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date: 21 July 2017

Positive Affect Related to Health and Risk Messaging

Summary and Keywords

Positive emotional appeals can be an important, if often underutilized, component in health campaigns. Research reviewed from advertising, marketing, health communication, and social influence demonstrated how campaigns can promote risk-reduction behaviors by focusing on positive incentives, highlighting positive outcomes, and evoking positive feelings toward the health-related behavior. People who feel good during and after exposure to a health message tend to have favorable attitudes toward the message, which in turn establishes more open, rather than resistant, attitudes toward the issue or risk-reduction behavior promoted in the message. Along with influencing behavior via attitudes, positive affect can have a direct impact on behavior or intention. As suggested by broaden-and-build theory, positive affect broadens attention and thinking processes, increases openness to information, and helps form beliefs that the behavioral change promoted in the message is possible. Relatedly, positive affect tends to activate approach-oriented behaviors through the function of the behavioral activation system.

Two primary strategies have demonstrated efficacy at promoting positive feelings: the use of gain-framed appeals and evoking the core relational theme of happiness. Gain-framed appeals emphasize the rewards obtained by following message recommendations and can boost behavioral adoption, particularly of proscriptive behaviors, by highlighting positive outcomes and goal congruency. Happiness occurs when people believe they are making progress toward realizing their goals, and messages can be created to induce positive feelings like happiness by focusing on self-efficacy, response efficacy, and perceived benefits. Positive message appeals are especially useful for counteracting the potential drawbacks of traditional negative appeals in that they can reduce message fatigue, gain attention, and attenuate psychological reactance. Challenges for future research include increasing efforts to systematically understand how and when to best utilize the power of positive messages in campaigns. Another related challenge is to examine how positive affect is aroused at a particular stage of exposure to health risk messages, and how emotions (both negative and positive), flow, evolve, and transit from one to another (e.g., fear to relief, anxiety to happiness) during and after message exposure.

Keywords: positive affect, message attitude, issue attitude, behavioral change, broaden-and-build theory, BIS/BAS, gain frames, self-efficacy

Many health campaigns emphasize fear and risk to motivate individuals to change unhealthy behaviors or to prevent them from trying risky things, yet people are quite good at avoiding information that is personally threatening to them (Jemmot, Ditto, & Croyle, 1986; Van’t Riet & Ruiter, 2013). Therefore, message designers need tools to reach those who might find fear-based appeals too threatening. The use of positive message appeals is one such tool. Work from advertising, social marketing, persuasion, and particularly health communication campaigns shows how best to harness positive affect to influence health attitudes, behavioral intent, and behavior.

Affect is the product of an individual’s evaluation of the person–environment relationship. It is a general term that encompasses both specific emotions, such as joy and anger, as well as broader diffuse states, such as mood (see Batson, Shaw, & Oleson, 1992; Isen & Daubman, 1984). Affect may result from a specific stimulus, such as an uplifting message, or from a variety of stimuli, such as being in a positive mood when everything seems to be going your way. In the context of health and risk messaging, positive affect is considered a dimension (e.g., feeling good) and a specific emotion (e.g., happiness) induced in the individual by the message.

First, a dimensional approach emphasizes pleasant feeling states and moods (Cameron, Bertenshaw, & Sheeran, 2015; Russell & Barrett, 1999). Individuals who are in a positive mood are more likely to establish incentive-oriented motivation and to engage in goal-directed behaviors (Yan, Dillard, & Shen, 2010). Typically, researchers create a positive mood in participants and then assess how mood affects their perceptions of health messages. A number of studies have demonstrated that global affective states, such as feeling good, influence both the processing of messages and the recall of messages (see Bless, 2000; Forgas, 1998). For example, Mitchell, Brown, Morris-Villagran, and Villagran (2001) examined how mood and message features interacted to affect participants’ judgments of an appeal to donate bone marrow. They found that happy individuals had more relevant thoughts about strong persuasive messages encouraging bone marrow donation and were more likely to recall the strong persuasive messages than were angry or sad individuals, yet those in a happy mood also were more likely to discount weak messages.

Second, from a discrete emotion perspective, researchers examine how messages evoke specific emotions, which in turn affect the persuasion process. Dillard and Meijnders (2002) argued that specific emotions induced by messages provided the basis for persuasion. Researchers assess how the use of strategies like humor and uplifting appeals in a message triggers feelings of happiness, positive self-regard, or benefits for the self, which in turn affect attitude and behavior (Baek & Reid, 2013; Nabi, 2015). In the context of persuasive health communication, research has suggested that messages that induce happiness also provoke judgments of effectiveness, as happy individuals are more accepting of almost any sort of advocacy (Dillard & Peck, 2000).

In a Good Mood and Processing a Health Message

Mackie and Worth (1989) were among the first to argue that being in a positive mood may interfere with the processing of persuasive messages. They hypothesized that people want to retain happy moods and thus are motivated to avoid health messages like fear appeals, which may adversely affect their happy mood state. Other early work indicated that a positive mood can lead people to process messages more carelessly or in a more heuristic way (Schwarz & Bless, 1991).

While early work argued that being in a happy mood reduced one’s ability or motivation to process messages, later work suggested that a positive mood interacts with features of the message itself to influence message processing. Specifically, dual process theorists (for a review, see Bless & Fiedler, 2006) argue that people in happy moods should process both strong and weak messages more positively. Dual process theories, such as the elaboration likelihood model, propose that recipients of a persuasive health message may arrive at an evaluative judgment by assessing the merits of the message in one of two ways: They may engage in contemplative and systematic analysis of the argumentative quality of the message, or they may rely on heuristic cues, such as the credibility of a communicator or the number of arguments in the message. In a typical study examining mood and persuasion (Bless, Bohner, Schwarz, & Strack, 1990), participants were first induced to feel happy or sad, and then were exposed to multiple strong or weak arguments in favor of a given issue. Those in happy moods tended to be relatively persuaded by both strong and weak arguments. The dual-process argument is that happy participants process the information less deeply and thus are more likely to rely on a simple heuristic to judge a message: The larger number of arguments in favor of the issue in the message. Thus, people in a good mood tend to be relatively persuaded regardless of whether the arguments themselves are strong or weak, as long as there are enough arguments (see Rucker, Petty, & Briñol, 2014).

A different theory that accounts for these findings and one that has garnered considerable support is the hedonic contingency model, which posits that people are motivated to achieve, maintain, or enhance a good mood (Wegener & Petty, 1994; Wegener, Petty, & Smith, 1995). Therefore, people in a good mood are motivated to assess a health message to figure out whether it leads to positive or negative feelings (i.e., its hedonic consequences). If there is a possibility for negative feelings or consequences, they are less likely to process the message in depth. Thus, according to the hedonic contingency model, people in good moods are more likely to carefully or systematically process a health message when the message provides no threat to their good mood. Because people in good moods are processing more carefully, they are more persuaded by strong arguments in a nonthreatening health message than by weak arguments.

A meta-analysis by Hullett (2005) found evidence supporting the hedonic contingency model. Hullett reported that, for those in positive moods, messages that were positive in hedonic consequences enhanced their message processing. In addition, those in positive moods avoided messages when the messages were both highly self-relevant and negative in hedonic consequences. Hullett (2005) argued that the meta-analytic results suggested people quickly formed impressions of a message they were viewing or reading and then processed the message in a way that would maximize their rewards.

Thus, the literature generally suggests that positive mood states are likely to result in message acceptance when messages make strong argument appeals and when they are framed positively, so that they suggest the likelihood of good outcomes (e.g., positive hedonic appeals).

Affect in Messages

Social marketers and advertisers have long relied on positive message appeals to encourage prosocial behaviors, such as helping others, volunteering one’s time, donating money, and/or buying products that benefit a good cause (Small & Verrochi, 2009). The assumption is that if people feel good, they are more likely to do good (Cavanaugh, Bettman, & Luce, 2015). Positive affect is far more often evoked in advertising than it is in public health campaigns. This is perhaps unsurprising, as scholars have argued that the divergent objectives and topics make the nature and design of commercial advertising and health campaigns different (Dillard & Peck, 2000; Slater, 2006). Advertising usually attempts to evoke positive feelings, uses pleasant language, and creates positive brand images, while health messages are often normative in demonstrating common social values (e.g., being healthy; Rokeach, 1968), depicting significant health issues (e.g., obesity), and eliciting negative affect (e.g., fear; Dillard & Peck, 2000). However, there are places where positive affect can be quite useful for health message designers.

As in advertising, some health messages are also assurance messages that focus on positive incentives (e.g., maintaining one’s good self-image), highlight predictable benefits (e.g., making progress toward a goal), and evoke positive affect (e.g., happiness). Such themes can make people feel good, lead to favorable evaluations of the message during and after exposure, and encourage message recipients to be open to, rather than resistant to, the promoted behavior in the message. This claim is consistent with gain frames and several constructs (e.g., perceived benefits, self-efficacy, response efficacy, etc.) in classical health behavioral theories (see the section “Design Health Messages to Induce Positive Affect”).

Because emotions serve as the primary motivational system for human behavior (Izard, 1977), message designers often use emotions in health behavior messages. Prior research, for example, shows that emotion-arousing messages tend to be better recalled and are perceived as more effective (Dillard & Peck, 2000; Lang, Dhillon, & Dong, 1995). In the context of persuasive health communication, researchers typically study positive affect as a specific emotion, typically happiness. Message-based affect has a specific target (i.e., message content) and the potential to guide behavior. Therefore, message-based affect shares the features of discrete emotions (e.g., fleeting, intense, and foregrounded; see Dillard & Nabi, 2006; O’Keefe, 2002; Shen & Bigsby, 2010; Witte & Allen, 2000).

Message designers employ positive-affect appeals to encourage the message’s recipients to view the message as consistent with their goal(s). Theoretically, positive affect is evoked in goal-congruent circumstances or when one sees the environment as somehow consistent with one’s goal(s) (Lazarus, 1991). Thus, individuals feel happier, more hopeful, and relieved, etc., when a health message facilitates their personal goals and suggests a positive or desired outcome is possible. Consider, for example, a campaign on positive parenting techniques called “Accentuate the Positive,” which promoted the good outcomes associated with an encouraging parenting style (Henley, Donovan, & Moorhead, 1998). The campaign focused on mastering positive parenting skills by modeling positive behaviors and outcomes. Because parents desire well-behaved children, the campaign was designed to reinforce that positive parenting techniques result in that goal’s being achieved.

Establishing a Positive Message Attitude

One way in which positive affect can be used to change behavior is via attitudes. Attitudes are positive- or negative-valenced evaluations of a message, a person, or an event. Attitudes are not static, as they can fluctuate over time (Erber, Hodges, & Wilson, 1995) and can depend on contextual and situational influences (Petty & Cacioppo, 1996). Two forms of attitudes are important for message design. First, message attitudes are feelings about a message, such as “I liked that message” or “That message made me laugh.” Second, issue attitudes are attitudes toward a behavior advocated in the message, such as “I feel positively about getting my child vaccinated.” Of course, issue attitude is of primary importance to health communication practitioners because it is an immediate predictor of behavioral intention (Ajzen, 1991). Research by Dillard and Peck (2000) and Nan (2008) demonstrated that positive affect can influence issue attitude through message attitude (i.e., positive affect ➔ message attitude ➔ issue attitude). When a message induces feelings of positive affect in the message viewer, he or she is more likely to establish a positive attitude toward the message (i.e., message attitude), which in turn positively influences attitude toward the issue promoted in that message (i.e., issue attitude).

Positive Affect ➔ Message Attitude

While health practitioners use the term message attitude, social marketing practitioners may be more familiar with the term attitude towards the ad, which refers to “a predisposition to respond in a favorable or unfavorable manner to a particular advertising stimulus during a particular exposure occasion” (Lutz, 1985, p. 46). Thus, we use the term ad attitude when referring to advertising research, and message attitude when referring to public health communication research. Pham, Geuens, and De Pelsmacker (2013) examined responses from 1,576 viewers of over 1,000 commercials that advertised a wide array of products. They found consistent support for positive feelings evoked by the messages predicting positive ad attitude across types of products and that this relationship was not dependent on the level of involvement with the message.

Affect-as-information theory helps explain how positive feelings induced by a message can lead to a positive ad attitude or message attitude. According to affect-as-information theory, individuals interpret their momentary subjective affective state as a piece of information when making decisions and judgments (Clore, Gasper, & Garvin, 2001; Schwarz, 1990; Schwarz & Clore, 1996). Specifically, affect has a direct and congruent effect on evaluation—positive affect is associated with positive evaluation, and negative affect leads to negative evaluation. Affect-as-information theory argues that “people attend to their momentary feelings as a source of information in forming judgments, essentially asking themselves, ‘How do I feel about this?’” (Schwarz, 2011, p. 292).

Several studies provided support for this prediction (for a review, see Schwarz, 2011). Batra and Ray (1986) exposed participants to four TV commercials and examined the influence of positive affective responses to the ads on ad attitude. Their findings revealed that messages that promoted feelings of surgency, elation, vigor/activation (as indexed by items like “upbeat” and “happy”) and social affection (as indexed by items like “warmth” and “caring”) resulted in positive ad attitudes. In an investigation of televised political advertising effects, Tedesco (2002) found that favorable affective responses were associated with positive evaluations of the candidates’ images. Similarly, research has found that positive affect induced by a public service announcement (PSA) was associated with a positive message attitude, while negative affect was associated with negative message attitude (Dillard & Peck, 2000). Cho and Choi (2010) also found that public service messages that elicited happiness and contentment and promoted the benefits of taking action were associated with positive message attitude. Thus, in advertising for products, political advertising, and public service announcements, positive affect induced by a message is often associated with positive attitudes toward the message itself.

Message Attitude ➔ Issue Attitude

A positive message attitude is a step toward the more important goal for practitioners: A positive attitude toward the issue or behavior promoted in the message. In advertising, a wealth of research has shown that ad attitude predicts attitude toward the brand (i.e., brand attitude) featured in the ad (see Bergkvist & Rossiter, 2007; Brown & Stayman, 1992; MacKenzie, Lutz, & Belch, 1986; Mitchell & Olson, 1981; Spears & Singh, 2004). In other words, the more consumers like an ad, the more favorable their evaluation of the brand. In a study of online advertising, Huang, Su, Zhou, and Liu (2013) found that ad attitude was the major factor affecting the likelihood that an individual would share the message with others.

Similarly, research has shown that attitude toward a health message can predict the attitude toward the health behavior promoted in the message (Dillard & Peck, 2000; Nan, 2008; Slater, 2006). In an investigation of the influence of message attitude toward a PSA on issue attitude, Dillard and Peck (2000) showed participants one positively toned PSA (i.e., advocacy: live an active life) and one negatively toned PSA (i.e., advocacy: never leave your child alone in the bathtub). They found that message attitude predicted issue attitude when the message was positively toned yet not when it was negatively toned. To replicate and extend that finding, Nan (2008) examined several video and print PSAs on a variety of health topics and reported that message attitude was positively associated with issue attitude. Specifically, a positive association between message attitude and issue attitude was strongest when the message had a positive tone, the message recipient perceived lower issue relevance, and he or she had less issue knowledge. In addition, Cho and Choi (2010) found that, after controlling for age, gender, prior substance use, and perceived prevalence of substance use among peers, an adolescent’s attitude toward antidrug television messages was a strong positive predictor of attitudes toward anti-alcohol and anti-tobacco behaviors among adolescents who viewed messages that promoted the benefits of taking action.

In summary, across both advertising and public health communication research, positive affect induced by messages results in positive attitudes toward a message, which, in turn, result in positive attitudes toward the issue or behavior advocated in the message. There is some evidence that this association will be even stronger when the message recipients are less knowledgeable and/or when they perceive the issue as less relevant. While the studies reviewed above did not specifically assess behavior, the findings of this body of research indicate that a positive attitude toward a given behavior is a direct predictor of behavioral intent. Therefore, these findings suggest that an important way to promote more open and positive attitudes toward health behavior would be to use positively valenced appeals. Practitioners need to carefully pilot test messages, however, to ensure that messages are liked by viewers, because the positive feeling about the message is the first step toward a positive attitude toward the issue/behavior.

Positive Affect: Behavioral Intent and Behavioral Change

Prior research has shown that message-induced positive affect can have a direct impact on behavior or intention to engage in the behavior promoted in messages. For example, Stephenson and colleagues (2005) compared the effectiveness of positive-, negative-, and neutral-affect messages in encouraging voluntary hearing protection behaviors among coal miners. Findings from a six-week delayed posttest revealed that coal miners who received positive-affect messages reported significantly stronger intentions to wear hearing protection regularly than those who received negative-affect messages. In a study designed to promote safe drinking behaviors, Previte and colleagues (2015) found that message-evoked happiness was associated with intentions to moderate their drinking among alcohol consumers.

Furthermore, positive-affect appeals can help change behavior, because when properly utilized, they can result in more openness to behavioral change. As argued by Lazarus (1991), when individuals judge the person–environment relationships as beneficial, they may engage in more prosocial behaviors, feel less strained cognitively, and feel more favorable and open toward other options. In addition, extant research documents a positive association between positive affect and cognitive and behavioral processes, such as helping behavior (Shaffer & Graziano, 1983), decision making (Estrada, Isen, & Young, 1997), and intrinsic motivation (Isen & Reeve, 2005).

Understanding the theoretical and empirical evidence that supports the relationship between positive affect and behavioral tendencies requires review of the broaden-and-build theory (Fredrickson, 1998) and behavioral inhibition/behavioral activation systems (Gray, 1981), because they are theoretical mechanisms that help account for why and when positively valenced messages may result in behavioral change.

Broaden-and-Build Theory

Fredrickson’s (1998) broaden-and-build theory proposes that positive affect broadens people’s attention and thinking, which in turn helps people build cognitive, psychological, social, and physical resources. Experimental studies have shown that induced positive affect widens individuals’ visual attention, broadens their thought-action repertories (Fredrickson & Branigan, 2005), and increases their openness to information (Estrada, Isen, & Young, 1997). Consistent with this theory, a number of Isen and colleagues’ experiments suggested that individuals experiencing positive affect (vs. individuals in a neutral control condition) were more likely to broaden their minds to enact creative and diverse solutions to tasks (see Isen, 1987; Kahn & Isen, 1993). Moreover, numerous theorists argue that positive responses to external stimuli often result in approach behaviors, which then allow individuals to open up and be receptive to advocacy (Cacioppo, Gardner, & Berntson, 1999; Hart & Gable, 2013).

The broaden-and-build theory can help message designers make decisions about when to employ positive affect. For example, research has shown that positive affect can help motivate people to pay attention to messages about self-relevant threats (Das & Fennis, 2008). From a broaden-and-build perspective, Fredrickson (2001) argues that under conditions of high self-relevance, a positive mood can promote self-regulation and buffer the short-term costs of dealing with self-threatening information. Das, Vonkeman, and Hartmann (2012) tested this argument with anti-smoking messages. They predicted and found that smokers were more likely to systematically process anti-smoking messages only when in a positive mood. In addition, systematic processing of the anti-smoking messages resulted in smokers’ having more positive attitudes toward the anti-smoking message, which in turn predicted intent to quit. The authors argued that consistent with the broaden-and-build theory of positive mood, “For highly relevant health messages, long-term adaptive consequences appear to overrule short-term hedonic consequences, which results in systematic processing of aversive information” (pp. 124–125).

A broaden-and-build perspective suggests that when designing messages for respondents who may find the message relevant yet potentially threatening, message designers may want to craft messages that provide individuals with the mental and practical resources needed to cope with a threat. Designers can do so by including positive affect, such as uplifting music, positive imagery, images of other like individuals who have overcome obstacles, or encouragement that the behavioral change is “doable.”

BIS/BAS Model

In 1970s, Gray hypothesized that humans have two motivational systems that control behavioral activity: the behavior inhibition system (BIS) and the behavior activation system (BAS; Davidson, 1992; Gray, 1990). The BIS is a neuropsychological system that is activated in response to punishment and nonrewards. It functions to inhibit behaviors that may bring about undesired outcomes or outcomes that may put a person at risk. In contrast, the BAS is sensitive to cues of reward and nonpunishment and therefore it functions to initiate goal-directed behaviors. Persuasion researchers have shown that BIS is associated with negative affect, while BAS is associated with positive affect (Dillard & Peck, 2001; Shen & Bigsby, 2010; Shen & Dillard, 2007).

While these motivational systems have been thought to be the sources of affect (Gary, 1990), a causal flow in the opposite direction is also true (Yan, Dillard, & Shen, 2010). In other words, positive affect can activate approach-oriented behaviors (i.e., BAS). For example, viewing pleasant pictures is associated with heightened activity of the approach system (Lang & Bradley, 2008). Yan and colleagues (2010, 2012) argued that emotion induction is likely to make individuals responsive to messages in which the advocated behaviors corresponded with the function of the motivational system of the induced emotion. Put differently, individuals who experience positive affect are more responsive to messages that advocate approach-oriented behaviors (i.e., BAS). Their findings supported this argument: happy moods produced higher reports of BAS, while sad moods produced higher reports of BIS (Yan et al., 2010, 2012). More importantly, the impact of positive affect on activating BAS can be extended to understanding when to employ positive affect so that a particular type of behavioral advocacy in a health message has more persuasive effects. Specifically, Yan et al. (2010) found that moods interacted with behavioral advocacies, such that happy moods coupled with prescriptive advocacies (i.e., to approach a healthy behavior; BAS) were more persuasive than happy moods coupled with proscriptive advocacies (i.e., to avoid an unhealthy behavior; BIS). Overall, these findings suggested an important takeaway for researchers and practitioners: When designing health messages in which the target behavioral advocacies are approach-oriented behaviors (e.g., exercise, wear sunscreen, breast cancer self-examination, etc.), inducing positive affect (vs. negative affect) is more effective, as approach-oriented behaviors (i.e., BAS) match the action tendencies of positive affect.

In summary, research from the broaden-and-build theory and the BIS/BAS model provides evidence that positive affect in messages can influence important behavioral outcomes, such as the repertoire of behavioral choices an individual might consider and intent to comply with the message advocacy.

Design Health Messages to Induce Positive Affect

Messages are the center of health communication interventions and campaigns. Health communication researchers and public health practitioners construct and disseminate messages with the aim of motivating behavioral modification or attitude change among message recipients. As articulated above, positive affect induced in health messages is an instrument we can use to achieve attitudinal and behavioral change. Inducing positive affect in health message design can be a function of gain frames, and the core relational theme of happiness.

Gain Frames

Gain frames are an essential tool for practitioners who want to use positive affect in message design, and so they are briefly reviewed here in terms of their association with positive emotions. As suggested by prospect theory (Kahneman & Tversky, 1979; Tversky & Kahneman, 1981), message framing is a technique by which the behavioral outcome can be described either positively (e.g., the advantages of compliance) or negatively (e.g., the disadvantages of noncompliance). Our interest is with gain frames that are positively toned messages, focusing on the advantages or the rewards to be obtained by following the recommended behavior.

Shen and Dillard (2007) noted that the link between message framing and affect was based on appraisal theories of emotion: Goal congruence generated positive affect, while goal incongruence produced negative affect (Lazarus, 1991). Thus, gain-framed messages that highlight beneficial outcomes and goal congruence are able to make people feel good (Schneider et al., 2001). In constructing gain-framed messages, researchers focus on positive outcomes associated with message adherence. For example, Millar and Millar (2000) created messages focusing on several driving circumstances (e.g., wearing seat belts, not exceeding the speed limit, etc.) and created gain-framed messages for encouraging driving at the recommended speed. In doing so they included information like “the driver will gain (vs. lose) time needed for braking in an emergency . . . will be more (vs. less) likely to maintain a good driving record, and . . . will have the opportunity for discounted insurance premiums” (p. 857). Results indicated gain-framed messages were associated with more positive affective responses to messages than loss-framed messages.

Shen and Dillard (2007) examined message framing and self-report affective responses to messages on three different health topics: skin cancer, obesity, and influenza. Each topic described two frames: one presented the benefits of the recommended behaviors, and the other presented the costs of not following the recommendations. For example, an advantage-framed skin cancer message included information like “Your skin can be: moisturized, firm, radiant, young, attractive, and without the damage that can lead to skin cancer” (p. 441). Results showed that advantage frame produced stronger positive affect. Cho and Boster (2008) also investigated the impact on adolescents of gain versus loss frame in antidrug ads. In their study, four ads portrayed the gains obtained by staying away from drugs, and another four ads presented the losses experienced when an adolescent uses drugs. They found that gain-framed ads generated a greater magnitude of joy and contentment than loss-framed ads, which generated more negative affect. In summary, messages that emphasize the gains (i.e., rewards to be obtained by following recommendations) are effective at inducing positive affect and, in turn, increasing the likelihood of engaging in the advocated behaviors.

Core Relational Theme of Happiness

Happiness tends to be the most often studied form of positive affect in message design research. Happiness can result from diverse causes (e.g., receiving a compliment, watching a very funny television show, etc.), but its core relational theme indicates that happiness is a discrete emotion. Happiness occurs when individuals perceive that they are “making reasonable progress toward the realization of [their] goals” (Lazarus, 1991, p. 267). We argue that health communication researchers and practitioners can design messages to induce positive affect, such as happiness, by focusing on self-efficacy, response efficacy, and perceived benefits.

Self-efficacy

Self-efficacy reflects the core relational theme of happiness. Self-efficacy, or individuals’ beliefs and judgments about their capabilities to execute a given behavior (Bandura, 1977), has served as a pivotal concept in many theories of health behavior change that guide health message design. As suggested by social cognitive theory, individuals’ actions can be influenced by observing how others perform them—and whether certain behaviors incur rewards or punishments—within the context of social interaction. As an important source of self-efficacy, vicarious experience can strengthen one’s perception of self-efficacy (Bandura, 1977). Put differently, when individuals observe similar others successfully performing a particular behavior, they tend to feel more confident and believe they possess similar capabilities of performing the behavior as well. The boosted self-efficacy allows the individuals to visualize that they can make reasonable progress toward the goals, as the models did, which is consistent with the core relational theme of happiness. For example, Lee (2010) noted that risk takers and rebellious individuals are often resistant to persuasive appeals. She further argued that the use of humor and self-efficacy (e.g., you are in control) might be a way to minimize their defensive reactions and promote a more positive attitude toward health messages. With college-age drinkers, she showed that adding self-efficacy statements to humorous anti-alcohol-abuse ads significantly increased highly rebellious individuals’ intentions to change their behavior and increased their sense of perceived risk. Luszczynska and colleagues (2005) found that higher general self-efficacy, or the belief in one’s competence to “deal effectively with a variety of stressful situations” (p. 81), was associated with high positive affect and low negative affect. Overall, message designers should consider designing health messages that include similar others engaging in advocated health behaviors and obtaining beneficial outcomes. Exposure to such themes may enable message recipients to strengthen their perceived self-efficacy, which in turn makes them feel good.

Perceived Benefits and Response Efficacy

Perceived benefits and response efficacy also reflect the core relational theme of happiness. As suggested by the health belief model (HBM), perceived benefits refer to an individual’s belief about the effectiveness of the recommendations in reducing an undesired health outcome (Janz & Becker, 1984; Rosenstock, 1974). A similar construct, response efficacy, can be found in protection motivation theory (PMT; Rogers, 1975, 1983) and the extended parallel process model (EPPM; Witte, 1992). Response efficacy refers to an individual’s belief about the availability and effectiveness of a coping response in reducing a noxious stimulus. Again, the goal is to stay away from a risky situation. Both constructs were originally conceptualized in terms of avoiding, reducing, or eliminating a negative circumstance, which is consistent with avoidance-oriented motivation (O’Keefe, 2015).

Yet, from a different perspective, the desired outcome of a healthy behavior (e.g., doing exercise) might not be avoiding aversive health outcomes, and the focus could be on positive incentives (e.g., feeling energized, maintaining a positive self-image, setting a role model for children, and increasing work productivity). In other words, we can also conceptualize the two constructs as an individual’s belief about the effectiveness of an advocated behavior in obtaining, increasing, and optimizing positive incentives, which is consistent with an approach-oriented motivation (O’Keefe, 2015). Messages can focus on physical incentives, such as better health and a longer lifespan; social incentives, such as gaining approval and respect, forming friendships, or building trust with others; and psychological incentives, such as having control over one’s life, maintaining a positive self-image, attaining a particular goal, or feeling secure (Silk, Atkin, & Salmon, 2011).

Approach-oriented motivation is consistent with the action tendencies of positive affect. More specifically, approach-oriented behavioral advocacies are in line with the core relational theme of happiness (i.e., making reasonable progress toward the realization of goals) and with gain frames (i.e., presenting benefits of adopting recommended behaviors). Thus, to reflect the function of perceived benefits and response efficacy in persuasive messages, health communication researchers and practitioners might include information about the effectiveness of approach-oriented behavioral advocacies.

When Should Positive-Affect Appeals Be Used?

Positive-affect appeals should be used with suitable health topics, among the target audience, and in the appropriate context. Otherwise, a message, no matter how well designed, might not induce the intended affect or achieve the intended persuasive outcomes if not deployed appropriately. While existing research does not specify any particular context in which positive affect may outperform other kinds of appeals, positive affect may be especially useful when the practitioner needs to overcome an audience’s defense mechanisms and filtering devices.

First, positive-affect appeals can be effective in reducing message fatigue and (re)gaining attention. Message fatigue occurs when people feel “exhausted and bored by overexposure to similar, redundant messages over an extended period of time” (So, Kim, & Cohen, 2017, p. 6). Low audience involvement, as an inhibitor of successful persuasion, may result from being overly familiar with a campaign topic or perceiving a campaign as boring/unattractive. Many public health campaigns use threat-based appeals in which negative affect is often a component (Ruiter, Kessels, Peters, & Kok, 2014). Some health topics have already become associated with the use of aversive graphics and portrayal of negative consequences (e.g., road safety; Donovan & Henley, 2003). When individuals are exposed to familiar topics, such as smoking cessation or skin cancer prevention, they tend to perceive fear appeals as intrusive and manipulative (Nabi, Roskos-Ewoldsen, & Carpentier, 2008). For example, Frew et al. (2013) developed an HIV prevention research brand strategy for men who have sex with men (MSM). Through focus group interviews and questionnaires, they found that the majority of MSM felt “burned out on safe sex campaigns” and perceived messages regarding HIV prevention (e.g., condom promotion, safer sex) as “beginning to sound the same” (p. 5). Introducing another type of affective appeal may help to draw new attention to a campaign issue that has been widely disseminated, aired, and known (Nabi, 2002). Indeed, Ogilvy and Raphaelson (1982) argued long ago that positive-affect appeals, such as warm feelings or touching scenes, are effective in getting individuals to process messages about familiar topics. Thus, scholars and practitioners might consider using positive affect to regain the attention of those who consider themselves to be overly familiar with a topic or a campaign or are turned off by the use of negative affect or fear appeals.

Second, we recommend the use of positive-affect appeals to help attenuate psychological reactance. As suggested by the theory of psychological reactance, “when a freedom is eliminated or threatened with elimination,” individuals are motivated to reestablish that freedom (Brehm & Brehm, 1981, p. 37) through various ways, including derogating the source of threat (Smith, 1977) or adopting the opposite of the advocated behavior (Worchel & Brehm, 1970). Thus, a persuasive message may serve to threaten the freedom of a target audience by asking the audience to change or modify a current behavior, thereby creating psychological reactance. Research has evidenced that anger and negative cognitions are two intertwined components of reactance (see Dillard & Shen, 2005; Rains, 2013). Nabi and colleagues (2008) found that men who had more knowledge about testicular self-examination were more reactant to fear appeal messages, which suggested that perhaps positively framed appeals might be more suitable for those who were reactant. Indeed, Reinhart, Marshall, Feeley, and Tutzauer (2007) found that students who read positive gain-framed appeals reported more positive attitudes and less reactance toward messages encouraging organ donation. Along with gain frames, the use of positive affect, such as uplifting messages, empathy appeals (e.g., Shen, 2010), and the use of music (Strick, de Bruin, de Ruiter, & Jonkers, 2015), may help attenuate reactance by buffering the experience of anger and negative cognitions associated with a threat to freedom.

Third, positive-affect appeals are more effective when the recommendations are prescriptive (vs. proscriptive) behaviors. Persuasive messages typically aim to change individuals’ behaviors by either encouragement/prescriptive advocacy (i.e., to do something) or discouragement/proscriptive advocacy (i.e., not to do something; Janoff-Bulman, Sheikh, & Hepp, 2009). Winter and colleagues (2000) assessed the effectiveness of messages that used prescriptive versus proscriptive advocacies to promote environmental protection in wild lands and urban settings. Findings showed that individuals viewed encouragement-based prescriptive messages (e.g., “Protect our environment. Please extinguish your fire”) as more effective than discouragement-based proscriptive messages (e.g., “Don’t endanger our environment. Please don’t leave your fire burning”). Yan and colleagues (2010) examined the interaction effect among behavioral advocacy, message framing, and mood. In their study, “getting an eye exam” and “limiting intake of junk food” were chosen to represent prescriptive and proscriptive behaviors, respectively. Results indicated that for the prescriptive advocacy, happy individuals reported more favorable attitudes and stronger intentions than sad individuals. In line with these findings, one takeaway for health communication researchers and practitioners is: gain-framed messages were most effective when coupled with positive moods and prescriptive behavioral advocacy.

Conclusion

In 1995, Monahan proposed the importance of “thinking positively” when designing health messages and argued that more research was needed to demonstrate how positive appeals can be effective for health communication. Today, there are promising new theoretical approaches to positive affect and positive affect in message design, as well as research on gain frames, hope-based appeals, altruism, and humor appeals to motivate attitudinal and behavioral change. Ideally, the next generation of scholars will build on these findings to study how best to harness other forms of positive affect, such as joy and elation, that are mostly missing from current studies.

While both negative- and positive-affect appeals are necessary in health communication, positive affect has real promise, especially with audiences who may be experiencing message fatigue and those who are likely to be reactant. Integrating research in advertising, social marketing, public health, and communication shows that positive affect can predict message attitude, which in turn results in a positive issue attitude. Both broaden-and-build theory and behavioral inhibition/behavioral activation systems (BIS/BAS) reveal the link between positive affect and behavior or intent to comply with the message’s advocacy. The new generation of scholars are encouraged to incorporate positive appeals when designing health messages, especially with the aim of counteracting the potential drawbacks of traditional negative appeals.

Further Reading

Das, E. (2011). Improving the effectiveness of mass-mediated health campaigns: Overcoming barriers to risk communication. In J. Merrick (Ed.), Public health yearbook 2011 (pp. 1–10). New York: Nova Science Publishers, Inc.Find this resource:

Dillard, J. P., & Shen, L. (Eds.). (2012). The SAGE handbook of persuasion: Developments in theory and practice. Thousand Oaks, CA: SAGE.Find this resource:

Forgas, J. P. (Ed.). (2001). Feeling and thinking: The role of affect in social cognition. Cambridge, U.K.: Cambridge University Press.Find this resource:

Fredrickson, B. L. (2004). The Science of Well-being: Integrating Neurobiology, Psychology and Social Science . Philosophical Transactions-Royal Society of London Series B Biological Sciences, 359(1449), 1367–1377.Find this resource:

Schwarz, N. (2001). Feelings as information: Implications for affective influences on information processing. In L. L. Martin & G. L. Clore (Eds.), Theories of mood and cognition: A user’s handbook (pp. 159–176). Mahwah, NJ: Lawrence Erlbaum.Find this resource:

Tugade, M. M., Shiota, M. N., & Kirby, L. D. (Eds.). (2016). Handbook of positive emotions. New York: Guilford Press.Find this resource:

Turner, M. M. (2011). Using emotional appeals in health messages. In H. Cho (Ed.), Health communication message design (pp. 59–71). Thousand Oaks, CA: SAGE.Find this resource:

Watson, L., & Spence, M. T. (2007). Causes and consequences of emotions on consumer behaviour: A review and integrative cognitive appraisal theory. European Journal of Marketing, 41(5/6), 487–511.Find this resource:

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