When risk communication backfires: randomized controlled trial on self-affirmation and reactance to personalized risk feedback in high-risk individuals

Health Psychol. 2013 May;32(5):561-70. doi: 10.1037/a0029887.


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).

Method: 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.

Conclusion: 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.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Defense Mechanisms*
  • Female
  • Follow-Up Studies
  • Health Communication*
  • Health Promotion / methods*
  • Humans
  • Intention
  • Male
  • Middle Aged
  • Photography
  • Psychological Theory
  • Risk Assessment
  • Risk-Taking*
  • Self Concept
  • Skin Neoplasms / prevention & control*
  • Sunbathing / psychology*
  • Ultraviolet Rays / adverse effects
  • Young Adult