Exploring the role of emotions on health decisions: Case studies in cancer screening, vaccination, and nutrition
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Introduction One of main the objectives of public health is to promote behaviors that improve mental and physical health. Consequently, public health researchers have been studying models of behaviorchange/decision-making for decades in order to understand how to propel people’s behavior. However, most of the traditional health behavior models are consequentialist models that view decision-making mostly as a cognitive process, in which an individual evaluates a set of alternatives based on certain criteria (i.e., perceived risks, perceived benefits, perceived cost, etc.) to choose the option that holds the best health outcomes. However, during the past two decades a growing stream of research has considered and examined the role of emotions on health decisions and behavior. The results of this stream of research demonstrate the significant role that emotions play in making health decisions. Therefore, understanding how emotions influence health decisions is critical to inform effective health interventions and policies. This thesis contributes to the existing body of the literature that examines the role of emotions on health decisions by investigating how emotions affect health decisions in the domains of vaccination, breast cancer screening, and nutrition. Background Decision and behavioral researchers have proposed a variety of emotional theories to explain how emotions affect judgement and decisions. Some of these theories are recognized as valence-based theories, such as affect transfer theory or affect as information hypothesis, that demonstrate how positive or negative emotions affect the decision-making process. However, the valence-based theories of emotions lack the explanatory power to address the difference that the-same-valence emotions (e.g., fear and sadness) have on judgement and decisions. Therefore, decision researchers adapted and advanced cognitive appraisal theories of emotions to illustrate how various discrete positive/negative emotions influence judgement and decisions based on cognitive appraisal tendencies associated with the emotions. This thesis utilizes both valence-based and cognitive appraisal theories of emotions to further the understanding of how emotions affect health decisions. More specifically, this thesis includes the following independent studies that all explore the role of emotions on health decisions in various domains. Research problems and methods The first study is a narrative review of the literature on the role of emotions on judgement and decisions with a focus on health decisions that 1-presents a highlight of the new findings and theories regarding the role of emotions in judgment and decision-making in an organized way, and 2- presents a broad range of examples and published work demonstrating how to apply these findings to inform more effective health interventions and policies. The second study investigates how affective evaluation of a vaccine can influence child vaccination, utilizing the affect as information hypothesis as a lens. The study examines the research question through a survey based experimental manipulation study run through Amazon Mechanical Turk (n=368) in which the researcher manipulated the affective impression of a vaccine to understand how affective impressions influence the perception of risks and benefits of a vaccine and the intention to vaccinate. The research findings showed that emotions both directly and indirectly (i.e., through a change in the perception of risks and benefits) influence the intention to vaccinate. The third study intends to understand the role of the emotion of embarrassment on the intention to undergo a mammogram. In this work, through a comprehensive review of the literature on breast cancer screening barriers, especially embarrassment, and consultation with experts, the researcher developed a 14-item questionnaire to evaluate mammography embarrassment considering the factors that contribute to a person feeling embarrassed in terms of both social embarrassment and bodily embarrassment. The scale was examined through conducting a survey-based study through Amazon Mechanical Turk with women older than 45 years old (the recommended age to start breast cancer screening in the US), who were residing in the US, with medical insurance to cover annual mammography (n= 402). The study compared the scale against other validated measures such as General Medical Embarrassment, Susceptibility to embarrassment scale, etc. The researchers validated the scale and showed that the breast cancer embarrassment score is significantly correlated with the participants' past screening behavior and their intention for future screening. The fourth study, which utilized a 2 (loss- and gain- frames) by 5 (emotions: happiness, sadness, fear, disgust, and anger) factorial design, investigated whether relative persuasiveness of a gain- versus loss-framed message regarding fruits and vegetables consumption would depend upon the emotional state (i.e., happiness, sadness, fear, disgust, and anger) of the individual receiving the message. The study was conducted through Amazon Mechanical Turk. Participants (n=644), who were all able to financially afford the recommended amount of fruits and vegetables yet were consuming less than the recommended amount, were randomly assigned to one of the five emotional conditions. The target emotions were induced through validated methods. The participants were then presented with either a loss/gain message regarding the side-effects/benefits of inadequate/adequate consumption of fruits and vegetables. The results of this study showed a significant main effect of emotion, and the interaction between emotions and message framing on the intention to increase the consumption of fruits and vegetables. More specifically, participants who were primed with the emotion of happiness and fear had a significantly higher intention to increase their consumption of fruits and vegetables than sadness, disgust, and anger. In addition, the results suggested a significant frame by emotion interaction that showed participants primed with sadness, happiness, and anger were more likely to have a higher intention to increase their fruits and vegetables consumption when presented with the gain framed message, compared to the loss framed message. However, participants in the fear and disgust conditions were more likely to have a higher intention to increase their fruits and vegetables consumption when presented with the loss-framed message compared to the gain framed message. We explained how the cognitive appraisals of the certainty, control and valuation and choice associated with each of the emotions contributed to the results. The practical implications in health intervention and policies were also discussed. The fifth study looks at the effect of discrete emotions including sadness, fear, disgust, and anger on the persuasiveness of health messages regarding the consumption of sugar sweetened beverages (SSBs) through a randomized between subject design (including the emotional states and a neutral condition). The participants (n=392), who were all drinking four or more sugary drinks per week, were randomly assigned to one of the five conditions, in which the target emotion (i.e., sadness, fear, disgust, and anger) was induced through validated methods. The subjects then were presented with a health message regarding the health consequence of SSBs to examine how a combination emotions and health messages can influence their intention to reduce SBBs’ consumption. The results, which were analyzed through the lens of the Appraisal Tendency Framework (ATF), revealed that the intention to decrease the consumption of SSBs was higher when participants were primed with disgust and fear compared to sadness and anger. A detailed discussion demonstrating how these results are related to the cognitive appraisals of valuation and choice, certainty and personal control associated with any of the emotions was presented in the paper. Also, the practical implications in health intervention and policies were discussed. Conclusion This dissertation investigates the role of emotion on health decisions and contributes to our understanding of how affect and emotions can influence health decisions. The first study presented a broad framework on the role of emotions in health decisions through an organized narrative review that can serve as a lens through which more informed health interventions and policies can be designed. Then, in the next studies we focused on exploring the role of emotions in specific health domains. For instance, through the development of a scale for breast cancer screening we showed the significant impact of the emotion of embarrassment on the intention to get breast cancer screening. Furthermore, we explored how emotions affect decisions regarding vaccination and choice of nutrition by utilize existing lenses and theories in the (behavioral economic) and decision-making literature. More specifically, these studies investigated how affects and emotions impact the perception of health messages and the intention to engage in the advised health behaviors. The findings of the later studies contribute 1- to a better understanding of the original theories by exploring them in a different domain (i.e., health domain) and also 2- to expand the comprehension of how emotions can influence health decisions. All in all, the studies presented in this thesis indicate the significant role that emotions play in health decisions and demonstrate how they can be utilized to inform more effective health interventions and policies.
Cite this version of the work
Mehrnaz Mostafapourdehcheshmeh (2022). Exploring the role of emotions on health decisions: Case studies in cancer screening, vaccination, and nutrition. UWSpace. http://hdl.handle.net/10012/18125