Social comparison and persuasion in health communications

Two basic social processes, persuasion and social comparison, have figured prominently in the development and implementation of health communications since the early 1950s. This chapter reviews relevant theory and evidence from basic persuasion and comparison research to demonstrate the centrality of the self-concept for understanding changes in personal belief, opinion, self-efficacy, and behavior change. Then, selective evidence and implications from health communications research are reviewed: Interventions using self-affirmation; gain-loss framing and graphic warning labels/fear appeals from the persuasion area; and interventions using normative provision, social comparison interventions, and support groups from the comparison area. In the final section, personalized, tailored health-communication approaches that capitalize on both persuasion and comparison paradigms are described. For intervention and public-policy purposes, it is recommended that communications that increase personal relevance, cognitive elaboration, and assimilation to health role-models have the strongest potential for creating lasting health behavior change

Social Comparison Features in Physical Activity Promotion Apps: Scoping Meta-Review.

BACKGROUND: Smartphone apps promoting physical activity (PA) are abundant, but few produce substantial and sustained behavior change. Although many PA apps purport to induce users to compare themselves with others (by invoking social comparison processes), improvements in PA and other health behaviors are inconsistent. Existing literature suggests that social comparison may motivate PA for some people under some circumstances. However, 2 aspects of work that apply social comparison theory to PA apps remain unclear: (1) how comparison processes have been operationalized or harnessed in existing PA apps and (2) whether incorporating sources of variability in response to comparison have been used to tailor comparison features of apps, which could improve their effectiveness for promoting PA. OBJECTIVE: The aim of this meta-review was to summarize existing systematic, quantitative, and narrative reviews of behavior change techniques in PA apps, with an emphasis on social comparison features, to examine how social comparison is operationalized and implemented. METHODS: We searched PubMed, Web of Science, and PsycINFO for reviews of PA smartphone apps. Of the 3743 initial articles returned, 26 reviews met the inclusion criteria. Two independent raters extracted the data from these reviews, including the definition of social comparison used to categorize app features, the percentage of apps categorized as inducing comparison, specific features intended to induce comparison, and any mention of tailoring comparison features. For reference, these data were also extracted for related processes (such as behavioral modeling, norm referencing, and social networking). RESULTS: Of the included review articles, 31% (8/26) categorized app features as prompting social comparison. The majority of these employed Abraham and Michie\u27s earliest definition of comparison, which differs from versions in later iterations of the same taxonomy. Very few reviews specified what dimension users were expected to compare (eg, steps, physical fitness) or which features of the apps were used to induce comparison (eg, leaderboards, message boards). No review referenced tailoring of comparison features. In contrast, 54% (14/26) reviews categorized features for prompting behavioral modeling and 31% (8/26) referenced tailoring app features for users\u27 personal goals or preferences. CONCLUSIONS: The heterogeneity across reviews of PA apps and the absence of relevant information (eg, about dimensions or features relevant for comparison) create confusion about how to best harness social comparison to increase PA and its effectiveness in future research. No evidence was found that important findings from the broader social comparison literature (eg, that people have differing preferences for and responses to social comparison information) have been incorporated in the design of existing PA apps. Greater integration of the mobile health (mHealth) and social comparison literatures may improve the effectiveness of PA apps, thereby increasing the public health impact of these mHealth tools. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-https://osf.io/nh4td/

A Biobehavioral Framework to Address the Emerging Challenge of Multimorbidity

Multimorbidity, the co-occurrence of multiple physical or psychological illnesses, is prevalent particularly among older adults. The number of Americans with multiple chronic diseases is projected to increase from 57 million in 2000 to 81 million in 2020. However, behavioral medicine and health psychology, while focusing on the co-occurrence of psychological/psychiatric disorders with primary medical morbidities, have historically tended to ignore the co-occurrence of primary medical comorbidities, such as diabetes and cancer, and their biopsychosocial implications. This approach may hinder our ecologically valid understanding of the etiology, prevention, and treatment for individual patients with multimorbidity. In this selective review, we propose a heuristic biobehavioral framework for the etiology of multimorbidity. More acknowledgment and systematic research on multiple, co-existing disorders in behavioral medicine are consistent with the biopsychosocial model's emphasis on treating the “whole person,” which means not considering any single illness, its symptoms, risk factors, or mechanisms, in isolation. As systems analytics, big data, machine learning, and mixed-model trajectory analyses, among others, come online and become more widely available, we may be able to tackle multimorbidity more holistically, efficiently, and satisfactorily

ARTICLE PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN Chambers et al. / EGOCENTRISM AND EVENT FREQUENCY Egocentrism, Event Frequency, and Comparative Optimism: When What Happens Frequently Is "More Likely to Happen to Me"

Three studies investigated the role of nonmotivated egocentric processes in comparative optimism (and pessimism). According to an egocentric-processes account, when people judge their comparative likelihood of experiencing an event (e.g., "Compared to the average person, how likely are you to become wealthy?"), they consider their own chances of experiencing the event more so than the referent's chances. This should produce higher comparative estimates when an event's absolute frequency is high rather than low-a prediction supported in Study 1, which manipu- Peopleareoftenoveroptimisticaboutthefuture.They tend to believe that they are more likely than others to experience good fortune and less likely to suffer harm. Although these beliefs suffer from a logical fallacy-not everyone can be uniquely invulnerable-this unrealistic optimism is well documented. Weinstein (1980) had student participants rate their likelihood of experiencing various positive and negative life events (e.g., developing a stomach ulcer, achieving professional recognition) relative to their peers. He found that the average likelihood responses given by participants tended to be "above average" for positive events but "below average" for negative events. Since Weinstein's (1980) study, the comparative optimism bias has been found with a variety of other subject populations (e.g., Although motivated reasoning can play a major role in producing comparative optimism, nonmotivational factors also may play a critical, if not sufficient, role The research described in this article investigated how a nonmotivated form of egocentrism might underlie various patterns of comparative optimism and pessimism. In this article, we do not intend to dismiss the role of motivation in producing comparative optimism effects, but rather, we hope to better explicate the way in which egocentrism and a specific event characteristic interact to produce comparative optimism (and comparative pessimism). The event characteristic that is of key importance in the present work is the overall frequency of the event. Consider a case in which most individuals from a group assert that their chances of being falsely accused of a serious crime are less than that of other people in the group. A motivational account would assume that the undesirable nature of the event is a key reason why people report being less vulnerable than others to that event. However, the infrequent nature of this event might be important as well. From an objective standpoint, overall event frequency should be irrelevant; being falsely accused of a serious crime tends to be an improbable event for both the self and others. Therefore, an individual should use both absolute likelihood information for the self (e.g., "My chances of being falsely accused of a serious crime are low") and absolute likelihood information for others (e.g., "Other people's chances are low too") to formulate a comparative estimate (e.g., "My chances are the same as others of being falsely accused of a serious crime"). Nevertheless, empirical evidence suggests that people often fail to integrate information about others in their comparative judgments If people are affected by such egocentrism, then their comparative estimates for events should differ as a function of event base rate. Comparative estimates for their chances of experiencing a high base-rate event (e.g., having a cold this winter) should be high because people note their own high likelihood of experiencing the event without fully integrating others' high likelihood of experiencing the event. Similarly, comparative estimates for a low base-rate event should be low because people consider their own low likelihood of experiencing the event without fully integrating others' low likelihood of experiencing the event. Thus, comparative-judgment biases that might appear to arise from motivated reasoning, such as people believing they are less likely than others to be falsely accused of a serious crime, may actually result from nonmotivated sources of bias, such as egocentrism. The idea that comparative optimism can result from egocentrism was described by In this article, we report three studies conducted to further investigate the influence of event frequency on comparative estimates. Three features of the present investigation distinguish it from previous studies of comparative optimism and event frequency. First, we directly manipulated the perceived frequency of events using a novel time frame manipulation in Experiments 1 and 2. This manipulation helps us to avoid unidentified potential confounds between the frequency and other characteristics of events that might have existed in previous studies. Second, we empirically distinguish between two different explanations for the relation between event frequency and comparative optimism-egocentrism and focalism, which is described later. Third, we tested for systematic cases of comparative pessimism. If people consider only their own personal likelihood, then people should exhibit reliable comparative pessimism with respect to highly frequent, undesirable events and highly infrequent, desirable events. Previous work has documented reliable relationships between event frequency and comparative optimism (e.g., PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN Such results would illustrate that the role of event frequency and egocentrism can, at least at times, outweigh motivational considerations. Thus, to test for comparative pessimism and the independent influences of event frequency and desirability, we solicited comparative estimates across a broad array of both undesirable and desirable events that also varied substantially (either naturally or by manipulation) in event frequency. Finally, we also sought to assess the relation between perceived event frequency and an indirect index of comparative optimism-specifically, the differences between absolute estimates for the self and absolute estimates for others. The egocentric-processes account specifies that biases in comparative estimates arise through the differential impact of absolute estimates for the self and others, not as a result of biases in the formation of absolute estimates. Therefore, the egocentric-processes account predicts that there should be no relation between event frequency and differences in absolute estimates for self and others but a positive relation with comparative estimates. Such a finding would be counter to the results of a study by OVERVIEW In Study 1, we utilized a novel manipulation to increase or decrease the perceived frequency of an event and investigated the effect of this manipulation on participants' comparative estimates. Participants in this study were asked to provide comparative estimates either for an event within a short time frame (e.g., within the next 2 weeks) or for the same event within a long time frame (e.g., within the next 3 months). In Study 2, we attempted to address one possible alternative explanation for the results of Study 1 and to strengthen our claim that egocentric processes best account for the influence of event frequency on comparative estimates. We did this by employing the same time frame manipulation that was used in Study 1 but asked participants to provide comparative estimates for the average student (instead of for the self as in Study 1). In Study 3, we sought to investigate the relation between perceived event frequency, controllability, and desirability with both absolute and comparative likelihood estimates across a broad array of events. By obtaining both types of likelihood estimates, we were able to test several predictions made by the egocentricprocesses account. STUDY 1 To examine the influence of event frequency on comparative estimates for desirable and undesirable events, we directly manipulated the perceived frequency of each of the tested events, thereby avoiding a situation in which frequent and infrequent events under investigation can differ in systematic ways unrelated to the frequency dimension. Specifically, participants provided comparative estimates for a given event either in a short time frame (e.g., occurring within the next 3 days) or a long time frame (e.g., occurring within the next 4 weeks). Our egocentric-processes account suggests that when participants make a comparative estimate for an event (e.g., "Compared to the average student, how likely is it that you will purchase your dream home in the next 32 years [6 years]?"), thoughts about their own absolute likelihood of experiencing the event would have a greater influence on their comparative estimates than would thoughts about the absolute likelihood for other people. Because the absolute frequency of an event is necessarily greater in a long time frame than in a short time frame, we predict that participants will make higher comparative estimates for an event in a long rather than short time frame condition, regardless of the desirability of the event. Method Participants. Participants (N = 52) were recruited from an introductory psychology course at the University of Iowa (UI). They received partial credit for a research exposure requirement. Procedure. Participants were randomly assigned to complete one of two versions of a questionnaire that presented 16 critical events generated by the authors for this study (see Appendix A). In version 1, participants were presented with 8 events in a long time frame and 8 events in a short time frame. Half of the events in each of the time frame conditions were undesirable and half were desirable. In version 2, the time frame for each event was reversed. Thus, for each of the questionnaire versions, participants gave comparative estimates for 4 undesirable events in a short time frame, 4 undesirable events in a long time frame, 4 desirable events in a short time frame, and 4 desirable events in a long time frame. For each event, participants indicated their comparative estimates in an item phrased, for example, "Compared to the average UI student, how likely is it that you will purchase your dream home in the next 32 years [6 years]?" (-4 = much less likely than the average UI student to +4 = much more likely than the average UI student). Chambers et al. / EGOCENTRISM AND EVENT FREQUENCY 1345 Results and Discussion We calculated for each participant the averages for his or her comparative estimates for the undesirable events in a short time frame, for the undesirable events in a long time frame, for the desirable events in a short time frame, and for the desirable events in a long time frame. These averaged estimates were then submitted to a 2 (questionnaire version: 1 or 2) × 2 (time frame: short or long) × 2 (desirability: undesirable or desirable) mixedmodel ANOVA, with questionnaire version as a betweensubjects factor and both time frame and desirability as within-subjects factors. The key finding was a significant main effect of time frame, F(1, 50) = 82.70, p < .001. As predicted, participants gave higher comparative estimates for events in a long time frame (M = 0.66, SD = 1.23) than in a short time frame (M = -0.64, SD = 1.14). In addition, a significant main effect was found for desirability, F(1, 50) = 63.48, p < .001. Participants gave higher estimates for desirable events (M = 0.69, SD = 1.26) than for undesirable events (M = -0.67, SD = 1.10). Because these main effects were not qualified by a Time Frame × Desirability interaction, F(1, 50) = 2.36, p > .10, we may conclude that the influence of the time frame manipulation was not dependent on the desirability of the event. In fact, simple effect tests reveal that participants gave higher comparative estimates for the desirable events in a long time frame (M = 1.44, SD = 1.23) than in a short time frame (M = -0.06, SD = 1.29), t(51) = 6.53, p < .001. Participants also gave higher comparative estimates for the undesirable events in a long time frame (M = -0.13, SD = 1.22) than in a short time frame (M = -1.21, SD = 0.98), t(51) = 6.35, p < .001. In addition to these key findings, the ANOVA also revealed a significant Time Frame × Questionnaire Version interaction, F(1, 50) = 16.60, p < .001, a nonsignificant Desirability × Questionnaire Version interaction, F(1, 50) = 2.83, p > .10, and a significant Time Frame × Desirability × Questionnaire Version interaction, F(1, 50) = 8.04, p < .01. However, the effects involving the questionnaire version factor are inconsequential because they are simply a product of our arbitrary choices as to which events to assign to the long or short time frame in the two versions of the questionnaire. The desirability main effect is consistent with the idea that participants were motivated to maintain optimistic comparative beliefs; for the events tested in this study, participants tended to report higher comparative likelihoods of experiencing the positive rather than negative events. However, the time frame main effect, which was predicted by the egocentric processing account, cannot readily be explained by motivated reasoning. It is interesting to note with help fro

Clinical Usefulness of Bright White Light Therapy for Depressive Symptoms in Cancer Survivors: Results from a Series of Personalized (N-of-1) Trials

Publisher's version (útgefin grein)Purpose: Little is known about the effectiveness of bright white light therapy (BWL) for depressive symptoms in cancer survivors, many of whom prefer non-pharmacological treatments. The purpose of this study was to compare the effectiveness of BWL versus dim red light therapy (DRL) on depressive symptoms within individual cancer survivors using personalized (N-of-1) trials. Methods: Cancer survivors with at least mild depressive symptoms were randomized to one of two treatment sequences consisting of counterbalanced crossover comparisons of three-weeks of lightbox-delivered BWL (intervention) or DRL (sham) for 30 min each morning across 12 weeks. A smartphone application guided cancer survivors through the treatment sequence and facilitated data collection. Cancer survivors tracked end-of-day depressive symptoms (primary outcome) and fatigue using visual analog scales. Within-patient effects of BWL were assessed using an autoregressive model with adjustment for linear time trends. Results: Eight of nine cancer survivors completed the 12-week protocol. Two survivors reported significantly (i.e., p < 0.05) lower depressive symptoms (-1.3 +/- 0.5 and -1.30 +/- 0.9 points on a 10-point scale), five reported no difference in depressive symptoms, and one reported higher depressive symptoms (+1.7 +/- 0.6 points) with BWL versus DRL. Eight of nine cancer survivors recommended personalized trials of BWL to others. Conclusions: There were heterogeneous effects of three-week BWL on self-reported depressive symptoms among cancer survivors, with some finding a benefit but others finding no benefit or even harm. Implications for Cancer Survivors: Personalized trials can help cancer survivors learn if BWL is helpful for improving their depressive symptoms.This research was funded in part with Federal funds from the National Cancer Institute, NIH, under Contract No. HHSN261200800001E. Drs. Kronish, Davidson, and Cheung received additional support from the National Library of Medicine (R01LM012836)."Peer Reviewed

Interdisciplinary Perspectives on Sun Safety and Skin Cancer Risk: achieving consensus

Overexposure to the sun is associated with an increased risk of melanoma and nonmelanoma skin cancer, but indications of improvements in sun protection behavior are poor. Attempts to identify emerging themes in skin cancer control have largely been driven by groups of experts from a single field. In December 2016, 19 experts from various disciplines convened for Interdisciplinary Perspectives on Skin Cancer, a 2-day meeting hosted by the National Academy of Sciences. The group discussed knowledge gaps, perspectives on sun exposure, implications for skin cancer risk and other health outcomes, and new directions. Five themes emerged from the discussion: (1) The definition of risk must be expanded, and categories for skin physiology must be refined to incorporate population diversities. (2) Risky sun exposure often co-occurs with other health-related behaviors. (3) Messages must be nuanced to target at-risk populations. (4) Persons at risk for tanning disorder must be recognized and treated. (5) Sun safety interventions must be scalable. Efficient use of technologies will be required to sharpen messages to specific populations and to integrate them within multilevel interventions. Further interdisciplinary research should address these emerging themes to build effective and sustainable approaches to large-scale behavior change

Explanatory pluralism in the medical sciences: theory and practice

Explanatory pluralism is the view that the best form and level of explanation depends on the kind of question one seeks to answer by the explanation, and that in order to answer all questions in the best way possible, we need more than one form and level of explanation. In the first part of this article, we argue that explanatory pluralism holds for the medical sciences, at least in theory. However, in the second part of the article we show that medical research and practice is actually not fully and truly explanatory pluralist yet. Although the literature demonstrates a slowly growing interest in non-reductive explanations in medicine, the dominant approach in medicine is still methodologically reductionist. This implies that non-reductive explanations often do not get the attention they deserve. We argue that the field of medicine could benefit greatly by reconsidering its reductive tendencies and becoming fully and truly explanatory pluralist. Nonetheless, trying to achieve the right balance in the search for and application of reductive and non-reductive explanations will in any case be a difficult exercise