IU Indianapolis ScholarWorks :: Browsing by Author "Cox, Anthony D."

Browsing by Author "Cox, Anthony D."

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Behavior and health beliefs as predictors of HIV testing among women: a prospective study of observed HIV testing
(Taylor & Francis, 2018) Fan, Hao; Fife, Kenneth H.; Cox, Dena; Cox, Anthony D.; Zimet, Gregory D.; Pediatrics, School of Medicine
Much of the research examining predictors of HIV testing has used retrospective self-report to assess HIV testing. Findings. therefore, may be subject to recall bias and to difficulties determining the direction of associations. In this prospective study, we administered surveys to women in community clinics to identify predictors of subsequent observed HIV testing, overcoming these limitations. Eighty-three percent were tested. In the adjusted multivariable model, being born in the U.S., perceived benefits of testing, worries about being infected with HIV, having had more than 15 lifetime sexual partners, and having had one or more casual sexual partners in the previous three months predicted acceptance of testing. Perceived obstacles to testing predicted non-acceptance. Those who had never been tested for HIV and those tested two to five years previously had greater odds of test acceptance than those who had been tested within the last year. The findings from this study with observed testing as the outcome, confirm some of the results from retrospective, self-report studies. Participants made largely rational decisions about testing, reflecting assessments of their risk and their history of HIV testing. Health beliefs are potentially modifiable through behavioral intervention, and such interventions might result in greater acceptance of testing.
Brand and usability in content-intensive websites
(2014-07-11) Yang, Tao; Bolchini, Davide; Pfaff, Mark; MacDorman, Karl F.; Cox, Anthony D.
Our connections to the digital world are invoked by brands, but the intersection of branding and interaction design is still an under-investigated area. Particularly, current websites are designed not only to support essential user tasks, but also to communicate an institution's intended brand values and traits. What we do not yet know, however, is which design factors affect which aspect of a brand. To demystify this issue, three sub-projects were conducted. The first project developed a systematic approach for evaluating the branding effectiveness of content-intensive websites (BREW). BREW gauges users' brand perceptions on four well-known branding constructs: brand as product, brand as organization, user image, and brand as person. It also provides rich guidelines for eBranding researchers in regard to planning and executing a user study and making improvement recommendations based on the study results. The second project offered a standardized perceived usability questionnaire entitled DEEP (design-oriented evaluation of perceived web usability). DEEP captures the perceived website usability on five design-oriented dimensions: content, information architecture, navigation, layout consistency, and visual guidance. While existing questionnaires assess more holistic concepts, such as ease-of-use and learnability, DEEP can more transparently reveal where the problem actually lies. Moreover, DEEP suggests that the two most critical and reliable usability dimensions are interface consistency and visual guidance. Capitalizing on the BREW approach and the findings from DEEP, a controlled experiment (N=261) was conducted by manipulating interface consistency and visual guidance of an anonymized university website to see how these variables may affect the university's image. Unexpectedly, consistency did not significantly predict brand image, while the effect of visual guidance on brand perception showed a remarkable gender difference. When visual guidance was significantly worsened, females became much less satisfied with the university in terms of brand as product (e.g., teaching and research quality) and user image (e.g., students' characteristics). In contrast, males' perceptions of the university's brand image stayed the same in most circumstances. The reason for this gender difference was revealed through a further path analysis and a follow-up interview, which inspired new research directions to unpack even more the nexus between branding and interaction design.
Can Self-Prediction Overcome Barriers to Hepatitis B Vaccination? A Randomized Controlled Trial
(2012-01) Cox, Anthony D.; Cox, Dena S.; Cyrier, Rosalie; Graham-Dotson, Yolanda; Zimet, Gregory D.
Objective: Hepatitis B virus (HBV) infection remains a serious public health problem, due in part to low vaccination rates among high-risk adults, many of whom decline vaccination because of barriers such as perceived inconvenience or discomfort. This study evaluates the efficacy of a self-prediction intervention to increase HBV vaccination rates among high-risk adults. Method: Randomized controlled trial of 1,175 adults recruited from three sexually transmitted disease clinics in the United States over 28 months. Participants completed an audio-computer-assisted self-interview, which presented information about HBV infection and vaccination, and measured relevant beliefs, behaviors, and demographics. Half of participants were assigned randomly to a “self-prediction” intervention, asking them to predict their future acceptance of HBV vaccination. The main outcome measure was subsequent vaccination behavior. Other measures included perceived barriers to HBV vaccination, measured prior to the intervention. Results: There was a significant interaction between the intervention and vaccination barriers, indicating the effect of the intervention differed depending on perceived vaccination barriers. Among high-barriers patients, the intervention significantly increased vaccination acceptance. Among low-barriers patients, the intervention did not influence vaccination acceptance. Conclusions: The self-prediction intervention significantly increased vaccination acceptance among “high-barriers” patients, who typically have very low vaccination rates. This brief intervention could be a useful tool in increasing vaccine uptake among high-barriers patients.
The CDC Revised Recommendations for HIV Testing: Reactions of Women Attending Community Health Clinics
(2008-01) Burrage, Joe W.; Zimet, Gregory D.; Cox, Dena S.; Cox, Anthony D.; Mays, Rose M.; Fife, Rose S.; Fife, Kenneth H.
The purpose of this study was to examine reactions to the Centers for Disease Control and Prevention revised recommendations for HIV testing by women attending community health clinics. A total of 30 women attending three community clinics completed semistructured individual interviews containing three questions about the recommendations. Thematic content analysis of responses was conducted. Results were that all agreed with the recommendation for universal testing. Most viewed opt-out screening as an acceptable approach to HIV testing. Many emphasized the importance of provision of explicit verbal informed consent. The majority strongly opposed the elimination of the requirement for pretest prevention counseling and spontaneously talked about the ongoing importance of posttest counseling. The conclusion was that there was strong support for universal testing of all persons 13 to 64 years old but scant support for the elimination of pretest prevention counseling. In general, respondents believed that verbal informed consent for testing as well as provision of HIV-related information before and after testing were crucial.
Communicating the Consequences of Early Detection:The Role of Evidence and Framing
(2001-07) Cox, Dena S.; Cox, Anthony D.
Despite the enormous benefits of early-detection products, consumers are reluctant to use them. The authors explore this reluctance, testing alternative approaches to communicating the consequences of detection behaviors. The results suggest that anecdotal messages are more involving than statistical messages and that positive anecdotes (about gains from screening) are less persuasive than negative anecdotes (about the losses from failing to get screened); positive anecdotes appear to cause a “boomerang” effect. The authors discuss implications for promoting consumer risk-reduction behaviors.
Consumer Response to Drug Risk Information:The Role of Positive Affect
(2010-07) Cox, Anthony D.; Cox, Dena S.; Mantel, Susan Powell
Risk disclosure is an essential element of the marketing of prescription drugs and other medical products. This study examines how consumers respond to verbal information about the frequency and severity of medical-product risks and how media-induced affect can moderate such responses. The study finds that consumers tend to overestimate the actual likelihood of adverse events described with words such as “common” or “rare” (compared with the probabilities such terms are typically intended to convey) and that consumers tend to give little weight to such probability language when forming product use intentions. However, consumers in positive media-induced moods seem to engage in more nuanced evaluation of product risk information, weighing both frequency and severity information and using such information to make inferences about other product attributes (e.g., product efficacy). These findings suggest that medical marketers and regulators need to devise more effective means of communicating risk probability to consumers and that positive mood induction (e.g., by placing advertisements in upbeat media environments) can enhance consumers' ability to process product risk information.
The Effect of Background Music on Ad Processing: A Contingency Explanation
(1993-10) Kellaris, James J.; Cox, Anthony D.; Cox, Dena S.
Music is an increasingly prominent and expensive feature of broadcast ads, yet its effects on message reception are controversial. The authors propose and test a contingency that may help resolve this controversy. Experimental results suggest that message reception is influenced by the interplay of two musical properties: attention-gaining value and music-message congruency. Increasing audience attention to music enhances message reception when the music evokes message-congruent (versus incongruent) thoughts.
The Effects of Background Music in Advertising: A Reassessment
(1989-06) Kellaris, James J.; Cox, Anthony D.
Gorn's (1982) pioneering article on the effects of background music in advertising has spurred a significant controversy and inspired vigorous interest in the topic. Following the recommendation of Allen and Madden (1985), we conducted three experiments that attempted to replicate Gorn's results. Contrary to Gorn's findings, there was no evidence that product preferences can be conditioned through a single exposure to appealing or unappealing music.
The effects of HIV testing advocacy messages on test acceptance: a randomized clinical trial
(2014-11) Kasting, Monica L.; Cox, Anthony D.; Cox, Dena S.; Fife, Kenneth H.; Katz, Barry P.; Zimet, Gregory D.
Background Nearly 1 in 5 people living with HIV in the United States are unaware they are infected. Therefore, it is important to develop and evaluate health communication messages that clinicians can use to encourage HIV testing. Methods The objective was to evaluate health communication messages designed to increase HIV testing rates among women and evaluate possible moderators of message effect. We used a randomized four-arm clinical trial conducted at urban community outpatient health clinics involving 1,919 female patients, 18 to 64 years old. The four health message intervention groups were: i) information-only control; ii) one-sided message describing the advantages of HIV testing; iii) two-sided message acknowledging a superficial objection to testing (i.e., a 20 minute wait for results) followed by a description of the advantages of testing; and iv) two-sided message acknowledging a serious objection (i.e., fear of testing positive for HIV) followed by a description of the advantages of testing. The main outcome was acceptance of an oral rapid HIV test. Results Participants were randomized to receive the control message (n = 483), one-sided message (n = 480), two-sided message with a superficial objection (n = 481), or two-sided message with a serious objection (n = 475). The overall rate of HIV test acceptance was 83%. The two-sided message groups were not significantly different from the controls. The one-sided message group, however, had a lower rate of testing (80%) than the controls (86%) (OR, 0.66; 95% CI, 0.47–0.93; P = 0.018). “Perceived obstacles to HIV testing” moderated this effect, indicating that the decrease in HIV test acceptance for the one-sided message group was only statistically significant for those who had reported high levels of obstacles to HIV testing (OR, 0.36; 95% CI, 0.19–0.67; P = 0.001). Conclusions None of the messages increased test acceptance. The one-sided message decreased acceptance and this effect was particularly true for women with greater perceived obstacles to testing, the very group one would most want to persuade. This finding suggests that efforts to persuade those who are reluctant to get tested, in some circumstances, may have unanticipated negative effects. Other approaches to messaging around HIV testing should be investigated, particularly with diverse, behaviorally high-risk populations.
The effects of message framing and healthcare provider recommendation on adult hepatitis B vaccination: A randomized controlled trial
(Elsevier, 2019-08-09) Kasting, Monica L.; Head, Katharine J.; Cox, Dena; Cox, Anthony D.; Zimet, Gregory D.; Pediatrics, School of Medicine
Many adults in the U.S. do not receive recommended vaccines, and the research literature remains inconclusive on the best communication strategies for increasing this behavior. This study examined the association of message framing (gained-framed vs. loss-framed vs. control), and healthcare provider (HCP) recommendation (offered vs. recommended) on uptake of adult hepatitis B virus (HBV) vaccination in a high risk population using a 3×2 block design randomized controlled trial. Fear of shots, fear of vaccines, and perceived message framing were examined in secondary analyses. Of the 1,747 participants, 47.7% (n=833) received 0 doses of HBV vaccine, 27.8% (n=485) received 1 dose, 10.4% received 2 doses, and 14.1% received all 3 recommended doses. There was not a significant interaction between message framing and HCP recommendation (p =.59). Mean number of doses received by the gain-framed group (m=.96) was not significantly different from the loss-framed group (m=.97, RR=.99, 95% CI=.88–1.12). However, those receiving any framing message received significantly more doses (m= .96) than those in the control condition (m=.81, RR=1.17, 95%CI=1.06–1.31). Participants who received a HCP recommendation received significantly more vaccine doses (m=.95) than those in the vaccine-offered condition (mean=.82, RR=1.16, 95%CI=1.05–1.28). These results suggest there is no difference in vaccine uptake between gain-frame and loss-frame messages, but both are better than a control message. These results also support advising HCP to provide a strong recommendation for vaccinations beyond merely offering it to patients. This study has implications for vaccine uptake beyond HBV, and can inform future research on effective vaccine communication research.

Browsing by Author "Cox, Anthony D."

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