Effect of message congruency on attention and recall in pictorial health warning labels

Abstract

Objective: The nine pictorial health warning labels (PWLs) proposed by the US Food and Drug Administration vary in format and feature of visual and textual information. Congruency is the degree to which visual and textual features reflect a common theme. This characteristic can affect attention and recall of label content. This study investigates the effect of congruency in PWLs on smoker's attention and recall of label content.

Methods: 120 daily smokers were randomly assigned to view either congruent or incongruent PWLs, while having their eye movements recorded. Participants were asked to recall label content immediately after exposure and 5 days later.

Results: Overall, the image was viewed more and recalled better than the text. Smokers in the incongruent condition spent more time focusing on the text than smokers in the congruent condition (p=0.03), but dwell time of the image did not differ. Despite lower dwell time on the text, smokers in the congruent condition were more likely to correctly recall it on day 1 (p=0.02) and the risk message of the PWLs on both day 1 (p=0.01) and day 5 (p=0.006) than smokers in the incongruent condition.

Conclusions: This study identifies an important design feature of PWLs and demonstrates objective differences in how smokers process PWLs. Our results suggest that message congruency between visual and textual information is beneficial to recall of label content. Moreover, images captured and held smokers' attention better than the text.

Keywords: attention; congruency; eye-tracking; health warning labels; recall.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1

Pictorial health warning labels (PWLs) used in the congruent and in the incongruent condition. The PWL of a toddler with text stating, ‘Tobacco smoke can harm your children’ was the least consistently scored PWL and was dropped to achieve balanced numbers of PWLs per condition.

Figure 2

Differences between conditions in dwell time. Average dwell times of the AOI image and the AOI text (and SE bars) by condition. Conditions differ significantly in dwell time of the AOI text (p=0.03). AOI, area of interest.

Figure 3

Differences between conditions in correct recall at times 1 and 2. Average number of correctly PWLs (and SE bars) by condition at times 1 and 2. PWL, pictorial health warning labels.