Effective Communication as a Vehicle for Behavior Change: Monique Turner Presents at Adult Immunization Summit

Parents hear the message early and often: Get your kids vaccinated. But the truth is, vaccines are not just for kids. Adults need certain shots — such as those against shingles and pneumonia — that children do not. And grown-ups need booster shots against some common diseases, such as the vaccine for diphtheria, tetanus, and pertussis. When it comes to seasonal influenza, many adults do not vaccinate as recommended, leaving them needlessly vulnerable. In fact, the CDC estimates that in the 2013-2014 season, just under half of those eligible for the flu vaccine were immunized. For an illness that kills between 3,000 and 49,000 people in the U.S. every year, why aren’t more people protecting themselves? What can public health professionals do to help change the culture of immunization?

Dr. Monique Turner, a social marketing and public health communication faculty member at GW, addressed this very issue on November 4, 2015, at the Adult Immunization Summit at Princeton University. Hosted by the New Jersey Immunization Network (NJIN) and the American College of Physicians (ACP), the summit brought together leaders in health care, business, government, academia and medical research to discuss how increasing adult immunization rates can improve public health. Dr. Turner’s discussion, “Adult Flu Vaccination: The Role of Anticipated Regret,” highlighted how effective communication can be used as a vehicle for behavior change. Specifically, she focused on the effect that emotion has in risk perception. Dr. Turner is well positioned to speak on this topic. In addition to her research on the effects of regret, she also examines guilt, anger, anxiety, sadness and happiness, and how these emotions also play a part in behavior change. She is currently working on a theory predicting the efficacy of anger and guilt appeals and the cognitive processes underlying persuasion by such messages.

Prior to the summit, Dr. Turner investigated some of the current flu messages and found that they are very knowledge and cognition based, meaning chock full of statistics and facts. These types of messages, she explained, are perfect for those who want to get vaccinated but just needed a reminder.

“But there are others who need more than a reminder,” she said. “We may need to appeal to what they’re afraid of — their sense of feelings and emotions.”

Dr. Turner identified the four predictors of whether a person will choose to get the flu vaccine: risk perception, perceived vaccine effectiveness, worry and anticipated regret. Of these, the best predictor of getting the flu vaccine is anticipated regret. “People are almost two times more likely to get vaccinated if they think they would regret not getting vaccinated,” she explained. To illustrate this point, Dr. Turner spoke about her own experience, noting that her attention to vaccinations changed once she had children. “If I forgot to vaccinate, or if I got too busy and didn’t vaccinate, and then something happened to my kids, and it was because I chose not to vaccinate, I would never forgive myself.” When people believe they will regret their behaviors in the future — feeling remorse for their actions — they are more likely to engage in preventive behaviors.

Another emotion closely linked to regret is guilt. In the context of immunization, guilt arises when someone failed to do something they should have, and now they are suffering the consequences. “Similar to regret, when people anticipate feeling guilty, they are more likely to engage in altruistic and preventive health behaviors,” she explained. “But we don’t want to make people feel guilty in the moment. Instead, we want them to feel anticipated regret.”

She used the examples of safer sex and mammograms. “You might be more likely to engage in safer sex behaviors if you thought about how you would feel if you hurt someone else. Maybe you would be more likely to get a mammogram if you thought about how you would feel if you weren’t there for your children anymore.”

With all of this said, Dr. Turner touched upon some caveats when it comes to appeals, specifically as they relate to the pharmaceutical industry’s interest in vaccination messaging. For example, if GlaxoSmithKline aired a guilt appeal prompting parents to vaccinate their teenagers for the HPV vaccine, would it be effective? Overwhelmingly, according to Dr. Turner’s research, the answer is no. Why? When people feel that their emotions are being manipulated to sell a product, it does not work. “Intense guilt appeals fail or backfire when the message is trying to sell a commercial product,” she explained. This is called a for profit appeal — when the message is trying to sell a product or service. A pro social appeal, on the other hand, does not contain this ulterior motive. Instead, their messages try to change behavior without manipulation. Pro social appeals, for example, only try to change behavior to benefit an individual or group at large because it is the right thing to do. “In the pro social domain, there is no evidence of high guilt appeals failing,” Dr. Turner explained.

“When we are using anticipated guilt for pro social purposes, people are open to that and it often changes their attitudes, their intentions and behaviors. But when they get a sense that this is a manipulated tactic, and the messenger is trying to make a buck, people become instantly frustrated, and it actually increases feelings of anger.”

Dr. Turner recommended that in order to increase adult vaccination rates, communication messages should remind people that they may regret their decision — but not in a coercive or manipulative way. “For example,” she explained, “Messages should ask, ‘How would you feel if … ? ‘What would this mean if … ?’ ‘Do you think you might regret … ?’ and get people to anticipate their emotions given their decisions or lack of decision.”

Ultimately, Dr. Turner emphasized the need to connect with people on an emotional basis, and the need to understand what moves people to change. Once this takes place, vaccination messages may positively influence people to get their flu shot, keeping themselves and their loved ones healthy.