Media Effects Research Lab - Research Archive

Modalities in health communications: A study evaluating the effectiveness of breast self-examination

Student Researcher(s)

Akshaya Sreenivasan (Ph.D Candidate); Ruobing Li (Ph.D Candidate); Soo Jung Hong (Ph.D Candidate)

Faculty Supervisor

Dr. S. Shyam Sundar


A four condition between subject experiment (Stimulus: Breast self –examination messages) was conducted to test the impact of modalities on health communication messages. Results indicated that video based modalities were particularly useful in predicting the self –efficacy of the individuals as well as creating better attitudes towards breast self- examination messages. Similarly, memory acted as a mediator between the modality cues, and the self –efficacy of the individual to confidently perform breast self –examinations correctly.


For the current study, we tested the following hypothesis. Additionally, we also tested the mediation effect of the variables memory, vividness, comprehension, and distraction.

H1-Modalities will affect the individual’s self -efficacy towards BSE messages.

H2- Modalities will affect the individual’s attitude towards BSE messages.

H3- Modalities will affect the individual’s memory in recalling BSE messages.

H4- Modality will affect the vividness of BSE messages.

H5-Modalities will affect the way the user comprehend BSE messages.

H6-Modalities will affect the way the individuals are distracted towards BSE messages.


An electronic between subjects experiment using an online questionnaire was administered to collect the data for the study. Since the study required only female participants, they were recruited through an online request form sent to different introductory level courses in various departments at a large co-ed university. The participants were given 6 points or 2 extra credits for their participation in the study. Alternatively, if the participants declined to participate, they were given an article to review for equal number of extra credits. Participation was purely based on individual interest, and the participants had the liberty to quit the survey at any given time. Also, in accordance with the rules of the institutional review board (IRB), participants were recruited only after they agreed to take part of their free will. An informed consent form along with the basic information about the study was provided to the participants to read. The participants could access the survey from any computer that was connected to the Internet. The link for the experiment was hosted on SurveyMonkey, a popular online surveying tool. The survey link was active for a period of 5 days that comprised of 3 weekdays, and 2 weekend days.


H1 which stated that there will be a relationship between modalities and the self- efficacy in performing BSE was supported F (3, 71) = 4.32, p = .007, ηp2 = .15. Post-hoc analyses showed that participants in picture plus text condition (M=5.53), and video condition (M=5.33) had better self-efficacy than participants in picture only condition (M=4.40).

H2 which stated a relationship between modality and attitude towards BSE messages was partially supported F (3, 71) = 1.13, p = .32, ηp2 = .05. Independent t-test was performed to compare the mean difference of attitude in specific two conditions (picture only vs. picture plus text). Results showed a significant difference between these two conditions, t(40) = -2.03, p = .049, d = -0.63.

H3 stating the relationship between modality and memory was partially supported F (3, 69) = 2.15, p = .10, ηp2 = .09, while the relationship between the variables vividness, comprehension, distraction with modality were not supported.

In order to test H3a, H4a, H5a and H6a that stated that memory, vividness, comprehension and distraction will affect the individual’s self-efficacy towards BSE messages, we performed a Simple Linear Regression test. Regression analysis showed a significant relationship between memory, and self-efficacy, b = .23, t (71) = 2.38, p = .02, and between vividness, and self-efficacy, b = .24, t (72) = 2.29, p = .03. Besides, a partially significant relationship was found between distraction, and self-efficacy, b = -.25, t (71) = -1.98, p = .05. However, no significant relationship was found between comprehension and self- efficacy, b = .15, t (73) = 1.31, p = .19. Therefore, H3a and H4a were supported, H5a was not supported and H6a was partially supported.

Mediation analysis using Indirect Macros revealed a significant relationship between modalities and self- efficacy via memory. Bootstrapping results showed that the indirect effect through memory was significant, b = .41, 95% C.I. from .07 to .99, SE = .23, which suggested that video modality strengthened participants? memory of BSE messages, which in turn, led to greater self-efficacy towards the BSE messages compared to text based modalities. While the other three mediators; vividness, comprehension and distraction did not show any significant effect.


The significant effect we found between modality, and self –efficacy can be attributed to the fact that there could have been a high degree of central information processing involved while studying the BSE messages. According to the elaboration likelihood model (ELM), women process most of the information via the central route. In other words, they need more cues, and details in order to be persuaded. Hence, the results that we found are coherent with the ELM assumption. That is picture plus text condition, and video condition presented more information to effectively perform BSE messages compared to picture only condition. The other interesting finding from our study was the effect of memory. When information is presented via multiple mediums the chances are that they are effectively processed and recalled. This is the tenant of the media richness theory. Hence, participants, in the video condition had better memory, or in other words, they were confident to recall messages. Once there was confidence in recalling messages, the participants felt more efficacious to perform breast self-examination correctly. Media richness theory can once again be recalled to explain the effect of video modalities on creating better attitudes towards BSE messages than those in text conditions.

For more details regarding the study contact

Dr. S. Shyam Sundar by e-mail at or by telephone at (814) 865-2173

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