Testing EPPM propositions among an at-risk population for cardiovascular disease: a think aloud study

Abstract

Background: The study experimentally tested six threat-to-efficacy ratio messages based on the EPPM for CVD and the associated health behaviours among older adults (60+ years) given the considerable lack of previous investigations in this area. Methods: 24 participants (4 per group; Female = 14; Age, M = 74.38, SD = 7.16) were randomly assigned to one of six EPPM threat-to-efficacy CVD message groups: 1) “standard†message with 1/1 threat-to-efficacy ratio, 2) “low efficacy†message with 1/0 threat-to-efficacy ratio, 3) “low threat†message with 0/1 threat-to-efficacy ratio, 4) “high efficacy†message with 1/2 threat-to-efficacy ratio; 5) “high threat†message with 2/1 threat-to-efficacy ratio; and 6) “overload†message with 2/2 threat-to-efficacy ratio. A ‘think aloud’ methodology was utilised and a thematic analysis was conducted. Findings: Findings were consistent across all groups. Important themes were those of different threat perceptions for varying CVD manifestations (heart disease versus stroke), the role of comparative (versus personal) threat and efficacy perceptions, and the impact of misleading levels of health literacy. Discussion: The study presented the first empirical test of EPPM-based threat-to-efficacy ratios for communicating about CVD and associated health behaviours. The stark difference between threat appraisals for stroke versus other CVD manifestations was a novel finding. For the EPPM and other theories of health risk and decision-making, the impact of comparative risk and social examples for individual threat and efficacy perceptions needs to be counted. These findings, along with the highlighted issues for CVD health literacy, can be applied to future, tailored risk communications.