Health campaigns usually adopt a message-frame in communication that provides arguments to prompt people to behave in a certain way (Hamilton, Biener & Brennan, 2008). Framing is a process by which an issue is represented from different perspectives. Different perspectives have different implications for people’s considerations about this issue (Chong & Druckman, 2007). Framing influences attitudes, intentions and behaviors (Rothman, Bartels, Wlaschin & Salovey, 1993).
Over the years, several researchers (Detweiler, Bedell, Salovey, Pronin & Rothman, 1999; Kreuter & McClure, 2004; Rothman, Salovey, Antone, Keough & Martin, 1993) have focused on the effectiveness of gain-framed messages and loss-framed messages in promoting health behaviors. Gain-frame messages highlight the advantages of engaging in a health behavior whereas loss-frame messages highlight the disadvantages of not engaging in the health behavior (Gallagher & Updegraff, 2012). Meta-analyses suggested that gain-framed messages work more efficiently for preventive behaviors whereas loss-framed messages work better for detection behaviors (Gallagher & Updegraff, 2012; O’Keefe & Jensen, 2008). Due to the preventive nature of the behavior under study and in line with these previous findings, I overtly decide to focus only on the benefits (gain-framed messages) of engaging in daily SPF sunscreen application.
For the sake of clarity, I follow unfold the structure of the theoretical background. First, I present the role of temporal framing messages and CFC on attitude and behavioral beliefs. Second, I propose the mediating role of counter-arguing. And finally, I introduce the moderation effect of the type of the claims (health vs marketing claims). The conceptual model and hypotheses are below presented in Figure 1.
Figure 1. Theoretical conceptual model and hypotheses. Conditional effects of temporal framing messages and CFC are indicated by H1. Conditional effects of temporal framing messages and CFC on behavioral beliefs are indicated by H2.1.The mediation effect of behavioral beliefs is indicated by H2.2. The main effect of temporal framing messages on and counter-arguing is indicated by H3.1 and the mediation effect through counter-arguing on attitude by H3.2. The moderation effect of the type of claim is indicated by H4.1. Whereas the moderated mediation effect of type of claim on attitude through counter-arguing is indicated by H4.2.
Temporal Framing Messages and Consideration for Future Consequences (CFC)
Why does temporal framing matter? What kind of temporal framing would enhance positive attitude towards daily SPF sunscreen application? Further, are people predisposed in the same way towards different temporal frames? In this section, I address these questions by introducing: firstly, temporal framing and the psychological theory which lies behind it, secondly, the cognitive trait of consideration for future consequences (CFC).
According to the construal level theory (CLT; Trope & Liberman, 2010), people directly experience the present: the “here” and the “now”. Although people cannot experience what is not “here” and what is not “now”, they can make inferences about the future (i.e., about tomorrow or about next year). These inferences are also known as temporal predictions. Generally, temporal predictions may be more or less accurate according to how distant they are from the present. For instance, a person may be more accurate to predict whether she will go to the beach tomorrow, compared to whether she will go to the beach in a year. Temporal predictions are usually operationalized as temporal framing messages (Chandran & Menon, 2004; Trope & Liberman, 2010). Temporal framing messages express objective time periods which may either convey the short- or the long-term consequences of a certain behavior (Chang & Lee, 2009). In specific, short-term consequences address to immediate (near future) outcomes whereas long-term consequences address to delayed (distant future) outcomes.
In the domain of preventive behaviors, previous studies did not find any effect of framing on attitudes (Gallaggher & Updegraff, 2012; O’Keefe & Jensen, 2008). However, Strathman et al. (1994) found a significant effect of temporal framing messages on attitude towards the message. In particular, attitude was strengthen by the conditional effect between temporal framing messages and peoples’ cognitive trait of CFC. This supports the assumption that the effectiveness of temporal framing is largely moderated by CFC (Orbell & Kyriakaki, 2008; Orbell, Perugini & Rakow, 2004).
CFC is a stable cognitive trait which impacts on the persuasiveness of the message. People differ on the extent they think about future consequences. In deciding how to behave, they take into consideration the short- or long-term outcomes of their choices (Strathman et al., 1994). People lower in CFC tend to focus more on the short-term consequences of a choice. Whereas people higher in CFC tend to focus more on the long-term consequences of a choice (Orbell & Kyriakaki, 2008; Orbell et al., 2004). CFC also guides information processing and attitude formation with regard to a certain behavior (Orbell & Hagger, 2006). People’s final evaluations of a behavior arise from the temporal frame manipulation of the message. Evidence showed that people lower in CFC had more positive evaluations towards the message when its outcomes occurred in the short-term, compared to the long-term. Whereas people higher in CFC had more positive evaluations towards the message when its outcomes occurred in the long-term, compared to the short-term (Orbell & Hagger, 2006; Orbell & Kyriakaki, 2008).
Because temporal framing and people’s variations in CFC share the same temporal orientation (Adams, 2012), many studies adopted the “interactionist perspective” (Kees, Burton & Tangari, 2010; Orbell & Kyriakaki, 2008; Orbell et al., 2004; Ouellette, Hessling, Gibbons, Reis-Bergan & Gerrard, 2005). Building on these findings, I propose CFC as a moderator on the main effect of temporal framing messages on attitude. The conditional effects may provide great insights in explaining under which circumstances people engage or not engage in the daily SPF application. Thus, the first hypothesis of this study is put forward:
H1: CFC moderates the effects of temporal framing messages such as short-term consequences lead to more favorable attitude towards daily SPF sunscreen application for people lower in CFC, compared to people higher in CFC.
An Extension from the Theory of Planned Behavior (TPB; Ajzen, 1991)
The theory of planned behavior (Ajzen, 1991) suggests that behavioral beliefs may work as determinants of the behavior, which indirectly influence attitude (Conner & Sparks, 2005). Behavioral beliefs may be activated by the mere message exposure. And they may reinforce the conditional effects of temporal framing messages and CFC on attitude. Preventive behaviors are commonly retained to be a function of several beliefs such as general health values and beliefs about the severity of threat (Strathman et al., 1994). Behavioral beliefs determine a person’s attitude toward the behavior (Abroms, Jorgensen, Southwell, Geller & Emmons, 2003). For instance, a person who believes that SPF sunscreen application reduces the threat of severe skin damages will have a more favorable attitude towards daily SPF sunscreen application.
A focus group study investigated about participants’ reasons for and against protecting themselves from the sun. It was found that several behavioral beliefs were involved in predicting whether people would have undertaken or not the preventive behavior. Participants who held more positive behavioral beliefs about sunscreen application were more likely to engage in sunscreen application, compared to the ones who held more negative behavioral beliefs (Abroms et al., 2003). The intensity and the valence of people’s behavioral beliefs influenced attitude. Taking into account these findings and building on the TPB (Ajzen, 1991), the second hypothesis of this study is put forward:
H2: Behavioral beliefs mediates H1. Short-term consequences and lower CFC lead to more favorable behavioral beliefs (H2.1), which in turn positively influence attitude towards daily SPF sunscreen application (H2.2).
Now, building upon the persuasion knowledge model (PKM; Friestad & Wright 1994), I propose the other two factors which may inhibit SPF sunscreen application. First, I present the mediating effect of counter-arguing. Second, I introduce the moderator type of claim (health vs marketing claims).
Before addressing to counter-arguing, I explore how associations in the memory may influence attitude. People’s mind automatically evokes associations. Evidence suggest that the mere exposure to a message activates a causal sequence of associative connections in people’s memory. The associative connection works as follow: claims, or messages, evoke associations, which in turn elicit reactions and attitudes (Kahneman, 2012). This mechanism is also known with the term associative coherence. Associative coherence is either positive (i.e., cognitive ease) or negative (i.e., cognitive strain). The positive associative coherence is associated with good feelings and it evokes favorable attitudes. Whereas the negative associative coherence is associated with bad feelings and it evokes unfavorable attitudes (Kahneman, 2012). This latter may be one of the psychological foundations on which the persuasion knowledge model (PKM) is built upon (Friestad & Wright, 1994).
The PKM suggests that the exposure to persuasive messages leads to the activation of people’ persuasion knowledge (PK). The PK is people’s ability to identify when a persuasion attempt occurs. Because people want to protect their freedom in choices, to cope with the persuasion attempt, they will engage in counter-arguing (Brehm, 1966). Eventually, counter-arguing will lead to less favorable attitudes towards the message (Matthes, Schemer & Wirth, 2007). Specifically, counter-arguing may be translated in terms of disbelief and scepticism. It reflects a person’s orientation to question about the message validity (Obermiller, Spangenberg, & MacLachlan, 2005). Previous studies focused on message counter-arguing with regard to persuasive appeals, however, the effects of temporal framing messages on counter-arguing are still open to debate.
With regard to the time context, the CLT (Trope & Liberman, 2010) suggests that the retrieval process is more concrete for near future events than for distant future events. Short-term consequences should be easier to elaborate, compared to long-term ones. However, due to their low level of abstraction, short-term consequences may prompt people to experience more cognitive strain, therefore more counter-arguing, than long-term consequences. Cognitive strain may arise when the message evokes associations which do not align with its claims. When a discrepancy is noted, the cognitive strain may mobilize people to engage in a more analytical mode which eventually enhances counter-arguing (Kahneman, 2012). Further, the CLT (Trope & Liberman, 2010) proposes that the time context influences the abstract representation of a behavior and its outcomes. In the distant future (i.e., visible skin improvements within six months), the representations of a behavior and its outcomes are vague and blurry. Whereas in the near future (i.e., skin improvements within one week), due to the behavioral outcomes proximity in time, details and behavioral outcomes are much better retrieved and remembered. Thus, a discrepancy between the message claims and the consequences of the SPF sunscreen application on one’ skin may be faster and easily detected. Building upon this idea, I follow put forward the third hypothesis of this study:
H3: Counter-arguing mediates the effects of temporal framing messages on attitude. Short-term consequences, compared to long-term consequences, endorse more counter-arguing (H3.1) which in turn negatively influences attitude towards daily SPF application (H3.2).
Type of the Claim
Is the type of the claim another factor which may moderate the persuasiveness of preventive messages? Are people able to differentiate between health and marketing claims? These are the leading questions of the last section of this study.
To engage in the preventive behavior, namely, the daily SPF sunscreen application, people need to own or buy SPF sunscreens. SPF sunscreen is a purchasing prevention product (Chang, 2007), which completely falls into the category of cosmetics (regulations (EC) No 1223/2009: ec.europa.eu). As marketers, health marketers1 use claims with a persuasive intent. Here again my line of argument is built upon the PKM , which suggests that persuasion knowledge develop simultaneously with the persuasion experience (Friestad & Wright, 1994). When the relationship between persuasion knowledge and persuasion experience holds true, people should be able to detect marketers’ persuasive attempts.
For their persuasive character, health messages (i.e., promoting a healthier skin) are identical to any other marketing messages (i.e., a message promoting a new shampoo or a chocolate bar). Because claims are often used as shortcuts in product evaluation, they are very likely to affect people’s attitudes towards the product (Souiden, Abdelaziz & Fauconnier, 2013). Evidence suggests that marketing claims, compared to nutrient or health-related claims, on food packaging enhance more counter-arguing and scepticism towards the food product (Tan & Tan, 2007). Most studies so far focused on the type of the claim with regard to food products. Whereas no research was conducted with regard to preventive purchasing products (i.e., SPF sunscreens).
In the healthcare sector, people face a bewildering number of health information combined with marketing claims (Chang, 2007). For instance, a SPF sunscreen may claim to be a “20 broad spectrum UVA protection” and “hydrorush moisturizing and hydrant express” (Clinique.com). According to the European Commission report (2016), sunscreens, as well as skin care products, contain claims addressing the product efficacy to improve one’s health (i.e., against free radicals) and claims addressing the product performance (i.e., anti-ageing). Although literature on health and marketing claims is very poor, I build my definitions on the aforementioned differentiation. I categorize as health-related claim any message which conveys evidence about the product efficacy on one’ skin health (i.e., for a healthy skin). Whereas as marketing claim any message which conveys general evidence about the product performance on one’ skin appearance (i.e., smooth your skin to perfection). It may be that the nature of the claim, whether health-related or marketing-oriented, influences people’s attitudes towards daily SPF sunscreen application. The type of claim may moderate the relationship between temporal framing messages and counter-arguing, such as the marketing claim will endorse more counter-arguing towards the SPF sunscreen, which would lead to more negative attitudes towards the daily SPF sunscreen application. The fourth hypothesis of this study is put forward:
H4: Type of claim (health vs marketing claim) moderates H3 such as short-term consequences endorse more counter-arguing (H4.1) which in turn negatively influences attitude towards daily SPF application (H4.2). The effect is stronger when the SPF sunscreen is presented with a marketing claim, compared to a health claim.
1 With the term health marketers, we refer to those marketers who address the second stage “safety needs” of the Maslow hierarchy of needs (Maslow, 1971).