Preventive Behaviors for Cognitive Health Maintenance: Understanding the Role of Message Framing and Involvement

Introduction: Neurocognitive conditions like Alzheimer’s disease, associated with decline in cognitive functioning and progression to loss of mental and physical functioning are on the rise due to lack of available treatment and increasing proportion of aging population. There are 5.3 million Americans currently with Alzheimer’s disease and the number is expected to rise to 1.1. trillion by 2050 with equally exponential rise in costs, morbidity and mortality. In such times, efforts are being made by national organizations such as National Institute of Health and CDC to increase awareness of early identification and engagement in behaviors which preserve cognitive functions. Such efforts have highlighted the importance of effective communication in disseminating information about cognitive health. Communications need to address the prevailing concerns of the target older adult population and encourage them to engage in preventive behaviors for maintenance of cognitive health. Psychosocial research in communication has depicted that the manner in which the information about preventive behaviors can influence the perceptions, judgements, decisions and behaviors. At the same time, individual characteristics like the involvement (e.g., personal relevance) can affect the predisposition towards a behavior. The current study therefore aimed at evaluating the effect of message framing and involvement on intention to engage in preventive behaviors. Methods: The study was an experimental, cross-sectional factorial survey design consisting of two factors each with two levels: (a) Message-framing (positive-framing and negative-framing) and (b) Involvement (Low and High). Protection motivation theory of fear appeals was used to develop a conceptual model. The proposed model was developed measured the association between the manipulated factors levels of message-framing and involvement on constructs of PMT namely perceived severity, perceived vulnerability, response-efficacy, self-efficacy and intention to engage in recommended preventive behaviors. Vignettes were developed for each level of message-framing and involvement scenarios were constructed. The PMT questionnaire was developed using pre-validated questionnaires and adapting them to the current study. All PMT variables were measured on a 7-point Likert scale. The survey was developed in an online data collection survey software Qualtrics and was disseminated online. Reliability analysis, descriptive statistics, ANCOVA and multiple linear regression were performed using SAS® version 9.2 at a priori significance level of 0.05. Comprehensive model testing was conducted using structural equation modeling (SEM) technique. Mplus was used to test the model. Results: A total of 368 completed surveys were obtained. Multiple linear regression analyses indicated that involvement had a significant positive association with perceived severity (p=0.0478), perceived vulnerability (p=0.0318) and intention (p=0.0001). Message framing had a significant positive association with perceived severity (p=0.0041) and perceived vulnerability (p=0.0007) but a negative association with self-efficacy (p=0.002). There was no effect of message-framing and involvement on response-efficacy. Message-framing also did not have a direct effect on intention. However, path analysis indicated that message-framing had an indirect negative effect on intention. Perceived severity, perceived vulnerability, response-efficacy and self-efficacy were all significantly associated with increased intention to engage in preventive behaviors. Conclusion/Implications: The study results indicated that higher level of involvement (i.e. personal relevance) has a positive effect on PMT constructs towards improving engagement in preventive behaviors. At the same time, although message-framing had a positive effect on perceived severity and vulnerability, it had a negative effect on self-efficacy and a negative overall indirect effect on intention. The results highlight the importance of increasing awareness about personal risk factors for Alzheimer’s disease and using appropriate message-framing structures in developing materials to improve engagement in preventive behaviors for cognitive health. Healthcare professionals and organizations may take these findings into consideration to develop future studies and communication material.