"I Needed This Message During the Covid-19 pandemic" An Interview Study on Mental Well-Being Outcomes and Health Message Effectiveness Across Depressive Symptoms

Persuasive health messages are designed to promote behavioural change, yet they may also unintentionally impact mental well-being of message receivers. While some appeals may offer support, others can be distressing, particularly for individuals with higher depressive symptoms, who may be disproportionately negatively impacted. These well-being effects, in turn, may impact adherence. This study explores how young adults with varying levels of pre-existing depressive symptoms perceive the impact of persuasive health messages on both mental well-being and message effectiveness. During stimulus-based qualitative interviews with 30 participants, individuals were shown 12 COVID-19 health messages promoting social distancing, each using a different message appeal. Findings suggest that some message appeals negatively impact mental well-being, with those with pre-existing moderate/severe depressive symptoms appearing disproportionally affected. However, while all participants expressed experiencing distress from certain negative appeals (e.g., shame, controlling language), those with moderate/severe symptoms found them effective, whereas those with no/normal symptoms exhibited resistance and even boomerang effects. In contrast, some positive appeals (e.g., hope, empathy) and pro-social appeals were generally well-received, supporting perceived message effectiveness while safeguarding mental well-being. These insights highlight the need for health messages that balance their impact on both physical and mental well-being, thereby targeting well-being holistically.