Elsevier

Appetite

Volume 106, 1 November 2016, Pages 37-47
Appetite

Promoting change in meat consumption among the elderly: Factual and prefactual framing of health and well-being

https://doi.org/10.1016/j.appet.2016.02.150Get rights and content

Highlights

  • The effects of messages on reducing meat consumption by the elderly were examined.

  • Messages were focused on health vs. well-being outcomes of meat consumption.

  • Messages were also framed as either factual or prefactual (“If … then”) statements.

  • Prefactual, not factual, well-being-focused messages reduced intentions to eat meat.

  • Factual, not prefactual, health-focused messages reduced intentions to eat meat.

Abstract

Messages aimed at changing eating habits of the elderly are often not persuasive. In two studies, we tested the hypothesis that the persuasiveness of messages regarding the effects of meat consumption on health versus well-being would depend on their factual versus prefactual (‘if … then … ’) framing. Different groups of elderly participants were presented with different versions of a message describing the possible negative effects of excessive meat consumption. Results of a preliminary study showed that messages about the effects of meat consumption on health and well-being induced a different regulatory concern in recipients, safety and growth concerns respectively. Results of the two main studies then showed that messages about health/safety had stronger effects on participants' involvement, attitudes, and intentions to change eating behaviour when framed in factual rather than prefactual terms. Conversely, messages about well-being/growth had stronger effects when framed in prefactual rather than factual terms. Discussion focuses on how the appropriate framing of messages about meat consumption can effectively promote changes in eating habits of elderly people.

Introduction

Health authorities around the world have invested substantial resources in public campaigns (Hornik, 2002) informing citizens about the potentially undesirable effects of certain foods and the importance of following a good diet. Widespread conditions such as coronary artery disease, myocardial infarction, stroke, hypertension, etc., can be effectively prevented by reducing dietary intake of certain nutrients, such as cholesterol, triglycerides, salt and sugars (Franco, Cooper, Bilal, & Fuster, 2011; WHO, 2014). Furthermore, consumption of red and processed meat has been found to significantly increase the risk of developing several types of cancer (Bouvard et al., 2015).

Due to the high prevalence of chronic and degenerative diseases in the later stages of life, older individuals are frequently the target of nutritional campaigns (Hornik, 2002). However, the effects of these campaigns are often limited (Dodson et al., 2010, Snyder, 2007, Wakefield et al., 2010), for reasons that have yet to be fully understood.

In two experimental studies, we investigated some of the conditions under which a message can effectively motivate older individuals to change their habits regarding meat consumption. We expected that the persuasiveness of the message would depend on two related factors, namely the concern raised by the message and its factual/prefactual framing.

Regarding the concern raised by the message, we made a distinction between messages focused on health and messages focused on well-being. The majority of the messages employed in public campaigns point to health conditions we may wish to avoid, for example: “An unbalanced diet increases your chances of suffering a heart attack or stroke” (Wakefield et al., 2010). However, maintaining and improving one's well-being is another powerful motivation that often leads people to change their eating habits (Block et al., 2011). We therefore aimed to test the persuasiveness of messages focused on health against the persuasiveness of messages focussed on well-being, for example: “An unbalanced diet strains your metabolism and reduces your psychophysical well-being”.

A message regarding the effects of nutrition on health or well-being can be also framed in several alternative ways (Brug et al., 2003, Wilson, 2007). In our research, we made a distinction between factual messages and prefactual messages. In the two examples above, messages were formulated in a factual form, that is, they described the causal relation between an unbalanced diet and certain outcomes. However, the same messages can also be formulated in a prefactual form, presenting an hypothetical future outcome as the consequence of an hypothetical present behaviour (Sanna, 1996). Messages may therefore also be formulated in this way: “If you follow an unbalanced diet, your chances of suffering a heart attack will increase”, and “If you follow an unbalanced diet, you will strain your metabolism and reduce your psychophysical well-being”.

Research on message framing indicates that the persuasiveness of communication promoting change in attitudes and behaviours depends on whether the formulation of a message fits with recipients' growth versus safety concern in terms of self-regulation (Cesario and Higgins, 2008, Cesario et al., 2008, Freitas and Higgins, 2002). In our research, we assumed that messages focused on well-being are connected with a growth concern, because they put an emphasis on the progressive pursuit of a good quality of life (Cesario, Corker, & Jelinek, 2013). Conversely, messages focused on health are connected with a safety concern, because they put an emphasis on the avoidance of punctual and well-defined outcomes, such as specific diseases (Lee & Aaker, 2004). We hypothesised that messages focused on well-being (and therefore inducing a growth concern) would differently affect participants' motivation, attitudes, and intentions to reduce meat consumption when framed in prefactual rather than in factual terms, while messages focused on health (and therefore inducing a safety concern) would be more persuasive when framed in factual rather than in prefactual terms.

In the following paragraphs, we first briefly review past research on the focus on health versus well-being when communicating with the elderly. Then we discuss these two nutrition-related concerns as specific instances of the two basic concerns that regulate individual behaviour (Higgins, 1997, Higgins, 2000), namely the fulfilment of safety needs, on the one hand, and the fulfilment of growth needs on the other. Finally, we speculate on why prefactual formulation better fits with a well-being/growth concern, while factual formulation better fits with a safety/healthy concern.

As individuals age, they are often urged to reduce or even cease their consumption of certain types of food, in order to treat diagnosed conditions (such as diabetes, hypertension, hyperlipidemia, and hypercholesterolemia; see Gariballa, 2004, Janssen et al., 2012; Willett & Stampfer, 2013), or to prevent them (see Boeing et al., 2012 for a review). Neither nutritional advice given by personal physicians, nor public calls by authorities to adopt an appropriate dietary regime are always effective, however (Dodson et al., 2010).

The limitations of nutritional counselling delivered by primary care professionals to older patients (Ryan and Butler, 1996, Sparks and Nussbaum, 2008) include, among other practical aspects such as lack of time and resources, a lack of specific training in nutrition-related matters and in counselling techniques (Kushner, 1995). Furthermore, research on doctor-patient communication (Baltes & Wahl, 1996) highlighted physicians' tendency to focus communication on the aspects of elder patients' life that imply dependence, for example, compliance with medication or coping with disability, rather than on those characterised by autonomy and resilience, for example, physical activity, social interactions, and the preparation of daily meals. More recent research also investigated age as a moderating factor in the effectiveness of public health-promotion campaigns (Southwell, 2010). Age-related changes in cognitive functioning affect the way older adults process information (Koutstaal, 2003), including medical and nutritional guidelines. Older individuals may therefore be less likely to understand and retain information provided by these campaigns.

In addition to cognitive factors, motivational factors may play a role. The elderly may perceive messages promoting changes in eating habits as irrelevant or not sufficiently engaging, as concerns different than health may drive their eating behaviour. Some indication in this sense comes from a study on the motivations of individuals following some form of diet to reduce their weight (Bish et al., 2005). This study, which was conducted using a representative sample of Americans, showed that the percentage of people undertaking efforts to reduce their weight was highest (80.8%) among those who had received medical advice about losing weight, but it was considerably high (40.6%) also among those who had not received any medical advice. Several motivations account for these spontaneous attempts to change eating habits, including a desire to improve physical fitness and psychophysical well-being (Block et al., 2011, Hayes and Ross, 1987, McCabe and Ricciardelli, 2004).

There is an increasing interest in non-health related motivations underlying the decision to change eating habits (Fleury, 1996, Fleury and Sedikides, 2007), reflecting a general shift from a strict biomedical perspective, which considers health as the mere absence of disease, to a broader, holistic perspective, which considers health and well-being as equally important components of individual welfare (McMahon & Fleury, 2012). This is the case across the whole lifecycle, including later stages of life. For example, research on the subjective experience of ageing has shown that despite the high prevalence of chronic and degenerative diseases among the elderly, maintaining a good quality of life remains an important goal even in this stage of life (Gabriel & Bowling, 2004). Therefore, it is possible that most communication advocating dietary change addresses only one concern of the elderly, that is, maintaining health, leaving another relevant one, that is, well-being, unaddressed.

The notions of health as the absence of disease and well-being as the presence of a positive quality of life (Amarantos, Martinez, & Dwyer, 2001) are consistent with the distinction between the two fundamental concerns of safety and growth which regulate individual behaviour, according to social psychological research (Higgins, 1997, Higgins, 1998). Safety concern encompasses the fulfilment of security needs, such as maintaining satisfying life conditions, keeping one's job, and complying with social duties and obligations. Growth concern encompasses the fulfilment of nurturance needs, such as enjoying one's life, advancing one's career, or attaining one's hopes and aspirations. Past research showed that a prevailing safety concern is associated with greater sensitivity to potential loss and a preference for risk-avoidance strategies (Freitas and Higgins, 2002, Higgins, 2000). Conversely, a prevailing growth concern is associated with greater sensitivity to potential gains and a preference for proactive approach strategies.

Persuasive messages can activate growth or safety concerns in recipients (Cesario et al., 2013, Cheng et al., 2013), inducing a “regulatory fit” (Cesario et al., 2008, Freitas and Higgins, 2002, Higgins, 2000) between an individual's self-regulatory concern and the way a message is framed. Some research has shown that regulatory fit can be triggered not only by explicitly framing messages in terms of safety or growth, but also by more subtle aspects of message presentation, such as the body language of the person delivering the message (Cesario & Higgins, 2008). In the present research, we started from this and hypothesized that the effectiveness of messages focused on health (i.e., a safety concern) versus well-being (i.e., a growth concern) can be enhanced by framing the message in factual versus prefactual terms, respectively.

Prefactual thinking is the mental simulation of the possible future outcomes resulting from hypothetical behaviours and decisions (Bakker, Buunk, & Manstead, 1997). While a factual statement (e.g., “Eating vegetables improves your health”) provides a simple causal connection between an antecedent (eating vegetables) and a consequence (improving one's health), a prefactual statement (e.g., “If you eat vegetables, your health will improve”) presents the consequence as an hypothetical event that depends upon the realisation of the antecedent. Prefactual thinking has been found to affect expectations and intentions to act in the future (Petrocelli, Seta, & Seta, 2012), and to improve actual performance in prefactually anticipated behaviours (Sanna, 1996). Individuals engaging in prefactual thinking estimate the subjective likelihood of both the antecedent and the consequence (Petrocelli et al., 2012), regardless of the contingencies that restrain one's actual behaviour. This allows them to mentally simulate how changing one's present choices can lead to different future outcomes, thus increasing their perceived control of reality.

Prefactual thinking has been used successfully in cognitive-behavioural interventions, such as mental contrasting and implementation intentions (Stadler et al., 2009, Stadler et al., 2010). In mental contrasting, individuals first indicate the goal they wish to achieve by changing a certain behaviour, and then they are asked to imagine the most positive outcome of successfully changing their behaviour, and the most critical obstacle they could encounter during the process (Oettingen, Pak, & Schnetter, 2001). By generating implementation intentions, individuals are asked to anticipate the steps leading to a desired outcome by framing them in the if-then prefactual format (Gollwitzer & Sheeran, 2006). Both behavioural strategies have proven to be effective in increasing physical activity, because anticipating possible obstacles and difficulties improves goal commitment and makes possible solutions more readily available. Similarly, Bagozzi, Moore, and Leone (2004) found that the attitudes towards different prefactual scenarios regarding a diet predicted the intention to actually implement such diet. In particular, negative attitudes towards the prefactual failure scenario (“Imagine you're following a diet and not achieving weight loss”) were associated with a strong intention to undertake weight control behaviours.

Findings from previous research therefore suggest that prefactual thinking (either spontaneous or induced) is effective in making the connection between one's behaviour and its future consequences salient. This enhances the perception of control, resulting in a stronger intention to engage in the proposed behaviour.

In the present research, we assumed that the above mentioned properties of prefactual formulation make it particularly suitable to frame messages about the effects of nutrition on well-being. This would be the case because the negative outcomes of nutrition related to well-being, such as being out of shape or having a poor quality of life, are usually experienced as deviations from the progressive pursuit of self-improvement (Wrosch, Scheier, Miller, Schulz, & Carver, 2003), thus making the prefactually-framed proposed behaviour a particularly fitting solution to this type of problems.

In contrast, negative health-related outcomes are usually seen as sudden and hardly controllable events that interrupt a state of healthiness (Balog, 2005). Therefore, the idea of progressively adjusting one's behaviour, which is implicit in prefactual formulation, may not be perceived as fully consistent with health as avoidance of diseases, making a prefactual formulation less suitable than a factual formulation for messages about health.

In the present research, we analysed the effectiveness of different persuasive messages about the negative effects of excessive meat consumption on health or well-being. We chose to analyse the effects of this kind of messages because the frequent consumption of meat products, in particular red meat (veal, beef, pork, etc.) has been recognised as having a significant negative impact on consumers' health and well-being (Bouvard et al., 2015, Micha et al., 2010). Despite evidence of the several downsides of meat consumption, consumers remain ambivalent on the prospect of reducing it, as shown by several studies on consumer attitudes and behaviours (Berndsen and van der Pligt, 2005, Graça et al., 2015).

The sample of our studies was made of elderly participants (above 60 years old). This part of the population is targeted by an increasing number of campaigns regarding the negative effects of nutrition on health (Houston et al., 2009, Millen et al., 2002), but it is also the object of an increasing attention (Edwards & Chapman, 2004) to the notion of active or successful ageing, intended as “a period of opportunity and well-being, with retention, or development, of the psychological resources to cope with life's challenges” (Bowling & Iliffe, 2011). In light of this particular attention to the elderly population, the City of Milan decided to support this research project.

In a Pilot Study, we tested whether messages focused on health or well-being would indeed, as we assumed, activate different concerns among elderly individuals ─ a safety concern in the case of health and a growth concern in the case of well-being. In Studies 1 and 2, we tested our main hypothesis, namely, that messages focused on well-being (but not messages focused on health) would be more effective when framed prefactually than when framed factually. They would lead to a better evaluation of the message and more negative attitudes towards meat consumption (Study 1), as well as lower intention to consume meat (Study 2). We expected that this would be the case because, as discussed in the previous section, prefactual statements would best address the growth regulatory concern related to well-being, but not safety concern related to health.

Section snippets

Pilot study

Before testing our main hypothesis, we assessed whether a message describing the effects of meat consumption on health would indeed raise a safety concern in participants, whereas a message describing the effects of meat consumption on well-being would raise a growth concern. We presented two groups of elderly participants with two versions of a fictitious article describing the negative effects of excessive meat consumption. One version of the article described the effects of consumption on

Study 1

In Study 1, we presented different groups of elderly participants with the same fictitious articles on the negative effects of meat consumption on health or well-being that were used in the Pilot Study. The manipulation of the text was altered to provide different groups of participants with either a factual or prefactual framing of the messages regarding health or well-being. We expected that the message about health would be more effective when framed factually than prefactually, whereas the

Study 2

In Study 2, we investigated the effects of message content (health vs. well-being) and frame (factual vs. prefactual) on behavioural intentions. We expected that participants' intentions to decrease meat consumption and increase vegetable consumption would be higher after reading prefactually framed well-being messages than after reading factually framed well-being messages, whereas the opposite would be true for messages about health.

General discussion

Our research investigated the possibility of broadening the scope of communication about nutrition aimed at the elderly population, by focussing messages not only on health, but also on well-being (Amarantos et al., 2001). Results indicate that older adults' attitudes, intentions, and choices regarding meat consumption can be influenced by both types of appeal, depending on their framing. We found that messages focussing on the effects of food on well-being are more convincing when framed

Acknowledgements

This research was conducted under the patronage of the City of Milan, and was funded by a research grant of the Catholic University of Milan (D.3.2 2012). We wish to thank them, the staff of the socio-recreational centres involved in data collection, and all the participants who joined the studies.

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