The impact of self-affirmation on health-behavior change: A meta-analysis

Health Psychology

Volumn 34, Issue 3, 2015, Pages 187-196

  Epton, Tracy ^a   Harris, Peter R ^b   Kane, Rachel ^c   van Koningsbruggen, Guido M ^d   Sheeran, Paschal ^e  

^a UNIVERSITY OF MANCHESTER   (United Kingdom)

^b UNIVERSITY OF SUSSEX   (United Kingdom)

^c UNIVERSITY OF SHEFFIELD   (United Kingdom)

^d VU UNIVERSITY AMSTERDAM   (Netherlands)

^e University of North Carolina at Chapel Hill   (United States)

Author keywords

Defensiveness; Health behavior; Intentions; Message acceptance; Self affirmation

Indexed keywords

ALCOHOL; CAFFEINE;

ARTICLE; BEHAVIOR CHANGE; DIET; EFFECT SIZE; EXPERIMENTAL TEST; HEALTH BEHAVIOR; HUMAN; META ANALYSIS; OUTCOME ASSESSMENT; OUTCOME VARIABLE; PERCEPTION; SELF AFFIRMATION; SOCIAL ACCEPTANCE; ADULT; BEHAVIOR; FEMALE; HEALTH PROMOTION; MALE; PERSUASIVE COMMUNICATION; PROCEDURES; SELF CONCEPT; YOUNG ADULT;

ADULT; FEMALE; HEALTH BEHAVIOR; HEALTH PROMOTION; HUMANS; INTENTION; MALE; PERSUASIVE COMMUNICATION; SELF EFFICACY; YOUNG ADULT;

EID: 84906038976     PISSN: 02786133     EISSN: 19307810     Source Type: Journal    
DOI: 10.1037/hea0000116     Document Type: Article

References (92)

1. Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179 -211. doi:10.1016/0749- 5978(91)90020-T
2. Armitage, C. J., Harris, P. R., & Arden, M. A. (2011). Evidence that self-affirmation reduces alcohol consumption: Randomized exploratory trial with a new, brief means of self-affirming. Health Psychology, 30, 633-641. doi:10.1037/a0023738
3. Armitage, C. J., Harris, P. R., Hepton, G., & Napper, L. (2008). Selfaffirmation increases acceptance of health-risk information among United Kingdom adult smokers with low socioeconomic status. Psychology of Addictive Behaviors, 22, 88-95. doi:10.1037/0893-164X.22.1.88
4. Briñol, P., Petty, R. E., Gallardo, I., & DeMarree, K. G. (2007). The effect of self-affirmation in non-threatening persuasion domains: Timing affects the process. Personality and Social Psychology Bulletin, 33, 1533- 1546. doi:10.1177/0146167207306282
5. Bucchianeri, M. M. (2012). An experimental test of women's body dissatisfaction reduction through self-affirmation. Applied Psychology - Health and Well-Being, 4, 188-201. doi:10.1111/j.1758-0854.2012 .01068.x
6. Caine, A. R. (2004). The influence of mood on responses to healthconsequence information. Unpublished doctoral dissertation, University of California, San Diego, CA.
7. Chalmers, I., Adams, M., Dickersin, K., Hetherington, J., Tarnow-Mordi, W., Meinhert, C., Chalmers, T. C. (1990). A cohort of summary reports of controlled trials. Journal of the American Medical Association, 263, 1401-1405. doi:10.1001/jama.1990.03440100117017
8. Chandran, S., & Menon, G. (2004). When a day means more than a year: Effects of temporal framing on judgments of health risk. Journal of Consumer Research, 31, 375-389.
9. Cohen, G. L., Garcia, J., Purdie-Vaugns, V., Apfel, N., & Brzustoski, P. (2009). Recursive processes in self-affirmation: Intervening to close the minority achievement gap. Science, 324, 400-403. doi:10.1126/science .1170769
10. Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155-159. doi:10.1037/0033-2909.112.1.155
11. Cooke, R., Trebaczyk, H., Harris, P. R., & Wright, A. (in press). Selfaffirmation promotes physical activity. Journal of Sport & Exercise Psychology.
12. Correll, J., Spencer, S. J., & Zanna, M. P. (2004). An affirmed self and an open mind: Self-affirmation and sensitivity to argument strength. Journal of Experimental Social Psychology, 40, 350-356. doi:10.1016/j.jesp .2003.07.001
13. Coyne, J. C., Thombs, B. D., & Hagedoorn, M. (2010). Ain't necessarily so: Review and critique of recent meta-analyses of behavioral medicine interventions in Health Psychology. Health Psychology, 29, 107-116. doi:10.1037/a0017633
14. Critcher, C. R., Dunning, D., & Armor, D. A. (2010). When selfaffirmations reduce defensiveness: Timing is key. Personality and Social Psychology Bulletin, 36, 947-959. doi:10.1177/0146167210369557
15. Crocker, J., Niiya, Y., & Mischkowski, D. (2008). Why does writing about important values reduce defensiveness? Self-affirmation and the role of positive other-directed feelings. Psychological Science, 19, 740- 747. doi:10.1111/j.1467-9280.2008.02150.x
16. Dijkstra, A. (2010). Personalization, personal relevance and selfaffirmation. Unpublished manuscript, Department of Psychology, University of Groningen, Groningen, The Netherlands.
17. Dillard, A. J., McCaul, K. D., & Magnan, R. E. (2005). Why is such a smart person like you smoking? Using self-affirmation to reduce defensiveness to cigarette warning labels. Journal of Applied Biobehavioral Research, 10, 165-182. doi:10.1111/j.1751-9861.2005.tb00010.x
18. Dillard, J. P., & Shen, L. (Eds.). (2012). The SAGE handbook of persuasion: Developments in theory and practice (2nd ed.). Thousand Oaks, CA: Sage.
19. Epton, T. (2009). Self-affirmation and health behavior change: Affective and cognitive predictors, moderators and mediators. Unpublished doctoral dissertation, University of Sheffield, United Kingdom.
20. Epton, T., & Harris, P. R. (2008). Self-affirmation promotes health behavior change. Health Psychology, 27, 746-752. doi:10.1037/0278- 6133.27.6.746
21. Fein, S., & Spencer, S. J. (1997). Prejudice as self-image maintenance: Affirming the self through derogating others. Journal of Personality and Social Psychology, 73, 31-44. doi:10.1037/0022-3514.73.1.31
22. Frattaroli, J. (2006). Experimental disclosure and its moderators: A metaanalysis. Psychological Bulletin, 132, 823-865. doi:10.1037/0033-2909 .132.6.823
23. Fry, R. B., & Prentice-Dunn, S. (2005). Effects of coping information and value affirmation on responses to a perceived health threat. Health Communication, 17, 133-147. doi:10.1207/s15327027hc1702_2
24. Gallagher, K. M., & Updegraff, J. A. (2012). Health message framing effects on attitudes, intentions and behavior: A meta-analytic review. Annals of Behavioral Medicine, 43, 101-116. doi:10.1007/s12160-011- 9308-7
25. Good, A. (2008). Developing evidence based sun protection interventions. Unpublished doctoral dissertation, University of Sussex, United Kingdom.
26. Good, A., & Abraham, C. (2011). Can the effectiveness of health promotion campaigns be improved using self-efficacy and self-affirmation interventions? An analysis of sun-protection messages. Psychology & Health, 26, 799-818. doi:10.1080/08870446.2010.495157
27. Good, A., Harris, P., Jessop, D., & Abraham, C. (in press). Openmindedness can decrease persuasion amongst adolescents: The role of self-affirmation. British Journal of Health Psychology. doi:10.1111/bjhp .12090
28. Harris, P. R., Brearley, I., Sheeran, P., Barker, M., Klein, W. M. P., Creswell, J. D., Bond, R. (in press). Combining self-affirmation with implementation intentions to promote fruit and vegetable consumption. Health Psychology.
29. Harris, P. R., & Epton, T. (2009). The impact of self-affirmation on health cognition, health behavior and other health related responses: A narrative review. Social and Personality Psychology Compass, 3, 962-978. doi:10.1111/j.1751-9004.2009.00233.x
30. Harris, P. R., & Epton, T. (2010). The impact of self-affirmation on health-related cognition and health behavior: Issues and prospects. Social and Personality Psychology Compass, 4, 439.454. doi:10.1111/j .1751-9004.2010.00270.x
31. Harris, P. R., Mayle, K., Mabbott, L., & Napper, L. (2007). Selfaffirmation reduces smokers' defensiveness to graphic on-pack cigarette warning labels. Health Psychology, 26, 437-446. doi:10.1037/0278- 6133.26.4.437
32. Harris, P. R., & Napper, L. (2005). Self-affirmation and the biased processing of threatening health-risk information. Personality and Social Psychology Bulletin, 31, 1250-1263. doi:10.1177/0146167205274694
33. Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis. Orlando, FL: Academic Press.
34. Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003). Measuring inconsistency in meta-analyses. British Medical Journal, 327, 557-560. doi:10.1136/bmj.327.7414.557
35. Hofmann, W., Friese, M., & Wiers, R. W. (2008). Impulsive versus reflective influences on health behavior: A theoretical framework and empirical review. Health Psychology Review, 2, 111-137. doi:10.1080/ 17437190802617668
36. Howell, J. L., & Shepperd, J. A. (2012). Reducing information avoidance through affirmation. Psychological Science, 23, 141-145. doi:10.1177/ 0956797611424164
37. Jessop, D. C., Simmonds, L. V., & Sparks, P. (2009). Motivational and behavioral consequences of self-affirmation interventions: A study of sunscreen use among women. Psychology & Health, 24, 529-544. doi:10.1080/08870440801930320
38. Jessop, D., Sparks, P., Buckland, N., & Churchill, S. (2013). Combining self-affirmation and implementation intentions: Evidence of detrimental effects on behavioural outcomes. Unpublished Manuscript. Department of Psychology, University of Sussex, Sussex, United Kingdom.
39. Johnson, B. T., Scott-Sheldon, L. A. J., & Carey, M. P. (2010). Metasynthesis of health behavior change meta-analyses. American Journal of Public Health, 100, 2193-2198. doi:10.2105/AJPH.2008.155200
40. Klein, W. M. P., & Harris, P. R. (2009). Self-affirmation enhances Attentional bias toward threatening components of a persuasive message. Psychological Science, 20, 1463-1467. doi:10.1111/j.1467-9280.2009 .02467.x
41. Klein, W. M. P., Harris, P. R., Ferrer, R. A., & Zajac, L. E. (2011). Feelings of vulnerability in response to threatening messages: Effects of self-affirmation. Journal of Experimental Social Psychology, 47, 1237- 1242. doi:10.1016/j.jesp.2011.05.005
42. Klein, W. M., Lipkus, I. M., Scholl, S. M., McQueen, A., Cerully, J. L., & Harris, P. R. (2010). Self-affirmation moderates effects of unrealistic optimism and pessimism on reactions to tailored risk feedback. Psychology & Health, 25, 1195-1208. doi:10.1080/08870440903261970
43. Knapp, G., & Hartung, J. (2003). Improved tests for a random effects meta-regression with a single covariate. Statistics in Medicine, 22, 2693-2710. doi:10.1002/sim.1482
44. Ko, D. M., & Kim, H. S. (2010). Message Framing and Defensive Processing: A Cultural Examination. Health Communication, 25, 61-68. doi:10.1080/10410230903473532
45. Kraemer, H. C., Gardner, C., Brooks III, J. O., & Yesavage, J. A. (1998). Advantages of excluding underpowered studies in meta-analysis: Inclusionist versus exclusionist viewpoints. Psychological Methods, 3, 23-31. doi:10.1037/1082-989X.3.1.23
46. Krebs, P., Prochaska, J. O., & Rossi, J. S. (2010). A meta-analysis of computer tailored interventions for health behavior change. Preventive Medicine, 51, 214-221. doi:10.1016/j.ypmed.2010.06.004
47. Kunda, Z. (1987). Motivated inference: Self-serving generation and evaluation of causal theories. Journal of Personality and Social Psychology, 53, 636-647. doi:10.1037/0022-3514.53.4.636
48. Liberman, A., & Chaiken, S. (1992). Defensive processing of personally relevant health messages. Personality and Social Psychology Bulletin, 18, 669-679. doi:10.1177/0146167292186002
49. Lustria, M. L. A., Noar, S. M., Cortese, J., Van Stee, S. K., Glueckauf, R. L., & Lee, J. (2013). A meta-analysis of web-delivered tailored health behavior change interventions. Journal of Health Communication: International Perspectives, 18, 1039-1069. doi:10.1080/10810730.2013 .768727
50. McGuire, W. J. (1985). Attitudes and attitude change. In G. Lindzey & E. Aronson (Eds.), Handbook of social psychology (Vol. 2, pp. 223-346). New York, NY: Random House.
51. McQueen, A. L. (2002). The effects of self-affirmation and positive mood on the reduction of defensiveness after exposure to personally relevant health-risk information. Unpublished doctoral dissertation, University of Houston, Houston, TX.
52. McQueen, A., & Klein, W. M. P. (2006). Experimental manipulations of self-affirmation: A systematic review. Self and Identity, 5, 289-354. doi:10.1080/15298860600805325
53. Michie, S., & Abraham, C. (2004). Interventions to change health behaviours: Evidence based or evidence inspired. Psychology & Health, 19, 29-49. doi:10.1080/0887044031000141199
54. Michie, S., & Abraham, C. (2008). Advancing the science of behaviour change: A plea for scientific reporting. Addiction, 103, 1409-1410. doi:10.1111/j.1360-0443.2008.02291.x
55. Michie, S., Abraham, C., Whittington, C., & McAteer, J. (2009). Effective techniques in healthy eating and physical activity interventions: A metaregression. Health Psychology, 28, 690-701. doi:10.1037/a0016136
56. Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The PRISMA Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 7, e1000097. doi:10.1371/journal.pmed.1000097
57. Mokdad, A. H., Marks, J. S., Stroup, D. F., & Gerberding, J. L. (2004). Actual causes of death in the U. S., 2000. Journal of the American Medical Association, 291, 1238-1245. doi:10.1001/jama.291.10.1238
58. Napper, L. (2005). Self-affirmation and the processing of health-risk information. Unpublished doctoral dissertation, University of Sheffield, United Kingdom.
59. Neumann, C. A. (2005). Defensive bias and college student drinking: Do self-affirmations increase acceptance to threatening information? Un- published doctoral dissertation, Oklahoma State University, Stillwater, OK.
60. Palmgren, S. E. (2007). The efficacy of self-affirmation in debiasing defenses against continuation of substance abuse treatment. Unpublished doctoral dissertation, New School University, New York, NY.
61. Pavey, L. J., & Sparks, P. (2012). Autonomy and defensiveness: Experimentally increasing adaptive responses to health risk information via priming and self-affirmation. Psychology & Health, 27, 259-276. doi: 10.1080/08870446.2011.556251
62. Pietersma, S. (2009). Persuasive health communication: A self perspective. Unpublished doctoral dissertation, University of Groningen, The Netherlands.
63. Pietersma, S., & Dijkstra, A. (2011). Do behavioral health intentions engender health behavior change? A study on the moderating role of self-affirmation on actual fruit intake versus actual vegetable intake. British Journal of Health Psychology, 16, 815-827. doi:10.1111/j.2044- 8287.2011.02018.x
64. Pietersma, S., & Dijkstra, A. (2012). Cognitive self-affirmation inclination: An individual difference in dealing with self-threats. British Journal of Social Psychology, 51, 33-51. doi:10.1348/014466610X533768
65. Reed, M. B., & Aspinwall, L. G. (1998). Self-affirmation reduces biased processing of health-risk information. Motivation and Emotion, 22, 99-132. doi:10.1023/A:1021463221281
66. Rogers, R. W. (1983). Cognitive and physiological processes in fear appeals and attitude change: A revised theory of protection motivation. In J. T. Cacioppo & R. E. Petty (Eds.), Social psychophysiology (pp. 153-176). London: Guilford Press.
67. Rothman, A. J., & Salovey, P. (2007). The reciprocal relation between principles and practice: Social psychology and health behavior. In A. W. Kruglanski & E. T. Higgins (Eds.), Social psychology: Handbook of basic principles (2nd ed., pp. 826-849). New York, NY: Guilford Press.
68. Schmeichel, B. J., & Vohs, K. (2009). Self-affirmation and self-control: Affirming core values counteracts ego-depletion. Journal of Personality and Social Psychology, 96, 770-782. doi:10.1037/a0014635
69. Schüz, N., Schuez, B., & Eid, M. (2013). When risk communication backfires: Randomized controlled trial on self-affirmation and reactance to personalized risk feedback in high-risk individuals. Health Psychology, 32, 561-570. doi:10.1037/a0029887
70. Scott, J. L., Brown, A. C., Phair, J. K., Westland, J. N., & Schüz, B. (2013). Self-affirmation, intentions and alcohol consumption in students: A randomized exploratory trial. Alcohol and Alcoholism, 48, 458-463. doi:10.1093/alcalc/agt027
71. Sheeran, P., Gollwitzer, P. M., & Bargh, J. A. (2013). Nonconscious processes and health. Health Psychology, 32, 460-473. doi:10.1037/ a0029203
72. Sheeran, P., Harris, P. R., & Epton, T. (2014). Does heightening risk appraisals change people's intentions and behavior? A meta-analysis of experimental studies. Psychological Bulletin, 140, 511-543. doi: 10.1037/a0033065
73. Sherman, D. K., & Cohen, G. L. (2006). The psychology of self-defense: Self-affirmation theory. Advances in Experimental Social Psychology, 38, 183-242. doi:10.1016/S0065-2601(06)38004-5
74. Sherman, D. K., Cohen, G. L., Nelson, L. D., Nussbaum, A. D., Bunyan, D. P., & Garcia, J. (2009). Affirmed yet unaware: Exploring the role of awareness in the process of self-affirmation. Journal of Personality and Social Psychology, 97, 745-764. doi:10.1037/a0015451
75. Sherman, D. K., Hartson, K. A., Binning, K. R., Purdie-Vaughns, V., Garcia, J., Taborsky-Barba, S., Cohen, G. L. (2013). Deflecting the trajectory and changing the narrative: How self-affirmation affects academic performance and motivation under identity threat. Journal of Personality and Social Psychology, 104, 591- 618. doi:10.1037/ a0031495
76. Sherman, D. K., Nelson, L. D., & Steele, C. M. (2000). Do messages about health risks threaten the self? Increasing the acceptance of threatening health messages via self-affirmation. Personality and Social Psychology Bulletin, 26, 1046-1058. doi:10.1177/01461672002611003
77. Sherman, D. K., Updegraff, J. A., & Uskul, A. K. (2010). Matching the affirmations to the culture: The effect of culture and approach and avoidance self-affirmation on health persuasion. Unpublished manuscript. Department of Psychology, University of California, Santa Barbara, CA.
78. StataCorp. (2009). Stata statistical software: Release 11. College Station, TX: StataCorp.
79. Steele, C. M. (1988). The psychology of self-affirmation: Sustaining the integrity of the self. Advances in Experimental Social Psychology, 21, 261-302. doi:10.1016/S0065-2601(08)60229-4
80. Steichen, T. J. (1998). Tests for publication bias in meta-analysis. The STATA Technical Bulletin, 41, 9-15.
81. Triandis, H. C. (1980). Values, attitudes, and interpersonal behavior. Nebraska Symposium on Motivation, 27, 195-259.
82. van Koningsbruggen, G. M. (2009). Processing and acceptance of threatening health information: The impact of self-affirmation under different levels of self-threat. Unpublished doctoral dissertation, VU University Amsterdam, The Netherlands.
83. van Koningsbruggen, G. M., & Das, E. (2009). Don't derogate this message! Self-affirmation promotes online type 2 diabetes risk test-taking. Psychology & Health, 24, 635-649. doi:10.1080/08870440802340156
84. van Koningsbruggen, G. M., Das, E., & Roskos-Ewoldsen, D. R. (2009). How self-affirmation reduces defensive processing of threatening health information: Evidence at the implicit level. Health Psychology, 28, 563-568. doi:10.1037/a0015610
85. Van Koningsbruggen, G. M., Harris, P. R., Smits, A. J., Schuez, B., Scholz, U., & Cooke, R. (2013). Self-affirmation before exposure to health communications promotes intentions and health behavior change by increasing anticipated regret. Unpublished manuscript. Department of Communication Science, VU University Amsterdam, The Netherlands.
86. Wakslak, C., & Trope, Y. (2009). The effect of construal-level on subjective probability estimates. Psychological Science, 20, 52-58. doi: 10.1111/j.1467-9280.2008.02250.x
87. Walton, G. M., & Cohen, G. L. (2011). A brief social-belonging intervention improve academic and health outcomes of minority students. Science, 331, 1447-1451. doi:10.1126/science.1198364
88. Webb, T. L., & Sheeran, P. (2006). Does changing behavioral intentions engender behavior change? A meta-analysis of the experimental evidence. Psychological Bulletin, 132, 249-268. doi:10.1037/0033-2909 .132.2.249
89. Weinstein, N. D. (1988). The precaution adoption process. Health Psychology, 7, 355-386. doi:10.1037/0278-6133.7.4.355
90. Whittington, C. J., Podd, J., & Kam, M. K. (2000). Recognition memory impairment in Parkinson's disease: Power and meta-analyses. Neuropsychology, 14, 233-246. doi:10.1037/0894-4105.14.2.233
91. Witte, K. (1992). Putting the fear back into fear appeals: The Extended Parallel Process Model. Communication Monographs, 59, 329-349. doi:10.1080/03637759209376276
92. Zhao, X., & Nan, X. (2010). Influence of self-affirmation on responses to gain- versus loss-framed anti-smoking messages. Human Communication Research, 36, 493-511. doi:10.1111/j.1468-2958.2010.01385.x