The Impact of Exposure to Illness on Compliance with Persuasive Communications about Advance Healthcare Directive Creation

Karla Vermeulen, Fordham University


Advance healthcare directives (ADs) allow individuals to express their desires about the type and extent of medical treatment they would like to receive in a situation in which they are unable to communicate their wishes. Clarifying those desires in an AD can provide the creator with a sense of control over his or her medical fate, and it can relieve family members of the distress caused by having to guess what a patient would choose. Despite their potential protective power, and the fact that the materials can be easily acquired and do not generally require a lawyer, only 20 percent of Americans have completed the documents. There is little literature on the topic of ADs among non-ill, non-elderly adults, so in order to explore why rates are so low and to test whether persuasive messaging can inspire completion, the current mixed-methods study began with in-depth interviews with eight adults in their 20s through 50s to examine understanding and beliefs about ADs. Qualitative analysis of the interviews using an empirical phenomenological approach identified themes including a lack of familiarity with ADs, inflated perceptions of the difficulty of creating them, lack of perceived relevance or priority, and superstitious beliefs that creating an AD will bring on calamity. A divide was identified between participants motivated by fear of losing control over their own treatment and those more motivated by a desire to protect loved ones from distress. Qualitative findings were then used to refine persuasive messages with threat and efficacy components systematically varied, in keeping with the Extended Parallel Process Model of fear appeals. Messages were presented to 429 participants in an on-line survey. The impact of interactions between past exposure to illness in others and message strength on two outcome measures, download of an AD form and ratings on the Risk Behavior Diagnosis form, were examined. None of the hypotheses regarding the proposed interaction were supported, with actual download rates of the AD form far higher than predicted for most message combinations. Issues concerning sampling and instrumentation are addressed, alternative theoretical models are considered, and directions for future research are suggested.

Subject Area

Psychology|Public policy|Health education

Recommended Citation

Vermeulen, Karla, "The Impact of Exposure to Illness on Compliance with Persuasive Communications about Advance Healthcare Directive Creation" (2010). ETD Collection for Fordham University. AAI3431915.