Pilot Evaluation of the Impact of Lottery-Based Incentives on Engagement Levels of Male Low SES Vocational Students With an mHealth App

In general, individuals with lower socioeconomic status (SES) are less physically active and adhere to poorer diets than higher SES individuals. To promote healthier lifestyles in lower SES populations, we hosted a digital health promotion program among male vocational students at a school in The Netherlands. In a pilot study, we evaluated whether this target audience could be engaged with an mHealth app using lottery-based incentives that trigger feelings of anticipated regret. Especially, we studied the social and interpersonal aspects of regret lotteries in a within-subject experimental design. In this design, subjects either participated in a social variant (i.e., with students competing against their peers for a chance at a regret lottery), or an individual variant (i.e., with subjects solely individually engaged in a lottery). Additionally, we studied the impact of different payout schedules in a between-subject experimental design. In this design, participants were assigned to either a short-term, low-value payout schedule, or a long-term, high-value payout schedule. From a population of 72 male students, only half voluntarily participated in our 10-week program. From interviews, we learned that the main reason for neglecting the program was not related to the lottery-based incentives, nor to the prizes that were awarded. Instead, non-enrolled subjects did not join the program, because their peers were not joining. Paradoxically, it was suggested that students withheld their active participation until a larger portion of the sample was actively participating. From the subjects that enrolled in the program (N = 36, males, between 15 and 25 years of age), we found that a large proportion stopped interacting with the program over time (e.g., after roughly 4 weeks). Our results also indicated that students performed significantly more health-related activities when assigned to the social regret lottery, as opposed to the individual variant. This result was supported by interview responses from active participants: They mainly participated to compete against their peers, and not so much for the prizes. Hence, from this study, we obtained initial evidence on the impact of social and competitive aspects in lottery-based incentives to stimulate engagement levels in lower SES students with an mHealth app.

The Moderating Role of Anticipated Regret and Product Involvement on Online Impulsive Buying Behavior

Online impulsive buying behavior has drawn an increasing amount of attention from researchers and marketers as well; however, little research has explored how cognitive aspect and emotional aspect effect online impulsive buying together. The study examines the role of product involvement (cognitive aspect) and anticipated regret (emotional aspect) on the online impulsive buying behavior of the consumer. The results indicate that consumers who experienced downward anticipated regret showed more online impulsive buying behavior than those who experienced upward anticipated regret. Moreover, anticipated regret moderates the relationship between product involvement and online impulsive buying behavior, for participants who experienced downward anticipated regret showing more online impulsive buying behavior than those who experienced upward anticipated regret in the low product involvement group, but there is no differential between downward and upward anticipated regret in the high involvement product group. These findings suggest that anticipated regret helps consumers make more deliberative online shopping choices. The implications for both future research and online consumers are discussed.

Effect of Proactive Personality on Career Decidedness: The Mediating Role of Career Exploration and the Moderating Role of Anticipated Regret

In order to deepen the understanding of the personality antecedents of students’ career decidedness, this study, based on social cognitive career theory and career development theory, examined the effect of proactive personality on career decidedness as well as the mediating mechanism and moderating factors in this process. The results of the survey of 783 Chinese college students showed that proactive personality was positively related to career decidedness via career exploration, and anticipated regret moderated the relationship between proactive personality and career exploration significantly. Both theoretical and practical implications are discussed at the end of this research.

Attitude Toward Prostate Cancer Screening in Hong Kong: The Importance of Perceived Consequence and Anticipated Regret

There are long-standing debates about the benefits of prostate cancer screening. Conflicting trial results and inconsistent recommendations regarding prostate cancer screening in clinical guidelines highlight the importance of patient factors that influence decision making in prostate cancer screening. Attitude is an important factor associated with cancer screening. However, attitudes toward prostate cancer screening among Chinese men are still poorly understood. The objective of the study was to evaluate attitudes toward prostate cancer screening and their association with prostate cancer screening intention among Chinese men. In this community-based study, 340 males were randomly recruited. Three distinct concepts related to prostate cancer screening attitudes were evaluated, including perceived consequences of screening, moral obligation, and anticipated regret. The intention to have prostate cancer screening was asked. Only 5.00% of the study participants had prostate cancer screening before, while 69.71% have an intention to undergo screening in the future. Participants with a high level of anticipated regret also had a high likelihood to have screening in the future, with an adjusted odds ratio (aOR) of 1.82. Participants who had favorable attitudes toward the consequence of participating in prostate cancer screening had a high likelihood to undergo screening, with an aOR of 1.22. Participants who were more concerned about pain and invasion of privacy were less likely to have an intention to have prostate cancer screening, with aORs of 0.53 and 0.57, respectively. To enhance screening intention, public health programs should include components related to anticipated regrets and perceived consequences.

Promoting Vaccination with Lottery Incentives

Background: In May, 2021, U.S. states began implementing “vaccination lotteries” to encourage vaccine-hesitant individuals to get a COVID-19 vaccine. Purpose: Drawing on theories from math cognition and behavioral economics, we tested several monetary lottery structures and their framing to determine which would best motivate unvaccinated individuals. Methods: In two online experiments conducted in May, 2021, U.S. adults were asked to imagine that their state had implemented a vaccination lottery. In Experiment 1, participants (n=589) were randomly assigned to 1 of 12 conditions that varied the monetary amount and number of winners, holding constant the total payout ($5 million). In Experiment 2, participants (n=274) were randomly assigned to 1 of 4 conditions in a 2 (Message Framing: Gain versus Loss) by 2 (Numeric Framing: 5 total winners versus 1 winner for 5 weeks) factorial design; in all four conditions, 5 people would each win $1 million. Following the manipulation, participants rated their COVID-19 vaccination intentions, perceived likelihood of winning, and anticipated regret. Results: Vaccination intentions did not differ across conditions in either experiment, and post-manipulation vaccination intentions were strongly associated with baseline vaccination willingness. When asked to choose from 12 different lottery structures, participants tended to prefer options that awarded less money to more people, with 41.9% of participants across experiments indicated they would not vaccinate for any lottery-based monetary incentive. Conclusion: Findings suggest that multiple lottery structures could be equally motivating for unvaccinated adults, although states could consider structures that distribute incentives across more people.

Integrating Health Behavior Theories to Predict COVID-19 Vaccine Acceptance: Differences between Medical Students and Nursing Students

Background: This study aimed to explore behavioral-related factors predicting the intention of getting a COVID-19 vaccine among medical and nursing students using an integrative model combining the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB). Methods: A cross-sectional online survey was conducted among medical and nursing students aged > 18 years in their clinical years in Israel between 27 August and 28 September 2020. Hierarchical logistic regression was used to predict acceptance of a COVID-19 vaccine. Results: A total number of 628 participants completed the survey. Medical students expressed higher intentions of getting vaccinated against COVID-19 than nursing students (88.1% vs. 76.2%, p < 0.01). The integrated model based on HBM and TPB was able to explain 66% of the variance (adjusted R2 = 0.66). Participants were more likely to be willing to get vaccinated if they reported higher levels of perceived susceptibility, benefits, barriers, cues to action, attitude, self-efficacy and anticipated regret. Two interaction effects revealed that male nurses had a higher intention of getting vaccinated than did female nurses and that susceptibility is a predictor of the intention of getting vaccinated only among nurses. Conclusions: This study demonstrates that both models considered (i.e., HBM and TPB) are important for predicting the intention of getting a COVID-19 vaccine among medical and nursing students, and can help better guide intervention programs, based on components from both models. Our findings also highlight the importance of paying attention to a targeted group of female nurses, who expressed low vaccine acceptance.

What Predicts the Physical Activity Intention–Behavior Gap? A Systematic Review

Background Intention is theorized as the proximal determinant of behavior in many leading theories and yet intention–behavior discordance is prevalent. Purpose To theme and appraise the variables that have been evaluated as potential moderators of the intention–physical activity (I-PA) relationship using the capability–opportunity–motivation– behavior model as an organizational frame. Methods Literature searches were concluded in August 2020 using seven common databases. Eligible studies were selected from English language peer-reviewed journals and had to report an empirical test of moderation of I-PA with a third variable. Findings were grouped by the moderator variable for the main analysis, and population sample, study design, type of PA, and study quality were explored in subanalyses. Results The search yielded 1,197 hits, which was reduced to 129 independent studies (138 independent samples) of primarily moderate quality after screening for eligibility criteria. Moderators of the I-PA relationship were present among select variables within sociodemographic (employment status) and personality (conscientiousness) categories. Physical capability, and social and environmental opportunity did not show evidence of interacting with I-PA relations, while psychological capability had inconclusive findings. By contrast, key factors underlying reflective (intention stability, intention commitment, low goal conflict, affective attitude, anticipated regret, perceived behavioral control/self-efficacy) and automatic (identity) motivation were moderators of I-PA relations. Findings were generally invariant to study characteristics. Conclusions Traditional intention theories may need to better account for key I-PA moderators. Action control theories that include these moderators may identify individuals at risk for not realizing their PA intentions. Prospero # CRD42020142629.

Factors Associated With Obtaining Lung Cancer Screening Among Persons Who Smoke

Background. Screening with low-dose computed tomography scans can reduce lung cancer deaths but uptake remains low. This study examines psychosocial factors associated with obtaining lung cancer screening (LCS) among individuals. Methods. This is a secondary analysis of a randomized clinical trial conducted with 13 state quitlines’ clients. Participants who met age and smoking history criteria were enrolled and followed-up for 6 months. Only participants randomized to the intervention group (a patient decision aid) were included in this analysis. A logistic regression was performed to identify determinants of obtaining LCS 6 months after the intervention. Results. There were 204 participants included in this study. Regarding individual attitudes, high and moderate levels of concern about overdiagnosis were associated with a decreased likelihood of obtaining LCS compared with lower levels of concern (high levels of concern, odds ratio [OR] 0.17, 95% confidence interval [CI] 0.04–0.65; moderate levels of concern, OR 0.15, 95% CI 0.05–0.53). In contrast, higher levels of anticipated regret about not obtaining LCS and later being diagnosed with lung cancer were associated with an increased likelihood of being screened compared with lower levels of anticipated regret (OR 5.59, 95% CI 1.72–18.10). Other potential harms related to LCS were not significant. Limitations. Follow-up may not have been long enough for all individuals who wished to be screened to complete the scan. Additionally, participants may have been more health motivated due to recruitment via tobacco quitlines. Conclusions. Anticipated regret about not obtaining screening is associated with screening behavior, whereas concern about overdiagnosis is associated with decreased likelihood of LCS. Implications. Decision support research may benefit from further examining anticipated regret in screening decisions. Additional training and information may be helpful to address concerns regarding overdiagnosis.