Effects of message framing, psychological distance, and risk perception on exercise attitude in Chinese adolescents

Wang, Xiaohua; Duan, Xiyan; Li, Shichen; Bu, Te

doi:10.3389/fped.2022.991419

ORIGINAL RESEARCH article

Front. Pediatr., 30 August 2022

Sec. Children and Health

Volume 10 - 2022 | https://doi.org/10.3389/fped.2022.991419

This article is part of the Research Topic Physical Activity and Lifestyle Sustainability: From Childhood to Old Age View all 25 articles

Effects of message framing, psychological distance, and risk perception on exercise attitude in Chinese adolescents

$\nXiaohua Wang&#x;$ Xiaohua Wang¹^†

Xiyan Duan²^†

Shichen Li²^*

Te Bu²^*

¹School of Physical Education and Health, Wenzhou University, Wenzhou, China
²College of Physical Education, Hunan Normal University, Changsha, China

Objectives: Health communication campaign that promotes physical activity may aid in reducing the prevalence of childhood and adolescent obesity in China. This study examined the effects of message framing and psychological distance on the exercise attitude of Chinese adolescents, along with the interactive role of risk perception.

Methods: Participants in this study were between 10 and 19 years of age. Three experiments were conducted independently. In experiment 1, 76 participants were recruited to assess the effectiveness of message manipulation. In experiment 2, 40 participants were recruited to compare the effects of gain- and loss-framed messages on the exercise attitude. In experiment 3, 37 participants were recruited to explore the interaction between message framing (gain vs. loss), temporal distance (proximal vs. distal), and risk perception (low vs. high) on the exercise attitude. Exercise attitude and risk perception were assessed by Likert-type questionnaires.

Results: There was a significant main effect of message framing (P < 0.05), with the gain-framed message inducing a stronger exercise attitude than the loss-framed message. There was a significant main effect of temporal distance (P < 0.05), with the proximal temporal distance condition inducing a stronger exercise attitude than the distal temporal distance condition. In addition, a significant interaction (P < 0.05) was observed, and the perception of obesity-related risk was a crucial moderator of the message framing and temporal distance. Regardless of whether they were exposed to a gain- or loss-framed message, the proximal temporal distance condition induced a stronger exercise attitude in participants with a high risk perception (P < 0.05).

Conclusion: Messages promoting exercise that are framed as having a near-future gain effect and that emphasize disease risks are effective in motivating adolescents to engage in physical activity.

Introduction

Obesity is caused by an excess of energy intake over energy expenditure, which develops gradually over time and results in an excessive accumulation of body fat. Obesity leads to a wide array of health problems, including hypertension, type 2 diabetes, coronary heart disease, osteoarthritis, and stroke, and contributes significantly to morbidity and mortality (1). The Chinese government prioritizes preventing and resolving the issue of childhood obesity. In 2016, the Outline of the “Healthy China 2030” Plan (2) proposed strengthening the prevention and treatment of childhood overweight and obesity. According to the most recent Report on Chinese Residents' Chronic Diseases and Nutrition 2020, the prevalence of overweight and obesity in school-aged children aged 6–17 has reached 19% (3). Lifestyle modifications such as dietary intervention and physical activity are necessary for the effective management of obesity (1). In response to the alarming obesity trend, the National Fitness Program (2021–2025) emphasizes the promotion of physical activity for key populations and exercise interventions for childhood obesity (4). Participation in physical activity is voluntary and, thus, subject to individual's decision-making processes. Correspondingly, it is crucial to help children and adolescents shape a positive exercise attitude first.

According to the theory of reasoned action, behavioral attitude and subjective norms influence behavioral intention, and behavioral intention can directly determine the occurrence of behavior (5). The exercise attitude-behavior model has subsequently been proposed for exercise promotion (6). Theoretically, an individual's exercise attitude exerts positive influence on their exercise intention, which in turn influences their actual exercise behavior. With the continuous development and improvement of research theories pertaining to exercise attitude, more studies have been conducted on the practical applications of exercise attitude. Qiu and Zhang (7) reported a single session of cognitive learning can successfully modify implicit exercise attitude; nevertheless, its effect on physical activity is very transient, lasting only 1 day in their study. Liu and Li demonstrated that the exercise attitude of Chinese University students positively predicted exercise behavior, including duration, intensity, and frequency of exercise (8). A longitudinal study revealed that American adolescents with more positive exercise attitude engaged in 30–40% more moderate-to-vigorous physical activity at 5-year and 10-year follow-up than those with less positive exercise attitude (9). Recently, French researchers looked into the effect of eHealth (i.e., online and social media exercise and physical activity promotion) on exercise attitude and actual exercise activity during the first COVID-19 pandemic wave (10). eHealth users demonstrated significantly higher levels of exercise attitude, vigorous physical activity, and total physical activity per week compared to non-users. These findings illustrate the importance of developing health communication with evidence-based material for encouraging an exercise-friendly attitude, and its therapeutic implications are now being explored and expanded (11).

Message framing is a persuasive message that can influence an individual's decision preferences by altering the presentation of the alternative message (12). There are three types of framing effect: risky choice framing, attribute framing, and goal framing (13). The goal framing effect, which describes whether a persuasive message emphasizes the positive outcomes of performing an act or the negative outcomes of not performing the act, has gained popularity in health communication research of exercise attitude. In general, the effect associated with goal framing is both positive and diverse. Latimer et al. (14) presented gain- or loss-framed messages to sedentary, healthy participants at baseline, week 1, and week 5. At week 9, it was found that gain-framed messages led to greater participation in physical activity than loss-framed messages. Similarly, Berenbaum and Latimer-Cheung found that gain-framed messages resulted in stronger exercise attitude than loss-framed messages when presented to female University students (15). In anther study, University students who received framed mental health messages on social media had a stronger exercise attitude than those who got random health facts unrelated to physical activity (16). However, the authors did not find a significant difference between gain- and loss-framed messages in terms of exercise attitude or actual exercise behavior as measured by total MET minutes per week. This disparity in outcomes may be attributable to the heterogeneity of the focus participants investigated. For instance, Song et al. (17) demonstrated that exercise self-efficacy was negatively affected when individuals with high body image dissatisfaction viewed an image of themselves on a video game screen, indicating that overweight and obese individuals may have different psychological responses to physical activity. In addition, existing research have not explored the exercise attitude of children and adolescents in a more homogeneous manner. In light of these gaps, research of message framing should explore the framing effect on specific populations and likely include perception of disease risks as a covariate.

When constructing health communication aimed at fostering a more positive exercise attitude, it is crucial to take into account variables that mediate the presence, strength, or absence of framing effect. First, the relative persuasiveness of message framing is dependant on the psychological distance (18). Psychological distance is a cognitive separation between the self and other things, such as other people, events, or times (19). The theory posits four dimensions of psychological distance, including spatial distance, temporal distance, social distance, and hypotheticality. Research on marketing communication suggests that consumers in a pre-decisional mindset are more likely to be persuaded by psychologically distal messages, whereas those in a post-decisional mindset are more likely to be persuaded by psychologically proximal messages (20). To date, very few studies have been conducted on the interaction between message framing and psychological distance on exercise attitude (21) and are limited to the general population. A recent study examined the effects of a 3-month exercise promotion program on the attitude and behavior of 18- to 65-year-old adults (22). It has been observed that persons with more negative distal affective attitudes at baseline exhibited the highest proximal affective attitudes toward daily exercise. Moreover, the specific effect of temporal distance in adolescents is completely undocumented.

Second, the relative persuasiveness of message framing is also influenced by the risk perception associated with the advocated health behavior (23). Risk perception is an individual's subjective, more intuitive evaluation of risk (24). Research on health communication found that perception of junk food risk can amplify the relationship between regulatory focus and health consciousness, and message framing combined with the appropriate regulatory focus has a positive effect on consumers' intentions to avoid junk food (25). Similarly, a perception of obesity risk, may also influence one's exercise attitude, which has not previously been noted in published literature. Considering the cognitive connection between the perceived risk and behavioral responses in health decision-making, it is essential to understand the role of risk perception in shaping exercise attitude among adolescents in order to implement effective message framing.

Integrating health promotion campaigns into the school curriculum and daily life may be a promising strategy for encouraging children and adolescents to improve their health-related beliefs and behaviors. To develop tailored exercise promotion, a comprehensive understanding of the mechanisms underlying the formation of exercise attitude is urgently required. This study therefore examined the interaction between message framing, temporal distance, and risk perception on the exercise attitude of Chinese adolescents.

Experimental 1

Methods

Participants

Experiment 1 was designed to validate the framed messages employed in experiments 2 and 3. Participants had not previously participated in similar experiments. Seventy six students participated in experiment 1, with 39 participants being female. Their age was 14.5 ± 1.2 yrs (girls, 14.4 ± 1.2 yrs; boys, 14.7 ± 1.1 yrs). All participants and their legal guardians were verbally and in writing informed about the research prior to providing written informed consent to participate. This experiment was approved by the Ethical Review Board of Hunan Normal University.

Instrument

Table 1 presents the messages framed to motivate exercise. The gain-framed message emphasized the advantages of regular participation in exercise and sports, whereas the loss-framed message underlined the disadvantages of non-participation.

TABLE 1

Table 1. Framed messages (translated from Chinese).

The effectiveness of framing manipulation was evaluated based on participants' affective reaction and information acceptance to the framed message. Affective reaction to the framed message was measured using a peer-reviewed, 7-point semantic differential scale (scale: 1, mostly negative; 7, mostly positive) (26). It was anticipated that the gain-framed message would produce stronger positive affect, whereas the loss-framed message would produce stronger negative affect.

Information acceptance of the framed message was measured using a peer-reviewed, 7-point semantic differential scale (27). Participants rated the extent to which they thought the message was relevance (1, very relevant; 7, not at all relevant), interest (1, very interesting; 7, not at all interesting), objectivity (1, very objective; 7, not at all objective), and exaggeration (1, very exaggerated; 7, not at all exaggerated). In addition, participants rated their level of agreement with the message (1, I totally agree; 7, I totally disagree). The information acceptance score was calculated by reversing (except “exaggerated”), combining, and averaging all individual item scores. It was anticipated that the information acceptance score of both framed messages would be higher than the median score 4. Cronbach alpha of this scale was 0.81 (27).

Procedure

Participants read gain- and loss-framed messages at random. They completed the affective reaction scale after reading each message and the information acceptance scale after reading both messages.

Statistics

The deidentified data from experiments 1, 2, and 3 that supporting the conclusions of this study are available on figshare (https://doi.org/10.6084/m9.figshare.20286075.v2). Data were analyzed using the IBM SPSS Statistics (version 26.0). Data are expressed as mean ± standard deviation. A two-tailed Welch's t-test (28) was used to compare the affective reaction score between the gain- and loss-framed messages. A one-sample Wilcoxon signed rank test was used to compare the information acceptance score against the median score 4. A P-value < 0.05 indicates statistical significance.

Results

Affective reaction scores of gain- and loss-framed messages were compared. On average, gain-framed massage (6.12 ± 0.71) was perceived significantly more positive than loss-framed message (2.76 ± 1.30), t_(116.5) = 19.80, P < 0.001. The medium score for information acceptance was 5.4, which is significantly higher than 4, P < 0.001. In summary, the manipulation check confirmed that both framed messages satisfy the experimental conditions.