vx9af/?view_only=dcded8c906e6490ca38068ff98eb945f). Conversely, while conformity orientation is typically not associated with greater self-disclosure (Huang, 1999), higher levels of conformity may lead to family unity (Horstman et al., 2018). Conformity orientation was positively associated with higher levels of family closeness and relational maintenance (Ledbetter & Beck, 2014); thus, it is plausible that conformity orientation may be associated with perceived collective ownership of health information. We propose that those with greater conformity orientation will be more likely to view FHH as collectively-owned amongst family members. Specifically, we predict conversation and conformity will be positively associated with perceived collective psychological ownership of family health information (H1).

Perceived psychological ownership of FHH information

Perceived collective psychological ownership is thought to influence intergroup dynamics related to possession and responsibilities within the group that may result in gate keeping (Verkuyten & Martinovic, 2017). A study by Kennedy-Lightsey and Frisby (2016) showed that perceived psychological ownership of information mediated the relationship between conformity orientation and privacy invasion, which contributed to parents engaging in privacy invasion behaviors of their adult children’s personal information. However, the researchers examined individual not perceived collective psychological ownership. Following Kennedy-Lightsey and Frisby (2016) work, we expect lower perceptions of collective psychological ownership of FHH to view health information as personal, thus safeguarding the information. Conversely, greater perceptions of collective psychological ownership should be associated with views of health information as belonging to the family. Indeed, evidence that psychological ownership influences health-related outcomes has been documented. Individuals who felt greater psychological ownership of their health care program (i.e., as “theirs”) were more likely to adhere to physician-prescribed treatments (Mifsud et al., 2019). Therefore, we believe that perceived collective psychological ownership will positively predict FHH communication intentions (H2).

Psychological ownership and links to identity

Social categorization theory (Turner, 2010) states that certain circumstances lead individuals to perceive a shared identity with a collection of individuals that can result in shared beliefs, behaviors, and attitudes, which may have implications for psychosocial health outcomes. Research by Tarrant and Butler (2011) suggests that the salience of different social identities may influence intentions to perform health behaviors. Participants’ intentions to consume alcohol were higher when a social identity associated with alcohol (i.e., student identity) versus an alternative social identity (i.e., national identity) was made salient. Therefore, we expect salient family identity will increase the likelihood that health information is viewed as belonging to the family vs. an individual. One circumstance where group identity may be primed is through the selective use of language. Perdue et al. (1990) found that participants exposed to the word “we” exhibited higher in-group bias than those exposed to out-group pronouns (they).

The current study compares the persuasive impact of message priming personal versus collective identity. Based on the literature, we expect exposure to a collectively-framed message promoting FHH as shared among family members, versus an individually-framed or control message, should exhibit greater perceived collective psychological ownership of FHH information (H3).

In addition to group bias, social categorization theory implies group membership influences intragroup processes, which may predict behaviors resulting from family communication patterns. When a particular identity is activated, the individual adopts the norms and attitudes of that identity and the group membership of that identity (Hogg, 2012). For instance, individuals who identified strongly with a reference group (i.e., friends) reported higher norms and attitudes toward wearing sunscreen that, in turn, predicted behavioral intentions to prevent overexposure to sun (Terry & Hogg, 1996). Thus, when group membership is activated, group norms or rules become more salient.

Although social categorization theory is understudied in health communication, there is likely a psychosocial impact on health outcomes. Haslam (2014) contends that group membership and social influence work in tandem to create positive health outcomes. In support of this proposition, Jetten et al. (2017) showed that the more an individual identifies with a group, the more the individual will strive to enact the norms and values associated with that group on health outcomes. Furthermore, a meta-analysis shows that social-identity based interventions had a moderate to strong impact on health, underscoring the impact of intragroup processes on health outcomes (Steffens et al., 2019). Thus, the reinforcement of family identity should cause individuals to comply with norms and attitudes regarding FHH shared by the family.

Because shared ownership involves a shared mind-set with a group, perceived collective psychological ownership should impact both family attitudes (i.e., evaluation of a target to some degree of favorability/unfavorability, Eagly & Chaiken, 2007) and subjective norms (i.e., approval and support of a specific behavior, Fishbein & Ajzen, 1975). In other words, individuals with greater perceived collective psychological ownership should experience more favorable attitudes toward and greater perceived norms for collecting FHH. Thus, we propose that perceived collective psychological ownership will be positively associated with (a) attitudes and (b) perceived subjective norms for collecting FHH (H4).

Finally, per the theory of reasoned action (Fishbein, 1979), we expect that intentions to collect FHH will be directly predicted by attitudes and subjective norms. Intentions to seek FHH information were predicted by attitudes toward seeking FHH information previously (Hovick et al., 2021). Additionally, subjective norms regarding FHH communication were positively associated with current FHH communication (Hong, 2018). Thus, we expect FHH-related attitudes and perceived subjective norms will be positively associated with FHH communication intentions (H5).

Methods

Design

Undergraduate students (N = 488) were recruited from a large Midwestern university in 2018 and received course credit for participation in a two-part study. Attrition between part 1 and part 2 (n = 175), and individuals who failed attention checks (n = 14), resulted in a final sample size of 299.

Procedure

To assess study hypotheses, a randomized controlled experiment was conducted. After collecting consent, participants completed a pretest questionnaire (Time 1) including FCP, FHH, and individual characteristics. About one week later (Time 2), participants were randomly assigned to a between-subjects experiment. Each research subject was assigned to a condition featuring messages that were framed as either (1) collective, (2) individual, or (3) control (not collectively or individually framed). The messages were based on information from the Centers for Disease Control and Prevention (2018) and presented as a series of nine clickable slides about the importance of FHH (view at https://osf.io/vx9af/?view_only=dcded8c906e6490ca38068ff98eb945f). Following message exposure, a posttest questionnaire collected subjective norms, attitudes, intentions to communicate FHH, and perceived psychological ownership (Time 2).

Measures

All items for were measured on a scale of 1 (strongly disagree) to 5 (strongly agree) and the mean of the items were used in the analyses unless noted otherwise.

FCP. Conversation orientation was measured using 10 items from Ritchie and Fitzpatrick (1990) at Time 1. Sample items include, “In our family, we often talk about our feelings and emotions,” and “My parents like to hear my opinions, even when they don’t agree with me” (α = .92).

The extended conformity orientation scale (ECOS, Horstman et al., 2018) was used to measure conformity orientation. The ECOS measure was designed to capture four latent factors, respect for parental authority, experiencing parental control, adopting parents’ values/beliefs, and questioning parents’ beliefs/authority through 24 items. Example items include, “My parents expect us to respect our elders” (respect for parental authority, α = .87), “My parents become irritated with my views if they are different from their views” (experiencing parental control, α = .84), and “My parents encourage me to adopt their values,” (adopting parents’ values/beliefs, α = .84). The last dimension labeled as questioning parents’ beliefs/authority was reverse coded so that all dimensions of the conformity orientation were measured in the same direction. A sample item included, “In our home, we are encouraged to question my parents' authority” (α = .78). Confirmatory factor analysis was conducted to validate the scale, as noted below.

Attitudes. Attitudes were measured at Time 2. Five semantic differential items assessed, on a scale of 1 to 10, if talking with family members would be worthless/valuable, bad/good, harmful/beneficial, not helpful/helpful, and foolish/wise (Ajzen, 2014), (M = 8.52, SD = 1.92, α = .97).

FHH Communication Intentions. Two items were asked to determine intentions to communicate FHH at Time 2. Items included, “I plan to seek information from my family about my disease risk in the near future,” and “I intend to find more information about disease that affect my family soon,” (M = 3.57, SD = .83, α = .90).

Perceived collective psychological ownership. Two items were adapted from Van Dyne and Pierce (2004). “I sense that health history is our family health history,” and “This is our family’s health history,” were measured at Time 2, (M = 3.88, SD = .75, α = .82).

Perceived subjective norms. Four items were used to assess subjective norms surrounding seeking family health information at Time 2 (Ajzen, 2014). Items included, “Most people whose opinions I value would approve of my seeking information about family health,” and “Most people who are important to me would support that I seek information about family health,” (M = 3.49, SD = .76, α = .85).

Data analysis

First, pearson correlations between the model variables and descriptive statistics were calculated (see table in supplementary materials). A hierarchical CFA on the conformity orientation measure was also conducted to verify scale reliability. Cronbach’s alphas were calculated to assess scale reliabilities. Analysis of Covariance (ANCOVA) was conducted to determine the effects of the message frames on perceived collective psychological ownership and multiple linear regression analyses were conducted to test our study hypotheses. Indirect effects were also calculated using the PROCESS macro model 81 (Hayes, 2018), which allows for the testing of serial and parallel mediation pathways from one independent variable to one dependent variable. Gender (1 = female, 0 = male) and race and ethnicity (1 = non-Hispanic White, 0 = other races and ethnicities) were used as covariates in all analyses.

Results

Confirmatory factor analysis

Because Hovick et al. (2021) found weak support for a second-order factor using the ECOS scale, we performed a hierarchical CFA using Mplus Version 8 with a robust maximum likelihood method of estimation. To assess model fit (Brown & Cudeck, 1993; Hu & Bentler, 1999), we examined chi-square, standardized root mean residual (SRMR; values lower than .08), root mean square error approximation (RMSEA; values lower than .08), and comparative fit index (CFI; values close to or greater than .95).

The model fit indicators (χ2 (248) = 776.37 (p < .05), RMSEA = .084 (90% CI: .08, .09), CFI = .82, and SRMR = .10) indicated a poor fit to the data, although standardized loadings were above .48 onto their respective first-order latent subscale factors. When examining the standardized first-order loadings onto the second-order conformity factor, one of the latent factors (experiencing parental control) resulted in a loading above 1 and had a negative residual variance suggesting that the factor was highly correlated with other factors; indeed, experiencing parental control was highly correlated with adopting parents’ values/beliefs (values ≤ .69), and respecting parental authority (values ≤.44). We removed adopting parents’ values/beliefs from the model and ran a hierarchical CFA on conformity orientation with three latent factors (respect for parental authority, experiencing parental control, and not questioning parents’ beliefs/authority), but the model fit was still poor (χ2 (254) = 1504.175 (p < .05), RMSEA = .13 (90% CI: .12, .14), CFI = .56, and SRMR = .20); thus, the three factors (respect for parental authority, experiencing parental control, and not questioning parents’ beliefs/authority) were entered separately into the models tested.

A final CFA was conducted with the remaining model variables: perceived collective psychological ownership, attitudes, subjective norms, FHH communication intentions, and conversation orientation. The model provided a good fit to the data (χ2 (220) = 611.585 (p < .05), RMSEA = .08 (90% CI: .07, .08), CFI = .88, and SRMR = .05), with all standardized factor loadings between .55 and .97.

Preliminary analyses

Demographics. Research participants were between the ages of 18 and 49, predominantly female (67.9%; n = 203) and included 31.8% males (n = 95) and one participant who identified as gender non-binary. Only 11% (n = 34) indicated having a spouse or partner. The majority were non-Hispanic White (66.7%; n = 199), with the remaining sample including Asian (16.1%; n = 48), Black (10%; n = 30), and individuals with Latin origins (6.4%, n = 19).

Independent samples t-tests were used to assess differences in conversation and conformity orientation based on gender and race and ethnicity. No significant gender differences were detected on conversation orientation or on conformity dimensions (p > .05). However, gender differences on not questioning parent beliefs/authority (M_female = 2.96 (SD = .84), M_male = 3.16 (SD = .77)) approached significance (t(296) = 1.97, p = .05). Similarly, we did not detect race and ethnicity differences on conversation orientation or respecting parent authority (p > .05). However, non-White participants (M = 3.35, SD = .89) reported greater experiencing parental control than White participants (M = 2.86, SD = .89), t(297) = 4.55, p < .001. Non-white participants (M = 3.26, SD = .91) also reported higher levels of adopting parental beliefs/values relative to White participants (M = 2.83, SD = .82), t(297) = 4.13, p < .001, while White participants (M = 3.12, SD = .74), relative to non-white participants (M = 2.84, SD = .94) reported higher levels of not questioning parent beliefs t(297) = −2.91, p = .004.

Message manipulation

ANCOVA was used to assess the effects of message frames on perceived collective psychological ownership. No differences were found across conditions on perceived collective psychological ownership, F(2,294) = .109, p = .896 (H3 unsupported). Therefore, message condition was dropped from further analyses.

Main model tests

Multiple regression analyses examining FHH-related cognitions (collective psychological ownership, attitudes, subjective norms) and FHH communication intentions are shown in Table 1.¹ As expected, attitudes and subjective norms were positively associated with FHH communication intentions (p < .001; H5 supported), although collective psychological ownership, gender and race and ethnicity were unassociated (p > .05; H2 unsupported). Conversation orientation and the conformity dimension of experiencing parental control were also associated with FHH communication intentions (p < .01).

Table 1. Direct relationships between model variables (N = 298).

	Perceived Collective Psychological Ownership			Attitudes			Subjective Norms			FHH Communication Intentions
	B	SE	p	B	SE	p	B	SE	p	B	SE	p
White	−.054	.097	.582	.045	.242	.851	.118	.091	.194	−.128	.093	.172
Female	.134	.092	.144	.318	.229	.165	.102	.086	.237	.079	.088	.371
Conversation Orientation	.104	.063	.099	.385	.158	.015	.218	.059	< .001	.239	.062	< .001
Respecting Parental Authority	.214	.082	.010	.103	.207	.619	.174	.078	.026	−.077	.080	.335
Experiencing Parental Control	−.072	.060	.235	−.251	.150	.096	−.018	.056	.745	.190	.058	.001
Not Questioning Parents’ Beliefs	.011	.062	.858	.432	.153	.005	−.028	.057	.627	−.086	.060	.151
Perceived Collective Psychological Ownership				.407	.146	.006	.209	.055	< .001	.079	.058	.172
Attitudes										.087	.023	< .001
Subjective Norms										.305	.061	< .001
F(df)	3.044 (6,291)			5.006 (7,290)			9.297(7,290)			12.929(9,288)
R2	.06			.11			.18			.28

Conversation orientation was further associated with attitudes and subjective norms (p < .05), but unassociated with collective psychological ownership (p > .05). Only the conformity dimension of respecting parental authority was associated with collective psychological ownership (p < .05, H1 partially supported), which was positively associated with attitudes and subjective norms (p < .001, H4 supported). The conformity dimension of not questioning parents’ beliefs/authority was also associated with attitudes toward FHH collection (p < .05).

We also assessed the indirect effects of conversation and each conformity dimension (4 models in total) on FHH communication intentions via perceived collective psychological ownership, attitudes, and subjective norms were tested using PROCESS (Hayes, 2018). Direct relationships are shown in Figure 1. Conversation orientation indirectly influenced FHH communication intentions via perceived collective psychological ownership and subjective norms (Est. = .010, [CI .020, .022]), as well as via perceived collective psychological ownership and attitudes (Est. = .005, [CI .001, .013]). When testing indirect effects of each conformity dimension on FHH communication intentions, significant indirect effects were found for respecting parental authority only. Specifically, an indirect effect was detected for respecting parental authority on FHH communication intentions via perceived collective psychological ownership and attitudes (Est. = .008, [CI .001, .021]) and via perceived collective psychological ownership and norms (Est. = .018, [CI .002, .040]), significantly mediating the relationship between respecting parental authority and FHH communication intentions (Figure 2).

Figure 1. Direct effects of conversation orientation on FHH communication intentions via perceived collective psychological ownership, attitudes, and subjective norms (N = 298).

Figure 2. Direct effects of respecting parental authority on FHH communication intentions via perceived collective psychological ownership, attitudes, and subjective norms (N = 299).

Discussion

This study sought to test the persuasive effects of FHH messages, comparing individual versus collectively framed messages, on family communication patterns and FHH behaviors. Our results provide new insights regarding the facilitators of FHH communication. Perceived collective psychological ownership was shown to be a robust mediator of the effects of FCP on intentions. Those high in conversation or conformity orientation were more likely to perceive family health information as shared, which was associated with more positive attitudes, subjective norms, and FHH communication intentions. These findings provide support for self-categorization theory (Turner, 2010), which suggests that group membership activates a shared group mind-set and provides evidence that individuals from families who are more conversation-oriented and have more respect for parental authority may share a group mind-set regarding family (vs. individual) ownership of health information (i.e., greater perceived collective psychological ownership). For FHH messages to be effective (particularly those delivered interpersonally, such as from a genetic counselor to patient), health communicators must be aware of the degree to which individuals perceive FHH as owned by the individual versus the family. Additionally, it may be advantageous for communicators to consider ways to target or promote a shared group mind-set regarding the ownership of FHH information.

Interestingly, perceived collective psychological ownership was not shown to directly increase behavioral intentions to collect health history. Thus, its effects appear to be largely indirect via attitudes and subjective norms. As others have noted (Pierce et al., 2003), our findings suggest that the degree to which an individual views their health information as shared may shape their perceived attitudes and norms toward FHH communication and influence their seeking and sharing intentions. It is worth noting that recent research has distinguished norms at the societal or family level (Hay et al., 2016). It is possible that an individual’s family norms may differ from global subjective norms (as measured here). Future studies on FHH message effectiveness should incorporate broader measures of norms to include family norms, as well as investigate the relationship between perceived collective psychological ownership and family norms.

Future research would do well to investigate people’s perceptions of ownership of their FHH information as collective psychological ownership may potentially be a robust mediator for FHH communication intentions. Future research should also examine whether personal psychological ownership is inversely related to collective psychological ownership in health information contexts.

Interestingly, the messages we designed to activate collective or personal identities did not impact perceived collective psychological ownership; in retrospect, the manipulation of pronouns may have been too subtle for the topic of this study. Simply reminding everyone to collect FHH, a topic that was consistent throughout all conditions, may have increased familial identity. Conversely, writing about oneself or one’s family may have been a stronger manipulation of identity. Future studies should examine whether exposure to messages activating other identities (e.g., professional identity, gender, culture, etc.) impacts people’s perceived psychological ownership of health information and intentions to talk to family members. However, scholars should also explore how this message strategy compares to one focusing primarily on attitudes and subjective norms, particularly among individuals with higher perceived collective psychological ownership.

Our results suggest that family schemata (i.e., conversation and conformity orientation) may influence how an individual processes and responds to health appeals designed to encourage FHH collection. Although aspects of high conformity (i.e., respecting parental control) did not directly predict message consistent attitudes, perceived collective psychological ownership of health information indirectly effected favorable attitudes and intentions to collect FHH. Messages targeting families to engage in FHH could be tailored with conversation and conformity orientations of the individual receiver in mind. It is possible that those who are high in conversation orientation simply need a reminder of the benefits of collecting one’s FHH, while those who are high in conformity orientation may need to be convinced or provided with examples to build efficacy to start the conversation. Furthermore, appealing to conformity orientation – incorporating values that the family shares such as respecting elders – may elicit favorable attitudes and intentions to collect FHH; narrative messages, which are likely to encourage story consistent attitudes and behaviors, may be one way to do this (see Moyer-Gusé, 2008).

Interestingly, although conversation and conformity dimensions are thought to interact (Keating, 2016), we found no evidence of an interaction between FCP orientations. Furthermore, although we used a more recent version of the conformity measurement proposed by Horstman et al. (2018), conformity subscales failed to load a higher-order conformity factor were analyzed separately in our model.

It is possible that the different dimensions of conformity respond differently to message attributes, which would explain why experiencing parental control predicted message processing (Hovick et al., 2021) and respecting parental authority predicted perceived psychological ownership in the current study. It is also possible that higher respect for parental authority, unlike other conformity dimensions (e.g., experiencing parental control), may be an indicator of collective orientation of health information. In other words, those who have are higher respect for parental authority may already view health information as family-owned due to a deference toward parental figures. Although the conformity measurement has evolved, further clarification is needed to capture the full conceptualization of conformity.

Limitations

Our study adapted information from the Centers for Disease Control and Prevention (2018) to craft messages, however, our messages were rudimentary compared to actual health appeals (e.g., testimonials or pamphlets). Future studies should test a variety of health messages across different formats to better understand their persuasive impact. Another limitation of our study was the use of a convenience sample. It is likely that a general population which includes older adults may determine the topic of FHH collection to be more relevant than younger adults. Furthermore, testing FCP measures with more diverse participants is needed.

Conclusion

This study demonstrates FCP are distally related to FHH communication intentions, providing further support for the IMBP that FCP acts as a distal variable for message processing and persuasion. A link between FCP and perceived collective psychological ownership was found such that higher conversation orientation and respecting parental control was found to have higher levels of perceived collective psychological ownership. The more an individual believes their health information is shared among family members, the more favorable attitudes, subjective norms, and intentions to collect other family members’ health information are likely. Knowledge of conversation or respecting parental authority levels can be helpful in persuading communication of health information within the family. These individuals already view health information as collectively owned with family members, thus framing FHH as owned by the family should be received favorably. Conversely, low conversation or respecting parental authority led to lower perceived collective psychological ownership of health information. These individuals may be more guarded with health information; as such, other motivating factors (i.e., framing FHH seeking/sharing as a family duty) may assist in persuading these individuals to communicate.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes

1. Per the FCP, we also tested whether there was an interaction between conversation and conformity measures on the model variables. We did not find evidence of an interaction (p > .05) between subdimensions and conversation, therefore we test main effects of conversation and conformity in main model tests.