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Message Design and Audience Engagement

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Article in Journal of Cancer Education · November 2016

DOI: 10.1007/s13187-016-1135-x

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J Canc Educ
DOI 10.1007/s13187-016-1135-x
Message Design and Audience Engagement with Tobacco
Prevention Posts on Social Media
Yulia A. Strekalova 1 & Rachel E. Damiani 1
# American Association for Cancer Education 2016
Abstract Understanding the appropriate medium to commu-
nicate health promotion messages is vital for improving per-
sonal and societal health. As increasingly more people utilize
social media for health information, public health practitioners
use these platforms to engage an existing audience in health
promotion messages. In this study, the relational framing
theory was used as a lens for studying how message
framing may influence social media audience engagement.
Specifically, we assessed how posts from Tobacco Free
Florida’s Facebook page were framed as either dominant-
submissive or affiliate-disaffiliate to an implied audience
of either smokers, nonsmokers, active quitters, or a mixed
audience, and the extent to which a direct call for engagement,
in terms of a request to comment, like, or share the post, was
used for audience engagement. A three-way interaction for the
level of engagement through comments was significant,
F(3217) = 7.11, p < .001, ηp2 = .09, and showed that framing,
a call for engagement, and varying implied audience choice
played a role in audience engagement with smoking cessation
posts on social media. Implied audiences of Tobacco Free
Florida’s posts included smokers, those who are trying to quit,
and nonsmokers as health promotion can be targeted at the
individual’s health, social support infrastructure, or the well-
being of the society, and implications for strategic message
design and audience targeting are discussed.
Keywords Social media engagement . Message design .
Message framing . Smoking cessation
* Yulia A. Strekalova
yulias@ufl.edu
1
College of Journalism and Communications, University of Florida,
Weimer 2016, Gainesville, FL 32610, USA
Introduction
The purpose of health education and promotion efforts is to
encourage individuals to make decisions that contribute to
their own and community well-being [1]. For example, an
organization may urge a person to quit smoking for reasons
that benefit the individual, such as to reduce that person’s
likelihood of developing a smoking-related disease, or the
community, such as to decrease the amount of secondhand
smoke in the environment. Understanding the appropriate me-
dium to communicate health promotion messages is vital for
improving personal and societal health. Social networking
sites are potential platforms for health promotion messages,
which are becoming increasingly pervasive [2]. As more
people utilize social media for health information, the
CDC recommends that practitioners use these platforms
to engage an existing audience in health promotion mes-
sages [2, 3]. Within the context of social media, audience
engagement is conceptualized as an interactive process
resulting in a two-way communication between a health
promotion organization and the public [4]. In order for
an organization to accomplish their health promotion
goals, Neiger et al. recommend that organizations frame a
chosen message to a specific intended audience and evaluate
its efficacy at generating high user-engagement levels [4].
Their advice falls within the broader approach of message
tailoring, which seeks to deliver specific content to individuals
that aligns with their personal background and needs [5].
Evaluating how an organization frames messages on social
media can provide insights and facilitate effective interaction
with a chosen audience.
In this study, we used the relational framing theory (RFT) as
a lens for studying how message framing may influence audi-
ence engagement on social media. RFT states that individuals
process messages to make inferences about their relationships

across two independent frames, dominance-submissiveness and
affiliation-disaffiliation [6]. The dominance-submissiveness
frame can be interpreted as Bthe degree to which one person
controls, influences, or has status over the other,^ while the
affiliation-disaffiliation frame Bcaptures the appreciation,
esteem, or solidarity one person has for the other^ [7].
The theory posits that people interpret messages as primarily
dominant-submissive or affiliate-disaffiliate instead of a blend
of the two frames, and that frames serve as mental shortcuts to
facilitate quick interpretations of potentially ambiguous mes-
sages communicated in fast-paced environments [6, 7]. RFT
also specifies that people will gauge the level of communica-
tion engagement, which can act as an intensifier to bolster the
person’s interpretation of either frame [6]. Extended to the
context of communication on social media, user comments
have been shown to indicate audience engagement and
amplify message effects [8].
The researchers in this study assessed how posts from
Tobacco Free Florida’s (TFF) Facebook page were framed
as either dominant-submissive or affiliate-disaffiliate to an im-
plied audience of either smokers, nonsmokers, active quitters,
or a broader mixed audience for messages that could be rele-
vant and applicable to any audience including smokers and
nonsmokers, and the extent to which a direct call for engage-
ment, in terms of a request to comment, like, or share the post,
was used for audience engagement.
RQ1: What are the differences in the use of a call for en-
gagement, message framing, and implied audience as message
strategies for smoking cessation communication on social
media?
While the first research question focused on how TFF
framed messages to their implied audience, we also aimed to
assess the audience’s response. The number of comments per
post was used as an indicator of social media audience en-
gagement, to evaluate the influence of message framing on
audience engagement with Facebook posts.
RQ2: What message strategies are most effective in engaging
specific audiences in smoking cessation communication on
social media?
Method
Data were collected from TFF Facebook page, which predom-
inantly features posts by the TFF staff. Excel Power Query
was used to collect official TFF posts that appeared between
July 2015 and June 2016 (N = 233) and their associated meta-
data (i.e., post date and number of comments per post). Data
collection and analysis protocol have received approval from
an institutional review board.
A codebook was developed to code the posts for message
framing, the presence of a call for engagement, and implied
audience. Coding for message framing was guided by prior
J Canc Educ
research [6, 9]. First, 20 posts from a different time period
were coded, and categories were discussed to ensure the clar-
ity of the coding rules. Then, 50 posts from the data reported
in this study were coded to assess intercoder reliability [10],
which reached high Cohen’s kappa values between .84 and
.92 for the coding categories. Finally, we evenly split and
coded the remaining posts. Dominance-submissiveness
(D-S) frame was operationalized as communication from
the position of power and evidence that uses linguistic
markers associated either with dominance, including
self-confidence, determination, persuasiveness, head-
strong presentation of opinions, and confidence, or with
submissiveness manifested in the use of hedges and indirect,
cautious language [9, 11]. Affiliation-disaffiliation frame
(A-D) was operationalized as including the communication
of similarity or dissimilarity and focusing on commonality
or difference in values and norms beyond smoking cessa-
tion [12]. The presence of a call for engagement was
operationalized as featuring a direct request that audience
members share a post or submit a response to a posted
question. The dependent variable, audience engagement,
was operationalized as the number of audience comments
in response to a particular post. Finally, posts were coded
for the implied audience of nonsmokers, active quitters,
smokers, or a mixed audience. Examples of post represen-
tative of each coding category are presented in Table 1.
Table 1. Examples of representative messages for post frame, audience,
and engagement call coding categories
Coding category Example
Frame
Dominance/ Five years after you quit smoking, your risk of
Submissiveness bladder cancer is cut in half!
While on your quit journey, you may face
tough moments. If you quit, how did you
overcome these challenges?
Affiliation/ Happy Parents’ Day! Share if you are a
Disaffiliation tobacco-free parent.
Protect your loved ones from secondhand smoke. It
does not just hurt the smoker. #SHSExposed.
Audience
Nonsmokers Tobacco-free can mean a longer life with the ones
you love. Happy Father’s Day to all of the
tobacco-free dads.
Active quitters Your body can reverse the damage caused by
smoking. Have you noticed any changes?
Smokers Pack-a-day smokers in Florida can save $20,000 in
10 years by quitting smoking.
General audience Today is the 15th anniversary of the 2001 Surgeon
General’s Report on Women and Smoking.
Engagement call We can help you quit any form of tobacco,
including chew and dip. Ask us how!
J Canc Educ

Results
Three separate chi-squire tests and subsequent review of
the standardized residuals were performed to assess
whether message strategies differed among the TFF
posts (RQ1). The first test examined the relationship
between the implied audience and message frame and
was significant, χ 2 (3, N = 233) = 33.52, p < .001.
A-D frame was used more often to address nonsmokers
and a mixed audience but less often to address active
quitters and smokers. The second test examined the relation-
ship between the implied audience and presence of a call for
engagement and was also significant, χ2 (3, N = 233) = 22.47,
p < .001. Calls for engagement were used more often to
address nonsmokers and a mixed audience but less often
to address smokers. The third test examined the relation-
ship between message frame and presence of a call for engage-
ment and was also significant, χ 2 (1, N = 233) = 14.25,
p < .001. Calls for engagement were more frequent in combi-
nation with A-D frame and less frequent with D-S frame.
An ANOVA tested whether call for engagement and mes-
sage framing would lead to different levels of engagement
among implied message audiences (RQ2, Table 2). The test
showed significant main effects of a call for engagement,
F(1232) = 11.02, p < .001, ηp2 = .05, and implied audience,
F(3230) = 5.03, p < .01, ηp2 = .07, but not message framing,
F(1232) = .17, p = .68, ηp2 = .01. Post hoc analyses revealed
that messages addressed to nonsmokers and messages with
a call for engagement received a significantly greater num-
ber of comments. Two-way interactions of implied audience
with call, F(3230) = 4.05, p < .01, ηp2 = .05, and frame,
F(3230) = 7.33, p < .001, ηp2 = .09, were significant. The
presence of a call resulted in a significantly greater number
of comments when messages were addressed to non-
smokers and active quitters. However, a presence of a call
had no effect on smokers or a mixed audience. Based on
the frame used, messages that used D-S frame generated
significantly more comments when addressed to non-
smokers than to any other audience, and messages that
used A-D frame generated significantly more comments
when addressed to active quitters.
Finally, the ANOVA indicated that a three-way interaction
for the level of engagement through comments was signifi-
cant, F(3217) = 7.11, p < .001, ηp2 = .09. For messages with-
out a call for engagement, no between-subject differences
were observed for A-D frame, but for D-S frame messages
addressed to smokers attracted more comments than messages
addressed to active quitters, SE = 25.91, p < .001, 95% CI
[5.83, 107.95]. For messages that contained a call for engage-
ment, comments to both frames differed based on implied
audience. For D-S frame, messages addressed to nonsmokers
attracted more comments than messages to active quitters,
SE = 105.08, p < .001, 95% CI [281.56, 695.78], smokers,
SE = 93.99, p < .001, 95% CI [311.96, 682.45], and a mixed
audience, SE = 470.67, p < .001, 95% CI [263.56, 677.78].
For A-D frame, messages addressed to active quitters attracted
more comments than messages to nonsmokers, SE = 111.46,
p < .001, 95% CI [149.83, 589.17], smokers, SE = 157.62,
p < .05, 95% CI [1.84, 623.17], and a mixed audience,
SE = 98.93, p < .001, 95% CI [218.33, 608.31].

Table 2. ANOVA results for call, frame, and implied audience effects Discussion
on the number of comments per post

Tested effect n M (SD) F p η2 The goal of this study was to examine the differences in audi-
ence engagement in relation to varying message strategies in
Call for engagement (C) 11.02 .001 .05 the context of the posts on the Tobacco Free Florida Facebook
Absent 201 50.07 (16.30) page. This study showed that differences in message design
Present 32 157.77 (28.05) strategies can explain variability in the level of audience
Frame (F) .17 .68 .01 engagement. The examination of the interaction of a call
Dominance- 167 97.27 (19.23) for engagement, message framing, and implied audience
submissiveness 110.57 (26.13) led to the following insightful findings. First, the data
Affiliation-disaffiliation 66 showed that A-D frame was used more often to address
Implied audience (A) 5.03 .01 .06 nonsmokers and a mixed audience but gained more com-
Nonsmokers 19 169.91 (30.96) ments when addressed to active quitters. Second, a call for
Active quitters 41 148.23 (37.56) engagement was used more often to address nonsmokers
Smokers 118 61.63 (36.07) and a mixed audience. This strategy resulted in more com-
Mixed 55 35.90 (23.25) ments from nonsmokers in combination with D-S frame.
C×F .44 .51 .01 However, in the presence of A-D frame, it had an effect
C×A 4.05 .01 .05 only when addressed to active quitters. Finally, messages
F×A 7.33 .001 .09 to current smokers accounted for more than a half of all
C×F×A 7.11 .001 .09 posts, but only D-S framing without a call for engagement led
to increased commenting for messages to this implied audience.

Engaging with nonsmokers could support the develop-
ment of social capital for those who are attempting to
quit, and findings presented here suggest that strategic mes-
sage framing decisions can lead to more effective engagement
with target audiences.
This study has a number of theoretical and practical impli-
cations, which will be discussed next, but two limitations
should be acknowledged. First, this study presents a focused
evaluation of the posts as part of a tobacco cessation cam-
paign, but audience responses can further attenuate or amplify
the effects, which could be assessed by the examination of the
content of audience comments [8, 13]. Therefore, building on
the results of this study, future research could look at the
sentiment and themes of the audience comments. Second,
the posts were coded to assess implied audience, but
the extent to which these audience groups associate with
the messages that target them is not evident. Subsequent
experimental studies would be necessary to assess the effects
of audience segmentation.
Previous research on the relational frame theory has
focused on the content and linguistic features of messages
[7, 9], but the role of the intended audience has not received
much attention. This study showed that the differences in
audience engagement could not be explained by the main
effect of frame but rather by its interaction with the
intended audience. This finding leads to a proposition that
implied message audience moderates the relationship between
message framing and audience engagement. In addition, prior
research indicates that a person’s characteristics or perceptions
can influence their interpretation of a message within the
dominant-submissive or affiliate-disaffiliate frames [6, 7].
This finding is an important consideration for smoking
cessation, as smoking is a highly stigmatized behavior
[14]. A smoker may already view a message sender as
judging their behavior, which could influence their inter-
pretation of how the post and willingness to engage on
social media with the organization.
Health promotion organizations aim to convey information
to people with the goal of influencing behavior and improving
societal health. For example, TFF uses social media to facili-
tate smoking cessation. One step to this positive health change
can be interactions between organizations and individuals on
pervasive social media sites [4]. TFF engaged with smokers,
nonsmokers, and active quitters through their Facebook page.
The results of this study showed that message framing does
influence audience engagement on social media. The practical
implications of these results can inform the social media en-
gagement practices of health promotion organizations, such as
TFF, by providing additional evidence to support efforts that
focus on understanding their audience, tailoring messages to a
specific group, and evaluating the efficacy of their approach.
These suggested guidelines reinforce Neiger et al.’s recom-
mendations for health promotion practitioners [4].
J Canc Educ
This study also showed that RFT and social media audience
analysis are applicable in the context of public health policy.
Stakeholder engagement and feedback are essential compo-
nents of policy development, and the evaluation of audience
engagement can provide evidence of the topics or stakeholder
groups that are active participants in the policy development
dialog [15]. At the same time, social media analysis could
serve as an indicator that engagement of particular groups
might be insufficient. As this study showed, the number of
comments to messages addressed to smokers is lower than
that addressed to nonsmokers and active quitters, but the stra-
tegic use of framing could help address this inequity. In con-
clusion, message framing, a call for engagement, and varying
implied audience choice played a role in audience engagement
with smoking cessation posts on social media. Strategic com-
munication and tailored message design can facilitate educa-
tional efforts and support stakeholder engagement in public
policy debates.
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J Canc Educ

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