The Impact of Message Framing and Source Credibility on Breastfeeding Intention:

--;;

,"

Jfada International Journal of Business , .,-

li. \0.

2 (May-August 2014): 93-109

iriiiiiii?6Nlr .l#LIRNAL'I

st",g$xNKsg

The Impact of Message Framing and Source Credibility on Breastfeeding Intention:

A Social Marketing Approach#

Ananda Sabil Hussein,^r Valeile Mannab and David Cohenh

" Faculty of Economics & Business, Universias Brawljaya, Malang Indonesia

b Faculty of Commerce Lincoln Univeniq'Canterbury, New Zealand

q-ritract: Though highly recommended by health organizaaons woddwide, breastfeeding an infant from : ,--:. rcr a period of several months is not universal. There is thus a need to investigate appropriate and

,':;::r-e

means to promote this breastfeeding behavior. This study, rooted in a scicial marketing perspec-

r

:. :.sts the impact of message ftaming and source credibility on the behavioral intention to breastfeed.

- -

^{:; 2} factorial experiment was conducted in Indonesia, an especially relevant setting given that the

:::,-ntage

of

Indonesian women who breastfeed is low compared to other countries. Two hundred and :' ::n- nine pregnant women participated in this study. The findings

of

this study indicate that the inter-

,:--,r

between message framing and source credibility has a significant effect on a person's attitude and

-

_{=:jon to provide} exclusive breastfeeding. In addition, this study finds that attitude is an essential deter-

--.-::rr ^{of intention.}

-1'bstrak: Meskipun sangat dianjurkan oleh organisasi-organisasi kesehatan secara global, meny.rsui bayi

:,.:1ahir untuk iangkawaktu ^{beberapa bulan} tidak uniuersal. Oleh karena itu,adanya kebutuhan untuk

- .:'

:lidiki cara yan1 tepat dan efektif dalam rangka mempromosikan perilaku ^menyusui. Penelitian ini,

-':

^{rerdasar pada perspeknf social marketing} dimana penelitian ini menguji dampakframingpesan dan ::

:

_{:i-iitas sumber pada} niat berperilaku untuk menl'usui. Sebuah percobaan dengan menggunakan desain

j,..: ial

2x2dllaksanakandilndonesia.Duaratustujuhpr,rluhsembilanperempuanhamilberpartisipasi

-.

=:: penelitian ini. Temuan dari penelitian ini menuniukkan bahvz interaksi antaraframing pesan dan

:.

i':Itas

_{sumber memiliki pengaruh} signifikan terhadap sikap dan niat untuk memberikan ASI eksklusif.

r

:

- :- :iu, peneJitian ini menemukan bahwa sikap merupakan.

^Ke-ru'ords: attitude; framing; behavioral intention; breastfeeding; credibility

# This is a part of Hussein's doctoral dissertation at Lincoln Universiq., New Zealand.

'

Corresponding author's e-mail: sabil@ub.ac.id

.:S\:

1141-1128

-

::::

/u-rvw.g2maijb.mmugm.ac.id/

93

Introduction

The way ^{a message} is framed can have a significant effect on the result of

its

com-

munication (Rothpan

and Salovey 1997).

Message framing ^has been widely used in de- signing

promotional

messages, especially those seeking to influence individual behar'- ior. I(ahneman andTversk/s (1979) Prospect Theory

is

one basis by which the impact

of

message framing on behar,'ior can be better understood. This theory explains that when presented in different ways, information can encourage an alteratton

of

people's perspec-

tives,

preferences and actions.

This is

re- flected

in

practice, where message framing strategies have been used in manyhealth pro- motional messages involving both prevention and detection behaviors. To intluence people

to

adopt prevention behavior

-a

^behavior

designed to avoid the ^onse t

of

a health prob-

Iem-

a positively-framed message is thought to be more effective ^than a negatively-framed message (R.othman and Salovey 1997). How- ever,

to

influence

individuals to

engage in detection behavior, a negatively-framed me s- sage is

likely to

be better than a positively- framed message.

Although this

suggestion reflects the Prospect Theory's core proposi-

tion,

empirical findings have been inconsis- tent

in

regards to these effects (Arora 2000;

O'I(eefe

and Jensen 2007; Rothman

et

al.

1993). The inconsistent findings suggest that there is value in testing the relationship in a

different setting with different

behaviors from those that have previously been exam- ined.

In addition, our incomplete knowledge on the impact ofmessage framing on behav-

ior

suggests that

further

study

is

needed to examine the credibility of the message source as an additional variable which could moder-

ate the impact of

message framing

on

an

HwseinetaJ.

individual's behavior.

To

date, the moderat- ing effect of source credibility has been found in stud.ies on the promotion of goods or ser-

vices (Arora

et

aL.2006; Jones

et

al. 2004;

I{umkale et al. _{201,0 ;} Zhangand Buda 1,9 99).

Though examples

of

studies focused on the role

of

source credibility

in

social marketing programs can be

found,

they arc relativell' rare.

For

example,

I(im

and

I(im's

(2014) study observed the effect

of

message fram- ing and source credibility on individual's at- titude s and intentions about green messages provided by ^a hotel. \Xtrile source credibiliq' has been

found to

moderate

the effect of

framing on behavioral intention and its ante- cedents,

no

studv has been found which ad- dresses the

potential

interaction

effect

be- tween ^message framing and source credibil-

ity with

a

paricular

focus

on

breastfeeding behaviot

Breastfeeding has been

widely

recog- nized as

the

perfect source

of nutrition for

babies

for the first

six months

of their

life.

The term "exclusive breastfeeding" refers to

the

situation

in

which a baby is given only breast-milk

with

no supplementary food (a1-

though medicines and vitamins,

if

needed, conform

to

the

definition).

While

it is

esti-

mated that an

^verage

of 32 percent of

women around

the wodd who

exclusir.el), breastfeed

will do

so

for up to

six months, the proportion

of

Indonesian mothers $/ho exciusive

ly

breastfeed

is

substantially less than that figure.

It

fluctuates from below 20

percent to less than 10 percent

since

1991 (Statistics Indonesia and Macro Interna- tional 2008). These very modest figures sug- gest that devising a strategy

to

increase the proportion ofwomen u'ho provide six months exclusive breastfeeding could make a valu-

abie contribution to

Indonesian's

public

health.

In

addition, a better understanding

of

the impact of health message framing in gen-

Gadiah Mada InternationalJournl of B,tsness ^- May,4tg.rt, t/01. 1 6, N0. 2, 201 4

erai could contribute to public health efforts

)oth

there and elsewhere.

These gaps

in our

knowledge provide 'ustification for ^research that replicates and estends prior studies in orderto guna deeper :aderstanding

of

how to best stfucture per- .uasive communications used for social mar- sering promotions

tn

alternative settings.

Based on the recognizedresearch issues, --::rs study aims

to

detetmine

the effect of

:nessage framing and source ctedibility on the :.:titude and intention to provide six months

-sclusive

breastfeeding.

In addition,

this

':-idv

^also looks in detail at the relationship :-r\\:een attitude and intention. The results

,

i

rhis study are expected

to

contribute to

:'rth

academic andpractical perspectives. For

--:-e academic perspectivg, this study

will

pro- -.-rde an understanding about

the effect of

::ressage framingand source credibility on the

.::itude

and intention of people

in

the con-

:=rt of

breastfeeding behavior. For the prac-

:cal

perspective, this study

will

be the guide-

-res ^for

social marketers and health practi- :':ners to create a breastfeedingpromotional

:.npaign.

Research Model and Hwotheses

Social marketing has been recognized

,.

an important approach to formulate strat- -::'e _s to change health behaviot (Secket et al.

- ,'95). In terms

of

promoting new behavior, :::-rrketing communication

is an

important : -,mponent

of

social marketing (Alden et al.

-.,11). In

the general context

of

social mar-

ce ung promotion strategy, social communi-

:.dons

plzy an important role

in

describing

--:-- actions which the target audience should ::r. and in telling them the benefits

of

adopt-

ing the desired behavior (I(eller

and Thackeray 201,1).

Alden

et

al. Q01.1) suggest

that

social marketing

is different ftom

ordinary health education. Parkinson et.al. Q011) ^argue that current breastfeedingpromotiors ^do not have any effect in motivating women to breas tfeed.

In particular, they explain that people akezdy have knowledge about breastfeeding and its consequences. Hence, ordinary health edu- cation is

not

enough

to

influence individu- als, to cafryr out this particular behavior.

In

order to promote new health behav-

ior, social marketers rely on promotion (I(otler

and Lee 2008). Specifically, promo-

tion

includes both the design and the deliv- ery

of

persuasive communication in terms

of

inspiring the target market to take ^a particu- lar action. Stubblefield (1,997) identifies two factors that seem to be particulady related to persuasive messages, namely

the

character- istics of the source and the characteristics

of

the message. Source factors telate to the per- son

of orgxlzatton

responsible

fot

the mes- sage andits distribution; meanwhile, message factors relate to the characteristics of the in- formation itself.

Sevetal studies have shown that framed messages have a significant effect on behav-

ior

change (Abhyankar

et

aL.2008; Banks et

al.

1.995; Rivers

c,

^,1. 2005).

With

specific tegard to

influencjn

lrealth behavior, paying attentionto howa nlessage is framed has been shown

to

be effective

for

altering attitudes and subsequent behavior (Levin et al. 1998;

Rothman and Salovey 1,997; Rothman et al.

2006).In

recognition

of

this, the manipula-

tion

ofmessage framing has been widely

uti-

lized

in

sociai marketing efforts.

The effect of

^message

framing

on peoples attitudes and intentions can be ex-

95

plained by the Prospect Theory (Iversky and I{ahneman 1981).

The

Prospect Theory ar- gues that people ^set an expected outcome as a reference point. Any outcome beyond this reference

pointis

considered a gain; and any- thing less is viewed as a loss. The certainty

of

reahzingan outcome increases the ^degree to which people

will

seek to avoid ^a loss and increases how attractiye

^

g

rn is petceived to be (I{ahneman and Tversky 1'979). There- fore, a persuasive rnessage being framed ei- ther in terms

of

gains or losses should be rel- evant

to the

preferences for

a

nnge

of

be- haviors.

With

the present focus, where ^{a spe-}

cific

behavior -breastfeeding-

is the

focus, the following hlpotheses can ^be generated:

H,:

^Message

_franing

^has

^an

^impact

⁰ⁿ

^an

in diuid aa I's attita de toward bgea sfee ding.

Hr:

Message

framing

^has

^an

^impact

⁰ⁿ

^an

indiuidual's intention to engage in breasfeeding.

Researchers have also shown

that

the

influential effect of a

message

on

an individual's attitudes and intentions is mod- erated by the credibility ^of the message source (A.rora and

Arora

2004; Jones

et

aI. 2003;

Jones et zI. 2004).The current study ^uses the Elaboration Likelihood

Model

(ELX,[) pro- posed by Petty and Cacioppo (1986) ^as aba- sis

for

examining

the

moderating

effect of

source

credibility on, first, the

relationship between message framing and attitude, and second, between ^message framing and inten- tion. The ELMexplains that, ^under low elabo- ratio n conditi ons, receivi ^ng information from

a credible source

would

^be

likely

to provide

a cognitively easier route to accept the

infor-

mation given in ^{a me ssage.} In other words,

if

someone

tfusts

the source and easily under- stands

the

facts

of the

issue, there

is little

need to mofe thoroughly elabotate ofl, or ^de- bate,

the

contentions made

in a

message.

Given that

bteastfeeding

is a natural

be-

Husseinet al.

havior with widely recognized benefits,

it

is classified in this study as low elaboration be- havior.

In terms of the interaction

between message framing and source credibiliry Olson andZanna (1993) ^suggested that the combi- nation of a positively-framed ^message

with

^a highly credible ^source

will

be the most effec-

tive

combination in promoting

low

elabora- tionbehavior Thereforg the credibility of the message soufce should moderate the persua- siveness

of the

message

on afl

individual's attitude and

intention to

provide exclusive breastfeeding. Thus we propose that:

Hr:

There is a signtficant interaction

ffict

^between

message Jraning ^{and sowrce} credibili\ on the attitade to prouide exclusiue breastfeeding.

Given that breastfeeding ^is likely to be

alow

elaborationbehavior, as argued above, we expect that a positively-framed ^message with a high credibilitysource

will

be the most effective combination

for

affecting people's attitude.

Hr:

There is a signrficant interaction

ffict

^betueen

ruessage franing ^{and source} credibiliry on the intention to prouide exclusiue breasfeeding.

Recognizing the Jinkage between atti- tudes and intentions, we expect that a posi- tively-framed message

with

^a high credibility source

will

be the most effective combina-

tion

for affecting people's intentions.

Several theories argue

that

attitudes exhibit strong influence on, and thus can be used to predict, intention. These perspectives

include the Theory of

Planned

Behavior

GPB) ^{(Ajzen 1,991,), the Theory of Reasoned} Action

GRA)

^{(Ajzen and} Fishbein 1980) and theTriandis Model (friandis 1977). Ajzenand

Fishbein (1980)

enhance

the potential of

these theories by linking

intention with

^be- havior

which is, ultimatell',

^{a key} outcome

Sflla&

Intemationallournt of hrsines -Mayfugat, W I 6 ^I{0, 2, 201 4

&ure

^1.

^The

^Reseatch

^Model

marketing efforts.

In

the realm

of

ing behaviot,

t\e

hypothesized re-

b

between attitudes and intention has

onfirmed through empitical work

et al. 1998; \ilfambach 1997). Thus that:

/Wdc

^{bas an}

_ffict

^{on a} tuznan's intention

lrcl*riue!

^breasfeed.

These

five

hypotheses are graphically

as Figure 1.

Ate

sample

of this

study

is

pregnant The selection

of

the group

of

preg- was based on the argument stat- the decision to start breastfeeding is

rpde

duringpregnancy (I(ramer et aI.

llertens

and

Young

1,997). Further-

tions such as peer suppoft andhealth educa- tion duringpregnancy

will

^increase the

likeli-

hood

of

providing breastfeeding (Dyson et

21.2005; Ryan 1997).

The study relied on a

convenience sample drawn

from

a

variety of

locations.

Participants wefe rectuited viz a face-to-face request made

in

several maternity hospitals, obstetrici an clinics, and brea stfe eding work- shops located in Malang, EastJava Province, Indonesia. Three hundred and twenty ques- tionnaires were

distributed. Of

these, 279 were completed, yielding a response rate

of

87 percent.

The following demographic profile

emerged

ftsn

the sample: 68.1 percent of the respondents areagedbetween ^21. to30 years, 60.1 percent have completed

a tefrary

de- gree, 54.8 percent are working mothers, and 54 percent have more than one child. Table

1

presents

the

respondent's demographics information

irrstudies have shown that intetven-

Husseinet aJ,.

Table 1.

Demogtaphic of

Sample

Population

Variable Category

^o

Ag.

Education

Job

Number

of

Children (including in utero)

Younger than20 21

-30

31, - 40

41 -50

High school graduate or ^less Diploma

Bachelor's Mastef's Working

Not

Working

Over 5

1,

2 3 4

2.9

68.1,

27.6

1.1,

36.9 16.8

40.1,

3.2 54.8 43 46 39.1, 12.5 0.7 1.5

Ques tionn

afue

Develop men t

Measures

of attitudes

and behavioral intentions were generated from the basic con- tentions

of

the Theory of Planned Behavior (Ajzen1,991,; Duckett et al. 1998). The atti- tude toward exclusive breastfe eding wa s mea- sured

by

six items using seven-point seman- tic differential ^scales. The scales utilized end points of weak

-

strong, unpersuasive

-

^per-

suasive, unimportant

-

important, unbeliev- able

-

believable, uninformative

-

^informa-

tive,

not

convincing

-

convincing, and bad afgument

-

good argument. Three seven-point

Likert

scales were employed to measufe the intention to exclusively breastfeed.

Design and Procedures

h 2 x 2

factonal design was used to measure

the

influence

of

message framing and source

credibility on

a woman's inten- tion

to

breastfeed. Since the design consists

of four

factors, each discrete possible value and all expedmental units take onall possible combinations of these levels across

all

such factors; the factorial design ptepared

in

this study

is

considered as a

full

factortal experi- ment.

Four

different

adverti sing pamphlets were designed to provide the unique combi- nations

of

positive and negative

fnming

as

well

as

low

and high source credibility. Ma-

I

h Mada IntemationalJoutrnl of Brniner;s - Itfuy'4ryut, Vul I 6 Na ^2, 2U 4

nipulation of the positively-framed message uas done by presenting arguments that out-

fned

the gains/benefits

to

be derived from breastfeeding.

In contrast, the

negatively Trble 2. Messhge

Ftaming Manipulation

ftamed m€ssage identified the benefits lost by not engagingin the behavior Table 2 sum- marizes the framing manipulation ^used in this study.

Itoeitively

Ftamed

Me ss age

Negatively Framed

Message

-rhat supplying exclusive breastfeeding

5r &e first six months -with

^continued

hasfeeding

fo.tthe first year, ptovides sev-

cr{

^benefits for both baby and mother.

hbaby:

- fttrntially

save 1.3

million

lives

- Gmtaining

^{all the vitamins} and minerals

roded

by a young baby,

- ^Lc'easing

^{the level}

^of

^antibodies

- rihcing

_{the chance}

_of

_infection

- Hd

^a health digestion system

m&er:

*tcing

pregnancies

Lecingthe

^chance to get

ovananen- GT

Dccreasing

the

risk

of breast cancer

lDrrrcrnigally _cheaper

than botde feed-

I

Lrtry will

have

more chance of being

and suongand the mother

will

have chance of avoiding many health prob-

exclusive breas tfee ding

ptovides hcalth benefits

compared

with

pro- botrle-feeding or other solid and

liq-

...reported that not providing exclusive breastfeeding for

the

first

six months

with continued

breastfeeding

for the first

year could potentially ^te sult

in

serzet al dis advan- tages for both baby and mother.

For baby:

-

Potentially

lead to

7.3 million

deaths

ev- ery

ye f

-

Less chance to receive complete nutrition, vitamins and minerals

-

Less

eftctive

antibodies

- Incteasing the chance

of getting infec-

tion

-

Weakening the digestive system For mother:

-

Less

chance

to space pregnancies

- Having

more

potential

to get ovaiancan- cer

- Mote likely

to get breast cancer

- Economically more expensive

than breastfeeding

... ababy will

have

less chance of being hedthy

and strongand the mother

will

have less

ability

to avoid many health problems.

Providing botde-feeding

or

other solid and

liquid

food potentially

will not provide

as

many benefits

as

six months

exclusive breastfeeding

Husseinet aL

Table 3. Soutce

Credibitty Manipulation High Credibility

Source

B]':

Dr

Ana Sofi,vanti, M.I{es., Ph.D., SPA (I{ons)

Low Credibility

Soutce By: Ana Sofiyanti

Undergaduate Student Faculty

of

EconomicsJaya Manggala Universiry Jakafta

Regarding the ^message credibility r.'an- able,

the

high

credibility

^message was pre- sented by

a

(fictitious) breastfeeding exPert and also included a logo designed

to

repre- sent a breastfe edingbased organization, v'hile the 1ow credibility message was signed by a

university student and

did not

appear

with

any organi:zati on's logo.

The tesearch stimulus was in the form

of

a booklet,

which

contained instructions and

information

relating

to

the study, ^mes- sage stimuli . ^{and a} questionnaire.

To

begin the experiment, an informa-

tion

sheet was distributed when

the

poten-

tial

participants ardved

at the

registtation desk. After reading the information sheet and agreeing to participate, the participants were given brief instructions, asking them to read the article and compiete the attached ques- tionnaire. The participants were given ^one

of

the four randornly selected stimulus ^messages.

Reading the article and completing the ques-

tionnaire took participants from

15

to

²⁰

minutes.

During the

experimental session, participantswere allowed to stop at any time.

In addition, participants were allowed to ask

the

experimenter

for

assistance

if

they had anv difficulties in reading and understanding either the ^message stimulus or the question-

naire.

Data Analysis

Parttal Least Square regression ^(PLS) was ^{use d}

to

^analyze the data and test the hy- potheses.

Specificaily, Smart PLS with

^a

bootstrapping

re-sampling procedure lvas employe d. PLS was used since this technique can handle both formative and reflective in- dicators.

In

this studl', ftaming and credibil-

ity

are the formative indicators,

whiie

atti- tude and intention are the reflective indica- tors. Furthermore, the ability

of

PLS

to

ana

lyze

data

which

have non-notmal distribu- tions is anothet advantage. Finally, PLS ^has the abilit1,

to

contfol measufement ertor and can enhance

testing of

nomological webs among

muitiple

dependent variables. ^PLS thus is able to contribute to an improved ex- perimental tesearch analysis in social sciences (Streukens et al. 2010).

Forthis study, to model the experimen-

tal

data

with the

framework

of

a structurai equation, single indicators

for

the manipu- iated factors, namely, message framing and source credibilitv as

well

as the interaction effect are specified. These manipulations uti- hze effect coding, such as a positively-framed message

is

coded as

1,

and

a

negativeh-- framed message as 0, and a highly credible source is coded as 1, and a lovr credible source

Gadiah Mada Internationauournal of Btrsiness -MayArqut,I'al. / 6,li,,. 2, 20/ 4

:s 0. Since the manipulations do not have the :, pical propertie s of a reflective scale and

it :s

assumed

that the

manipulation

itself

^is

:re asured without error, this study depicts the

:rl :rnipul a tr ons a s formative indi ca tors. \X'hile

---re manipulations afe fepresented as forma- -r'e indicators, the dependent variables

-

^at-

:r.ide

and intention afe fepresented as reflec- :r-e indicators.

Manipulation Checks

Two tests examined whether the stimuli

:id

^any impact onperceptions. The first mea- . -red the manipulation

of

credibilit,v.

Parici- :::rts

wefe asked to fate the two versions

of

--:r- message on six seven-point semantic

dif- :::ential

scales,

with the

end

points

being

-: ustrvorthl'

*not

trustrirorthy, open minded

-:r,lr

open minded, good

-bad,

^expeft

-not :!)ert,

experienced

-not

expefienced, and -:.tred

-not

trained. The mean difference be-

I::le

4.

Construct Loadings

tween the high

credibility

source

(HC)

and low credibilitl,

sent..

(LC), where meanHc=

6.29 and

meanlcr

4.13, was significant (p<

.001), indicating that the intended difference in the message soufce's credrbility level was perceived by the respondents.

A

seven-point semantic differential was also use d to measure the framingstimuli. This

use d end-points of positive

-negative

^{to rate}

perceptions on how the message was framed.

The

comparison

of

the mean scofes

of

the positively-framed message (meanor.= 6. 78) and negatively-framed message (mean^,.=

3.78), yielded

a

significant difference (p<

.001). This demonstrared that the rwo frames were perceived as different bv the sample.

Results

Before testing the hl,potheses,

it

begins

with

teliability, convergent

validity

and dis-

criminant validity

checks. Table 4 provides

Code Factof Loading

-{.rritude

--- rple a sant f Ple asant

I rbarrassing/Not

embarrassing '-:,healthy

/Healthy

1-lu1sive/Appealing -: ^{--on r-e nie n t} /Con ^{venie n t}

-

rr-atural/Natural lntention

-

:rpect...

- ;--rnt. ..

- -:lrend...

. ..to provide my baby

with

six months of exclusive breastfeeding

Atd_1 Atd-2 Atd_3

Atd*4

Atd_5 Atd_6

Lrt_1 Int_2

Int

3

0.751 0.81 7 0.80 ¹ 0.762 0.799 0.75 B

0.751 0.78 9

0.729

101

the PLS parameter estimates for the measure- ment model. The factorloadings for all ^scales are ^cceptable, indicating robust measures.

Table

5

explains

the

measures

for

ex- amininginternal consistency of ^a given block

of

indicators based

on

composite reliability (Hair et aL.2010) and Average Variance

Ex-

tracted

(AVE)

(Fornell and

Larcker

1981).

The composite

reliability for

the constructs tested exceed the

cut-off

value of 0.70 pro- posed by Nunnally.(l978). The

AVE

for the constructs also exceeds the

cut-off

value

of

0. 50 suggested by Fcrnell and Larcker (1 981 ).

Following Chin's ⁽¹ 998) guidelines, two methods were used

to

check discriminant validity. The first was to compare the factor loadings and cross loadings. To avoid having a discriminant

validity

problem,

the

factor loading coefficients should

be

higher than their respective cross loadings. Table 5 indi-

cates that the value

of

factorloadings foreach construct is higher than the value

of its

re- spective cross loading.

The

second method was

to

compare the value

of

square

root of

AVE

with

the inter-correlation between con-

structs. Table 5

shows

that the value of

square root

of

AVE is higher than the inter-

corelation

among the constructs. Based on these outer model evaluations,

it

can be said that the measures used

in this

study are ro- bust.

Husseinet al.

With

the outer model assessment

indi-

cating robust measufes, we then tested the hypotheses. Findings indicate

that

message framing does not have a significant main ef- fect on eitherattitude

(t=

1.534, p>0.05),

ot

intention

(t=

1.424,

p>

0.05). This leads to the rejection

of

both Hypotheses

1

and 2.

In

terms

of

moderating effects,

it

was found that the source ctedibility significandy moderates the effect

of

message framing on

attitude (t=

12.602,

p<

0.01).

This

result supports Hypothesis 3. Since there is a sig-

nificant interaction effect between message

framing and source

credibility on

attitude, Analysis

of

Variance (ANOVA) was used to investigate

the

nature

of this

interaction.

Analysis indicates that

the

Estimated Mar-

ginal

Mean (EMXO

of

a positively-framed

message coupled

with

^a high source credibil-

ity is

the highest

@MNt=

5.756) comparec to other framing and source credibility corn-

binations

(positively-framed message

witi

low

source credibility

EMM=

5.236, negz tively-framed message

with

high credibilir' source

EMM=

5.155 and negatively-ftame- message

with low

credibility source

EMII=

5.671). Thus, in terms of influencin:

women's attitudes

to

provide six months

-:

exclusive ^breastfee ding, a positively-fran:=

:

message coming from a highly credible sou:r:

is the most effective combination. Horver--:

Table 5. Composite

Reliability, AVE

and

Correlation among Consttucts

A\rE {^,ru

i

Composite

Reliability Intention Attitude

Intention

Attitude

0.573 0.611

0.80 1

0.904

0.756

0.696 0.781

&4h Mada IntemationalJouml of Bueiness -Iftayfuwt, Vul ¹ 6 M. 2, 2A4

rt is noteworthy that the combination of the negaliysly-fiamed message with the low cre&

ilility

sorrce yielded an

EEM

impact on at- rimde thatwas not substantially different from

-'

positive-framed message, high credibility lrxlrce

EEM

(5.756 versus 5.671,).

fgure 2. lnteraction between Framing

and

tion

The significant

moderating

effect of

sorrce credibiJity was also found in the rela- tibnship between ^message framing and inten- tion

(t=

3,079;

p<

0.01), supporringHypoth- esis 4.

ANOVA

was again used to determine the nature of the interaetion,

with

outcomes Source

Credibility

on

Attitude and Inten-

c6

a

o

d

.so0

.o

z

xq, d

.EE

lrl

c

-Low ^crdility

-Iow

^crdility

c

-Lwaodillr -I.ow ^edility

do

a

dc

'5n

!

a

Xo d 'dE rI]

Negatively-firamed Positively-fnmed

Estimatexd Marginal Means of Intention Estimatexd Marginal Means of Attitude

Neptivdyftrned Positively-frrmed

I

indicating that ^a positively-framed message

coming from a relativelv high credibility

source was

the

most effective combination in affectingintention. The r.aiue of the

EMM for this

combina,tion (5.910)

is the

largest among

the

other combinations (positively- fiamed message and

low credibilitv

source

EMM=

5.497,

negativell-framed

message andhigh- credibiJity source EMNI= 5.333 and negatively-framed and lou' credibility source EN{NI= 5.835).

Aswith

the framingquestion results desc ribed above, the contf ^a st betrve en the impacts

of

the positive-frame

with

high credibility and negative-frame and iow cred-

ibiliw onintention

were of comparable mag- nitudes (5.910 versus 5.835),

F[ure

2 depicts the interaction effect of message framing and source

credibilitl'

on attitude and intention.

Hlpothesis 5's proporiiion that there is

a

significant effect

of attitude

on intention v/as supported

by the

data

(t=I2.782; p<

0.01 , B = ^{0. 6 1} 5). Attitude was shown to posi- tivelv influence intention; the more positive the attitude of rvomen towatd providing six Table 6.

Hypotheses Testing Summary

Husseinet al.

months of exclusive breastfeedirig the higher their intention to exclusively breastfeed.

Referring to the coefficient

of

determi- nation

(R),

message ftarningand the interac-

tion of

message framing and

credibiiitv

ex- plarns roughly a quafter Q4.6Vo) of the vari- ance

in

attitude. In addition, 50.8 percent

of

the variance

in intention

was expiained b1'

attitude, messa€le framing and the interaction

of

message framing

and

source credibility.

Table 6 summaizes the results

of

the hypoth- eses testing.

To ensure the robustness

of

the research model, this study also uses the Goodness

of Fit

(GoF)

index.

Since PLS

is a

variance- based SEN{,

it

^does

not

harre a formal GoF Therefbre,

the

calculation

of

GoF refers to Tenenhaus et al's (2004) srygestion. Derived from Tenenhaus

et

aI. (2004), Daryanle ^s1

al. (2010) proposed that the baselines

forGoF

are

small=

0.1,

medium=

0.25 and large=

0.3(r.The GoF for this study (0.471) is quite robust.

Hypothesis

Path t-value

H1 H2 H3 H4 H5

Message Framing

-+ Attitude

Message Framing

-)

^Intention

MF

*

_SC

-> ^Attitude MF *

SC

-+

Intention

Attitude -+

Intention

1..534 1.424 1.2.602

3.07 9

12.782

NS NS Supported Supported Supported

'r:irh ^Mada IntemationalJoumal of Busines - Jlay,4tgli,lhl. l6,l,o.2,2014

Discussion

The

hlpothesized direct relationshrps

r.- :\\-een 1) message framing and attitude, and

-

^{nessage framing and} intention were not

-

.:rd.

These results are inconsistent

with r-,se

obtained

in

studies

by Arora

(2000,

: ^,-)

andJones et aL. (2004).

The

first pos-

.-:-e

expianation

for this

difference

is

cen-

:.:ed

on the nature

of

breastfeeding behav- :.

\Iany

campaigns have been launched to

::

^,rnote exclusive breastfeeding behavior

in

-:::onesia;

for

example,

in

2010

UNICEF

.

-:norted

^{a mobile} media-based advertising

:,:rpaign to

raise awafeness

of

the benefits

-

^e

^rclusive

breastfeeding

for children. In ,::r:ion,

and

with

respect

to

demographic :--.r:cteristics, around 54 percent

ofthe

cur- -=:-, study's participants haVe more than one

: --d.

suggesting

that

breastfeeding and its -:-.:ed _{issues afe} not new to thern. Thus, it is :..

-.ible that this

study's participants were

,-:;;dr-

^ware

of the

benefits

of

exclusive ::=.stfeeding and, by recognizingthose ben-

.::'.

already had a positive attitude toward

:::-;sive

breastfeeding. These are attitudes

',, --cn could have ^been formed through

prior :::,

_'sure to similar messages, personal expe-

-:::ce

or, perhaps, as a result ofgeneral soci- ::=- :uppoft of the practice. Therefore, there

.

possibility

that

any stimulus provided

i

^{. '-ci} not have had anincremental effect on :':--.-ious favorable evaluations

of the

prac-

:::-

The belief that they and their children

.:= certain to tezltze the benefits of

- :;.s rteeding is another possible explanation

-"

i

::re insignificant main effect

of

message :.:.::::nq on women's attitudes towards pro- '

:-::

exclusive breastfeeding.

If the

argu-

-::-:s

presented by

the

advertisement con- -'

::: ro

aheady held attitudes,

it

^is feason-

r

-.:

_ro expect Little or no impact

of

framing

on the attitude. The Prospect Theory

(I(ahneman and Tversky 197 9) posits that

for

relatively lovz risk behaviors, gain-framed or positivell.framed ^messages

will

be more per- suasive than loss-or negatively-framed mes- sagrs. Thus, iow risk behaviors can be thought

of

as having

little risk of not

realizing the expected outcomes

-that ^s,

^{do this and these}

outcomes

will

occur" Altematively, although breast

milk

has been clinically demonstrated

to be the complete nutrition fot infants

(Galson 2008),

it is

possible

that

message framing alone was

not

enough

to

overcome

the

thought that

the

outcomes

of

adopting this behavior

will

vary between infants and mothers.

In

addition, because positive _out- comes are not easy

to

discern, perhaps thete is an underlying concern that ^they

will

not be attained.

Yet,

when the positively-framed mes- sage is deliveted by a credible source, there are differences

found in both the

attitudes towards exclusive breastfeeding and the in- tention to engage in exclusive breastfeeding.

Perhaps

while

framing alone cannot dispel perceptions

of risk,

the addition

of

a cred-

ible

message source may

lower to a

degree

the

possible uncertainfy

that positive

out- comes

will

be achieved and, consistent

with

the tenets of ELM, make the message easier to internalize.

Ftaming alone does

not

establish the type of connection

with

the target audience that framing

in

conjunction

with a

credible message source appears

to provide. If

^the

focus

is

shifted

from the

effect

of

external stimuli, such as an advertisement that could be use d in a social marketing campaign, and looks instead at

the

psychologv behind the motivation, or intention, to engage in a cer- tain behavior, ^the Theory ofPlanned Behav-

ior

(TPB) can be used as a basis

to

under- stand this study's findings. Based on the TPB

105

I

(Ajzen L99I),

an

individual's intention

to adopt

a

desired behavior was affected by three robust variables; attitudes, perceived

behavioral control (PBC) and

subjective norms.

In

accorda4ce

to

the

TPB

approach

and several studies in the area of

breastfeeding behavior(Dodgson et al. 2003;

Duckett et al.

L998; Wambach 1997), this study found that the women's favorable atti- tude toward providing exclusive breastfeeding has

a

significant positive effect

on

their in-

tention to

exclusively breastfeed.

This

atti- tude is unlikely

to

be something formed by one exposure to an advertisement, but

nther it

is formed over time and

with

repeated ex- posure

to

the stimulus, or as a result

of

dif- ferent sources

of

influence

pointing to

the same basic evaluation. Advertising can cer- tainly serve as one

of

those sodrces tn alarger social marketing campaign.

Based on the research findings, the most significant theoretical

contribution of

this research

is the

extension

of the body of

knowledge by integrating

ELM

and the Pros-

pect Theory in

investigating

the effect of

message framing and source

credibility

on behavioral intention and attitude in the area

of

social marketing. Specifically, the present study provides a comprehensive evaluation

of the effect of

message framing and the moderating effect of source credibility on an individual's attitude and intention to provide exclusive breastfeeding behavior This study validates previous studies such as Abhyankar et al. (200 8), Jones et aI. (200 4) and O'Connor et

al.

(2005), who found that message frzm-

ing

does

not

have

a

significant main effect on behavioral

intention

and attitude. Mean-

while, this

study challenges

the

findings

of

Jones

et

al. Q004) who investigated the ef- fect of message framing and source credibil- ity on behavioral interition and its predictors.

\X4rile Jones' ^study

did not find

significant

Husseinet al.

interaction effect berween message framing and source credibilityon behavioral intention and other socio-cognitive variables, this re- search found a significant interaction effect where a positively-framed message coming from a high credibility source was the most effective combination

in

influencing behav- ioral intention and attitude. The combination of a positively-framed ^message which comes from a

highly

credible source supports the

prediction of the Prospect Theorl'

(I(ahneman and Tversky 1979),

which

sug- gested that an individual

will

avoid

risk

in the domain of gains, and the

ELM

(Petty and Cacioppo 19 86) which claimed that under the

low

elaboration condition, a high credibility source

will

be more persuasive than a low credibility source.

Limitations and Recommendations

The primary

limitation of

this study is

that

it

does

not

measufe the actual behavior

of

interest; instead,

it

only measures the in- tention of women to exclusively breastfeed.

This

limitation

is common

to

many studies utilizing intention as a dependant construct.

It is

recommended that a future study could move beyond measurement ofthis behavioral proxy and could include a measure of actual behavior. Another

limitation is in

regard to the sample rectuitment. tJilhile this study ob- tained a relanvely large sample (n

=

^{279), re-}

spondents were pfegnant mothers recruited during a brief time span from several hospi- tals, matemity dinics and breastfeeding work- shops in Malang, Indonesia. Hence the sampie does

not

represent

the

population

of

preg- nant Indonesians and the findings thus mar-

not be

genera[zed

to either

non-pregnanr mothers or pregnant women

in

other ^places.

Finally, since this study only investigated the

Gr&h fixda fnunationalJoutnal of hrsi'nas ^- May,&gast, Vll. I 6 M. 2, 2014

drect

relationships among constfucts, any

frture

study could also investigate indirect rdationships to provide more comprehensive

knowledge about persuasive communication, message framing, source

credibility

and be- havioral change.

Refetences

"tbhpnkar, ^{P, D. B.} O'Connor, and R. Lawton 2008. The role

of

message

ft*r.g

ⁱⁿ promoti4g MMR vacciration: Evidence

of

^a loss-frame advantage. Pslcbokgy, Health and Mediciru 13 (1): 1.

Apeq I.1,991.. The theory

of

^{planned behavior.} OrganiqationalBebauir andHumanDecision Process 50:1,79-

21,7.

!

.!flren, I., and M. Fistrbein 7980. UnderstandingAttitudrs and Prediding Social Behauior. Prentice-Hall.

Jl5co, D. L., M. D. Basit and S. Destrpande. 2071. Communications in social marketing. In G. Hastings,

K.

Angus, and C.

A.

Bryant @dt), ^The SAGE Handbuk of Social Marketing. London: SAGE Publications Ltd.

Am,ra" R. 2000. Message framng and credibilityr application in dentd services Healtb Marketingpuarteill

18 (1-2):29.

fmr4

R. 2007. Message frami4g strat%ies for new and mature products

lomul

^{of Produa and Brand}

Maragement 16 (6): 377-385.

drcre, R., and A. Arora. 2004.T1:r.. irnpact

of

message frami4g and credibility. SeruireMarketirgpaarterll 26 (1):35 -53.

"erora, R, C. Stoner, and A. Arora . 2006. Using framing and ctedibility to irrcoqporate exercise and fitness in individuals' hfestty'e. Journal of Consumr Marketing

%

_@: 199

-

^{207 .}

fdqSM.,P.

Salovey,S. Greener,A,J. Rothman,A. Moyer,J.Beauvais,andE. Epel. 1995.The effects

of

message franirg on mammography utilization. Heahb Pgclnhgy 1,4: 1,78-778.

Dqrafto, n., K. de Ruyter, and M. $Tetzels 2010. Getti4g a discount or sharing the cost The influence

of

regulatory

fit

on corsumer response to service

pricrg

schemes lournal of Seryite Rsurch 13 _Q):

153-167.

brfusorlJ.

^E., S.J. Henly, L. Duckett, and M. Thrrant. 2003.Theory

of

^planned behavior-based models for bteastfeeding duration among Hong Kong mothers NarsingRcrearcb 52

p): M&

Eett,

L., ^S. Henly, M. Avery S. Pottet, S. Hills-Bonczyk, R.Huldeq and

I{.

Savik. 1998.

A

theory

of

planned behavior-based strucn:rd model for breast-feedtng. NursingResearcb 47

(6). f

&mq

^{L., E} McCormick, and M, J. ^Renfrew. 2005. Interventions

for

promoting the initiation

of

breasdeeding. Cuhrane Database Slst Rn 2.

E#l,

C., and D. E Latcker. 1981. Evaluati4g strucural equation models with unobservable vadables and measuremerit effor. lournal of Marketing ^resarch 18 (1): 39-50.

S K.

E

^{A). 2008. Mothers and} childrenbenefit from breastfeedi4g. Jonrnalof tbeAnericanDietetic Assuiation 108 (7): 7106

-

1707.

ElE,nfiC.Black,B.J.BabiaandD.R.Andetson

2010.MultimriateDataArafusirAGlo;batPerEatiue Cf*

.d).

Upper Saddle River: Pearson Education Inc.

t07

{t

HussehetaJ,.

Jones,

L. ![,

R. C. Sinclair, and

K.

^{S. Courne}

va.

2003.The effects

of

^source credibility and message

ftaming on exercise intentions, behaviors and attitudes: An integration

of

the elaboration likeli- hood model and prospect theory. Journal of Applied Socia/ Pychologt, 3J(1),1,79

-

1,96.

Jones, L. \V, Sinclak, R. C., Rhodes, R. E., and Courneya, K. S. (2004). Promoting exercise behaviour: an integration of "persuasion theories and the theory

of

planned behaviour. Bitish jotu'nal of health py ch ology, 9 (4), 505-521,.

I{ahneman, D., and A. Tversky. 1979. Prospect theory: An analysis

of

decision under risk. Econometrica:

Journal of the Econometric S ocie!: 263-291' .

I(eller, H., and R. Thackeray. 201 1. Social matketing and the cteative process Heahh Promotion Practice 1.2

(5): 651-653.

Kim, S.-8., and D-Y.'I<m.2014. The effecm

of

message framing and soutce credibility on green mes- sages in hotels Cornell Hospitali4, puaterfi 55 (1): 64-75.

Kotler, P., and N. R. Lee. 2008. SocialMarketing InfkncingBehaborsfor Good (3'd ed.). Thousan Oaks: Sage PubLications

I{ramer, M. S., B. Chalmers, E.

D.

Hodnett,

Z.

Sevkovskaya,

I.

Dzikovic}r, S. Shapiro, J. P Colleg I.

Vanlovictql.MezeryandT. DucrueLnC1. Promotionof bteastfeedurg inerventbn trial (PROBIT).

J.4MA: thejournal of the American Medical Association 285 (4): 413-420.

I(umkale,G. T.,D. Albarraciqand P.J. Seignourel.2010. Theeffecs

of

^source credibiliryinthepresence

or

^absence

of

prior attitudes: Implications

for

the design

of

petsuasive communication ^cam-

patgns Journal of Appbed ^S ocial Pslchology a0 (6): 1325-1,356.

Leviq I. P, S. L. Schneider, and G.J. Gaettr- 1998. All frames arerrot created equal A gpology and cdtical analysis

of

framing effects Organrqatnnal Behauior and Human Decision ProcessesT6 (2):149-188.

Martens, P.J., and T. I{. Young. 1997. Determinants

of

breastfeeding in four CanadtanOJibwa commu-

nities: A decision making model. Ameican Journalof ^{Human Bnlogy} 9 (5): 579-593.

Nunnally, l. ^{1 97 8. P1} v ^{ho me} tri c T h e or1. New York: M cGrav' -HilL

O'Connor, D. B., E. Ferguson, and R. C. O'Connor. 2005.Intentions to use hormonal male contracep- tion: The role

of

mess€e framing, attitudes and stress appraisals Biti:h _Journalof Pychology 96 (3):

351.-369.

O'I{eefe, ^D. _J., andJ. D. _Jensen. 2007.The relative persuasiveness

of

gain-framed loss-framed messages

for encouraging disease prevention behaviors: Ameta-analytic review. Joarnal of Health Corumunica- tion 1.2 (7): 623 - 644.

Olson,J. M.,and M.P.Zaruw.1993. Attitudesand attitudechange. AnnualRwiew of Pgtchokgy 44(1):117-

1,54.

Parkirsoq _J., R. Russell-Bennett, and J. Previte . ^201,1,. Mum or bub? \X4rich influences breastfeeding loy-

aky. Aus tra lasi an Mark e ting J ^{o wr n a} I (AMJ _).

Petty, R. E., _{and J.} T. Cacioppo. 1986. The elaboration likelihood model

of

persuasion Aduanas in experi- mmtal socialpgchologl 19 (1): 123-205.

Rivers, S. E,., P Salovey', D. A. Pizarrq J.P'aano, ^and T. R. Schneider. 2005. Message framing and pap test utilization among women ^{attending a} community heahh clinic. _/a wrnal af Health Pychobgy 10 (1): 65.

Rothman, A. _{J., and}

P

Salovey. 1997. Shaping perception

to

motivate heahhy behavior: The role

of

message frami4g. Pslchobgical Bulleting 1.21 (1): 3 - 1,9.

':

,-;

#,

Ga diah Mada Intemationa{ournal of Busitess ^- May.Aryl t, W 1. 1 6, Nr. 2, 201 4

Rothman, A.J., R.D. Bartels,J. nflJaschiq and P. Salovey.2006. The strategrc use

of

gain-and loss-framed messages to promote ^healthy behavior: How theory cafl inform practice. _Journal of Communication 56 (s1):202-220.

Rothman, A.J., P. Salovey, C. Antone,

I{.

I(eougir, and C. D. Martin. ^1993. The id-luence

oi

^message

framing on intentions to perform health behaviors. Journal af Expeinntal SocialPg,.ho/agt 29 ^(.5):

408-433. doi: 1 0.1 006/ jesp. 1 993.1 01 9

R1zn, A. ^{S. 1997.} The resurgence

of

breastfeeding in the United States. Pediatrics 99 @: ^e1.2-e12.

Secker, J., E. \7imbush,J. Watson, and

I{.

Milburn. 1995. Qualitative methods in heakhpromotion re- searclu some criteria for qualiry. Health E dacation lournal54 ^(1):74.

Statistics Indonesia, and Macro International. 2008. Indonuia Denographic andHealth Suruq 2007.MaryJand:

BPS and Macro International

Streukens, S., M. \feuels, A. Daryanto, and

I{.

De Ruyter. 20i0. AnalyAng factonal experimental data using PI-S: An altemative approachand applbationin anonline complaining conto(t.

InV

^Esposito-

Vinzi W Chin, _J. Henseler and H. Wand _{(Eds.) ,} Handbook of Panial l-.east Squares: Conceptq Methods

a n d App li c ati ors Springer.

Stubblefield, C.l,99l.Persuasivecommunication:Marketingheaithpromotion.l{ursingOutlook45:1.73-

171.

Tenenhaus, M., S. Amato, anfl V Esposito Yirut2004. A ^global goodness-of-fitindex for PLS sffuctwal equation modeiling. Paper presented at the Proceedings

of

^the

XLII

SIS scienti{ic meetrng.

Triandis, H. ^C.1,977. Interpersonalbehailon Brooks/Cole Pub. Co.

Tr-erslq',A.,andD. I{ahneman.

l98l.Theframingof

decisionsandthepsychologyof choice. Science,211.

(4481):453.

N-ambaclr, K. A. 1997. Breasdeeding intention and outcome: A test

of

the theory

of

planned behavior.

Raearch in Nursing and Health 20 (I):51-60.

Zhang, Y, and R. Buda. 1999. Moderating fffects

of

^need for cognition on responses to positively versus negatively framed advertising messages Jowrnalof Aduertiing28 (2): I-15.

109