BACKGROUND Serious games for the training of prevention behaviors have been widely recognized as a potentially valuable tool for adolescents and young adults across a variety of risk behaviors. However, the role of agency, as a distinguishing factor from traditional health interventions, has seldomly been isolated and grounded in persuasive health communication theory. Fear appeals have different effects on intentions to perform a prevention behavior depending on the immediacy of the consequences. Looking into how to increase self-efficacy beliefs for health behavior with distant consequences is a first step to improving game-based interventions for adverse health outcomes. OBJECTIVE The current study investigated the effect of agency on self-efficacy and intention to drink less alcohol in an interactive digital narrative fear appeal. Further, the communicated immediacy of threat outcomes was evaluated as a potential moderator of the effect of agency on self-efficacy. METHODS An experimental study was conducted among university students (N=178). Participants were presented with a fear appeal outlining the consequences of alcohol abuse in an interactive narrative format. Participants either had perceived control over the outcome of the narrative scenario (high-agency) or no control over the outcome (low-agency). The threat was either framed as a short-term or long-term negative health outcome resulting from the execution of the risk behavior (drinking too much alcohol). RESULTS Self-efficacy and intention to limit alcohol intake were not influenced by the agency manipulation. Self-efficacy was shown to be a significant predictor of behavioral intention. Immediacy of the threat did not moderate the relationship between agency and self-efficacy. CONCLUSIONS Although the agency manipulation was successful, we could not find evidence for an effect of agency or threat immediacy on self-efficacy. The implications for different operationalizations of different agency concepts is discussed, as well as the malleability of self-efficacy beliefs for long-term threats. The usage of repeated, versus single, interventions and different threat types (e.g., health and social threats) should be tested empirically to establish a way forward for diversifying intervention approaches.
Background Serious games for the training of prevention behaviors have been widely recognized as potentially valuable tools for adolescents and young adults across a variety of risk behaviors. However, the role of agency as a distinguishing factor from traditional health interventions has seldom been isolated and grounded in the persuasive health communication theory. Fear appeals have different effects on intentions to perform prevention behaviors depending on the immediacy of the consequences. Looking into how to increase self-efficacy beliefs for health behavior with distant consequences is the first step toward improving game-based interventions for adverse health outcomes. Objective This study aimed to investigate the effect of agency on self-efficacy and the intention to drink less alcohol in an interactive digital narrative fear appeal. Furthermore, the communicated immediacy of threat outcomes was evaluated as a potential moderator of the effect of agency on self-efficacy. Methods A web-based experimental study was conducted with university students (N=178). The participants were presented with a fear appeal outlining the consequences of excessive alcohol use in a fully automated web-based interactive narrative. Participants either had perceived control over the outcome of the narrative scenario (high agency) or no control over the outcome (low agency). The threat was either framed as a short-term (high immediacy) or long-term (low immediacy) negative health outcome resulting from the execution of the risk behavior (drinking too much alcohol). Results A total of 123 valid cases were analyzed. Self-efficacy and intention to limit alcohol intake were not influenced by the agency manipulation. Self-efficacy was shown to be a significant predictor of behavioral intention. The immediacy of the threat did not moderate the relationship between agency and self-efficacy. Conclusions Although agency manipulation was successful, we could not find evidence of an effect of agency or threat immediacy on self-efficacy. The implications for different operationalizations of different agency concepts, as well as the malleability of self-efficacy beliefs for long-term threats, are discussed. The use of repeated versus single interventions and different threat types (eg, health and social threats) should be tested empirically to establish a way forward for diversifying intervention approaches. Trial Registration ClinicalTrials.gov NCT05321238; https://www.clinicaltrials.gov/ct2/show/NCT05321238
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