The Relationship between Perceived Health Message Motivation and Social Cognitive Beliefs in Persuasive Health Communication

Round 1

Reviewer 1 Report

The purpose of this study, to explore how gender and social-cognitive beliefs influence responses to different messages about the negative consequences of physical inactivity, is interesting and timely. This investigation of how audience characteristics moderate the influence of health messages featured in fitness apps has the potential to offer an important contribution to health communication scholarship. I encourage the author to consider the following suggestions/comments as they work to revise the manuscript for publication:

1. The study is framed as an exploration of the relationship between audience reception (i.e., how people receive health messages) and message types. However, the emphasis on message reception seems somewhat misguided, as the study does not really offer any kind of analysis of how the audience is receiving (e.g., engaging with or reacting to) the messages. Instead, the study examines the association between different message types and perceptions about the ability to engage in, and expectancies about, the recommended health behavior. It might be helpful to rework the framing of the study to more accurately describe the analysis of the relationship between health message content and perceptions about the health behavior (rather than message reception). Alternatively, the author might want to provide a clear conceptual definition of “message reception” and some information about why they think this study is about message reception (rather than perceptions about health messages)
2. There’s not much theoretical rationale for the examination of gender as a moderator; why is it necessary and useful to examine the influence of gender on these constructs?
3. More attention to and clarity about the messages will be useful. The author has suggested that the key health message feature that was manipulated was the framing of the negative consequences of physical inactivity (e.g., obesity, financial cost, illness, etc.) but it seems that this framing may be confounded with the presentation of different kinds of health information. For example, in the obesity and death messages offer base-rate data about the negative effects of physical inactivity but the stigma and illness messages don’t. In other words, I am not sure this is a study about the framing of the negative consequences of physical inactivity; the manipulation of message frames is conceptually and practically different because it involves saying the same thing in a different way. In this study, the message conditions offer different kinds of information. Thus, it seems like this is really an exploratory study to investigate how information about the different negative effects of physical inactivity, featured in a health app, influence health perceptions and motivation.
4. It seems important to really work to emphasize the importance of studying health message information presentation and effects in the health app message context (e.g., elaborate on why this study makes a meaningful contribution to an area of health communication scholarship that hasn’t received as much attention). The fact that the study involved the creation and application of a fitness app prototype is important and warrants more elaboration in the manuscript.
5. Are there citations for measures reported in Table1? The measure for self-efficacy seems to capture perceptions about the ability to engage in the heath behavior when confronted with various internal and external barriers; is this scale really measuring self-efficacy?
6. I am not sure I understand the author’s decision not to include racial identity as a moderating variable in the present study. What does it mean in the manuscript, on line 122, where the author writes “we based our study on a quantitative approach” (presumably as a rational for not including race as a moderating variable)?
7. There’s a typo on line 406 (the “e main findings”)

Author Response

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Reviewer 2 Report

In the reviewed paper, the author reports on how social cognitive beliefs, different types of health messages and gender are related and can be used in persuasive health communication. Overall, I find the reported study interesting, however, there are some major issues which I present below. 

A major lack of the paper is the missing details about the study design. For me it is not clear how the participants rated the messages. Were they presented within the prototype or afterwards? Was the sequence of presented questions varied or was it the same for everyone (order effects)?

Further, the questions are very hypothetical, meaning that they (probably) are not related to participants’ everyday life and therefore not of high ecological validity. Imagining to perform physical exercises and assuming how motivating specific messages would be is different to performing physical exercises in combination with messages in a real life context (and then not rating them by participants but measuring if there is an actual effect of messages on individuals’ motivation). I can see that the present study can be seen as a first step in such a direction, however, this has to be explicitly stated and discussed as it is a major limitation of the paper from my point of view. In relation to this, results have to be considered as limited. 

At the beginning of the paper, the author points out the importance of tailoring to different user groups. What I miss is a clear link to this „tailoring to different user groups“ based on the results. So far, the author claims that illness- and death-related messages  are more effective than other types of messages, however, is remains open what this means for different user groups. 

The author concludes that illness- and death-related messages can be employed in the fitness domain as a persuasive technique to motivate exercising. I am not convinced about this claim; in my point of view, the author should critically discuss why negative messages should be used to motivate people. 

A limitation of the paper - which should at least be discussed - is the missing long-term perspective (e.g., perhaps people get used to illness- and death-related messages and thus the effect fades away). 

Minor issues: 

*on p. 5, Method section, the reference of McGuire is missing 

Author Response

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Round 2

Reviewer 1 Report

The revised manuscript significantly improves the presentation of this study; it is evident that the author worked hard to address the reviewers' concerns. As I indicated in my first review, I think reference to message "receptiveness" lacked conceptual clarity but I am not sure that references "users' perceptions of illness- and death-related messages" improved the clarity of the manuscript. The title revision makes sense but the author refers to "perception of illness- and death-related messages" without really defining what this means. It appears that the mentions of "perception" about health messages refer to the first construct described in Table 1, which seems to measure the degree to which health messages motivated the users. Wouldn't it make more sense to frame the entire study in the context of the exploratory investigation of the associations between health message types, social-cognitive beliefs, and health motivation (or behavioral intention)? Because the distinction between these constructs is theoretically,  operationally, and practically important, I think the manuscript should offer readers more conceptual clarity (as reflected in the language used to define and describe the constructs of interest). 

Author Response

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