Promoting Stretching Engagement through Health Belief Model-Based Nudges: The Effectiveness of Threat vs. Benefit-Based Nudge Messages
Abstract
Background: We aimed to investigate the effectiveness of health belief model-based nudge messaging on engagement in stretching that was either threat-based or benefit-based.
Methods: A quasi-experimental design allocated the participants (N=69) into three groups: the threat nudge group, which received messages emphasizing perceived susceptibility and severity; the benefit nudge group, which received messages on the advantages of stretching; and the control group, which received no messages. The study was conducted in South Korea from October to November 2024. Participants’ engagement in stretching was measured over a six-week period using the health application, which provided the stretching exercise sessions and tracked and recorded their duration.
Results: The threat nudge group exhibited the largest increase in stretching behavior, significantly outperforming both the benefit nudge group and the control group. The benefit nudge group showed an improvement but it tended to be a generally smaller and less dramatic effect than the threat nudge group. Analysis of variance showed a significant difference in stretching time across groups (F2,67 = 26.43, P=.000; ηp2 =0.44), with post-hoc tests indicating that the threat nudge group significantly outperformed both the benefit nudge and the control group in stretching duration.
Conclusion: One implication of these findings was that, as suggested by the health belief model, perceived threat can be a strong motivator for behavior change in the short term while perceived benefits alone may not be sufficient to drive immediate action. Practically, threat-based messaging can be particularly useful in the short term for physical activity instructors and app developers to motivate clients.
2. World Health Organization (2022). Global Status Report on Physical Activity 2022. https://www.who.int/teams/health-promotion/physical-activity/global-status-report-on-physical-activity-2022
3. Sallis JF, Bull F, Guthold R, et al. (2016). Progress in physical activity over the Olympic quadrennium. Lancet, 388(10051):1325–36.
4. Ministry of Culture, Sports and Tourism (2022). National Leisure Activity Survey 2022.
5. Ministry of Culture, Sports and Tourism (2023). National Sports for All Survey. 2023
6. Medeiros DM, Cini A, Sbruzzi G, Lima CS (2016). Influence of static stretching on hamstring flexibility in healthy young adults: Systematic review and meta-analysis. Physiother Theory Pract, 32(6): 438-445.
7. Arntz F, Markov A, Behm DG, et al. (2023). Chronic effects of static stretching exer-cises on muscle strength and power in healthy individuals across the lifespan: A systematic review with multi-level me-ta-analysis. Sports Med, 53(3):723–745.
8. Kokkonen-Harjula K, Hiilloskorpi H, Mänttäri A, et al. (2007). Self-guided brisk walking training with or without poles: a randomized-controlled trial in middle-aged women. Scand J Med Sci Sports, 17(4):316-323.
9. Takeuchi K, Nakamura M, Konrad A, Mi-zuno T (2023). Long-term static stretch-ing can decrease muscle stiffness: A sys-tematic review and meta-analysis. Scand J Med Sci Sports, 33(8):1294-1306.
10. Zvetkova E, Koytchev E, Ivanov I, Ranchev S, Antonov A (2023). Biomechanical, healing and therapeutic effects of stretching: A comprehensive review. Appl Sci, 13(15):8596.
11. Sudo M, Ando S (2020). Effects of acute stretching on cognitive function and mood states of physically inactive young adults. Percept Mot Skills, 127(1):142-153.
12. Sevimli D, Kozanoglu E, Guzel R, Doga-nay A (2015). The effects of aquatic, isometric strength-stretching and aero-bic exercise on physical and psycholog-ical parameters of female patients with fibromyalgia syndrome. J Phys Ther Sci, 27(6):1781-6.
13. Gómez-Hernández M, Gallego-Izquierdo T, Martínez-Merinero P, et al. (2020). Benefits of adding stretching to a mod-erate-intensity aerobic exercise program in women with fibromyalgia: A random-ized controlled trial. Clin Rehabil, 34(2):242-251.
14. Rosenstock IM (1974). Historical origins of the health belief model. Health Educ Monogr, 2(4):328–335.
15. Prentice-Dunn S, Rogers RW (1986). Protec-tion motivation theory and preventive health: Beyond the health belief model. Health Educ Res, 1(3):153–161.
16. Janz NK, Becker MH (1984). The health be-lief model: A decade later. Health Educ Q, 11(1):1–47.
17. Rosenstock IM, Strecher VJ, Becker MH (1988). Social learning theory and the health belief model. Health Educ Q, 15(2):175–183.
18. Weinstein ND (2000). Perceived probabil-ity, perceived severity, and health-protective behavior. Health Psychol, 19(1):65-74.
19. Champion V, Skinner CS (2008). The health belief model. In: Glanz K, Rimer B, Viswanath K, editors. Health behavior and health education. San Francisco, CA: Jossey-Bass; pp. 45–65.
20. Karl JA, Fischer R, Drulca E, et al (2022). Testing the effectiveness of the health belief model in predicting preventive behavior during the COVID-19 Pan-demic: The case of Romania and Italy. Front Psychol, 12:627575.
21. Faghih M, Rahimi M, Bahrami M, et al (2024). Effect of health belief model-based training and social support on the physical activity of overweight middle-aged women: a randomized controlled trial. Front Public Health, 12:1250152.
22. Wang HM, Chen Y, Shen YH, Wang XM (2024). Evaluation of the effects of health education interventions for hy-pertensive patients based on the health belief model. World J Clin Cases, 12(15):2578-2585.
23. Sheng J, Gong L, Zhou J (2023). Exercise health belief model mediates the rela-tionship between physical activity and peer support among Chinese college students: A cross-sectional survey. Front Psychol, 14:1103109.
24. Reedman S, Boyd RN, Sakzewski L (2017). The efficacy of interventions to in-crease physical activity participation of children with cerebral palsy: a systemat-ic review and meta-analysis. Dev Med Child Neurol, 59(10):1011-1018.
25. Van Wely L, Balemans AC, Becher JG, Dallmeijer AJ (2014). Physical activity stimulation program for children with cerebral palsy did not improve physical activity: a randomized trial. J Physiother, 60(1):40-49.
26. Tara Mantler (2013). A systematic review of smoking Youths’ perceptions of addic-tion and health risks associated with smoking: Utilizing the framework of the health belief model. Addiction Research & Theory, 21(4):306-317.
27. Victor Romano, Imani Scott (2014). Using Health Belief Model to Reduce Obesity amongst African American and Hispan-ic Populations. Procedia - Social and Behav-ioral Sciences, 159: 707-711.
28. Sharifirad G, Entezari MH, Kamran A, Azadbakht L (2009). The effectiveness of nutritional education on the knowledge of diabetic patients using the health be-lief model. J Res Med Sci, 14(1):1-6.
29. Purohit AK, Schöbel S, Bill O, Holzer A. (2023). Nudging to Change, the Role of Digital Health. In: Rivas H, Boillat T. (eds) Digital Health. Health Informatics. Springer, Cham.
30. Shah N. Adusumalli S. (2020). Nudges and the meaningful adoption of digital health. Per Med, 17(6):429-433.
31. Angellotti E, Wong JB, Pierce A, et al (2019). Combining wireless technology and behavioral economics to engage pa-tients (WiBEEP) with cardiometabolic disease: a pilot study. Pilot Feasibility Stud, 5:7.
32. Zhang H, Chen L, Zhang F (2022). Revisit the Effects of Health Literacy on Health Behaviors in the Context of COVID-19: The Mediation Pathways Based on the Health Belief Model. Front Public Health, 10:917022.
| Files | ||
| Issue | Vol 54 No 7 (2025) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v54i7.19155 | |
| Keywords | ||
| Nudge messaging Low-intensity exercise Physical activity promotion Perceived threat Health behavior change | ||
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