Tsuyoshi Okuhara

Designing persuasive health materials using processing fluency: a literature review

BackgroundHealth materials to promote health behaviors should be readable and generate favorable evaluations of the message. Processing fluency (the subjective experience of ease with which people process information) has been increasingly studied over the past decade. In this review, we explore effects and instantiations of processing fluency and discuss the implications for designing effective health materials. We searched seven online databases using “processing fluency” as the key word. In addition, we gathered relevant publications using reference snowballing. We included published records that were written in English and applicable to the design of health materials.ResultsWe found 40 articles that were appropriate for inclusion. Various instantiations of fluency have a uniform effect on human judgment: fluently processed stimuli generate positive judgments (e.g., liking, confidence). Processing fluency is used to predict the effort needed for a given task; accordingly, it has an impact on willingness to undertake the task. Physical perceptual, lexical, syntactic, phonological, retrieval, and imagery fluency were found to be particularly relevant to the design of health materials.ConclusionsHealth-care professionals should consider the use of a perceptually fluent design, plain language, numeracy with an appropriate degree of precision, a limited number of key points, and concrete descriptions that make recipients imagine healthy behavior. Such fluently processed materials that are easy to read and understand have enhanced perspicuity and persuasiveness.

Assertions of Japanese Websites for and Against Cancer Screening: a Text Mining Analysis

Background: Cancer screening rates are lower in Japan than in Western countries such as the United States and the United Kingdom. While health professionals publish pro-cancer-screening messages online to encourage proactive seeking for screening, anti-screening activists use the same medium to warn readers against following guidelines. Contents of pro- and anti-cancer-screening sites may contribute to readers’ acceptance of one or the other position. We aimed to use a text-mining method to examine frequently appearing contents on sites for and against cancer screening. Methods: We conducted online searches in December 2016 using two major search engines in Japan (Google Japan and Yahoo! Japan). Targeted websites were classified as “pro”, “anti”, or “neutral” depending on their claims, with the author(s) classified as “health professional”, “mass media”, or “layperson”. Text-mining analyses were conducted, and statistical analysis was performed using the chi-square test. Results: Of the 169 websites analyzed, the top-three most frequently appearing content topics in pro sites were reducing mortality via cancer screening, benefits of early detection, and recommendations for obtaining detailed examination. The top three most frequent in anti-sites were harm from radiation exposure, non-efficacy of cancer screening, and lack of necessity of early detection. Anti-sites also frequently referred to a well-known Japanese radiologist, Makoto Kondo, who rejects the standard forms of cancer care. Conclusion: Our findings should enable authors of pro-cancer-screening sites to write to counter misleading anti-cancer-screening messages and facilitate dissemination of accurate information.

Improving health literacy in a Japanese community population—A pilot study to develop an educational programme

Although a growing number of interventional studies on health literacy have been conducted recently, the majority were designed in clinical settings, focusing mainly on functional health literacy. This study evaluated a programme designed to improve health literacy in a community population, with a scope of going beyond functional health literacy.

Readability Comparison of Pro- and Anti-Cancer Screening Online Messages in Japan

Background: Cancer screening rates are lower in Japan than those in western countries. Health professionals publish pro-cancer screening messages on the internet to encourage audiences to undergo cancer screening. However, the information provided is often difficult to read for lay persons. Further, anti-cancer screening activists warn against cancer screening with messages on the Internet. We aimed to assess and compare the readability of pro- and anti-cancer screening online messages in Japan using a measure of readability. Methods: We conducted web searches at the beginning of September 2016 using two major Japanese search engines (Google.jp and Yahoo!.jp). The included websites were classified as “anti”, “pro”, or “neutral” depending on the claims, and “health professional” or “non-health professional” depending on the writers. Readability was determined using a validated measure of Japanese readability. Statistical analysis was conducted using two-way ANOVA. Results: In the total 159 websites analyzed, anti-cancer screening online messages were generally easier to read than pro-cancer screening online messages, Messages written by health professionals were more difficult to read than those written by non-health professionals. Claim × writer interaction was not significant. Conclusion: When health professionals prepare pro-cancer screening materials for publication online, we recommend they check for readability using readability assessment tools and improve text for easy comprehension when necessary.

Identification of gain- and loss-framed cancer screening messages that appeared in municipal newsletters in Japan

BackgroundResearch suggests that cancer screening messages are more persuasive when framed in terms of the costs of not obtaining screening (i.e., loss-framed) than when framed in terms of the benefits of obtaining screening (i.e., gain-framed). However, to what extent these findings have been integrated into public health practice is unknown. To analyze message framing of cancer screening information, the present study examined message framing of cancer screening announcement articles that appeared in municipal newsletters published from 23 wards in central Tokyo, Japan. Two independent raters coded the articles. Gain- and loss-framed sentences in each article were identified, and based on what the sentences conveyed, articles were classified into gain-framed, loss-framed, mixed-framed, and non-framed.ResultInter-rater reliability was acceptable (intraclass correlation coefficient = 0.88). Of the 129 articles evaluated, the total number of gain-framed sentences was 87, while that of loss-framed sentences was six. The total number of gain-framed articles was 32 (24.8%) while that of loss-framed articles was zero (0%). Five (3.9%) articles were mixed-framed. Ninety-two (71.3%) articles were non-framed.ConclusionsCancer screening announcement articles of municipal newsletters were mostly non-framed or gain-framed in 23 Tokyo wards in Japan. The absence of loss-framed articles and only a small number of loss-framed messages indicate a missed opportunity to persuade readers to obtain cancer screenings. Loss-framed messages and articles need to be increased to enhance the persuasiveness of cancer screening information in municipal newsletters.

Processing fluency effect of a leaflet for breast and cervical cancer screening: a randomized controlled study in Japan

ABSTRACT Processing fluency (the inferred subjective ease with which people process information) has been a topic of increasing research attention in the field of psychology over the past decade. We examined the effect of improving written materials in terms of processing fluency with regard to encouragement for obtaining breast and cervical cancer screening. We randomly assigned 670 women to intervention or control conditions; the 215 who mailed back distributed questionnaires were the study participants. A standard leaflet for cancer screening was mailed to the control group, while the materials mailed to the intervention group were improved in terms of perceptual fluency (e.g., legibility), linguistic fluency (e.g., readability), retrieval fluency (e.g., reducing amount of information) and imagery fluency (having recipients imagine future behavior and events). The screening rate of the intervention group was significantly higher than that of the control group (29.4% vs. 14.2%, χ2 = 7.275, df = 1, p = .007, φ = .184). Improving the processing fluency of written materials may be useful for encouraging individuals to obtain breast and cervical cancer screening.

Cancer information needs according to cancer type: A content analysis of data from Japan's largest cancer information website

The provision of information about cancer is an important aspect of cancer care. Cancer information provided online is expected to meet the needs of information seekers. Whether information needs vary according to tumor site is largely unknown. We aimed to examine similarities and differences in informational needs by cancer type. Data were collected using a questionnaire administered on Japans largest cancer information website, “Ganjoho service”. A total of 2782 free descriptive responses in the period from April 2012 to December 2017 were analyzed using text-mining software. We identified the top 10 informational need contents, in order of appearance frequency, for eight tumor sites: gastric, colorectal, esophageal, lung, pancreatic, breast, cervical, and prostate cancer. Frequent information needs common to all tumor sites included symptoms, disease stages, treatments, chance of cure, recovery, metastasis, and recurrence. A need for information about diet, pain, side effects of treatments, complementary and alternative medicine was frequent for some tumor sites. Tumor site-specific information should include the following, according to cancer type: information of scirrhous carcinoma for gastric cancer; unusual feces for colorectal cancer; lung X-ray images for lung cancer; early detection for pancreatic cancer; adenocarcinoma, sexual activity, pregnancy, and childbirth for cervical cancer; breast conservation or reconstruction and triple negative cancer for breast cancer; test values and diagnosis and urinary problems for prostate cancer; and hormone therapy for breast and prostate cancer. Cancer information provided online should meet these frequent informational needs, considering similarities and differences of the information required according to tumor site.

A qualitative analysis of the beliefs of Japanese anti-influenza vaccination website authors

Background Influenza vaccine coverage among the Japanese population is less than optimal. Anti-vaccination sentiment exists worldwide, and Japan is no exception. Anti-influenza vaccination activists argue on the internet that influenza vaccine has little or no efficacy and a high risk of side effects, and they warn that people should forgo vaccination. We conducted a qualitative analysis to explore beliefs underlying the messages of anti-influenza vaccination websites, by focusing on the perceived value these beliefs provide to those who hold them. Methods We conducted online searches in January 2017 using two major Japanese search engines (Google Japan and Yahoo! Japan). Targeted websites were classified as “pro”, “anti”, or “neutral” depending on their claims. We applied a dual analytic approach—inductive thematic analysis and deductive interpretative analysis—to textual data of the anti websites. Results Of the 113 anti websites, we identified two themes that correspond to beliefs: it is necessary to 1) protect others against risks and exploitation related to influenza vaccination, and 2) educate others about hidden truths and self-determination. Authors of anti websites ascribed two values (peoples “safety” and ones own “self-esteem”) to their beliefs. Discussion Website authors may engage in anti-vaccination activities because they want to feel they are virtuous, saving people from harm caused by vaccination, and to boost their self-esteem, thinking “I am enlightening uninformed people.” The anti-vaccination beliefs of website authors were considered to be strong. In promoting vaccination, it would be better not to target outright vaccine refusers, such as the authors of anti-vaccination websites; it is preferable to target vaccine-hesitant people who are more amenable to changing their attitudes toward vaccination. We discuss possible means of promoting vaccination in that target population.

Persuasiveness of Statistics and Patients’ and Mothers’ Narratives in Human Papillomavirus Vaccine Recommendation Messages: A Randomized Controlled Study in Japan

Background The human papillomavirus (HPV) vaccination percentage among age-eligible girls in Japan is only in the single digits. This signals the need for effective vaccine communication tactics. This study aimed to examine the influence of statistical data and narrative HPV vaccination recommendation massages on recipients’ vaccination intentions. Methods This randomized controlled study covered 1,432 mothers who had daughters aged 12–16 years. It compared message persuasiveness among four conditions: statistical messages only; narrative messages of a patient who experienced cervical cancer, in addition to statistical messages; narrative messages of a mother whose daughter experienced cervical cancer, in addition to statistical messages; and a control. Vaccination intentions to have one’s daughter(s) receive the HPV vaccine before and after reading intervention materials were assessed. Statistical analysis was conducted using analysis of variance with Tukey’s test or Games–Howell post hoc test, and analysis of covariance with Bonferroni correction. Results Vaccination intentions after intervention in the three intervention conditions were higher than the control condition (p < 0.001). A mother’s narrative messages in addition to statistical messages increased HPV vaccination intention the most of all tested intervention conditions. A significant difference in the estimated means of intention with the covariate adjustment for baseline value (i.e., intention before intervention) was found between a mother’s narrative messages in addition to statistical messages and statistical messages only (p = 0.040). Discussion Mothers’ narrative messages may be persuasive when targeting mothers for promoting HPV vaccination. This may be because mothers can easily relate to and identify with communications from other mothers. However, for effective HPV vaccine communication, further studies are needed to understand more about persuasive differences in terms of statistics, narratives, and narrators. Directions for future research are also suggested.

Lessons learned from previous environmental health crises: Narratives of patients with Minamata disease in TV documentaries as the main media outlet

Abstract On 16 August 2017, the Minamata Convention on Mercury entered into force to protect human health and the environment from the adverse effects of mercury. Minamata disease is caused by methylmercury poisoning in humans. The victims’ acute symptoms were captured in photographs by Eugene Smith by which people worldwide became aware of this environmental health crisis. Over 60 years have passed since the first case of methylmercury poisoning. The victims/patients have aged and little is currently known how the crisis affected them and their community. Additionally, little is understood about patients affected by serious environmental pollution in socio-economic poverty. This study aimed to describe narratives of these patients from public broadcasting company’s documentaries, as well as to overview media coverage on TV. Descriptive analysis of TV documentaries showed patients’ various concerns and sorrow through their narratives in consecutive years. Archiving these TV documentaries that cover environmental health crises may provide an educational opportunity that does not fade with time. People worldwide can learn from the narratives of patients, even in local environmental health crises, via TV documentaries.