Getting Ahead of Illness: Using Metaphors to Influence Medical Decision-Making

Transcription

1 Getting Ahead of Illness: Using Metaphors to Influence Medical Decision-Making Introduction There are many behaviors that we know we ought to engage in, but fail to, such as exercising, volunteering, and spending more time with family. These gaps between what ought to be done (injunctive norms) and what is actually done (descriptive norms) are known as descriptive-injunctive norm gaps (Cialdini, 2012). These descriptive-injunctive norm gaps are especially prevalent in health and medical decision-making. Take flu vaccinations for example. We all know that we should get vaccinated every year and yet many of us fail to do so. This particular descriptive-injunctive norm gap becomes concerning when one considers that the number of individuals who contracted the flu nearly doubled between the and flu seasons, while the number of individuals who received flu vaccinations remained relatively stable (Center for Disease Control, 2012), which incurs not only public health costs, but also economic costs in terms of lost productivity. Why do descriptive-injunctive norm gaps exist? Research on descriptive-injunctive norm gaps suggests that these gaps exists due to whether attention is directed towards the descriptive or injunctive norm (Cialdini, 2012). Research on medical decision-making has demonstrated that we often fail to engage in healthy decision-making because the risks are too abstract, reducing comprehension of the risk (e.g., Fagerlin, Ubel, Smith, & Zikmund-Fisher, 2007). Because risk causes us to focus on what we ought to do, underestimating risk may cause individuals to fall back on descriptive norms (i.e., the suboptimal health decision). The focus of the current studies is an examination of the possibility of using metaphors as a method of reducing descriptive-injunctive norm gaps, specifically with flu vaccination

2 intentions. A metaphor is a description of an abstract concept as a superficially dissimilar, concrete concept (Landau, Meier, & Keefer, 2010). Metaphor use is ubiquitous, with the average person using six metaphors per minute, and processed fluidly for a native speaker of the language (Landau et al., 2010; Williams Camus, 2009). For example, if I say Justice is blind, you easily recognize that I m not talking about the visual abilities of a person named Justice, but that the concept of justice is characterized by an indifference to factors that are irrelevant for making a fair determination. Metaphors have been demonstrated to influence a wide variety of judgments, from the evaluation of job candidates (Ackerman, Nocero, & Bargh, 2010) to preferred responses to crime (Thibideau & Boroditsky, 2011). For example, Thibideau and Borditsky (2011) found that individuals preferred a more rehabilitative response to crime when crime was described as a virus (implying treatment) and more retributive responses when crime was described as a beast (implying containment/neutralization). Metaphors may be particularly useful in narrowing descriptive-injunctive norm gaps for medical decision making, such as choosing to get a flu vaccination, due to the pervasive use of metaphors when describing medical conditions (e.g., I m burning up from this fever ) or medical campaigns (e.g., the war on cancer; see Williams Camus, 2009). While the causes of medical conditions are physical, such as the flu virus, individuals may only understand the causes of medical conditions abstractly, thus underestimating the risk. In the context of the current studies, describing the flu virus metaphorically may more strongly communicate the risk that the flu virus poses, shifting attention away from descriptive norms (re: not getting vaccinated) to injunctive norms (re: getting vaccinated), increasing behavioral intentions to get vaccinated. 2

3 Methods Two studies were conducted to provide an initial test of whether metaphors might influence willingness to get a flu vaccination. Due to the similarity in methodologies, the data and methodologies for Studies 1 and 2 will be described together. Participants Participants in Study 1 (N = 167) were University of Iowa undergraduates enrolled in either Elementary Psychology or Research Methods who received credit towards the research requirement for their course. To examine the generalizability of the results of Study 1, participants in Study 2 (N = 236) were recruited via Amazon s Mechanical Turk. Mechanical Turk is a service where researchers put their study online and individuals complete the study in return for a (usually) small monetary payment ( Previous research has demonstrated that data obtained from MTurk participants do not significantly differ in reliability compared to data obtained from participants run in the lab (e.g., Buhrmester, Kwang, & Gosling, 2011). To participate in the study, participants were required to have an approval rating of 95% or higher and were compensated $.20 for completion of the study. Procedure Participants began the study by reading a short description of rising prevalence of the flu (see Materials). Critically, the flu was described literally (as a virus that infects the body ) or metaphorically (as a wild beast that preys on the body or a riot that revolts against the body ). After reading the description of the rising prevalence of the flu, participants indicated the likelihood that they would get vaccinated during the next flu season (Studies 1-2) and whether they would like to receive an reminder to get vaccinated (Study 2). Participants concluded the study by answering questions that measured potential mediators and moderators of the 3

4 impact of metaphors on willingness to get a flu vaccination. These measures included perceived risk of getting the flu, perceived severity of getting the flu, and flu and vaccination history. Materials The descriptions of the flu used in the two studies were modeled on the descriptions of crime that Thibideau and Boroditsky (2011) used. Two different metaphors were used to provide some protection against stimulus sampling issues (Wells & Windschitl, 1999). The prevalence rates in the descriptions were actual prevalence rates obtained by the Center for Disease Control (Center for Disease Control, 2012). The descriptions used are presented below with the manipulation in bold and the two metaphor conditions in the parentheses. The flu is a virus that infects (beast that preys on/riot that revolts against) the body. The percentage of people in the United States getting the flu has steadily climbed over the past three years. In fact, these days it seems that the flu is infecting (lurking in/rising up in) every neighborhood. In the flu season, 55,403 people in the US tested positive for the flu compared to 27,682 in The rise in the flu is particularly alarming. Results A suspicion check question at the end of the study revealed that no participants in either study inferred the purpose of the study. There were no significant differences across the two metaphor conditions for both studies, ps >.45, so the two metaphor conditions will be combined for ease of presentation for Studies 1-2. Study 1 Metaphor use significantly increased behavioral intentions towards getting a flu vaccination in the upcoming flu season (see Figure 1). The average reported likelihood of getting 4

5 vaccinated among participants in the metaphor conditions was 54.8%, while participants in the control condition reported a mean likelihood of 41.4%, t(165) = 2.47, p =.015. Metaphor use had no impact on the perceived risk of getting the flu (for both direct and indirect measures of risk), ps >.39, but marginally increased the perceived impact of getting the flu, t(165) = 1.65, p =.10. Unfortunately, perceptions of the impact of getting the flu were uncorrelated with the reported likelihood of getting vaccinated (r = -.04), p =.61. The effects of metaphor use on behavioral intentions to get vaccinated were not moderated by flu or vaccination history, ps >.37. Consequently, none of the potential mediators or moderators of the impact of metaphors on behavioral intentions to get vaccinated were significant. Study 2 As a reminder, Study 2 contained an additional measure that asked whether the participant would like to receive an reminder to get vaccinated during the upcoming flu season. Unlike Study 1, there was no significant effect of metaphor use on reported likelihood of getting vaccinated, p =.60. Additionally, there was no significant effect of metaphor use on reminder requests, p =.60. However, there was a significant interaction between metaphor use and vaccination frequency on both behavior intent to get vaccinated and reminder requests, ps =.05 and.02, respectively. Critically, participants who reported occasionally getting flu vaccinations reported a higher likelihood of getting vaccinated in the upcoming flu season in the metaphor conditions (59.8%) than the control condition (43.2%; see Figure 2). Participants in the occasional vaccination group also had a higher rate of requests to receive an reminder to get vaccinated in the metaphor conditions (20%) than the control condition (8.0%; see Figure 3). Metaphor use had no theoretically meaningful main effects or interactions with measures of perceived flu risk or flu impact, ps >.15. 5

6 General Discussion The results of these two studies provides the first empirical evidence that metaphors could be used to narrow descriptive-injunctive norm gaps. Metaphors had a main effect on behavioral intentions in Study 1 and produced an effect among individuals who occasionally receive flu vaccinations in Study 2. These results are easily reconciled by the fact that Study 1 had a relatively homogenous sample (all college undergraduates), while Study 2 had a more heterogeneous sample (online sample). Additionally, the finding that the results are present primarily among individuals who occasionally receive flu vaccinations makes the most sense theoretically and practically. Individuals who always or never receive flu vaccinations probably already have firmly established attitudes towards flu vaccinations that are unlikely to be influenced by such a subtle manipulation as the introduction of a metaphor. It is among individuals who occasionally get vaccinated who simply require a little nudge to increase their behavioral intentions of getting vaccinated that would be targeted by public health research and practitioners. The effects of metaphor use on vaccination reminder requests was also found only among occasional vaccinators. While there was a dip among individuals who requested reminders in the metaphor conditions for the individuals who never or always received vaccinations, metaphor use appeared to leave their behavioral intentions to get vaccinated relatively unaffected, which should reduce any concern that there would be a metaphor-backlash against getting vaccinated for individuals who never or always receive vaccinations. Including metaphors in decision aids or information packets could provide a very cost efficient way of reducing descriptive-injunctive norm gaps in health and medical decision making. That being said, more research is needed before this suggestion is implemented. The 6

7 most obvious next step would be to measure actual vaccination behaviors following exposure to the flu being described metaphorically. While behavioral intentions are highly predictive of actual behaviors (see Ajzen, 1991, for a review), research examining actual vaccination decisions should be conducted before implementing metaphor use on a large scale. Additionally, given that the two proposed mediators, perceived flu risk and flu impact, failed to differ as a function of condition, additional research is needed to determine why the metaphors had the effect they did. One possibility that was discussed in the Introduction, but was not directly measured in the current studies, is that metaphors might draw attention away from descriptive norms (re: not getting vaccinated) towards injunctive norms (re: getting vaccinated), increasing the individual s willingness to get vaccinated. Consequently, individuals who perceive the flu metaphorically may not feel like their risk of getting the flu has increased, but might feel a greater obligation, and consequently inclination, to get vaccinated. We plan on including a measure of how much the individual feels like they ought to get vaccinated (as a measure of injunctive norms), as well as perceptions of what percent of the population gets vaccinated (descriptive norms), in future studies to test this possibility. Finally, additional research should examine whether metaphors influence other types of descriptive-injunctive norm gaps beyond vaccination decisions. Conclusion While the exact mechanism remains unknown, the current studies provide the first evidence that metaphors may be one means of reducing descriptive-injunctive norm gaps, particularly among individuals who occasionally engage in the injunctive norm. If the effects of the current studies generalize to other behaviors for which descriptive-injunctive norm gaps exist, metaphors could provide a no-cost boost to the effectiveness of any sort of informational 7

8 campaign that seeks to narrow a particular descriptive-injunctive norm gap by nudging individuals towards making the right decision. 8

9 Reported Likelihood of Getting Vaccinated Reported Likelihood of Getting Vaccinated USING METAPHORS Figure 1. Study 1 reported likelihood of getting vaccinated by condition. Error bars represent standard errors Condition Control Metaphor Figure 2. Reported likelihood of getting vaccinated by condition and vaccination frequency. Error bars represent standard errors Control Metaphor Vaccination Frequency 9

10 % Requesting Reminder USING METAPHORS Figure 3. Study 2 vaccination reminder requests by condition and vaccination frequency. Error bars represent standard errors Control Metaphor 0 Vaccination Frequency 10

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