Messages Directed at Abstaining From Alcohol During Pregnancy
Messages Directed at Abstaining From Alcohol During Pregnancy
Given the relatively small numbers of pregnant women assigned to each exposure condition (n = 40 to Control; n = 25/26 to each of the three concepts), the results for pregnant women are not presented in detail here. Furthermore, as some questions differed slightly for pregnant and non-pregnant women, only results from the larger non-pregnant sample are reported. Overall, no substantial differences in relative reactions that would warrant concept modification were identified between the pregnant and non-pregnant women.
The demographic characteristics of the non-pregnant participants are shown in Table 1. There was a relatively even spread of age groups, but a bias towards post school qualifications, and only just over a quarter living in lower SES postcodes. Just over half had at least one child, with the majority of those having two or more children. Approximately one in five had never married and almost one in three thought they might become pregnant in the next two years. With respect to alcohol consumption, approximately seven in ten scored positive for alcohol misuse (with a composite score of ≥3 on the AUDIT-C alcohol screening tool), and just under half drank two or more times a week, with a similar proportion drinking three or more drinks on a typical drinking occasion. Table 2 shows the number of non-pregnant participants who saw each concept.
Significant differences in 'top box' percentages for each concept were explored using Chi-Square testing. Analysis of variance and the Scheffe post-hoc tests were conducted to determine whether there were any significant differences between the mean responses. Significance at the value of p ≤ 0.05 is indicated in the results tables with bold type and symbols (key shown below each table). Given the applied aims of the study, we focus primarily on the 'top box' analyses in this paper. As anticipated, the Tables indicate that many variables that were significant via a 'top box' analysis showed no significant difference on mean scores – thus 'masking' differences in impact of the different concepts.
The presence of threat in the concepts was confirmed: 74.7% of women who saw Threat only and 82.7% who saw Threat and self-efficacy perceived a threat in the message compared with 41.7% of participants who saw Self-efficacy. Self-efficacy was also confirmed: 85.6% of women who saw Self-efficacy only and 75.3% who saw Threat and self-efficacy perceived that the advertisements implied that reducing or stopping drinking during a social situation could be easier than they thought. In contrast, only 12.0% of women who saw Threat only perceived this self-efficacy message.
All three experimental concepts significantly increased women's intention to abstain from alcohol in a future pregnancy, and the two threat concepts also increased women's intention to reduce alcohol use in a future pregnancy, compared to the control (Table 3). The two threat concepts increased women's confidence to reduce alcohol during pregnancy compared to the control, but Self-efficacy only did not.
Content analysis of answers to the question "What do you think is the main message in this advertisement? What is it telling people?" showed that the experimental concepts were effective at communicating at least one of the following main messages that directly aligned with the communication objectives (for a list of the range of communication objectives pertaining to the experimental concepts see Additional file 1). Up to two main messages were coded per participant. The perceived main messages for each of the experimental concepts and the percentage of participants who noted them were:
The three experimental concepts were rated well in terms of believability and relevance to women in general (Table 4) with over 50% of participants who saw them reporting that they were "very believable" and "very relevant to women in general". The results show that Threat and self-efficacy was rated as interesting, convincing and as making the participant think about the topic in a new way by a greater percentage of participants than the other experimental concepts. All three experimental concepts rated well in providing important information.
Some distinct differences were found between the experimental concepts in the emotions they aroused for participants (Table 5). Those with threat appeals generated a small level of worry, anxiety and guilt, and these responses were not significantly attenuated by the addition of a self-efficacy message. Overall, the two threat concepts aroused more negative emotional responses (worry, anxiety, guilt, shame) and Self-efficacy only aroused more positive emotional responses (relief, happiness).The addition of a self-efficacy message to a threat appeal aroused more positive emotional responses of relief and happiness than the threat appeal alone.
Only a low proportion of participants experienced any defensive reactions as measured by the four responses relating to rejection of the message (Table 6). Furthermore, a very low percentage of participants indicated a potential for experiencing unintended effects following exposure to one of the experimental concepts. Importantly, there were no significant differences in this respect between women who saw an experimental concept and those who saw the control.
Multi-variable analyses showed no significant differences in the way in which participants with different characteristics responded to the concepts. Specifically, there were no significant differences in the responses to the two threat concepts compared to Self-efficacy only when viewed as a function of at-risk alcohol consumption, socioeconomic status, education and having borne children.
Results
Given the relatively small numbers of pregnant women assigned to each exposure condition (n = 40 to Control; n = 25/26 to each of the three concepts), the results for pregnant women are not presented in detail here. Furthermore, as some questions differed slightly for pregnant and non-pregnant women, only results from the larger non-pregnant sample are reported. Overall, no substantial differences in relative reactions that would warrant concept modification were identified between the pregnant and non-pregnant women.
Participants
The demographic characteristics of the non-pregnant participants are shown in Table 1. There was a relatively even spread of age groups, but a bias towards post school qualifications, and only just over a quarter living in lower SES postcodes. Just over half had at least one child, with the majority of those having two or more children. Approximately one in five had never married and almost one in three thought they might become pregnant in the next two years. With respect to alcohol consumption, approximately seven in ten scored positive for alcohol misuse (with a composite score of ≥3 on the AUDIT-C alcohol screening tool), and just under half drank two or more times a week, with a similar proportion drinking three or more drinks on a typical drinking occasion. Table 2 shows the number of non-pregnant participants who saw each concept.
Analyses
Significant differences in 'top box' percentages for each concept were explored using Chi-Square testing. Analysis of variance and the Scheffe post-hoc tests were conducted to determine whether there were any significant differences between the mean responses. Significance at the value of p ≤ 0.05 is indicated in the results tables with bold type and symbols (key shown below each table). Given the applied aims of the study, we focus primarily on the 'top box' analyses in this paper. As anticipated, the Tables indicate that many variables that were significant via a 'top box' analysis showed no significant difference on mean scores – thus 'masking' differences in impact of the different concepts.
Presence of Threat and Self-efficacy Within the Concepts
The presence of threat in the concepts was confirmed: 74.7% of women who saw Threat only and 82.7% who saw Threat and self-efficacy perceived a threat in the message compared with 41.7% of participants who saw Self-efficacy. Self-efficacy was also confirmed: 85.6% of women who saw Self-efficacy only and 75.3% who saw Threat and self-efficacy perceived that the advertisements implied that reducing or stopping drinking during a social situation could be easier than they thought. In contrast, only 12.0% of women who saw Threat only perceived this self-efficacy message.
Intentions and Confidence to Abstain from and Reduce Alcohol During Pregnancy
All three experimental concepts significantly increased women's intention to abstain from alcohol in a future pregnancy, and the two threat concepts also increased women's intention to reduce alcohol use in a future pregnancy, compared to the control (Table 3). The two threat concepts increased women's confidence to reduce alcohol during pregnancy compared to the control, but Self-efficacy only did not.
Perceived Main Message, Emotional Responses, Defensive and Unintended Effects
Content analysis of answers to the question "What do you think is the main message in this advertisement? What is it telling people?" showed that the experimental concepts were effective at communicating at least one of the following main messages that directly aligned with the communication objectives (for a list of the range of communication objectives pertaining to the experimental concepts see Additional file 1). Up to two main messages were coded per participant. The perceived main messages for each of the experimental concepts and the percentage of participants who noted them were:
Self-efficacy Only
do not drink alcohol during pregnancy (71.2%);
drink alcohol in moderation (11.4%); and
no alcohol is the safest option during pregnancy (5.3%).
Threat only
do not drink alcohol during pregnancy (55.4%);
they (health authorities) aren't sure how much alcohol will damage a baby so best not to drink at all (15.7%);
no amount of alcohol is safe during pregnancy (10.8%); and
you can damage your baby if you drink alcohol during pregnancy (8.4%).
Threat and Self-efficacy
do not drink alcohol during pregnancy (50.6%);
they (health authorities) aren't sure how much alcohol will damage a baby so best not to drink at all (16.0%);
you can damage your baby if you drink alcohol during pregnancy (14.8%); and
no amount of alcohol is safe during pregnancy (8.6%).
The three experimental concepts were rated well in terms of believability and relevance to women in general (Table 4) with over 50% of participants who saw them reporting that they were "very believable" and "very relevant to women in general". The results show that Threat and self-efficacy was rated as interesting, convincing and as making the participant think about the topic in a new way by a greater percentage of participants than the other experimental concepts. All three experimental concepts rated well in providing important information.
Some distinct differences were found between the experimental concepts in the emotions they aroused for participants (Table 5). Those with threat appeals generated a small level of worry, anxiety and guilt, and these responses were not significantly attenuated by the addition of a self-efficacy message. Overall, the two threat concepts aroused more negative emotional responses (worry, anxiety, guilt, shame) and Self-efficacy only aroused more positive emotional responses (relief, happiness).The addition of a self-efficacy message to a threat appeal aroused more positive emotional responses of relief and happiness than the threat appeal alone.
Only a low proportion of participants experienced any defensive reactions as measured by the four responses relating to rejection of the message (Table 6). Furthermore, a very low percentage of participants indicated a potential for experiencing unintended effects following exposure to one of the experimental concepts. Importantly, there were no significant differences in this respect between women who saw an experimental concept and those who saw the control.
Multi-variable analyses showed no significant differences in the way in which participants with different characteristics responded to the concepts. Specifically, there were no significant differences in the responses to the two threat concepts compared to Self-efficacy only when viewed as a function of at-risk alcohol consumption, socioeconomic status, education and having borne children.
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