Are need for affect and cognition culture dependent? Implications for global public health campaigns: a cross-sectional study

Many disciplines rely on persuasive communication with target audiences around affective goals (e.g., “do X to be happier”) or cognitive goals (e.g., “you will think more clearly”). An implicit assumption is that such affective goals are universal. Rather, affective and cognitive orientation (indexed by need for affect and need for cognition) differs across individuals and is associated with the effectiveness of messages in persuasive communication [1, 2] and consequent proactive behaviors [3]. Aquino et al. [4] explained the neural basis of this association by observing that the ventromedial prefrontal cortex (vMPFC) was specifically responsive when message receivers evaluated the match between a message and their affective and cognitive orientations. Affective and cognitive orientation may be particularly important for global persuasive communication efforts, e.g., public health campaigns, as similar campaign content might yield diverse outcomes across national cultures if there are cross-cultural differences in affective and cognitive orientation. In a review on structural matching effects in persuasive communication, Teeny et al. [5] pointed out that tailoring messages to cultural characteristics is a high-level matching strategy for persuasion enhancement.

Affective and cognitive orientations are indexed by self-report questionnaires. The Need for Affect (NFA) questionnaire assesses the tendency to approach or avoid emotion-inducing situations and activities. It focuses on the motivation to engage in the affective process rather than assessing emotional ability or emotional style [6]. People high in NFA tend to rely upon emotional information in attitude formation and the regulation of behavior [1, 2]. The Need for Cognition (NFC) questionnaire assesses the tendency to engage in and enjoy effortful thinking [7] and is related to rational decision-making [8] and effort expenditure [9]. Higher levels of NFA are associated with greater persuasion in response to an affect-based (but not cognition-based) persuasive message, whereas higher levels of NFC are associated with greater persuasion in response to a cognition-based (but not affect-based) persuasive message [1].

Geriatric health campaign messages are often geared towards affective goals (e.g., happiness, enjoyment), as evidence has shown that affective outcome expectancies have a significantly more positive impact on older people’s intentions to take proactive actions than rationale outcome expectancies [10]. However, cultural context may play a role in structuring affective goals. There are important differences across cultures in terms of the norms governing human engagement with emotions [11]. From the approach perspective of emotional engagement, East Asians – especially Chinese – differ from their Western counterparts in affective disposition [12]. For example, a unique study suggested that U.S. residents of Chinese descent tended to value high-arousal positive affect (e.g., excitement) less than Americans of specifically European descent [13]; they tended to want to maximize positive and minimize negative affect less than did Americans of European descent and therefore were more likely to feel the bad with the good, referred to as mixed affective experience [14]. From the avoidance perspective of emotional engagement, Chinese individuals are more affected by the perceived risk of potential losses than individuals from the Netherlands and the USA [15]. Compared to Americans, East Asians are less inclined to overestimate the emotional consequences of future events [16]. Additionally, there are differences across cultures in people’s engagement in thinking that might influence cognitive goal structures. The Confucian, Taoist and Buddhist philosophic traditions oppose public argumentation and debate [17] and focus on learning in a mechanical way without thought or meaning, which has evolved to the extent that people in such cultures are considered to lack abstract and critical thinking ability, to overemphasize concrete examples, and to lack originality and creativity [18].

Overall, these data suggest that the baseline levels of affective and cognitive intrinsic motivation may be low in certain cultures, so conventional emotion/cognition-based messaging is likely to be less effective. A prototypical example of diverse outcomes across cultures, given similar campaign content and service accessibility, is in the hearing healthcare domain. There are cross-cultural public health outreach efforts spanning China and the U.S. The prevalence of hearing loss in elderly individuals is 45 ~ 63% in both countries [19]. The WHO proposed a World Hearing Day (observed annually on March 3rd) to facilitate global hearing health campaigns. The themes of this day initially focused on the cognitive side, e.g., “Make listening safe: avoid noise-induced hearing loss”, “Earcare can avoid hearing loss”, “Proper use of hearing aids”, and “Act now, here is how”, while the more recent themes have emphasized the emotional side, e.g., “Hearing for life: don’t let hearing loss limit you”, “Hear the future”, “Make a sound investment”, and “Healthy hearing, happy life”. Although advocacy of early hearing intervention to reduce the long-term adverse effects of hearing loss has been carried out for over 2 decades using the same WHO messages, the hearing intervention rate in geriatrics remains low at < 2% in China [20], whereas it is approximately 16% in the U.S. [21]. Potentially, understanding differences in audiences’ affective and cognitive intrinsic motivation at a national level could help health professionals tailor persuasive messages to particular populations and hence facilitate successful campaigns globally.

The current study examines whether NFA and NFC differ systematically across relatively large Chinese and American samples. The objectives are to 1) develop a Chinese NFA scale based on Appel et al.’s English language version [22] and establish the validity of this scale; 2) examine the differences in NFA and NFC between our Chinese and American general public samples and perform a comparison with the European samples from Appel et al.’s study; and 3) taking hearing loss as an example, explore whether community-based seniors with a public health condition in the Chinese sample have reasonably high NFA or NFC, as assumed by public health campaigns, and examine whether their early hearing intervention intention is related to NFA and NFC. We hypothesized that the Chinese sample would have different levels of NFA and NFC than the American sample. We also hypothesized that Chinese seniors with hearing loss would be similar to those with normal hearing in terms of NFA and NFC, as no evidence has shown that hearing loss alters individuals’ affective and cognitive intrinsic motivation. We expected to observe a correlation between early hearing intervention and NFA and/or NFC in Chinese seniors, given that the Chinese hearing health campaign messages consist of both affective-driven and cognitive-driven content.

Considering target audiences’ needs for affect and cognition in contexts involving persuasive communication, such as global public health campaigns, is important because matching messages with receivers’ affective and cognitive orientation can significantly improve the effectiveness of persuasive communication [1]. Cultural differences could be associated with different levels of intrinsic motivation and could pose challenges to public health campaigns aiming to evoke desired attitudes and proactive health-promoting actions. The current study demonstrated cultural differences.

We first developed a Chinese translation of the original English NFA scale [22], which demonstrated acceptable psychometric properties. Based on the results of the ESEM, confirmatory factor analysis and multigroup invariance tests, we found that even a conservative one-level two-factor NFA model was able to had reliability and cross-cultural validity in the Chinese and American samples and can thus be used as a culture-fair assessment of NFA.

Our second question regarded the presence of differences in affective and cognitive intrinsic motivation among the Chinese, American and European samples. The Chinese participants reported lower motivation to approach emotional events and activities and a greater tendency to avoid emotion-inducing events and activities than their American and European counterparts (Fig. 2). This finding is consistent with the literature suggesting that Chinese participants demonstrate more aversion to strong emotions than Americans [48] and value high-arousal affective states less than Americans [13, 14]. Cognitive motivation, or the inclination to engage in and enjoy in-depth thinking and the processing of issue-relevant information [49], was also low in the Chinese sample, as previously observed [17].

A key notion underlying the NFA is that it subsumes both a motivation to approach emotions and a motivation to avoid them [6]. These two motivations are considered somewhat distinct in that approach motivations are closely linked to the experience of positive affect (e.g., gain), while avoidance motivations are closely linked to negative affect (e.g., loss) [50, 51]. That said, NFA approach and avoidance both focus on people’s attitude toward emotion as an end in itself, i.e., is emotion (positive and negative) something they want to approach or avoid? [22] In this way, they are different from emotion regulation. Behavior is regulated by these two distinct motivations, according to theories of individual differences in motivation [52‐54]. People with a predominant approach orientation are more responsive to cues of reward, while people with a predominant avoidance orientation are more responsive to cues of threat and punishment [53]. Hence, it is valuable to examine emotion approach and emotion avoidance separately.

In the present study, whereas NFA approach and avoidance were negatively correlated in the American and European samples, they were positively correlated in the Chinese sample. This counterintuitive motivation to approach emotions might be explained by observations regarding differential reactions to emotions (e.g., strategies to regulate emotions) across cultures [55]. According to Maio [6], people do not approach emotions if they regard them as unproductive or uncomfortable. In other words, if emotions are not generally appreciated by a society, people may prefer to keep them to themselves; their intention to approach emotions may thus be low or, if it is high, may be accompanied by a high level of restraint. Cultures that have a long-term orientation, that have embeddedness values, and that are hierarchical (e.g., East Asian cultures) tend to have higher scores on emotion suppression, and the correlation between emotion reappraisal and suppression tends to be positive, whereas Western cultures demonstrate an inverse relationship between affective approach and avoidance. Potentially, Chinese people have higher emotional ambivalence [56], where emotion desire is often compromised by concerns about the consequences of emotional expression and by efforts to refrain from emotional experience and expression. The goal of these exchanges is to avoid interpersonal conflict and maintain harmony [57], given that Chinese culture places strong emphasis on a harmonious and balanced relationship with nature and in social interaction [58]. As a result, affect-based motivation in Chinese culture may vary along a mixed emotion-coping continuum from low approach and low avoidance to high approach and high avoidance (rather than from high approach to high avoidance), with a precondition of maintaining balance and harmony in interpersonal and social relationships, which is not typical in Western cultures. We did not assess other affective constructs, personality traits, or culture-representative characteristics (e.g., individualism vs. collectivism, analytic vs. holistic, independent vs. interdependent) due to our lack of a priori model involving these constructs. The current study’s focus was to illustrate overall differences in affective/cognitive intrinsic motivation in the Chinese public compared to American and European samples. Thus, mechanisms of the observed cultural differences in NFA remain an open question for future research.

The low correlations between NFC and NFA within the samples (~.2) but the reliable sample-related differences could also suggest that cultural factors are responsible for differences in NFC. When people value harmonious social relationships, they tend to put less effort into information search and deliberation and into the utilization of issue-relevant information to think, reason and form attitudes and behaviors different from the mainstream [18]. These social strategies reflect low cognitive intrinsic motivation and might be a barrier to persuasive communication [59]. Indeed, as the NFC is essentially an affective scale assessing how enjoyable cognition is to an individual, given that Chinese generally were only 50% certain about whether approaching/avoiding emotions was enjoyable or not (Fig. 2), they might benefit less from emotions and therefore may be less likely to approach cognition than people in other cultures.

Our third objective was to explore whether the intrinsic motivation level of community-based seniors in China with a specific highly prevalent public health condition (i.e., hearing loss) is high, which would warrant affectively motivated health campaigns. Given the reduction in NFA and NFC in Chinese seniors relative to American seniors, Chinese seniors with hearing loss showed even lower NFA and NFC than those without hearing loss. This result differed from our hypothesis that NFA and NFC would be similar in seniors with and without hearing loss. The particularly low level of NFA in seniors with hearing loss, might be associated with the link between hearing loss and late-life depression [60], the latter typically indicating motivation disturbance [61]. The decreased level of NFC might be explained by Spotts [62], who reported that age-related declines in cognitive ability could affect NFC. Hearing loss is known to be associated with cognitive decline in older adults [63]; therefore, their cognitive motivations might be constrained by their cognitive capabilities.

Early hearing intervention intention was low regardless of hearing status; the majority of older Chinese people preferred to wait until their hearing condition became difficult to cope with. Our community-based geriatric sample was representative of the urban older population targeted by hearing health campaigns in China. It had a hearing loss prevalence of 62.6%, which is consistent with a previous report [64]. Low levels of NFA and NFC could help explain why geriatric hearing health campaigns in China are less successful than those in America, although Chinese campaigns have followed the American model [20]. A growing body of research in the U.S. has emphasized the importance of affective appeals in efficiently delivering health promotion messages [2]. However, perceptions of affective benefits (e.g., reduced anxiety, depression and stress; elevated self-confidence) and/or instrumental/cognitive outcomes (e.g., reduced risk of developing severe tinnitus and dementia) require a matching level of affective and/or cognitive intrinsic motivation in intended audiences. Our data suggest that this assumption should be questioned.

As the attempt to establish health goals by affective means has a relatively short history in China, the lack of a relationship between NFA (approach or avoidance) and intention to engage in early hearing intervention was not surprising. Given the numerous cultural differences associated with emotion [65], exploring strategies in which messaging is matched to a culture’s need for affect could be helpful in cross-cultural health campaigns. The presence of an association between NFC and early hearing intervention indicates that more effective persuasion might be possible in the Chinese geriatric population if hearing health campaign messages are framed to more specifically reflect the cognitive benefits that audiences actually value to match their low NFC. For example, early intervention could make you feel less “different” from your community (this is important for Chinese individuals). Alternatively, if a subdimension of NFC, such as NFC approach or NFC avoidance, as derived in other translations of the NFC scale [66], is found to be differentially relevant to health intentions, messages could be tailored to match that specific NFC subdimension to increase their persuasive power. We recommend research on these perspectives.

Our study has multiple limitations. First, limited demographic information was collected from the samples. Although the Chinese and American samples were comparable in terms of sex distribution (χ²(1) = 1.782, p = .182), only 55% of the age data were available in the American sample,. Other demographic differences (e.g., education, SES), as well as variables associated in the literature with affective style (e.g., neurodevelopmental history, disease exposure history, social network richness, frontal EEG asymmetry, and exposure to weather phenomena) [67‐69], might moderate our results. However, public health campaigns normally target audiences at the population level rather than the individual level, and as such, it would have been inappropriate to analyze individual differences in the current study. Our large-scale public samples were representative of the campaign target audiences who have access to the campaign messages usually spread on social media in both countries and advocated across community sites in China, so examining cross-cultural differences in NFA and NFC in those samples, as a whole, is more appropriate for our purposes. Individual differences were not controlled for or covaried, as this would require full analysis and understanding of potential moderation effects [70], which is beyond the scope of the current work. Second, as the original [22] scale scored items from 1 to 7 and the American version scored items from 1 to 5, we could not be consistent with both; our version inherited its scale from Appel’s [22] sample and was thus inconsistent with the American version in terms of scoring. We addressed this inconsistency by linearly converting responses from the American dataset to a 7-point scale, which could have distorted the NFA mean values of the American sample and biased the results. However, this conversion caused only a 0.17% change in the mean value and was unlikely to account for the 6% difference between the means on the 7-point scale. For future research reference, we reported the Chinese and American NFA norms by age and sex on both the 5- and 7-point scales (see supplementary material). The third limitation is the lack of hearing assessment and early hearing intervention intention data from the American sample. As a result, we were unable to directly compare the NFA and NFC levels of seniors with hearing loss between the two cultures. In addition, without data on how individuals in any of our samples responded to an actual public health campaign, all our considerations regarding campaigns, at this point, remain speculation; future research is necessary to confirm them.

These limitations notwithstanding, our results demonstrate a lack of affective and cognitive intrinsic motivation in Chinese individuals compared with the American public. These differences point to a potential challenge in framing effective messages for some cultures. Ideally, recognizing and understanding this challenge will inspire the consideration of novel persuasive strategies for these audiences. For example, using our example of public campaigns targeting hearing loss, instead of replicating the Western hearing healthcare campaign model, messages could target Asian values more specifically, such as by emphasizing a person’s ability to be in harmony with nature (e.g., hearing waterfalls) and society (e.g., reducing others’ communication burden and stress) rather than individual affective and cognitive goals. Another direction might be strengthening the influence of messages using newly available technology. Breves and Heber [71] reported that people low in NFA were influenced by immersive media, while people high in NFA were not, potentially because sensory-rich media experiences offer greater assistance to individuals with lower trait predispositions [72].

We conclude that the need for affect (NFA) construct may transcend its Western origins. Assessing NFA and NFC could inform global public health campaigns by helping them frame messages consistent with audiences’ culture-dependent intrinsic motivation.