How to develop successful health behaviour campaigns

choosing healthy foods

Designing effective health behaviour campaigns are essential given that today’s leading causes of death are behaviour-related, and thus, preventable. However, health campaigns can end up being disastrous if the intended message that gets communicated has the opposite effect to what was intended or desired. The main reason behind this ‘boomerang effect’ is what researchers term psychological reactance, which is a theory first coined by Brehm (1966)

According to psychological reactance theory (Brehm, 1966), people place high value on their freedomchoice and autonomy, as such, when people experience a threat to their freedom or ability to choose (e.g., a persuasive message) psychological reactance is said to occur. Psychological reactance is therefore a motivational state which presents itself in the form of anger and/or negative thoughts that are aimed at restoring threatened or lost freedom. 

To understand how this plays out in real life, and in persuasive health campaigns, we need to understand what is meant by freedom, threats to freedom, and how these two play a role in triggering psychological reactance. 

Freedom

In a nutshell, freedom entails the belief we hold about how we may act. Each of us holds a multitude of freedoms and include our beliefs, actions, emotions, and attitudes.  However, freedom for us only exists when we perceive it to be freedom. In other words, only when you have the knowledge that you are able to choose in that particular situation and have the ability to act on that freedom. As such, any freedoms that are perceived to not exist cannot be threatened, and therefore, cannot arouse psychological reactance.

Freedom Threats

Threats to our freedom arise whenever something makes it difficult for us to exercise our freedom. For example, when you have the freedom to choose what foods to eat and you are placed on a diet that prevents you from eating certain foods. This will present a threat to your freedom in choosing the foods you want to eat. As such, any persuasive health campaigns can be considered a threat to people’s perceived sense of freedom. 

Psychological Reactance

When we encounter a perceived threat to our freedom, it tends to “get our backs up”. In other words, it triggers what is better known as psychological reactance, which is described as a motivational state that gets us to eliminate or decrease the perceived, or actual, threat to freedom. The way in which psychological reactance shows up is through anger and negative thoughts. Our psyche makes use of this reactance as a way to re-establish our need for freedom.

However, in order to react to a perceived freedom threat, we need to consider what freedom means to people. What I consider to be freedom may differ from another person’s idea of freedom. A very obvious example in this instance would be one person who is able to choose his or her husband or wife, whereas in some cultures, it is accepted that your husband or wife is chosen for you. Similarly, some people tend to have a stronger need for freedom than others. Given this, it makes sense that we also need to take into account personal factors that may influence the degree of psychological reactance. 

Personal Factors

Because we are all unique, with our own experiences, values, beliefs, ethnicities, and attitudes, we do not all experience psychological reactance to the same threat, neither to the same intensity. As individuals, we also differ in our need for autonomy and self-determination, which refers to our ability to make choices voluntarily and direct our own life. Research has also shown that this need for autonomy plays an essential role in our psychological health and well-being. The more people perceive themselves to have autonomy or self-determined, the higher their level of psychological wellbeing. As such, the higher a person’s need for autonomy, the greater their reaction to perceived freedom threats will be. 

In fact, research has shown that people who tend to be highly reactant are characterized by a resistance to rules and regulations, show a high need for autonomy, are highly defensive, and have little regard for social norms.   It is then not surprising to learn that people who show strong psychological reactance are also those who are more likely to engage in high risk health behaviours. 

Just as our need for autonomy is very individualised, so is the strength of our psychological reactance and it all depends on the importance we place on the particular freedom that is being threatened. This means that, for example, the more important smoking is to you, the more you will show psychological reactance towards any limits placed on your ability to smoke.

All of this leads to one primary motivation, our need to restore this “endangered” freedom. 

Freedom Restoration

The way in which we restore or reclaim or freedom is through this state of psychological reactance which, at its core, is a motivational state with energising and behaviour-directing properties. This means that psychological reactance gets people to do something or to act in order to restore or reclaim their threatened freedom. This can be achieved either directly or indirectly. 

Direct ways of restoration may include engaging in the threatened behaviour (e.g., smoking after exposure to an anti-smoking message), or by resisting the advocated behaviour (e.g., refusing the flu vaccination after exposure to a flu vaccination message), or engaging in a closely related threat behaviour (e.g., instead of smoking cigarettes, smoking marijuana).

Given that directly reclaiming our freedom is not always possible, or appropriate, we often make use of indirect means to reclaiming freedom. Indirect ways of restoration may include behaviours such as liking the threatened choice even more, watching others perform the threatened choice in a freedom restoring way, denying that the threat exists, or insulting the source of the threat in order to regain feelings of control and autonomy. For example, in response to messages that discourage overeating, people who experience reactance may choose to restore their freedom by increasing their liking for overeating, or associating themselves with others who overeat, or by insulting the primary source of the message, or through denying that overeating is in fact a major problem.

Given the above, it is evident that persuasive health messages can sometimes have harmful or negative consequences through triggering the opposite effect of what was initially (and well) intended. By conducting a review of all the research done on reactance within the health promoting spheres, Reynolds-Tylus (2019) identified key health message features that are most likely to eliminate, or reduce, psychological reactance. I will summarise these key features for you below with the hope that it can provide you with some insight into how to frame your prospective health messages.

1) Freedom-threatening language use

Messages are said to be freedom-threatening when they use language that explicitly limits the autonomy of the reader. For example, messages that contain words such as “you must”, “it is impossible to deny,” “the only way is to do this”, or “stop fooling yourself”. The more threatening a message is, the higher the psychological reactance it will evoke. 

2) Adding choice postscripts

These are statements at the end of a message that increases the reader’s sense of autonomy by leaving them with a choice,  in other words, the decision to comply with the message recommendations is entirely their choice. For example, “ultimately the choice lies with you” or “if you were to choose this”. Statements that are NOT freedom enhancing are statements like “Please move to the next step” or “Get your vaccination today”. 

3) Using stories

When the persuasive message is tied to a narration (i.e. a story), then it camouflages or hides the persuasive intent of the message, and consequently, reduces psychological reactance. In fact, narrated messages have shown to increase positive attitudes towards both the message and the presented health behaviour. 

4) Using empathy 

When persuasive messages are structured to elicit empathy in the reader, it enhances persuasion by lowering psychological reactance. Empathy can be elicited either emotionally (i.e., affective empathy) or cognitively (i.e., cognitive empathy). When emotionally, the reader identifies on an emotional level with the situation of another person and shares their feelings. Cognitive empathy is elicited when the reader takes perspective of another person’s situation and allows for comprehension and understanding. 

5) Gain vs Loss-framed messages

Even though loss-framed messages are thought to be superior in the psychological literature, primarily due to the two psychological concepts of negativity bias and loss aversion, however, when it comes to persuasive health messages, neither gain or loss-framed messages have shown to make a significant difference. What did seem to make a difference is fear. Research has shown that loss-framed messages do tend to elicit fear, which in turn, is associated with higher psychological reactance. 

6) Using sensation messages 

A message is said to have sensation when its content (audio or visual or both) elicits a sensory or emotional response in the reader. For example, messages that provide a dramatic impact, emotional effect, or portrays novelty. High sensation messages have shown to be more persuasive than low sensation messages. An interesting fact is that high sensation messages are particularly appealing to high sensation seekers (i.e., those individuals who tend to engage more in high-risk behaviours), as these messages meet their psychobiological needs for activation. It then makes sense that high sensation seekers are also an ideal target audience for persuasive health messages. However, high sensation messages are ONLY effective if they do not contain controlling language.

7) Other-orientated messages

Other-orientated messages are messages that emphasise the potential influence of an individual’s choices on others such as their friends, family, and loved ones. For example,  a persuasive message that ends with the question: “When your kids watch your food choices, what are you teaching them?”

8) Reasonable endings

When messages end by providing reasons for why it makes sense to adopt the new health behaviour, have shown to be much more effective at lowering or eliminating psychological reactance. For example, if a message were to end with: “The facts reported here are pretty solid when you think about them. Therefore, making the necessary changes to improve your own health actually make a lot of sense”. 

Now you are equiped to develop SUCCESSFUL health campaigns by keeping these message features in mind.

It can be the difference between a win or a loss!

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