Examining the Effect of Multidimensional Distance Framing on Information-Seeking of Antibiotic Risk

Antibiotic resistance poses a significant health threat that demands urgent attention. However, a major challenge in combating this issue is the lack of risk awareness among the general public (Bennadi, 2014). Therefore, the current study seeks to explore effective persuasive health communication strategies that can raise public awareness of antibiotic risks and promote preventive behaviors. We focus on one specific health communication outcome: information seeking.

Information seeking encourages individuals to acquire knowledge about health risks and the health literacy needed for action (Yamashita et al., 2019), thus considered a prerequisite for health behavior (Amirudin et al., 2021). In the context of antibiotic risk, information seeking is particularly crucial for shaping effective preventive behaviors, especially since the public generally lacks correct knowledge about the complexity of it (Machowska & Stålsby Lundborg, 2018).

Construal level theory (CLT) and psychological distance serve as important theoretical frameworks in persuasive health communication. Construal level refers to the degree of abstraction when perceiving external objects or events, which is determined by the psychological distance from the perceived object: the closer the psychological distance, the more concrete the perception will be (Trope et al., 2007). Psychological distance includes multiple dimensions, such as hypothetical, temporal, spatial, and social distance (Liberman & Trope, 2008). It is generally believed that risks are often concrete (Liberman et al., 2007), and using close distance framing in health messages can reduce psychological distance, thus enhancing risk awareness. Therefore, research has shown that close distance framing can effectively promote risk awareness and preventive behavior intentions in various contexts.

However, most existing studies have focused primarily on the effects of single-dimensional psychological distance, using stimuli from one dimension of distance in highly controlled experimental environments (Griffioen et al., 2016), overlooking the fact that multi-dimensional distances often coexist in reality. In the context of risk, distance essentially represents different aspects of its characteristics, such as the location (spatial distance), time (temporal distance), probability (hypothetical distance), and the population affected (social distance). Individuals' subjective risk perceptions often form under the combined influence of these characteristics.

Distance framing can be considered a form of persuasion cue that drives attitudinal and behavioral change by matching individuals’ construal levels with the abstractness of the intended outcome. Existing evidence has indicated that multiple persuasion cues might not always aid the persuasion process, as individuals often pay attention to one or few deemed essential due to the limited cognitive capacity (Harkins & Petty, 1981). Furthermore, study suggests that when multiple distances coexist, individuals' sensitivity to distance may decrease, complicating its impact on cognitive processing (Kim et al., 2008). Thus, the effect of distance framing could be diluted when multiple distances coexist in health messages, with only single or few dimensions effective.

Therefore, driven by CLT, psychological distance, and the potential salience of information seeking in preventing antibiotic risks, our study aims to examine the effect of multidimensional distance framing and propose the following research question: How does multidimensional distance framing affect information seeking behavior intention toward antibiotic risk?

We conducted a 2 (hypothetical distance: low/high) × 2 (temporal distance: low/high) × 2 (spatial distance: low/high) experiment with 371 participants to address this question. Participants were recruited via a Chinese survey platform, Tencent Survey, which includes users from various demographics. Participants were randomly assigned to different groups and were asked to read a public health advertisement on antibiotic abuse. Each participant was exposed to a message incorporating three dimensions of distance. After reading the experiment material, participants completed a questionnaire measuring their intention to seek information related to antibiotic risk.

A three-way ANCOVA was conducted to assess the impacts of hypothetical distance, temporal distance, and spatial distance, along with covariates, on information-seeking intention, as well as possible interaction. The ANCOVA revealed significant main effects of hypothetical distance on information-seeking intention (F = 6.95, p < .01). Individuals who received far temporal distance stimuli had stronger intention to seek information related to antibiotic risk (close hypothetical distance group: M = 5.52, SD = 1.35; far hypothetical distance group: M = 5.84, SD = 1.01), whereas the main effects of hypothetical distance and spatial distance were not significant. Additionally, all the two-way or three-way interactions were non-significant.

These findings suggest that, of the three coexisting distance framings, only temporal distance was effective in promoting information-seeking intention. This result aligns with our previous estimation that when multiple distances coexist, only one dimension can be effective. Furthermore, the prominence of the temporal dimension suggests that individuals prioritize time-related aspects in when exposed to multiple overloading persuasion cues. This result also reflects the public's perception of antibiotic risk as a chronic risk, similar to health risks such as tobacco (Kim & Kim, 2018) and alcohol abuse (Kim & Kim, 2018), where temporal perception of risk consequences is crucial. Interestingly, contrary to previous studies, far temporal distance proved more effective than close temporal distance. This counterintuitive result may be due to the unique nature of antibiotic risk: antibiotic resistance is a gradual process that accumulates over time (Livermore, 2007). In this sense, the long-term threat may seem more significant than the immediate risks. This special characteristic of antibiotic risk may provide a reference for understanding the counterintuitive result, whereas far temporal distance framing that stresses long-term consequences is more effective. This finding may also reflect the differential temporal orientation of our Chinese participants, who tend to focus more on the present and future compared to Westerners, who are generally more present-oriented (Gao, 2016).

To summarize, our study contributes to a more nuanced understanding of the effects of distance framing in reality, where multidimensional distances coexist. This research fills a gap in the literature on the effects of multidimensional distance and offers valuable insights for future studies on CLT and psychological distance. Additionally, our findings provide practical implications for health communication professionals, suggesting that including multiple persuasion cues in health messages may not always be effective. Our study also has limitations, notably the exclusion of social distance due to its low discriminability from other distance dimensions. Future research could consider exploring the role of social distance and its interactions with other dimensions.