Is there a panacea for message adherence? Evaluating the effectiveness of social norms and self-construal on message adherence

Abstract

Although adhering to a specific health message may seem like a personal choice, this adherence is associated with a combination of internal factors and external influences. This study, conducted through an online survey experiment with 364 Chinese adults, explores how self-construal related to the role of social norms in message adherence, with perceived information diagnosticity as a mediator. The results show that descriptive norms correlate with higher health message adherence compared to injunctive norms. Specifically, among individuals with an interdependent self-construal, descriptive norms are associated with significantly greater adherence compared to injunctive norms. In contrast, among those with independent self-construal, adherence differences between norm types are non-significant. Furthermore, the interaction between social norms and self-construal is indirectly linked to adherence through perceived information diagnosticity. These findings enrich our understanding of social norm theory and provide practical strategic suggestions for improving the effectiveness of health communication.

Keywords

message adherence self-construal perceived information diagnosticity descriptive norms injunctive norms

Introduction

The World Health Organization (WHO) reported in 2023 that approximately 10% of global gross domestic product (GDP) is devoted annually to healthcare (WHO, 2023). A substantial portion of this expenditure is allocated to health communication, specifically to persuasive campaigns aimed at enhancing disease detection. Despite considerable financial investments, the efficacy of these communication initiatives varies significantly. This variation can be attributed to factors such as the framing of information, characteristics of the target audience, and the adaptability of the campaigns to cultural contexts. In the culturally diverse and extensive landscape of China, societal values are deeply intertwined with the pursuit of health and well-being. The dissemination of health information to the public constitutes a crucial initial step toward successful health communication. However, the true measure of effectiveness is gauged not merely by the reach of this dissemination but by the resultant impact on public behavior and subsequent health outcomes (Finset et al., 2020).

This phenomenon is particularly observable in the context of glaucoma screening. In China, screening initiatives are primarily community-based, often integrated with annual health check-ups for high-risk groups (Liang et al., 2018). It typically involves intraocular pressure measurement, optic nerve imaging, and visual field testing (McCafferty et al., 2025). Public awareness campaigns utilize state media (e.g., CCTV health programs), social media platforms (WeChat health portals), and community health worker outreach (Sun et al., 2022). Recent data indicates that the prevalence of glaucoma in China stands at 2.58%, with the affected population reaching 26 million. This figure represents approximately one-quarter of the global incidence of glaucoma, with 5.67 million of these cases potentially progressing to blindness. Notably, glaucoma is increasingly affecting younger demographics and remains the leading cause of irreversible blindness worldwide. Prevention and treatment strategies emphasize the importance of early screening, early prevention, and timely diagnosis. Regular eye examinations are essential for preventing glaucoma (McCafferty et al., 2025).

Within the Chinese cultural paradigm, the eyes are metaphorically described as “炯炯有神,” which translates to “bright and spirited,” reflecting their role as crucial organs for perceiving the world and expressing emotions (Yuki et al., 2007). Glaucoma, often dubbed the “silent thief of sight,” represents a significant threat to the visual health of numerous individuals in China. Despite its widespread prevalence, many individuals remain uninformed about their risk due to the insidious nature of the disease. Thus, the importance of effective health communication is paramount. However, our comprehension of how to effectively engage and motivate individuals to heed health advisories, particularly concerning glaucoma screening, is still evolving.

Research has demonstrated that social norms significantly correlate with individual behaviors, often to a greater extent than personal awareness (Andrighetto and Vriens, 2022). In the realm of health message adherence, individuals meticulously analyze, judge, and evaluate health information based on their personal health needs, which facilitates the absorption and internalization of this information. Nevertheless, the actual impact of this internalized information on subsequent behaviors is frequently shaped by prevailing social norms (Sun et al., 2019).

To enhance the effectiveness of health communication strategies pertaining to glaucoma screening in China, it is essential to possess a deep understanding of social norms and to skillfully apply this knowledge (Rimal and Real, 2005). Research has demonstrated that both descriptive and injunctive norms are predictive of adherence to health-related behaviors (Dillard et al., 2021; Rudert and Janke, 2021). However, there remains a significant gap in understanding the specific mechanisms and contexts associated with adherence to glaucoma screening guidelines (Yang, 2017).

Accordingly, this study examines how descriptive versus injunctive norms associate with individuals’ adherence to glaucoma screening messages. Additionally, it introduces the concept of perceived information diagnosticity to clarify the mechanisms underlying these effects. Health behaviors are also associated with personal characteristics and cognitive-cultural factors. Notably, the concept of self-control, which is heavily shaped by cultural definitions of self, emerges as a stable cultural trait that correlates with cognition, emotions, and motivations at the individual level (Cross et al., 2000). As such, this research will also explore the moderating role of self-construal. These insights are indispensable for elucidating the decision-making processes that underpin health behaviors from a social psychological perspective, and they provide crucial guidance for developing communication strategies aimed at enhancing glaucoma screening initiatives in China.

Literature review

The role of social norms in health issues

The Focus Theory of Normative Conduct, articulated by Cialdini et al. (1990), distinguishes between two types of social norms: descriptive norms and injunctive norms. These norms serve as unwritten guidelines that correlate with our social interactions and shape our attitudes and beliefs. Descriptive norms are based on the observable actions practiced by the majority within a group, suggesting that “if everyone is doing it, it must be sensible” (Nolan et al., 2008). In contrast, injunctive norms derive from the explicit approval or disapproval expressed by group members regarding specific behaviors (Cialdini et al., 1990). Descriptive norms often function like a shortcut or heuristic in the decision-making process (Jacobson et al., 2011). It provides information about the right way to act and through that serve our goal of accuracy. However, we conform to injunctive norms because we have a desire to build and maintain meaningful relationships with others. Through strategic action we aim to obtain social approval, and avoid disapproval and other social sanctions (Cialdini et al., 1990). Consequently, these two types of norms impact behavior differently (Crăciun et al., 2018).

The Focus Theory proposes that the role of descriptive and injunctive norms manifests only when individuals’ attention is directed toward normative information (Reno et al., 1993). Such norms demonstrate robust associations with behavior by signaling prevalent practices or expectations within groups. The efficacy of normative appeals in promoting desired attitudinal and behavioral changes has been robustly validated across various studies (Rhodes et al., 2020).

Descriptive versus injunctive norms

Descriptive norms and injunctive norms provide different types of information, leading to varying impacts on human behavior. Studies have illustrated the efficacy of descriptive norms in fostering healthy lifestyle habits (Burger and Shelton, 2011), promoting sustainable food choices (Salmivaara et al., 2021), supporting recycling initiatives (Nigbur et al., 2010), and encouraging healthier eating practices (Robinson et al., 2014). Conversely, research has highlighted the significance of injunctive norms in influencing decision-making across various contexts, including alcohol consumption (Rimal and Real, 2005), sun protection attitudes (Reid and Aiken, 2013), and chlamydia testing intentions (Booth et al., 2014). Academic discourse reflects diverse perspectives on the distinct roles of these social norm types, with ongoing debate regarding their associations with social behaviors. Recognized as a potent mechanism for nudging behavioral change, social norms offer a cost-effective and straightforward method for intervening in health behaviors. This study aims to investigate potential differences in the impact of descriptive and injunctive norms on adherence with health-related messages. Therefore, we pose the following research question:

RQ1: Which type of norm-based messaging—descriptive or injunctive—correlates with greater adherence to health messages?

Exploring the role of self-construal

Self-construal represents a constellation of thoughts, feelings, and behaviors pertaining to one’s relationships and distinctions between oneself and others (Singelis, 1994). This concept aids individuals in understanding their identities and in shaping their perceptions of interpersonal relationships (Cross et al., 2000). Self-construal is broadly categorized into two types: independent and interdependent. Independent self-construal characterizes the self as distinct and separate from the social environment, described as “clear-bounded, unitary, and stable.” Conversely, interdependent self-construal emphasizes a “flexible and changeable” self, highlighting the interconnectedness among individuals (Markus and Kitayama, 1991: 230). According to Singelis (1994), these types of self-construal are orthogonal, allowing individuals to adapt their emphasis on either type based on varying circumstances and needs, thereby influencing their motivations and cognitive processes. Typically, individuals with an independent self-construal value autonomy in decision-making and prioritize personal freedom, whereas those with an interdependent self-construal are more likely to assimilate into social networks and consider group interests.

Extensive research identifies self-construal as a key classifier of normative responsiveness, with systematic variations in behavioral patterns across cultural cognition types. Individuals with an interdependent self-construal derive a significant portion of their identity from their social relationships and group memberships. They prioritize maintaining group harmony and fulfilling social roles, which makes them more responsive to descriptive norms. Descriptive norms highlight the common behaviors within a group, and individuals with an interdependent self-construal are motivated to align their behavior with the group to maintain social cohesion and avoid social disapproval (Trumbo, 1999). For instance, individuals with pronounced interdependent self-construal demonstrate heightened responsiveness to normative contexts, reflecting their stronger emphasis on belongingness and commitment to social obligations compared to those with weaker interdependent orientations. (Markus and Kitayama, 1991). Moreover, interdependent self-construal shows a positive association with the weight given to subjective norms in behavioral intention formation. This heightened normative salience corresponds to stronger adherence linkages with sustainable behaviors when normative appeals are employed (White and Simpson, 2013). Additionally, Yang (2017) observed that interdependent self-construal differentiates responses to descriptive norms, with stronger covariation between these norms and drinking intentions among individuals high in interdependence. Based on these findings, we propose the following hypothesis concerning the role of self-construal in moderating the relationship between social norms and message adherence:

H1: Among individuals with interdependent self-construal, descriptive norm-based messages correlate with higher adherence than injunctive norm-based messages. For those with independent self-construal, adherence levels show no significant variation across norm types.

Exploring the role of perceived information diagnosticity

Information diagnosticity is defined as the degree to which inferences made from a piece of information are adequate for forming judgments and making decisions (Inman et al., 1997). When information is perceived as highly diagnostic, it significantly correlates with attitudes and behaviors. Under comparable conditions, individuals are more inclined to depend on information they perceive as diagnostic to support their judgments and decisions (Kramer and Yoon, 2007).

Perceived information diagnosticity acts as a critical mediating factor that correlates with the adoption of information and adherence with it. Previous studies have demonstrated that individuals evaluate the diagnosticity of information by assessing its usefulness, relevance, significance, and the extent to which it facilitates their decisions regarding disease screening (Pham and Avnet, 2004). Feldman and Lynch (1988) argued that diagnosticity is a prerequisite for information to be persuasive. Perceived information diagnosticity shows a positive association with individuals’ attitudes toward the information. Specifically, the greater the perceived diagnosticity, the higher the individual’s assessment of the information’s expected value, thereby enhancing their adherence with the information (Feldman and Lynch, 1988). Additionally, when individuals perceive high diagnosticity, it strongly correlates with the formation of robust beliefs (Kempf and Smith, 1998). Moreover, both descriptive and injunctive norms bolster individuals’ trust in and willingness to comply with the information by highlighting these aspects, ultimately leading them to adopt behaviors that align with health norms (Germar and Mojzisch, 2019). Notably, individuals with an independent self-construal tend to focus more on their internal feelings that distinguish them from others and act based on these feelings because they perceive them as diagnostic. Conversely, those with an interdependent self-construal value information that reflects others’ opinions or guidance on assimilation (Aaker, 2000). Consequently, the interplay between social norms and self-construal may correlate with individuals’ adherence with messages through the mediating role of perceived information diagnosticity. This mediation allows for the testing of the following hypotheses:

H2: Perceived information diagnosticity mediates the relationship between social norms and message adherence in health contexts.

H3: Perceived information diagnosticity mediates the interaction effect between self-construal and social norms (descriptive vs injunctive) on message adherence in health contexts.

The study further proposes a hypothetical model based on these hypotheses and research questions, as depicted in Figure 1.

Methods

Design and participants

A 2 (social norms: descriptive norms vs injunctive norms) × 2 (self-construal: independent vs interdependent) online between-subjects experiment was conducted in November 2024. Before the formal experiment, eight professors with doctoral degrees and research background in health informatics were invited to conduct a pre-test to optimize the experimental material design, typesetting structure, and language expression. Following the exclusion of eight participants due to screening errors, the final sample consisted of 364 Chinese adults, recruited via Qualtrics panels, a validated sampling framework widely used in behavioral research. Qualtrics maintains a proprietary database of pre-registered Chinese adults who opt into research studies. Upon completion of the experiment, each participant was compensated with 10 RMB. They were informed of the study’s purpose during recruitment but were blinded to the specific focus on glaucoma screening to avoid self-selection bias.

The demographic profile of the sample was balanced with respect to gender (50% female) and varied in age (M_age = 37.85, SD_age = 9.90). Educational backgrounds ranged from junior high school or less (22%) to postgraduate studies (7.4%), with additional categories including senior high school (28.6%) and bachelor’s degrees (42%). The study received approval from the institutional review board at the university, and only those participants who correctly answered an attention check regarding the primary topic were included in the final analysis.

Stimuli and experimental manipulations

The experimental stimuli focused on common symptoms and incidence rates of glaucoma, highlighting the importance of participation in glaucoma screening through a fictional program named “QGY.” The content of the stimuli was consistent across different conditions, barring the manipulation of social norms detailed in the Appendix. Messages employing descriptive norms stated, “Upon learning about the glaucoma screening program ‘QGY’, 8 out of 10 respondents undergo this examination to protect their eye health.” Conversely, injunctive norm messages indicated, “Upon learning about the glaucoma screening program ‘QGY’, 8 out of 10 respondents approve of undergoing this examination to help protect their eye health.” The length of these messages varied slightly, ranging from 595 to 603 words, and were derived from actual reports by Chinese official media. All materials and survey questions were developed in Chinese.

Procedure

The study was administered via the Qualtrics online survey platform. Participants consented to participate before commencing the survey, which began with a demographic assessment. Subsequently, participants were randomly assigned to one of the experimental conditions (descriptive norms or injunctive norms). After exposure to the stimuli, they responded to manipulation check questions and completed a questionnaire that assessed self-construal, perceived information diagnosticity, and message adherence. The entire procedure lasted approximately 15 minutes.

Measures

Self-construal was adapted from Singelis (1994) using an eight-item scale on a seven-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). It includes items such as “I’d rather depend on myself than others” and “The well-being of my co-workers is important to me.” Following the recommendations of Lee et al. (2021), items measuring interdependence were reverse-coded and combined with the scores for independence to define self-construal. Higher scores indicate greater independence, while lower scores suggest greater interdependence (Cronbach’s alpha α = 0.89, KMO = 0.85, M = 4.32, SD = 1.68).

Perceived descriptive norms was measured using four items adapted from Lapinski et al. (2014) on a seven-point Likert scale. Sample items are “Most of the coworkers around me undergo glaucoma screenings thoroughly,” “Most of the coworkers around me engage in thorough glaucoma screenings,” “Most of the coworkers around me undergo glaucoma screenings as thoroughly as they are supposed to,” and “The majority of the people around me undergo glaucoma screenings thoroughly” (Cronbach’s alpha α = 0.91, KMO = 0.86, M = 4.12, SD = 1.90).

Perceived injunctive norms were measured using four items adapted from Lapinski et al. (2014) on a seven-point Likert scale. Examples include “Undergoing glaucoma screenings is something that most coworkers around me believe you should do,” “The coworkers around me who I interact with daily endorse thorough glaucoma screenings,” “The coworkers around me may judge me based on whether or not I undergo glaucoma screenings thoroughly,” and “I feel like coworkers around me would think less of me if I didn’t undergo glaucoma screenings thoroughly” (Cronbach’s alpha α = 0.92, KMO = 0.82, M = 3.87, SD = 2.06).

Perceived information diagnosticity was measured using four items adapted from Pang et al. (2024) on a seven-point Likert scale, this scale includes questions such as “To what extent do you think your assessment of these claims is useful for you to form an opinion of this message?” and “To what extent do you think your assessment of these claims is relevant for you to form an opinion of this message?” (Cronbach’s alpha α = 0.90, KMO = 0.85, M = 4.42, SD = 1.80).

Message adherence was assessed using three items adapted from Yu and Shen (2012) on a seven-point Likert scale. Examples include “I intend to behave in ways that are consistent with the message,” “I am going to make an effort to do what the message urged me to do,” and “I plan to act in ways that are compatible with the position promoted by the message” (Cronbach’s alpha α = 0.73, KMO = 0.86, M = 4.49, SD = 1.71).

Control variables. Based on the research by Yang (2017), control variables included age, gender, and educational backgrounds. Additionally, to account for the potential influence of issue familiarity on processing motivation (Petty and Cacioppo, 1986), two screening questions were utilized: “Have you ever been diagnosed with the disease described in this message?” and “Have you ever read this message?” This approach helps mitigate bias or confounding effects arising from participants’ prior knowledge or experiences related to the disease or the content of the message.

Results

Random assignment and manipulation check

To evaluate the effectiveness of the random assignment, we performed a series of Chi-square tests and one-way ANOVAs. These tests confirmed that there were no significant differences in demographic variables such as sex, age, educational background, and history of glaucoma among participants.

Additionally, we conducted manipulation checks to measure the impact of exposure to social norm messages on participants’ perceptions of descriptive norms (PDN) and injunctive norms (PIN). A one-tailed t-test revealed that participants exposed to descriptive norms reported significantly higher PDN scores (M = 4.82, SD = 1.67) compared to those exposed to injunctive norms (M = 3.41, SD = 1.88), t = 7.55, p < 0.001. Conversely, those in the injunctive norms condition scored significantly higher on the PIN scale (M = 4.08, SD = 2.08) than their counterparts in the descriptive norms condition (M = 3.65, SD = 2.02), t = −1.97, p < 0.05.

Main results

The main effect of social norms on message adherence was significant (F(1, 363) = 10.76, p = 0.001, $η_{p}^{2}$ = 0.03). The descriptive norms group (M = 4.78, SD = 1.69) experienced significantly more message adherence compared to the injunctive norms (M = 4.20, SD = 1.69), addressing RQ1.

Furthermore, using the Model 4 (n = 364, bootstrapping: 5000 samples, unstandardized path coefficients) from the PROCESS in SPSS, while controlling for factors such as gender, age, and education level, we tested the mediating effect of perceived information diagnosticity in the relationship between social norms and message adherence. In this model, descriptive norms were coded as “1” and injunctive norms as “2.” The mediating variable, perceived information diagnosticity, was treated as a continuous variable and was mean-centered prior to analysis. The results indicated that the direct effect between social norms and message adherence was statistically significant (B = −0.26, 95% CI [−0.43, −0.08]). Additionally, the indirect pathway via perceived information diagnosticity was statistically significant (B = −0.32, 95% CI [−0.62, −0.02]), thereby supporting H2 (Figure 2).

Next, the Model 8 in the SPSS Process was used to test the moderated mediation model while controlling for gender, age, and educational attainment. The moderating variable was self-construal, which was a continuous variable and was mean centered prior to analysis. As Figure 3 shows, at interdependent self-construal (M − 1 SD), descriptive norms significantly provoked more message adherence than injunctive norms (B = −0.49, p < 0.001), whereas at independent self-construal (M + 1 SD), the effect was not significant (B = −0.14, p > 0.05), supporting H1.

The moderated effect (Table 1) of self-construal on the message adherence of “social norms → perceived information diagnosticity → message adherence” was significant (Indirect effect estimate = 0.21, 95% CI [0.08, 0.34]). More specifically, at a level of independent self-construal (M + 1 SD), the indirect effect is not significant (B = 0.01, 95% CI [−0.17, 0.19]). However, at a level of interdependent self-construal (M − 1 SD), the indirect effect is significant (B = −0.41, 95% CI [−0.62, −0.21]). This indicates that as self-construal shifts toward interdependence, the mediating role of perceived information diagnosticity between social norms and message adherence strengthens progressively, thus supporting H3.

Table 1.

Moderated mediation effects test.

Moderator variable	Mediation variable	Adjustment level	Indirect effect	SE	LLCI	ULCI
Self-construal	Perceived information diagnosticity	Interdependent (M − 1 SD)	−0.41***	0.10	−0.62	−0.21
		M	−0.20***	0.07	−0.34	−0.07
		Independent (M + 1 SD)	0.01	0.09	−0.17	0.19

***

p < 0.001.

Discussion

To enhance the effectiveness of health communication regarding glaucoma screening in China, it is crucial to have a deep understanding of social norms and to skillfully apply them. This study explores how self-construal correlates with the impact of social norms on message adherence, particularly through the mediating role of perceived information diagnosticity. The findings provide theoretical contributions and practical implications, which include the following aspects:

Firstly, the research demonstrates that descriptive norms result in higher message adherence regarding health than injunctive norms. This conclusion contradicts earlier studies that identified injunctive norms as more effective in altering health behaviors (Cheng et al., 2021; Liu et al., 2023; Rhodes et al., 2020). A potential explanation for this intriguing finding is that the two types of norms trigger different information processing mechanisms (Trumbo, 1999). According to the Heuristic-Systematic Model (HSM; Aaker and Lee, 2001), descriptive norms prompt heuristic processing, where decisions are made quickly based on external cues. This pattern reflects a tendency toward automatic social alignment via the bandwagon effect, characterized by trust in collective wisdom. Conversely, injunctive norms correspond to systematic processing—a cognitively effortful mode operating through deliberative evaluation pathways. Since individuals often seek to reduce cognitive effort and default to heuristic processing (Davis and Tuttle, 2013), descriptive norms can be more persuasive. Furthermore, the effectiveness of descriptive norms is likely heightened in the Chinese context, where communal life and collectivist values deeply correlate with behavior. These cultural factors encourage mimicking the behavior of others to align with the group (Ding et al., 2023). Therefore, within the Chinese cultural framework, descriptive norms could be more effective in promoting adherence with health behaviors than injunctive norms.

Secondly, when researchers explore the impact of descriptive versus injunctive norms, the role of individuals’ self-construal becomes a crucial factor to consider. This study addresses a research gap by examining how self-construal systematically stratifies the associations between descriptive/injunctive norms and health message adherence. The findings reveal that self-construal types systematically differentiate how social norms relate to health message adherence. Specifically, individuals with an interdependent self-construal are more responsive to descriptive norms compared to those with an independent self-construal. However, there is no significant difference in responsiveness to injunctive norms between these two groups. This observation aligns with the theoretical view that individuals high in interdependence exhibit heightened responsiveness to normative contexts, reflecting their prioritization of social relationships and focus on fulfilling collective duties while mitigating relational risks (Markus and Kitayama, 1991). Conversely, individuals with an independent self-construal tend to act based on their personal desires and values. Descriptive norms, which primarily illustrate prevalent behavioral patterns, are more likely to promote imitative behavior among those with an interdependent self-construal, who place a higher value on harmony and consistency within the group. On the other hand, injunctive norms, which prescribe specific behaviors, tend to have less impact on the behavioral choices of those with an independent self-construal.

Furthermore, this study examines the mediating role of perceived information diagnosticity, revealing that descriptive norms correlate with higher perceived information diagnosticity than injunctive norms, corresponding to increased message adherence. This is a significant discovery. Perceived information diagnosticity involves individuals’ evaluation of the usefulness, relevance, and significance of information for decision-making concerning health issues (Spencer et al., 2005). These findings contextualize prior research by revealing potential pathways linking distinct social norm types to glaucoma screening message adherence. When processing health information, individuals tend to prioritize data perceived to offer health advantages and mitigate disease risks. They assess the content through rational analysis, creating a diagnostic perception of the health information. When individuals perceive that a certain health behavior is common within a group (descriptive norms), they deem this behavior logical and effective, attributing high diagnosticity to it. Prevalent group behaviors serve as cognitive benchmarks, characterizing a sophisticated information processing mode that aligns with heightened perceptions of information diagnosticity. As a result, individuals show a higher degree of message adherence to maintain consistency with the group (Kim and Kim, 2021). This study contributes to the research on perceived information diagnosticity in health communication, deepening our understanding of this concept and its impact on individuals’ responses to health information.

This study has identified a moderated mediation effect that illustrates how social norms, self-construal, and perceived information diagnosticity correlate with message adherence. Specifically, the interaction between social norms and self-construal modifies perceived information diagnosticity, which in turn impacts message adherence. This finding offers psychological insights into potential pathways linking social norms, self-construal, and individual behavioral patterns. In this complex relationship, perceived information diagnosticity acts as a mediator, linking social norms, self-construal, and message adherence. Research on perceived information diagnosticity, especially within the field of health communication, is limited. Lynch et al. (1988) suggest that when people encounter new information, they are less likely to recall its overall performance from memory for direct evaluation. Instead, they assess the performance based on their pre-existing attribute preferences and how the information aligns with these attributes. This process enhances the diagnosticity of the information, positively influencing message adherence as individuals perceive the information as more credible and relevant to their personal goals and values. Additionally, individuals with an interdependent self-construal are more inclined to gather information from their social environment and others’ behaviors, using this as a key reference for their own actions (Aaker and Lee, 2001). They are more proactive in using descriptive social norms to shape their perception of information diagnosticity, believing that the behaviors of others provide essential insights into the validity and reliability of the information (Rimal and Real, 2005). This increased sensitivity to social norms further emphasizes the mediating role of perceived information diagnosticity between social norms and message adherence.

To provide clearer and more specific guidance on how China could tailor its messaging about glaucoma screenings to enhance their effectiveness, the following practical recommendations are proposed. Health communication campaigns should tailor messaging to different self-construals: for individuals with an interdependent self-construal, messages emphasizing the commonality of screening behaviors (descriptive norms) and the importance of group harmony and social approval are likely to be more effective, while for those with an independent self-construal, messages should focus on personal benefits, autonomy, and the value of individual decision-making. Given the significant impact of descriptive norms in the Chinese context, health campaigns should highlight the prevalence of glaucoma screening among high-risk groups and the general population. Leveraging the cultural perception of eyes as crucial organs for perceiving the world and expressing emotions, as metaphorically described as “炯炯有神” (bright and spirited), health messages should emphasize the importance of maintaining such eyes through regular glaucoma screening. This can be achieved through community-based initiatives, social media campaigns, and testimonials from well-known figures who have undergone screening. Additionally, to enhance perceived information diagnosticity, health messages should provide clear, detailed, and relevant information about glaucoma screening, including the screening process, potential benefits, and the importance of early detection. Furthermore, leveraging community health workers and local organizations can help bridge the gap between health messages and the target audience, as these intermediaries can offer personalized support, address cultural concerns, and foster trust in the disseminated health information.

Limitations and future research directions

While this study has made significant contributions, it also presents several limitations that could guide future research. Firstly, although message adherence is a strong predictor of behavior in health contexts, as demonstrated by Nguyen et al. (2020), our sole reliance on self-reported data may introduce bias. Future studies could address this limitation by measuring actual behavior through physiological data, response times, or other objective metrics. Secondly, our study is exclusively centered on glaucoma within Chinese samples, a focus that may constrain the generalizability of our findings to wider populations or individuals with varying health backgrounds. Although our research provides valuable insights into the specific dynamics of glaucoma screening in China, we recognize the importance of investigating whether these insights hold true in other contexts. To overcome this limitation, future studies could prioritize conducting comparable research across diverse cultures and health-related domains, thus enhancing the applicability of the research findings on a broader scale.

Footnotes

Acknowledgements

The author thanks the editor and the reviewers for providing constructive comments and suggestions throughout the review process.

ORCID iD

Hui Zhi

Wenqiang Teng

Min Zhou

Ethical considerations

The studies involving humans were approved by Ethics Committee at the university. The studies were conducted in accordance with the local legislation and institutional requirements.

Consent to participate

The participants provided their written informed consent to participate in this study.

Consent for publication

Consent to publication was obtained from the participants.

Author contributions

The authors confirm contribution to the paper as follows: study conception and design: Hui Zhi and Wenqiang Teng; data collection: Min Zhou; analysis and interpretation of results: Hui Zhi and Wenqiang Teng; draft manuscript preparation: Hui Zhi, Wenqiang Teng and Min Zhou. All authors read and approved the final version of the manuscript.

Data availability statement

The data on which the article is reported can be obtained from the corresponding author upon reasonable written request.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The work was supported by the National Social Science Fund of China [23BXW041].

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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