| dc.description.abstract | 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. | en |
