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Randomized Controlled Trial
. 2018 Mar 1;20(3):e63.
doi: 10.2196/jmir.7613.

Optimizing Tailored Communications for Health Risk Assessment: A Randomized Factorial Experiment of the Effects of Expectancy Priming, Autonomy Support, and Exemplification

Carmina G Valle  1   2 , Tara L Queen #  2 , Barbara A Martin #  2 , Kurt M Ribisl  2   3 , Deborah K Mayer  2   4 , Deborah F Tate  1   2   3
Affiliations
Randomized Controlled Trial

Optimizing Tailored Communications for Health Risk Assessment: A Randomized Factorial Experiment of the Effects of Expectancy Priming, Autonomy Support, and Exemplification

Carmina G Valle et al. J Med Internet Res. .

Abstract

Background: Health risk assessments with tailored feedback plus health education have been shown to be effective for promoting health behavior change. However, there is limited evidence to guide the development and delivery of online automated tailored feedback.

Objective: The goal of this study was to optimize tailored feedback messages for an online health risk assessment to promote enhanced user engagement, self-efficacy, and behavioral intentions for engaging in healthy behaviors. We examined the effects of three theory-based message factors used in developing tailored feedback messages on levels of engagement, self-efficacy, and behavioral intentions.

Methods: We conducted a randomized factorial experiment to test three different components of tailored feedback messages: tailored expectancy priming, autonomy support, and use of an exemplar. Individuals (N=1945) were recruited via Amazon Mechanical Turk and randomly assigned to one of eight different experimental conditions within one of four behavioral assessment and feedback modules (tobacco use, physical activity [PA], eating habits, and weight). Participants reported self-efficacy and behavioral intentions pre- and postcompletion of an online health behavior assessment with tailored feedback. Engagement and message perceptions were assessed at follow-up.

Results: For the tobacco module, there was a significant main effect of the exemplar factor (P=.04); participants who received exemplar messages (mean 3.31, SE 0.060) rated their self-efficacy to quit tobacco higher than those who did not receive exemplar messages (mean 3.14, SE 0.057). There was a three-way interaction between the effect of message conditions on self-efficacy to quit tobacco (P=.02), such that messages with tailored priming and an exemplar had the greatest impact on self-efficacy to quit tobacco. Across PA, eating habits, and weight modules, there was a three-way interaction among conditions on self-efficacy (P=.048). The highest self-efficacy scores were reported among those who were in the standard priming condition and received both autonomy supportive and exemplar messages. In the PA module, autonomy supportive messages had a stronger effect on self-efficacy for PA in the standard priming condition. For PA, eating habits, and weight-related behaviors, the main effect of exemplar messages on behavioral intentions was in the hypothesized direction but did not reach statistical significance (P=.08). When comparing the main effects of different message conditions, there were no differences in engagement and message perceptions.

Conclusions: Findings suggest that tailored feedback messages that use exemplars helped improve self-efficacy related to tobacco cessation, PA, eating habits, and weight control. Combining standard priming and autonomy supportive message components shows potential for optimizing tailored feedback for tobacco cessation and PA behaviors.

Keywords: eHealth; feedback; health behavior; health communication; health risk assessment; intention; personal autonomy; self-efficacy.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Flow of study participants in randomized 2x2x2 factorial experiment. CHART: Carolina Health Assessment and Resource Tool.
Figure 2
Figure 2
Estimated means (SE) for self-efficacy at follow-up as a function of three-way interaction of expectancy priming, autonomy support, and exemplar conditions. Error bars are SEs of the means. Higher scores represent higher self-efficacy. Tobacco (top): three-way interaction effect (P=.02) of autonomy support and exemplar conditions on self-efficacy to quit smoking, by priming condition. Physical activity, eating habits, weight (bottom): three-way interaction effect (P=.048) of autonomy support and exemplar conditions on self-efficacy to engage in physical activity, eating habits, and weight management behaviors, by priming condition.
Figure 3
Figure 3
Estimated means (SE) for self-efficacy for physical activity at follow-up as a function of two-way interaction of expectancy priming and autonomy support. Error bars are SEs of the means. Higher scores represent higher self-efficacy.
Figure 4
Figure 4
Estimated means (SE) for behavioral intentions at follow-up as a function of main effects of experimental conditions. Error bars are SEs of the means. Higher scores represent higher behavioral intentions. Tobacco (top): priming (P=.59), autonomy support (P=.94), and exemplar (P=.97) effects on behavioral intentions to quit smoking, controlling for baseline intention scores. Physical activity, eating habits, weight (bottom): priming (P=.15), autonomy support (P=.64), and exemplar (P=.08) effects on behavioral intentions to engage in other health behaviors, controlling for baseline intention scores.
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