The persuasive power of peer guides in Web sites that promote HIV/AIDS voluntary counselling and testing


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The persuasive power of peer guides in Web sites that promote HIV/AIDS voluntary counselling and testing
  2005 IEEE International Professional Communication Conference Proceedings 0-7803-9028-8/05/$20.00 © 2005 IEEE. The Persuasive Power of Peer Guides in Websites That Promote HIV/AIDS Voluntary Counselling and Testing Iris Nieuwboer Tilburg University, Communication & Cognition Alfons A. Maes Tilburg University, Communication & Cognition Maes@uvt.nlPiet Swanepoel University of South Africa  Department of Afrikaans and Theory of Literature Abstract This study investigates the persuasive power and cultural appropriateness of a personal agent in websites intended to persuade university students to go for Voluntary Counseling and Testing (VCT). Three versions of the same website were presented to Dutch and South African university students. The results show that visual personalization had more effect than verbal cues and that South  African students estimated all versions of the websites as more persuasive than Dutch students. The huge intercultural differences make clear that  personalization cues can be effective in sensitive health-related communication. The results stress the importance of cross-cultural research in developing culturally appropriate websites. Keywords:  personalization, website design, health communication, VCT, AIDS South Africa is experiencing an HIV/AIDS epidemic of catastrophic proportions. At an HIV-  prevalence rate of 11.4 %, it is one of the countries with the largest number of people living with AIDS in the world (an estimated 5.1 million). The higher education sector is disproportionately affected by the HIV/AIDS epidemic. In a 2003 HEAIDS (Higher Education Against HIV/AIDS) study it is estimated that overall 22.5% of the 680.000 students enrolled at Institutions of Higher Education (IHE) were HIV positive in 2003 and that this figure could be expected to rise by an additional 10% by 2005. [1]. In line with best practices, VCT services are the  backbone in redressing the HIV/AIDS epidemic in the student population[2, 3]. VCT services not only link prevention and care interventions, but also support them. A large number of IHE (74%)  provide VCT services to staff and students. However, the utilization of these services has been extremely low. According to a recent HEAIDS audit only 0.44% of students and staff (1984 out of 443 100) were tested for HIV during March to May 2003 when HEAIDS ran the audit [1]. One of the factors responsible for the inefficacy of current VCT programmes of IHE is an ineffective communication strategy to market VCT on campus [1]. VCT and the Internet At first sight, written documentation in general, and digital information distributed through the Internet in particular, is not the most evident communication medium for transferring sensitive  personal, AIDS related messages in South Africa. The digital medium is inaccessible to large  portions of the populations. The Internet is an impersonal medium, and is therefore not always suited to transfer complex behavioral health messages; "real" interactive communication, such as role play and individual patient consultations seems more suited to fit both the complex nature of AIDS communication. Yet, the Internet seems to have strong advantages to counter these shortcomings. AIDS-related communication still is highly associated with sex, illness and death, and therefore with feelings of shame and guilt which can dramatically obstruct communication in face-to-face settings. These feelings can be decreased 829  2005 IEEE International Professional Communication Conference Proceedings Figure 1. The central webpage with the arguments and testimonials  by the anonymity of the Internet. Furthermore, in South Africa access to the Internet is increasing. According to estimated from the CIA fact sheet 1  , about 8% of the South African population (more than 3 million) had Internet access in 2002. Moreover, Institutions of Higher Education as a group are one of the fastest growing users of the Internet, and students' on-campus access to the Internet via university networks is increasing rapidly [4]. This makes the Internet a powerful and more and more accessible medium for informing young adults about AIDS related issues. Survey In this study, we start from the context described above and present the set up and the results of an 1 experiment carried out in the context of Epidasa 2 ,an international research project. The goal of the experiment was to determine whether the  persuasive power of digital VCT information aimed at students could be improved by the addition of a peer guide presenting the arguments. On the basis of standard pro-VCT arguments, we constructed three versions of a website. The central part of the website consisted of arguments  pro-VCT, each accompanied with a positive testimonial (see Figure 1). In two versions we added a verbal or a visual+verbal peer guide, which was intended to create a personal relationship with the user. The guide welcomes the students to the website and explicitly 2 The project is part of Sanpad (  2005 IEEE International Professional Communication Conference Proceedings Figure 2. The Integrative Behavior Model (IBM)introduces the arguments and testimonials of 'her/his friends'. The three versions were presented to Dutch and (black and white) South African university students. In the next section, we discuss the role of a peer guide in relation to persuasion and  persuasive digital VCT information. Next, we describe the set up and results of the experiment. Finally, we discuss a number of results and recommendations for future design. A peer guide in a persuasive VCT website Persuading young adults to go for VCT is a complicated process. Document variables can only play a modest role in changing thepsychosocial variables involved in this process. The complexity of these variables is shown in theories that model the relation between attitude and behavior, such as the Integrative Behavior Model (IBM) [5]. Applied to VCT, the IBM embodies the assumption that only a limited number of variables, the so-called proximal variables, will be the most predictive of VCT uptake behavior (see Figure 2). The single best  predictor is the intention to present oneself for VCT. This variable is a function of the behavioral, normative, and efficacy beliefs one has about going for VCT. The more one believes that going for VCT will lead to good outcomes and prevent  bad outcomes, the more favorable one’s attitude should be toward it (behavioral beliefs). Similarly, the more a person believes that others think that he or she should or should not go for VCT, and the more motivated a person is to agree with those others, the stronger will be the subjective norm to go or not go for VCT (normative beliefs). Finally, the more a person perceives that he or she can (e.g. has skills and abilities to) go for VCT, even in the face of specific barriers or obstacles, the stronger will be the person’s self-efficacy with respect to going for VCT (efficacy beliefs) 3 .The IBM predicts a large amount of variance in the uptake of VCT depending on the interaction and relative weight of these variables in different  populations, which requires different types of messages for different target groups. This IBM-analysis makes it clear that the  persuasion process involved in VCT is complex and variable. IBM does not explicitly address the role of message variables. At best it suggests a role for content variables. Moreover, it suggests a highly custom driven determination of message content, dependent on subjective beliefs. The complex interaction between content and subjective beliefs, together with the open nature of the Internet, made it less desirable to address these individual content requirements. Therefore we decided not to focus on content variables in 3  The left column in the model represents distal variables, which according to Fishbein & Yzer are used in message design mainly to determine different target groups based on different beliefs. Distal variables Demographic variables  Attitude toward targets, e.g., stereotypes and stigmas Personality, moods, and emotions Other individual differences variables, e.g., perceived risk Exposure to interventions Behavioural beliefs & outcome evaluations attitudeskillsNormative beliefs & motivation to complyPerceived normintentionEfficacy beliefsSelf-efficacyEnvironmental constraintbehaviour  831  2005 IEEE International Professional Communication Conference Proceedings Figure 3. The Elaboration Likelihood Model (ELM)constructing the VCT website 4 . Instead, we started from a collection of standard uncontroversial pro VCT arguments as invariable baseline content in the VCT website. In the arguments, the individual and social advantages of VCT are stressed and the counterarguments refuted. As an independent variable, we focused on a generic and stable rhetorical variable, i.e. the peer guide, which we expected to be less sensitive to individual differences, and hence more generally applicable in website design. Peer guides as persuasive cues The effect of personalization variables like peer guides can be hypothesized on the basis of dual  process persuasion models, such as Chaiken's Heuristic Systematic Model and Petty and Cacioppo's Elaboration Likelihood Model (ELM). Unlike content oriented models, such as the IBM, they explicitly address the role of rhetorical 4 An additional reason was the lack of IBM based scales for the analysis of the determinants of the VCT uptake  behavior, as well as the unavailability of research on the determinants of South African students’ decisions to  present themselves for VCT. One of the few relevant  publications is Peltzer and Mpofu (2002), which uses Boshamer and Bruce’s HIV Antibody Testing Attitude Scale to determine the determinants of the VCT uptake  behavior of 760 first-year students from four African Universities [6] K. Peltzer and E. Mpofu, "The factor structure of the HIV Antibody testing Attitude Scale in Four African Countries,"  Eastern Journal of Medicine ,vol. 7, pp. 27-30, 2002. message variables [7, 8]. For example, the ELM assumes two different routes to attitude change (see Figure 3). There is a central route, which focuses on central information like the arguments in the website. It therefore implies a rational  process of learning, collecting information, and generating thoughts about the topic. This  processing route requires extra effort and is likely to occur in cases of high involvement   and a high need for cognition .The other route is the peripheral one, which is associated with low involvement and a low need for cognition. This route focuses on persuasion via heuristic cues and focuses on the impact of non-central informational aspects (heuristics). In the case of the VCT website, the peer guide is most likely active on this second level of attitude formation. The peer's assumed expert status may increase the credibility of the source or the attitude towards the information, and his personal style may increase the appreciation of the information. We confronted not only South African but also Dutch students with the different versions of the website. The ELM predicts substantial differences  between these cultural groups. Dutch ELMstudents know less about VCT and are less involved with HIV/AIDS than South African students. Therefore, it is expected that the  peripheral cues may be more persuasive to the Dutch than to the South African students. Motivated? Capable? Evaluation of arguments leads to positive reaction  Accept point of view Reject point of view  Application of heuristic cues possible? Does this lead to positive decision?  Accept point of view Reject point of view Don’t take point of view yes yes yes yes yes nonononono  Central route Peripheral route 832  2005 IEEE International Professional Communication Conference Proceedings Digital peer guides as social actors There is growing evidence about the beneficial nature of personalization cues in digital environments. For example, the use of informal,  personal style [9, 10], and expressive visual social actors [11, 12] is known to promote students' learning in multimedia environments. These social agency variables are associated with the activation of a conversational communication scheme and an increase in social presence and self referencing, which makes students more involved and motivated [13, 14]. There is also evidence for the  persuasive effect of social agency variables. Lee and Nass demonstrated that the addition of visual animations in digital interaction did not only increase the appreciation of the addressee, but also the extent to which users agreed with the addressee [15]. Likewise , Fogg et al. argue that users respond socially when computers adopt animated characteristics (e.g., physical features, emotions),  play animated roles (e.g., coach, assistant), or follow social rules or dynamics (e.g., greetings, turn taking) [16, 17]. Laboratory experiments have also demonstrated how computers can be  persuasive social actors. In particular, computers as social actors can persuade people to change their attitudes and behaviors by providing social support, modeling attitudes or behaviors, and leveraging social rules and dynamics. In most of these cases, social agents are realized by embodied animated cartoons or faces and (human or computer) voices. Given the delicacy of the information, and the variety of the target group to  be addressed, we decided again to opt for generic and fairly neutral personalization cues. Instead of cartoon animation and voice, we opted for realistic static visualization (by photographs) and personal written text on the screen. Using animation and voice would have forced us to make decisions on  personal styles, accents, etc., the effect of which is not trivial [18]. This makes it plausible to assume that the peer guide and the social function of the computer make a successful persuasive combination. The Internet enables tailoring the information in the experimental website in such a way that the source of the information appears to be a peer guide. Subsequently, this peer guide can be tailored to the  persona  the student prefers to be informed by [19]. As such, the mediated peer may function as a social actor, and persuade the students to change their attitudes. In this case, we expect the peer to have a positive effect on how students evaluate the source and the information of the website, and on their attitude and involvement. In sum By using this type of personalization, we intended to evoke effects of a real peer guide as a rhetorical and culturally appropriate strategy in HIV/AIDS communication [2, 20] without relapsing into the use of (culturally) inappropriate personalization cues. We expected the peer guides to have a  positive effect on the persuasive power of the website information. Given the positive effects of social cues, the combination of the verbal and visual peer guide is expected to be more beneficial than the verbal guide only. MethodParticipants and design The research was conducted in The Netherlands with students from Tilburg University and in South Africa with students from the University of Pretoria (UP) and the University of South Africa (UNISA). The group of Dutch students consisted of 29 male and 27 female students. The age varied from 19 to 28 years. In South Africa, two groups participated in the experiment. There were 30 white South African students, 16 male and 14 female students. The age varied from 18 to 24 years. And there were 33  black South African participants, 16 male and 17 female students; the youngest was 17 and the oldest 26 years old.  5 The experiment used a between subject design:  participants were exposed to one of three website versions only (objective, verbal peer or verbal+visual peer version). Materials and instrumentation The objective website consisted of 22 pages on two information levels. 5  Non-white South Africans, even after 10 years, are still  behind their white South African counterparts regarding health care. Therefore epidemiological studies in South Africa still use ethnicity as a variable in the analysis of health behavior. Thus, for comparability reasons only, it is appropriate to make this distinction [2] HSRC, "Household survey 2002," Nelson Mandela/HSRC Study of HIV/Aids 2002. 833
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