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Digital media technologies provide users with the ability to interact with content and to receive information based on their preferences and engagement.
We used skin cancer and sun protection as a health topic to explore how modality interactivity, interface tools that afford users greater activity, resulting in greater depth and breadth of mentally representing and experiencing mediated content, and message interactivity, the extent to which the system allows users to exchange messages back and forth on health websites, influenced users’ attitudes, knowledge, behavioral intentions, and experience.
We employed a 2×2 (modality interactivity: high vs low; message interactivity: high vs low) between-subject online experiment for which 4 websites were created. Participants (n=293) were recruited using Amazon Mechanical Turk and randomly assigned into to 1 of 4 conditions. After browsing the website, participants completed an online survey regarding their experience and cognitive perceptions. General linear models and path analysis were used to analyze the data.
Both modality interactivity (
Findings suggested that modality interactivity influenced intention to use sun protection directly as well as via attitudes toward the websites. Message interactivity impacted intention to use sunscreen directly and also through perceived knowledge. Implications for designing health websites and health intervention content are discussed.
The use of technology in communication is ubiquitous in today’s society. As a result, communication has shifted from traditional 1-way communication to 2-way reciprocal approaches [
According to the Pew Internet & American Life Project [
Interactivity, defined as how responsive a system is to a user [
We aimed to examine (1) how different types of interactivity influence health behavioral intentions and whether there is an interaction effect among these 2 types of interactivity on behavioral intentions; (2) how different types of interactivity impact behavioral intentions through different cognition; (3) how different types of interactivity influence individual user experience with health websites.
Skin cancer is the most common cancer in the United States [
According to the Modality, Agency, Interactivity, and Navigability (MAIN) model [
When interactivity is assessed as a functional modality on the medium interface, it is called
Message interactivity has been demonstrated by many researchers through the concept of message exchange [
Previous studies [
Based on previously reviewed literature, prior research mainly focused on the effectiveness of interactivity and compare the effects of different levels of interactivity; little research has been conducted to examine the interaction effects of different types of interactivity and whether there is an interaction effect between different types of interactivity. However, in real-life situations, different types of interactivity usually are presented together on the interface, and individuals interact with multiple technological affordances back and forth, curvilinearly. Furthermore, there has been limited research investigating how different types of interactivity influence user experience factors, such as satisfaction and interest.
Thus, we used skin cancer as the context and proposed the following hypotheses and research questions—
Hypothesis 1: Modality interactivity will be positively associated with attitudes toward a health website and intention to use sun protection.
Hypothesis 2: Message interactivity will be positively associated with knowledge of skin cancer and intention to use sun protection.
Research question 1: Is there an interaction effect on attitudes, knowledge or intention?
Hypothesis 3: Modality interactivity will mediate behavioral intention via its prior effects on attitudes toward health websites.
Hypothesis 4: Message interactivity will mediate behavioral intention via its prior effects on knowledge.
Research question 2: How will modality interactivity and message interactivity impact user satisfaction of and user interest in the experience with health websites?
This study was a 2×2 (modality interactivity: high vs low; message interactivity: high vs low) online experiment to evaluate effects of modality interactivity and message interactivity on user experience, knowledge, attitudes, and behavioral intentions.
Participants were recruited from Amazon Mechanical Turk, an online crowdsourcing marketplace for tasks, which are posted on the platform. The platform can provide a more diverse and valid sample according to previous studies [
An online questionnaire (Qualtrics XM) was used to collect data from the respondents. All the independent variables were between-subject factors. Participants gave consent to participate in this study and were randomly assigned to 1 of 4 experimental conditions. Each participant was provided with a link and asked to explore the websites as much as possible. They were instructed to read all the information on the website and click on as many links and buttons as possible. After browsing the website, each participant completed a questionnaire regarding the website, their perceptions about skin cancer, and sun protection and provided demographic information. At the beginning of the survey, a prompt asking them if they had browsed the website. Such reminders have been found to be one way to increase the viewing of content. The incentive for each participant was US $0.50. The study was approved by Washington State University's institutional review board.
Four websites were built for this research project. All 4 websites had the same webpage layout and health content. They only differed in terms of interactive features. The websites’ title was “Sun and Skin” with sections on the webpage including one about skin cancer and the other one about sunburn and aging (
Message interactivity was manipulated in the Skin Cancer section of the websites. High message interactivity condition had a clicking function, which the participants needed to click on the bars to get further information (
Modality interactivity was manipulated in the Sunburn and Aging section of the websites. The high modality interactivity condition had a slider bar feature, which the participants could slide from left to right to view the process of aging (
Screenshot of the website homepage.
Example of the high message interactivity webpage.
Example of high modality interactivity webpage.
Perceived interactivity was measured by 3 items adapted from Kalyanaraman and Sundar [
Behavioral intention to use sunscreen was measured by 3 items (using a 7-point Likert scale) items adapted from Kahlor [
User satisfaction of the experience was measured 5 items (using a 7-point Likert scale) such as “I am totally satisfied with my interaction with this health website” and “This site was very careful in considering my health information needs” (Cronbach α=.76).
User interest in the experience was measured by 3 items (using a 7- point Likert scale) such as “The interaction with this health website was interesting” and “I am interested in the health information presented on the website” (Cronbach α=.76).
Attitudes toward the health websites were measured by statements asking the respondents on a 7-point scale whether they felt that the website they just viewed was exciting or not exciting, high quality or low quality, fun or not fun, cool or not cool, imaginative or not imaginative, and entertaining or not entertaining (Cronbach α=.87).
Knowledge was measured from 2 aspects, the objective memory recall and the perception of knowledge increase. Perceived knowledge was measured by 4 items (using a 7-point Likert-scale ranging from 1=strongly disagree to 7=strongly agree) asking how knowledgeable the respondents felt after exploring the websites [
General linear model analyses were used to test the effects of the 2 independent variables (modality interactivity and message interactivity) on the dependent variables. To test the mediating relationships, PROCESS macro (version 3.3) was conducted using SPSS (version 25.0; IBM Corp). Age, gender, race (White vs non-White), and education were controlled as covariates in all analyses.
Participants in the high modality condition (mean 4.67, SD 1.55) scored higher on perceived interactivity than participants in the low modality condition (mean 4.22, SD 1.50; t291=2.58,
Of 316 participants who responded to the survey, data from 293 participants were included in the analysis (participants who were missing data on variables under study, n=7; participants who did not pass manipulation checks, n=16). Demographic characteristics of the sample are shown in
Demographics of sample.
Variable | Value | |
Age (years), mean (SD) | 35.97 (12.02) | |
|
|
|
|
Male | 133 (44.6) |
|
Female | 160 (53.7) |
|
|
|
|
Caucasian/White | 217 (74.1) |
|
African American/Black | 28 (9.5) |
|
Hispanic or Latino | 15 (5.1) |
|
Asian/Pacific Islander | 29 (9.9) |
|
Other | 4 (1.4) |
|
|
|
|
≤$20,000 | 35 (11.9) |
|
$20,001-$50,000 | 111 (37.9) |
|
$50,001-$70,000 | 52 (17.7) |
|
$70,001-$100,000 | 61 (20.8) |
|
$100,001-$150,000 | 23 (7.8) |
|
≥$150,000 | 11 (3.8) |
|
|
|
|
High school degree or less | 24 (8.2) |
|
Some college | 87 (29.7) |
|
College degree | 120 (41.0) |
|
Some graduate school | 17 (5.8) |
|
Graduate degree | 45 (15.4) |
The main effect of modality interactivity on attitudes toward health websites was significant (
The main effect of message interactivity on perceived knowledge was significant (
The main effect of message interactivity on intention to use sunscreen was significant (
No interaction effect was found for attitudes toward health website, perceived knowledge, or intention to use sunscreen. However, the interaction effect of modality interactivity and message interactivity on objective memory recall was significant (
According to the results of mediation analyses, there was a significant indirect effect of modality interactivity on intention to use sun protection via its prior effect on attitudes toward health websites (
In addition, there was a significant indirect effect of message interactivity on intention to use sun protection via its prior effect on perceived knowledge (
Mediation model of modality interactivity on intention through attitudes, including effects of control variables (age, sex, race, and education, which are not displayed). *
Mediation model of message interactivity on intention through attitudes, including effects of control variables (age, sex, race, and education, which are not displayed). *
According to the results of two 2-way analysis of covariance, there was no main effect of modality interactivity or message interactivity on user satisfaction; however, the interaction effect of modality interactivity and message interactivity on user satisfaction was significant (
Modality interactivity and message interactivity effect on user satisfaction.
Modality interactivity and message interactivity effect on user interest.
This study aimed to examine both the main effects and interaction effects of 2 types of interactivity presented on health websites regarding skin cancer. This study tries to illustrate the distinct effect of different types of interactivity in an empirical study and extends the literature by investigating skin cancer–related perceptions, interaction effects of different types of interactivity, and how interactivity impact user experience with health websites. This study has both theoretical and empirical implications.
Different types of interactivity influenced behavioral intention to use sunscreen differently through different mediators. Message interactivity had a direct negative effect on the intention to use sunscreen. The reason could be that message interactivity takes more cognitive effort or the process of information acceptance was not favorable [
Attitudes and perceived knowledge were found to mediate the effects of different interactivity on intention to use sunscreen. Individuals who experienced a high level of modality features on the health websites tended to have more favorable attitudes toward the health websites, which includes their evaluation of website design, interaction with the features, and user experience of the whole website.
One contribution of this study is that both perceived knowledge and actual knowledge gain were tested to see if there was a difference between how these 2 types of knowledge were impacted by interactivity and how they influenced behavioral intention. Message interactivity had a positive effect on perceived knowledge. Participants in the high message interactivity condition felt more knowledgeable than participants in the low message interactivity condition. But there was no main effect of interactivity on actual knowledge gain (memory recall). Although participants perceived that their knowledge about skin cancer increased, their actual knowledge gain was not significantly affected by interactivity.
Skin cancer is the most preventable cancer compared to other forms of cancer and prevention of skin cancer has tremendous potential to save lives [
These results also provide a direction for other health topics. Attitudes toward the website influenced behavioral intentions to perform actions related to the health topic, which should draw attention from health practitioners to website design. If the primary goal is to achieve health behavior change, health practitioners should focus on how to increase favorable attitudes toward health websites when designing health websites.
Previous digital health interventions have not focused on user experience with the media system or the program; however, the user experience may directly impact users’ absorption of the information and future behaviors [
In computer-mediated communication or human-computer interaction fields of study, scholars tend to use their own definitions or dimensions of interactivity in their studies [
This study also has empirical implications in designing health interventions or health campaigns. Previous studies have used interactivity as a general concept and have not differentiated among various technological functions, such as hyperlinks and 3D rotation function (eg, hyperlinks [
Like many studies, this study has some limitations. First of all, Mechanical Turk data were used in this study. Mechanical Turk data provide more socioeconomically and demographically diverse samples than those obtained from college and traditional internet sampling [
Participants who had been diagnosed with skin cancer or had relatives who had skin cancer might be more engaged or be impacted more by skin cancer interventions. Future studies should distinguish the effects of different experiences with skin cancer. Additionally, the outcome variables in this study were attitudes and behavioral intentions instead of actual behaviors. People may overreport their behavioral intentions to perform healthy activities for social desirability. Therefore, future studies should aim at measuring actual behavior change such as sun protection behaviors to investigate the behaviors in real-world situations. A longitudinal study is needed to evaluate how interactive features work in changing people’s health behaviors, which might be the ultimate goal of health campaigns and interventions.
This study, which used a 2×2 experimental design to assess 2 different types of interactivity, has contributions related to designing effective health websites for health interventions. Different types of interactivity along with attitudes, knowledge, and behavioral intention were examined to map the mediating relationships between independent and dependent variables. Both modality interactivity and message interactivity had direct positive effects on behavioral intention to use sunscreen. Modality interactivity also had an indirect positive effect on behavioral intention through attitudes toward the website. Message interactivity had an indirect effect on behavioral intention to use sunscreen via perceived knowledge. To design a health intervention or campaign in the digital age, health researchers and practitioners could employ interactive features in their designs accordingly. This study has important insights for health practitioners who have different aims when designing health websites for eHealth and mHealth interventions.
Modality, Agency, Interactivity, and Navigability
mobile health
None declared.