Beyond Text: The Acceptability of Short Video Messages to Pregnant Women Smokers

Theoretical Background and research questions/hypothesis:  Since the rapid acceptability and proven efficacy of Text4Baby, public health has recognized the feasibility and value of text-message based communication interventions for pregnant women. The format of text messaging also lends itself to links to short videos, which may enable more complex messages than those in short texts. The present study tested the acceptability of short video messages among a hard-to-reach population – pregnant women who are current or former smokers. We examined differences in video evaluations by demographic and psychological characteristics.

Methods:  Pregnant women who had smoked within three months of getting pregnant were recruited online nationwide using Facebook, Instagram, Craig’s List, and direct marketing emails between January, 2016 and March, 2017 (N=268). The sample largely reflected the population of pregnant women smokers: 72% white, 11% Hispanic, 9% Native-American or Native Hawaiian, and 8% African-American. The sample was low SES; half the sample earned less than $15,000 per year, and 61% received Women Infant and Children (WIC) funds, and 19% had not graduated high school, 44% had a high school degree, 28% had some college, and 4% had an Associates or four-year college degree. For the larger evaluation study, participants were randomly assigned to view either anti-smoking or nutrition (fruit and vegetable) promotion videos. Women completed an online pretest, viewed three short videos lasting about 8 minutes in total, and then completed an immediate posttest. Many completed the surveys on their phones. The videos in both conditions featured testimonials from pregnant women, new mothers, and experts, and included information and motivational points based on prior qualitative research. Video evaluations were measured by a scale of 14 items, including liking, believing, and relating to the video.

Results:  Video evaluations did not vary by ethnicity, education, or income. In terms of psychological traits, the video had higher evaluations among women who were more health conscious (F = 35.04, p < .001) and had less psychological reactance (F = 6.44, p = .012). Other psychological factors – perceived stress, depression, and generalized anger – did not covary with the video evaluations. Women who had already quit smoking evaluated the videos less favorably than those who still smoked (F = 11.1, p = .001).  

Conclusions:  The video format was received equally well across demographic groups. Women who were health conscious and had not yet quit smoking also rated the videos more highly, possibly because they found the videos more personally relevant. Tailoring might have enhanced effectiveness. Interestingly, psychological reactance - a factor that sometimes is important in dealing with risky behaviors in adolescent samples – played a slight role in devaluing the videos.

Implications for research and/or practice:  Health communicators could consider short videos as a supplement to text message-based interventions aimed at pregnant women smokers. Over and above text messages, videos may offer opportunities to model behaviors, depict a variety of people to enhance identification with others, and provide motivating testimonials. In addition, when creating messages for smokers, strategies to overcome psychological reactance should be considered.