Cancer Detection and Prevention 30 (2006) 432438 www.elsevier.

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Effects of pictures and textual arguments in sun protection public service announcements
Henk Boer PhD*, Ellen Ter Huurne MA, Erik Taal PhD
Department of Communication Studies, Faculty of Behavioral Sciences, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands Accepted 22 June 2006

Abstract Background: The effect of public service announcements aimed at promoting primary prevention of skin cancer may be limited by supercial cognitive processing. The use of both pictures and textual arguments in sun protection public service announcements were evaluated for their potentially benecial effects on judgment, cognitive processing and persuasiveness. Methods: In a 2 2 factorial experimental design individuals were shown public service announcements that advocated the advantages of sun protection measures in different versions in which a picture was present or not present and a textual argument was present or not present. The 159 participants were randomly assigned to one of four conditions. In each condition, participants were shown 12 different public service announcements designed according to the condition. Participants judged each public service announcement on attractiveness, credibility, clarity of communication and the required amount of reection. After the judgment task, they completed a questionnaire to assess knowledge, perceived advantages and disadvantages of sun protection and intended use of sun protection measures. Results: Pictures enhanced attractiveness, but diminished comprehension. Textual arguments enhanced attractiveness, credibility and comprehension. Pictures as well as textual arguments increased knowledge of sun protection measures. Conclusion: Pictures and textual arguments in public service announcements positively inuence the individuals perception of the advantages of sun protection methods and the advantages of their adoption. # 2006 International Society for Preventive Oncology. Published by Elsevier Ltd. All rights reserved.
Keywords: Skin cancer; Primary prevention; Communication; Experimental design

1. Introduction Overexposure to ultraviolet radiation leads to photo aging [1], and is a major factor in the etiology of skin cancer [24]. It is estimated that 90% of non-melanoma skin cancers and two-thirds of melanomas can be attributed to excessive exposure to the sun [5]. Sun protection methods like staying out of the midday sun, wearing protective clothing, and applying sun screen reduce the risk of skin cancer [6]. Furthermore, wearing sun glasses reduces the risk of lens opacities like cataracts. However, the proper use of these methods among the general public is limited [7,8]. To promote sun protective behavior, mass media campaigns usually employ television and printed
* Corresponding author. Tel.: +31 53 489 3291; fax: +31 53 489 4259. E-mail address: h.boer@utwente.nl (H. Boer).

public service announcements together with additional media, like billboards [9]. In general, sun protection messages consist of behavioral advice (like wear sun protective clothing), supported by arguments indicating the importance of the behavior addressed (like excessive sun exposure enhances wrinkling). For textual arguments to be effective, individuals should reect the messages content and subsequently consider the arguments presented in the message to reach a conclusion [1012]. Limited reection about the textual arguments leads to ineffective messages [13]. A promising approach to enhance the effectiveness of sun protection public service announcements is the appropriate use of pictures to evoke the use of mental imagery [14]. Research has shown that pictures may improve attention, comprehension, recall and adherence to health advice [1416]. Positively evaluated pictures may

0361-090X/$30.00 # 2006 International Society for Preventive Oncology. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.cdp.2006.06.001

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produce a higher level of public service announcements attractiveness and lead to more favorable attitudes towards the content of the message [17]. However, little is known about the interactive effects of textual arguments and pictures in health communication. Pictures possibly might evoke more reection about the message, resulting in acceptance of the sun protection advice, even without the presence of textual arguments. An individuals attitude towards different modes of sun protection is postulated as a major psychological determinant in predicting actual sun protection behavior [1820]. Attitudes refer to favorable or unfavorable feelings with respect to a given object or behavior. Therefore, sun protection public service announcements succeeding in changing these attitudes will be more effective. In the study described here, attitudes are related to the perceived advantages and disadvantages of sun protection measures use. Public service announcements, if targeted at transposing misperceptions about the advantages of sun protection measures, can be helpful of clarifying and illustrating these advantages. In their review of pictures effects in health communication, Houts et al. [16] concluded that in general, pictures provide signicant benets. However, it remains hard to predict peoples responses to pictures in health communication, because of the studies inconsistent results [16]. Therefore, this study aims at providing insight into both pictures and textual arguments benecial contribution to judgment, gained knowledge, and perceived advantages of sun protection measures in public service announcements.

Fig. 1. The 2 2 factorial between subjects design of the study, with four conditions with different combinations of pictures and textual arguments.

containing twelve different public service announcements aimed at promoting sun protective behaviorthree for each of the four sun protection measures, i.e., staying out of the midday sun, wearing protective clothing, using sun screen, and wearing sun glasses. The public service announcements were presented in a xed random order within each condition. After presentation of each public service announcement the participants answered a few questions on its judgment. After judging all of the public service announcements, the subjects completed a questionnaire. It took about 15 min for respondents to complete the judgement task and 5 min to complete the questionnaire. 2.3. Materials The public service announcements employed in this study were designed by using professional photo editing software. On the basis of the 2 2 factorial design with the factor textual argument (present or not present) and the factor pictures (present or not present), four different versions of each public service announcement were created. Fig. 2 represents an example of the four different executions as just described. The basic format of the public service announcements was similar across all conditions; a logo, consisting of a yellow sun with sunrays supported by a slogan (Practice safe sun tanning) combined with one of the four sun protection advices (using sun screen, wearing covering clothes, avoiding the sun between 12:00 p.m. and 3:00 p.m., and wearing sunglasses with UV-protection while in the sun). The presence or absence of textual arguments and pictures supporting the given behavioral advice differed across the experimental conditions. In condition A (argument present and picture present), sun protection advice was accompanied with one of the three arguments that explain the possible outcomes of that behavior (e.g., Overexposure to sunlight during a longer period of time causes premature skin aging). Different pictures were used in each of these public service announcements related to the different possible outcomes of unprotected sun tanning behavior: three pictures related to

2. Methods 2.1. Design This study involved four experimental conditions, in which subjects were confronted with public service announcements that contained a slogan (Practice safe sun tanning) together with a concrete sun protection advice (e.g., Always use sun screen on uncovered skin, when you are in the sun). The advice was supported by different combinations of pictures and textual arguments on the basis of a 2 2 factorial between subjects design of the factor picture (presentnot present) and the factor textual argument (presentnot present), as shown in Fig. 1. 2.2. Participants and procedure Participants (N = 159) were recruited from the University of Twente and a college, both located in Enschede, the Netherlands. Respondents were randomly allocated to one of the four experimental conditions according to a random list. The experiment was presented as a study on the execution of public service announcements about sun protection methods. Respondents received a booklet

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Fig. 2. A diagram with examples of the four types of public service announcements used in the experiment (condition (A): textual argument and picture; condition (B): no textual argument and picture; condition (C): textual argument and no picture; condition (D): neither textual argument nor picture).

sunburn (e.g., red sun burn faces), three pictures related to wrinkles (e.g., faces with wrinkles), three pictures related to skin cancer (e.g., melanomas), and three pictures related to damage of the eye (e.g., a Braille alphabet). Condition B (argument not present and picture present) resembled the format of condition A, however differing from that condition by absence of a textual argument. In this condition, each advice was accompanied simply by a picture related to the possible negative outcomes. Condition C (argument present and picture not present) differed from A in the sense that pictures were absent. The behavioral advice in this condition was simply accompanied by a textual argument. In condition D (argument not present and picture not present) the public service announcements consisted of the logo, slogan, and behavioral advice. Both pictures and textual arguments were absent. To obtain sufcient variety in all conditions, especially in condition D, the public service announcements were printed

on three different colors of paper that varied systematically among behavioral advice and conditions. By applying this method, we controlled for an equally distributed frequency of color use with arguments, pictures, and condition. A pretest among ten subjects was executed to assure comprehensibility of all public service announcements within all conditions. 2.4. Measures 2.4.1. Demographic characteristics and current sun protection behavior We assessed age, gender and existing sun protection behavior in the past summer (using sun screen, wearing protecting clothes, avoiding the erce midday sun, wearing sunglasses) on a ve-point scale with extremes never (1) . . . always (5). The items formed an internally consistent scale (Cronbachs a = 0.72).

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2.4.2. Judgement of the public service announcements Participants judged each public service announcement on attractiveness (I think the public service announcement is attractive), credibility (I think the public service announcement is credible), comprehensibility (I think the public service announcement is easy to understand) and the required amount of cognitive processing (The public service announcement has given me food for thought) on ve-point Likert scales (strongly disagree (1) to strongly agree (5)). Internal consistency was computed across the twelve public service announcements to indicate the scales reliability. Good levels of internal consistency were found for attractiveness (a = 0.86), credibility (a = 0.86), comprehensibility (a = 0.84) and required amount of reection (a = 0.91). 2.4.3. Knowledge To assess knowledge, respondents were asked to recall as many negative consequences of excessive sun exposure as well as sun protection advices as they could. The total number of correctly mentioned negative consequences (04) and the total number of correctly mentioned sun protection advice (04) was scored. 2.4.4. Perceived advantages of sun protection Perceived advantages of sun protection, like preventing sun burn, wrinkles and skin cancer, were assessed separately for using sun screen (a = 0.58), wearing skin covering clothes (a = 0.63) and avoiding the erce sun between 12:00 p.m. and 3:00 p.m. (a = 0.72). The advantages of wearing sun glasses were assessed by two items on the prevention of damage to the eyes and prevention of sight loss (r = 0.75). Respondents indicated their level of agreement with the statements on a ve-point Likert scale ranging from strongly disagree (1) to strongly agree (5). 2.4.5. Perceived disadvantages of sun protection methods Perceived disadvantages of sun protection were measured separately with three-item scales for using sun screen (tan less quickly, skin becomes greasy, unpleasant smell; a = 0.57), wearing skin covering clothes (tan less quickly, too hot, sweating; a = 0.69), avoiding the erce sun between 12:00 p.m. and 3:00 p.m. (tan less quickly, keeps me from doing what I like outside, keeps me from enjoying the sun; a = 0.63), and wearing sun glasses (causes white edges around the eyes, sunglasses do not suit me, sunglasses are inconvenient; a = 0.89). Participants responded on a vepoint Likert scale ranging from strongly disagree (1) to strongly agree (5). 2.4.6. Intended sun protection Intended sun protection behavior was assessed separately for each of the four sun protection behaviors stressed in this study by a ve-point Likert scale with extremes strongly

disagree (1) to strongly agree (5). Each of the particular sun protection behaviors was assessed by three items representing the behavior in three different settings (i.e., on the beach, around the house, during outdoor activities). The scales showed good internal consistencies; a = 0.80 (sun screen use), a = 0.85 (wearing skin covering clothes), a = 0.84 (avoiding the midday sun), and a = 0.93 (wearing sun glasses). 2.4.7. Statistical analysis Data were analyzed using the Statistical Package for the Social Sciences 12 (SPSS). Mean scores were computed for all scales. Univariate analysis of variance was performed to test equal distribution of the subjects among the four conditions for age and level of previous sun protection behavior. A x2-test was employed to test equal gender distribution across experimental conditions. Data analysis intended to determine both main and interactive effects of textual arguments and pictures in public service announcements on judgments, amount of reection, knowledge, and perceived advantages and disadvantages of sun protection behaviors. Univariate analyses of variance were performed to test the effects of pictures and textual arguments on these dependent variables. Statistical signicance was assumed with a p-value of 0.05.

3. Results The sample (n = 159) consisted of 103 males (65%) and 56 females (35%), ranging in age from 17 to 27 years old with a mean age of 21.5 years. No signicant differences between the conditions with respect to mean age (F (3, 155) = 1.3, ns), gender (x2 = 2.1, d.f. = 3, ns), and level of previous sun protection behaviors (F (3, 155) = 1.5, ns) were found. Table 1 shows the signicant effects of both pictures and textual arguments on the judgment of public service announcements. The presence of pictures enhanced attractiveness signicantly, but led to signicantly lower levels of comprehensibility. Furthermore, pictures in public service announcements affected reection signicantly in a positive direction. The presence of textual arguments led to signicantly higher levels of attractiveness, credibility, and comprehensibility. Furthermore, textual arguments evoked signicantly more reection. Pictures and textual arguments had signicant interactive effects on attractiveness of and reection about the public service announcements. Inspection of the mean scores showed substantially lower scores for attractiveness and reection for public service announcements with no pictures and no textual arguments. Public service announcements with pictures or textual arguments lead to signicantly more knowledge about sun exposure consequences than did public service

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Table 1 Mean scores (standard deviations) in the four experimental conditions on the judgments of the public service announcements and knowledge assessed after the judgment task Textual argument present Pictures Not present Noa Judgment of PSAs Attractiveness Credibility Comprehensibility PSA reection Knowledge Sun exposure consequences Sun protection advice 1.8 2.8 3.4 1.9 (0.5) (0.6) (0.5) (0.6) Yesb 2.3 3.3 3.7 2.3 (0.6) (0.6) (0.5) (0.7) Present Noc 2.6 2.8 3.2 2.6 (0.5) (0.5) (0.6) (0.6) Yesd 2.5 3.1 3.4 2.6 (0.5) (0.5) (0.5) (0.6) 41.4*** 1.4 7.9 ** 26.6*** 20.1*** <1 7.1 ** 16.5*** 8.4 ** 4.9 * 25.7*** <1 9.4 ** 1.4 <1 4.4 * 27.3*** 4.6 * Main effect pictures, F(1, 150) Main effect textual argument, F(1, 150) Interaction, F(1, 150)

1.8 (0.8) 2.8 (0.9)

3.2 (0.7) 3.1 (0.8)

3.1 (0.9) 3.1 (0.9)

3.1 (1.0) 2.9 (0.9)

Note: an = 40, bn = 40, cn = 40, dn = 39. * p < 0.05. ** p < 0.01. *** p < 0.001.

announcements without pictures or textual arguments, as shown in Table 1. The interactive effect of pictures and textual arguments appeared to be signicant on knowledge about the negative outcomes of overexposure to the sun. Inspection of the mean scores revealed substantially less knowledge in the condition without both pictures and textual arguments. Knowledge of sun protection advice was not signicantly inuenced by the presence of only pictures or textual arguments. The public service announcements used in this study were designed to positively inuence the perceived advantages of four sun protection measures: using sun screen, wearing protective clothing, avoiding erce midday sun and, wearing UV-protective sun glasses. No signicant main effects of pictures on the perceived advantages of sun protection measures were found, as shown in Table 2. The presence of textual arguments in public service announcements did not result in signicantly higher levels of perceived advantages of the following sun protection measures: using sun screen, wearing protective clothing, and wearing sun glasses. However, textual arguments led to higher levels of perceived advantages regarding the behavioral advice to avoid the erce midday sun. The presence of both pictures and textual arguments in the announcements had signicant interactive effects on the

perceived advantages of protective clothing, avoiding the erce sun, as well as wearing sun glasses. Mean scores were substantially higher than among subjects confronted with announcements lacking either pictures or textual arguments. Although the public service announcements were designed to positively affect the perceived advantages of four sun protection behaviors, we also analyzed whether they inuenced perceptions about the disadvantages of sun protection measures and intentions of their use. Neither pictures nor textual arguments in public service announcements affected the perceived disadvantages of sun protection measures signicantly, as shown in Table 3. The interactive effect was not signicant either. Using either pictures or textual arguments in public service announcements did not affect the intention to employ techniques for sun protection. Mean scores indicated that intention to wear sun glasses was signicantly lower among participants exposed to announcements without pictures or text arguments.

4. Discussion This study explored the effects of pictures and textual arguments in public service announcements to promote the perceived advantages of sun protection measures. In an

Table 2 Mean scores (standard deviations) in the four experimental conditions on perceived advantages of sun protection measures Textual argument present Pictorial argument Not present Noa Sun screen use Protective clothing Avoiding erce sun Wearing sun glasses 3.7 3.6 3.6 3.4 (0.6) (0.6) (0.7) (0.7) Yesb 3.9 4.0 4.0 4.0 (0.6) (0.6) (0.5) (0.8) Present Noc 4.0 3.9 3.8 3.9 (0.6) (0.8) (0.7) (0.8) Yesd 3.8 3.8 3.8 3.8 (0.6) (0.6) (0.6) (0.8) 1.7 <1 <1 <1 <1 3.0 5.7 * 2.8 3.6 4.8* 5.1* 6.4* Main effect pictures, F(1, 155) Main effect textual argument, F(1, 155) Interaction, F(1, 155)

Note: an = 40, bn = 40, cn = 40, dn = 39. * p < 0.05.

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Table 3 Mean scores (standard deviations) in the four experimental conditions on disadvantages of sun protection measures and intended sun protection behavior Textual argument present Pictorial argument Not present Noa Disadvantages of sun protection Sun screen use 2.8 Protective clothing 3.5 Avoiding erce sun 3.2 Wearing sun glasses 2.6 Intended behavior Sun screen use Protective clothing Avoiding erce sun Wearing sun glasses 2.9 2.9 2.2 2.9 (0.9) (0.9) (0.9) (0.9) (0.9) (1.0) (0.8) (1.0) Yesb 2.9 3.6 3.2 2.7 3.0 2.7 2.3 3.7 (0.9) (0.8) (0.8) (1.2) (1.0) (1.0) (0.9) (1.2) Present Noc 2.6 3.2 3.0 2.2 3.4 2.6 2.2 3.4 (0.8) (0.9) (0.8) (0.7) (0.8) (0.9) (0.8) (1.0) Yesd 2.7 3.5 3.2 2.6 3.0 2.6 2.3 3.2 (0.8) (0.8) (0.8) (0.8) (0.8) (0.8) (0.8) (1.0) 1.6 2.0 <1 3.0 2.4 1.6 <1 <1 <1 2.1 1.2 3.6 1.0 <1 <1 2.4 <1 <1 <1 1.9 2.5 <1 <1 9.0 * Main effect pictures, F(1, 158) Main effect textual argument, F(1, 158) Interaction, F(1, 158)

Note: an = 40, bn = 40, cn = 40, dn = 39. * p < 0.05.

experimental setting participants were exposed to public service announcements, with each containing similar advice on sun protection methods, although varying regarding presence or absence of both pictures and textual arguments. Pictures were hypothesized to underscore the advantages of the use of sun protection methods in a visual way (like a photo of a wrinkled face); textual arguments to underscore the advantages of sun protection advice by representing the possibly positive outcomes of the sun protection method addressed. Results of this study showed that pictures in public service announcements had a signicant positive effect on attractiveness, but a negative effect on comprehensibility. This effect might be due to the fact that the pictures used in the study required a higher level of attention and reection, as some of these pictures were a bit puzzling to attract attention and promote reection (e.g. a picture of a Braille alphabet in combination with the argument that overexposure to the sun can damage the eyes). Houts et al. concluded that pictures in health communication can improve comprehension, especially among people with low literacy skills [16]. We agree with their advice to use simple and realistic pictures, because as this study shows, the use of more difcult pictures negatively affects comprehensibility, even among highly educated students. Pictures in public service announcements led to signicantly higher levels of reection. This nding is in accordance with the expectation that pictures will allure subjects into more elaborate cognitive processing of the argument from the public service announcements [14,15]. Those presenting textual arguments were judged to be signicantly more attractive, comprehensible and credible than public service announcements without text arguments. Public service announcements with text arguments also lead to more reection, in accordance with the elaboration likelihood model, that assumes that with the presence of arguments in the message, subjects will make an effort to reach a conclusion on the basis of processing these arguments [12].

The more elaborate processing of public service announcements with pictures and textual arguments was also reected in the recall of the content of the public service announcements. Participants confronted with public service announcements with pictures or textual arguments were able to report a signicantly higher number of negative consequences of overexposure to the sun than participants confronted with public service announcements without pictures or textual arguments. A signicant interactive effect of pictures and textual arguments on knowledge about negative consequences pointed out that participants who were confronted with public service announcements with neither pictures nor textual arguments performed substantially poorer in reporting negative consequences of overexposure to the sun than the other participants. This indicates that the provision of either a picture or a textual argument in a sun protection public service announcement substantially improves the knowledge of the negative consequences of overexposure to the sun. The nding that pictures improve knowledge is in line with Houts et al.s nding that pictures in health communication enhance recall [16]. In general, public service announcements with pictures or textual arguments did not have a main effect on the perceived advantages of sun protection methods. Textual arguments only enhanced the perceived advantages of avoiding the erce midday sun. Pictures as well as textual arguments had signicant interactive effects on the perception of the advantages of wearing protective clothes, avoiding the erce sun and wearing sun glasses. Inspection of mean scores indicated that these interaction effects were caused by substantially lower perceived advantages of these sun protection behaviors among participants who were confronted with public service announcements lacking both pictures and textual arguments. No effects on perceived disadvantages and sun protection intentions were found. These results indicate that the persuasiveness of public service announcements is limited.

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H. Boer et al. / Cancer Detection and Prevention 30 (2006) 432438 [2] Osterlind A, Tucker MA, Stone BJ, Jensen OM. The Danish casecontrol study of cutaneous malignant melanoma. II. Importance of UV light exposure. Int J Cancer 1988;42:31924. [3] Green A, Siskind V, Bain C, Alexander J. Sunburn and malignant melanoma. Br J Cancer 1985;51:3937. [4] MacKie RM, Aitchison T. Severe sunburn and subsequent risk of primary cutaneous malignant melanoma in Scotland. Br J Cancer 1982;46:95560. [5] Koh HK, Geller AC, Miller DR, Grossbart TA, Lew RA. Prevention and early detection strategies for melanoma and skin cancer: current status. Arch Dermatol 1996;132:43642. [6] Verne J. Editorial: preventing skin cancer: messages should emphasize the need to cover up and stay out of the sun. Br Med J 2003;326: 1145. [7] Jones F, Harris P, Chrispin C. Catching the sun: an investigation of sun exposure and skin protection behaviour. Psychol Health Med 2000;5: 13141. [8] Mermelstein RJ, Riesenberg LA. Changing knowledge and attitudes about skin cancer risk factors in adolescents. Health Psychol 1992;11:3716. [9] Smith BJ, Ferguson C, McKenzie J, Bauman A, Vita P. Impacts from repeated mass media campaigns to promote sun protection in Australia. Health Promot Int 2002;17:5160. [10] Christensen TP, Ascione FJ, Bagozzi RP. Understanding how elderly patients process drug information: a test of a theory of information processing. Pharmaceut Res 1997;14:158996. [11] Petty RE, Cacioppo JT, Schumann D. Central and peripheral routes to advertising effectiveness: the moderating role of involvement. J Consum Res 1983;10:13546. [12] Petty RE, Cacioppo JT. In: Berkowitz L, ed. The elaboration likelihood model of persuasion. Advances in experimental social psychology, vol. 19. New York: Academic Press, 1986. p.123205. [13] MacInnis DJ, Jaworski BJ. Information processing from advertisements: toward an integrative framework. J Market 1989;53: 123. [14] Cherry KE, Park DC, Frieske DA, Smith AD. Verbal and pictorial elaborations enhance memory in younger and older adults. Aging Neuropsychol Cogn 1996;3:1529. [15] Cherry KE, Dokey DK, Reese CM, Brigman S. Pictorial illustrations enhance memory for sentences in younger and older adults. Exp Aging Res 2003;29:35370. [16] Houts PS, Doak CC, Doak LG, Loscalzo MJ. The role of pictures in improving health communication: a review of research on attention, comprehension, recall, and adherence. Pat Educ Couns 2006;61:173 90. [17] Mitchell AA. The effect of verbal and visual components of advertisements on brand attitudes and attitude toward the advertisement. J Consum Res 1986;13:1224. [18] Jackson KM, Aiken LS. A psychosocial model of sun protection and sunbathing in young women: the impact of health beliefs, attitudes, norms and self-efcacy for sun protection. Health Psychol 2000;19: 46978. [19] Jones F, Abraham C, Harris P, Schulz J, Chrispin C. From knowledge to action regulation: modeling the cognitive prerequisites of sun screen use in Australian and UK samples. Psychol Health 2001;16: 191206. [20] Branstrom R, Ullen H, Brandberg Y. Attitudes, subjective norms and perception of behavioral control as predictors of sun-related behaviour in Swedish adults. Prev Med 2004;9:9929.

Pictures in public service announcements mainly inuence attractiveness, reection and knowledge. Textual arguments affect attractiveness, credibility, comprehensibility, reection and knowledge. Some limitations of this study need to be mentioned. The experimental methods may have limited the external validity of results. Participants were exposed to a booklet of twelve public service announcements, which does not mimic exposure to public service announcements in real life. Furthermore, participants had higher educational backgrounds, which may limit the validity of the results to this specic population. A third limitation refers to the fact that participants in condition D (exposure to public service announcements containing neither pictures nor textual arguments), still showed rather high mean scores on advantages of sun protection behaviors. This indicates that the possible persuasive effects of the public service announcements may have been limited due to ceiling effects. Possibly more extensive effects of pictures and textual arguments on the perceived advantages of sun protection methods could be achieved among participants who are a priori less convinced of the advantages of sun protection methods. Finally, in this study single item measures were used to assess attractiveness, credibility, comprehensibility and reection. Although analyses of the internal consistencies indicated that respondents judgments were consistent across the public service announcements, it may be a better option in future research to use multiple item scales to get a better indication of the internal consistency of the judgment of individual public service announcements. It can be concluded from this study that pictures and textual arguments in public service announcements have complementary effects. Pictures enhance public service announcements attractiveness and instruct in the sense that they substantially improve knowledge about the negative consequences of unprotected overexposure to the sun. Text arguments also improve this knowledge. However, text primarily enhances credibility and comprehensibility. Practitioners are advised to use text as well as pictures in the design of effective sun protection public service announcements. Considering the limited persuasive effects of public service announcements in this study, it is suggested to support them with other communication means in sun protection campaigns.

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