Investigating the effects of threatening language, message framing, and reactance in opt-out organ donation campaigns

Abstract

Background: Under opt-out organ donation policies, individuals are automatically considered to have agreed to donate their organs in the absence of a recorded opt-out decision. Growing evidence suggests that the language used within organ donation campaigns influences donor intentions and decision-making. Purpose: As awareness campaigns to promote opt-out consent in the United Kingdom are ongoing, the objectives of this study were to investigate the effect of language and message framing used in opt-out organ donation campaigns on donor intentions and psychological reactance. Methods: Individuals from Scotland and England (n =1350) completed this online experiment. Participants were randomised to view one of four messages, designed in the format of a newspaper article, which described the upcoming opt-out system. This followed a 2 x 2 design whereby the degree of threatening language (high threat vs. low threat) and message framing (loss vs. gain) of the newspaper article was experimentally manipulated. Measures of intention (pre and post-exposure), and post-message reactance (threat to freedom, anger and counter-arguing) were obtained. Results: A mixed ANOVA revealed a significant group x time interaction on donor intentions; post-hoc analysis revealed intentions significantly decreased for individuals exposed to the high threat x loss frame article, but significantly increased for those exposed to the high threat x gain frame article. 2 Conclusions: In campaigns to promote opt-out legislation, high threat language combined with loss frame messages should be avoided. If high threat language is used, gain frame messaging that highlights the benefits of organ donation should also be incorporated.