title: When risk communication backfires: randomized controlled trial on self-affirmation and reactance to personalized risk feedback in high-risk individuals.
abstract: OBJECTIVE
  Health promotion often faces the problem that populations with high behavioral risk profiles respond defensively to health promotion messages by negating risk or reactant behavior. Self-affirmation theory proposes that defensive reactions are an attempt of the self-system to maintain integrity. In this article, we examine whether a self-affirmation manipulation can mitigate defensive responses to personalized visual risk feedback in the skin cancer prevention context (ultraviolet [UV] photography), and whether the effects pertain to individuals with high behavioral risk status (high personal relevance of tanning).
  
  
  METHODS
  We conducted a full-factorial randomized controlled trial (N = 292; age 11-71) following a 2 * 2 design (UV photo yes/no, self-affirmation yes/no). Follow-up period was 2 weeks. Subsequent tanning behavior, sun avoidance intentions, and risk perception.
  
  
  RESULTS
  A multivariate analysis of variance (MANOVA) revealed a three-way interaction between risk feedback, the self-affirmation manipulation, and risk status for the three outcome measures. Follow-up analyses of variance (ANOVAs) indicated that high-risk individuals receiving only the risk feedback intervention reacted defensively and reported higher exposure. A self-affirmation manipulation mitigates this reactance effect both on the level of cognitions and behavior.
  
  
  CONCLUSIONS
  Self-affirmation has influential implications not only for Social Psychology but also for health prevention measures. The findings support the effectiveness of self-affirmation in reducing reactant and defensive reactions to personalized visual risk feedback. Interactions with health risk status indicate that self-affirmation might increase the effectiveness of health promotion messages in high-risk populations.
authors: Centre of Research Excellence for Chronic Respiratory Disease, School of Medicine, University of Tasmania, Private Bag 23, Hobart TAS 7001, Australia. natalie.schuez@utas.edu.au
authors: Natalie
authors: N
authors: Schüz
authors: Benjamin
authors: B
authors: Schüz
authors: Michael
authors: M
authors: Eid
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003674:Defense Mechanisms; D005260:Female; D005500:Follow-Up Studies; D058015:Health Communication; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D033182:Intention; D008297:Male; D008875:Middle Aged; D010781:Photography; D011582:Psychological Theory; D018570:Risk Assessment; D012309:Risk-Taking; D012649:Self Concept; D012878:Skin Neoplasms / Q000517:prevention & control*; D055108:Sunbathing / Q000523:psychology*; D014466:Ultraviolet Rays / Q000009:adverse effects; D055815:Young Adult