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Background  Internet sites typically contain visual design elements that are unrelated to the quality of the health information presented but that could influence credibility judgments and responses to health advice. To assess the effects of such design elements, or credibility cues, experimentally, we exposed women with different levels of weekly alcohol consumption to a website containing high quality but unpalatable information about a related health risk (breast cancer). The information was presented alongside either positive or negative credibility cues unrelated to information content.    Objectives  We explored four research questions: (1) Did the cues influence how the women engaged with the site? (2) Did they influence how the women responded cognitively and emotionally? (3) Did they influence whether the women subsequently acted on the advice? (4) Did the impact of the cues vary with how much alcohol the women reported drinking?    Method  A total of 85 women were randomly assigned to view one of two versions of a website containing the same high-quality content but different cues. One version had positive credibility cues (trustmarks), the other had negative ones (adverts, pharmaceutical sponsorship, and a donation button). Objective measures included visual attention (using eye-tracking equipment), time studying the material, and recall. Subjective measures included cognitive and affective responses and intention to change. Measures of subsequent behavior were taken 1 week later.    Results  First, the cues did not affect how long the women spent on the site or how long they spent reading the text. However, women in the negative cues condition spent more time looking at a donation button than those in the positive cues condition spent looking at a TRUSTe seal (β = −.43,  P  < .001) but less time looking at a logo (β = .43,  P  < .001) or at certain other features of the site. Those in the negative cues condition also recalled more site content (β = −.22,  P  = .048). Second, there were no effects of the cues on any of the measures of cognition, affect, vulnerability, or intentions. However, third, at follow-up, the positive cues had promoted greater alcohol reduction than the negative cues among those women who had previously reported drinking more heavily (β =  −.22,  P  = .02). So, fourth, the responses to the cues did vary with how much alcohol the women typically drank.    Conclusions  Content-irrelevant images and logos can influence the behavioral response to quality health-risk information. These effects may be subtle, changing with time.

jmir. journal of medical internet research/journal of medical internet research

The Effect of Credibility-Related Design Cues on Responses to a Web-Based Message About the Breast Cancer Risks From Alcohol: Randomized Controlled Trial