Explicit attitude measures seem to be rather poor predictors of organ donation behaviour. This study examined whether implicit attitude measures acted as better predictors. Special attention was paid to the moderating role played by attitude strength in predicting deliberate donation behaviour. In this study (N = 78), explicit and implicit measures of attitudes towards organ donation, as well as behavioural commitment, were assessed. Implicit associations were measured by an Implicit Association Test; five constructs assessed self-reported—understood as reflected—attitude strength. The explicit attitude measure appeared to be the best single predictor of whether the participant ended up taking an organ donor card. More importantly, test results demonstrated the moderating role of attitude strength. In the case of low attitude strength, the likelihood of taking a donor card increased with an increasing positive implicit association. In contrast, increasing strength was associated with a weaker link between card taking and the implicit attitude measure. The results are discussed in light of the power of implicit associations to predict more deliberate behaviours.
Over the past 20 years, a gap has been observed between positive attitudes toward organ donation and their lack of translation into behavioural commitment in terms of organ donor card signing, e.g. [
There are good reasons to expect that implicit attitude measures add to the understanding of organ donation behaviour. Organ donation is socially desired and has moral implications, since to decide against donation is equal to a decision against saving lives. Likely, these pro-donation expectations support overly positive direct assessments and thus mask critical evaluations. Additionally, considering becoming an organ donor prompts reflection on one’s own mortality and thus is likely to inhibit introspection [
The most widely used approach to measure implicit social cognitions is the Implicit Association Test (IAT) [
Several studies provide evidence that the IAT can predict behaviours in some but not all cases, cf. [
Strong attitudes can be defined as attitudes that are stable, resistant to changes, and that influence thoughts and behaviours [
Strong attitudes are associated with a higher attitude-behaviour consistency, e.g. [
So far, the reported findings are in line with the motivation and opportunity as determinants of the behaviour model’s assumption (MODE) [
It remains an open question whether the above-reviewed assumptions and results can be generalised to this specific case of deliberate behaviours. If so, based on the MODE model in the deliberate mode, explicit attitude measures capturing conscious elaboration should predict donation behaviour while the impact of implicit associations should be minimal [
The RIM presents two information-processing systems that operate in parallel and interact with one another. The reflective system is characterised as an explicit decision-making process, while the impulsive system elicits behaviours through simple associative links and motivational orientations. Both the systems can activate behavioural schemata that, in turn, activate overt behaviours. Simultaneously, more than one schema can receive activation, even from both systems. Which behavioural schema will prevail depends on the conditions and on the strength of the activation for each schema. This offers a new perspective on the role of implicit associations in the case of more deliberative processing. Strong attitudes toward deliberative behaviours result from reflecting on behavioural outcomes and integrating them into an overall judgment, e.g. [
In sum, the present contribution aims to understand the role of implicit associations in the organ donation decision and the moderating impact of attitude strength on the implicit association-behaviour relation.
The sample consisted of 90 participants recruited on university campus. Nine participants were discarded for incomplete questionnaires, and three due to computer failure. Of the remaining 78 participants, 48.7% were wo- men, 51.3% were men. Ages ranged from 19 to 33 years, with an average age of 22.4. The majority held a university entrance qualification (96.2%) and were students (91.0%). Political (24.3%), nature (16.2%), and economic (16.2%) sciences were the most frequent subjects. Students of medicine and psychology, and organ-donor card holders were excluded from the survey.
Procedures and IAT-donation stimuli were modelled closely after Egloff and colleagues [
IAT data were treated using the improved scoring algorithm (D1 measure) [
To measure explicit attitude towards organ donation a four-item semantic differential scale had participants respond to “I think organ donation is…” on four adjective pairs (senseless/useful, dispensable/desirable, bad/good, negative/positive); 8-point bipolar scales ranging from –4 to +4 (a = 0.86).
In total, five constructs assessed attitude strength:
1) The first strength indicator was cognitive elaboration on signing an organ donor card. Participants were asked to self-report whether they had reflected (thought about/deliberate) on signing a donor card before participating in our survey. Two groups were categorised: participants who had not reflected on signing were coded as “low strength” (0), those who had as “high strength” group (1). To validate this categorisation, four further attitude strength indicator were assessed; 2) Five statements assessed issue involvement (a = 0.82); participants rated how strongly they disagreed (0 = not at all) or agreed (5 = strongly). An item example is “Organ donation is an important topic to me”. The mean of the items served as issue involvement indicator; 3) One item measured attitude certainty. Participants indicated how strongly they agreed with the statement “I am well enough informed to make a decision to sign an organ donor card or not” (0 = do not agree at all to 5 = strongly agree); 4) Next, participants rated their subjective knowledge on a 4-point scale ranging from 0 (not at all informed) to 3 (very well informed); 5) To assess communication activity, participants were asked how frequently they communicated about organ donation (0 = never to 2 = occasionally). Out of the last four indicators, we aimed to construct a compound strength measure.
Behaviour was assessed as taking (1) or not taking (0) an organ donor card after the survey. For this purpose, each questionnaire included a donor card on the second to last page, to be removed easily and anonymously. Participants were not informed about this card before.
Almost equal parts of the sample had either reflected on signing an organ donor card (47.4%, n = 37; high strength group) or not (52.6%, n = 41; low strength group). Average issue involvement was rather strong (M = 3.75, SD = 0.86) while attitude certainty was below the midpoint (M = 2.73, SD = 1.21). Subjective knowledge also was low; most participants (76.9%) indicated they felt little informed about organ donation, while only 13.6% felt well or very well informed. Additionally, none of the respondents communicated occasionally about organ donation with others, 76.9% only seldom, and 23.1% had never done so.
The explicitly assessed attitude toward organ donation was high positive on average (M = 3.14, SD = 0.75) while the implicit association was only slightly positive (M = 0.10, SD = 0.42). The majority of respondents (60.3%) took the donor card after answering the questionnaire. The variables’ intercorrelations (
To construct a compound attitude strength measure we conducted a factor analysis. Unfortunately, only the sta- tements of the assessed strength indicators involvement and attitude certainty could be involved in that analysis, since subjective knowledge as well as communication activity were extremely unequally distributed, as described. Consequently, we abstained from further analyses with those measures. The rotated factor loadings
Variable | EA | IA | CE | I | AC | SK | CF |
---|---|---|---|---|---|---|---|
Explicit attitude (EA) | 1.00 | ||||||
Implicit association (IA) | 0.13 | 1.00 | |||||
Cognitive elaboration (CE) | 0.07 | 0.26* | 1.00 | ||||
Involvement (I) | 0.26* | 0.20 | 0.38** | 1.00 | |||
Attitude certainty (AC) | 0.15 | 0.18 | 0.32** | 0.15 | 1.00 | ||
Subjective knowledge (SK) | 0.13 | 0.14 | 0.33** | 0.09 | 0.28* | 1.00 | |
Communication frequency (CF) | 0.15 | 0.09 | 0.28* | 0.37** | 0.03 | 0.01 | 1.00 |
Behaviour (BE) | 0.47*** | 0.17 | 0.19(*) | 1.00 | 0.15 | 0.15 | 0.18 |
Note: (*)p < 0.10; *p < 0.05; **p < 0.01; ***p < 0.001.
showed that involvement’s items and the attitude certainty statement loaded on two different factors. Therefore, in contrast to Nosek [
A significant overall IAT effect was observed. However, against expectation the IAT measure provided evidence for positive implicit associations (M = 0.10, SD = 0.42; t (77) = 2.06, p < 0.05), indicating a greater facility for the organ donor + calmness task. The explicit and implicit attitude measures did not correlate significantly (r = 0.13, ns.;
To investigate both the unique contribution of the implicit and explicit attitude measure, as well as the moderator effect of attitude strength, hierarchical logistic regressions were performed, using hierarchically well-for- mulated models. The continuous attitude variables were centred [
Firstly, the impact of implicit and explicit attitude measures on behaviour was tested. At the first step, both variables were entered as predictors of taking a donor card. The model explained 30% of variation in behaviour (Nagelkerkes R2) with the explicit attitude measure being the only significant predictor (B = 1.55, SE = 0.43, p < 0.001; implicit association: B = 0.71, SE = 0.64, p = 0.27). To explore a possible interaction, in a second step, the concept’s multiplicative term was entered, improving the overall prediction only moderately by 4% (Nagelkerkes R2 = 0.34, R2 change = 4%; χ2 = 2.96, p = 0.085). This trend towards significance was reflected in the interaction term (B = 2.10, SE = 1.27, p = 0.097).
Secondly, the moderating role of the attitude strength measures was calculated. The analysis was conducted consecutively with the three attitude strength indicators—cognitive elaboration, involvement, and attitude certainty. In each analysis, in the first step the implicit and explicit attitude measures, together with one of the three attitude strength indicators, were entered as predictors of taking a donor card. The second step involved all two-way interactions while the three-way interaction was entered in step three (
The first analysis tested the moderating impact of cognitive elaboration. The first step’s model explained 33.3% of variation in behaviour (Nagelkerkes R2), with the explicit attitude being the only significant predictor (B = 1.61, SE = 0.45, p < 0.01; implicit association: B = 0.52, SE = 0.67, p = 0.44; cognitive elaboration: B = 0.83, SE = 0.56, p = 0.14). Next, the two-way interaction terms were entered. This improved the model fit (χ2 (6) = 34.36, p < 0.001) over and above the first model, implying a significant omnibus interaction effect (χ2 change (3) = 12.35, p < 0.01). The interaction between the implicit association and attitude strength was the only significant interaction term (B = −3.89, SE = 1.57, p < 0.05). The multiplicative term between the implicit and explicit attitude measure showed a trend towards significance (B = 2.81, SE = 1.68, p = 0.095). Jointly, the two-way interaction terms increased the explained amount of variation in the behaviour by 14.9% to 48.2%. Finally, the
Attitude strength = cognitive elaboration | Attitude strength = involvement | Attitude strength = attitude certainty | |||||||
---|---|---|---|---|---|---|---|---|---|
Variable | B | SE | Wald | B | SE | Wald | B | SE | Wald |
Step 1 | |||||||||
Explicit attitude (EA) | 1.61 | 0.45 | 12.90** | 1.47 | 0.45 | 10.54** | 1.51 | 0.43 | 12.33*** |
Implicit association (IA) | 0.52 | 0.67 | 0.61 | 0.45 | 0.67 | 0.46 | 0.66 | 0.65 | 1.04 |
Attitude strength (AS) | 0.83 | 0.56 | 2.22 | 0.97 | 0.38 | 6.50* | 0.13 | 0.23 | 0.34 |
Nagelkerkes R2 | 0.33*** | 0.40*** | 0.31*** | ||||||
Step 2 | |||||||||
EA × IA | 2.81 | 1.68 | 2.79(*) | 1.70 | 1.53 | 1.24 | 2.91 | 1.47 | 3.92(*) |
EA × AS | −1.84 | 1.29 | 2.04 | −0.30 | 0.72 | 0.18 | 0.89 | 0.66 | 1.83 |
IA × AS | −3.89 | 1.57 | 6.14* | −2.17 | 0.99 | 4.77* | −1.90 | 0.80 | 5.62* |
Nagelkerkes R2 | 0.48** | 0.49* | 0.45** | ||||||
Step 3 | |||||||||
EA × IA × AS | −1.01 | 0.49 | 0.08 | 2.41 | 2.36 | 3.85 | 0.81 | 2.32 | 0.12 |
Nagelkerkes R2 | 0.48 | 0.51 | 0.45 |
Note: N = 78; B = unstandardised Beta coefficient; SE = standard error of B; (*)p < 0.10, *p < 0.05, **p < 0.01, ***p < 0.001.
three-way interaction term was included but was not a significant predictor (B = 0.45, SE = 3.13, p = 0.77), Nagelkerkes R2 = 0.48 remained. Consequently, the three-way interaction could be eliminated [
To interpret the interaction between the implicit association and attitude strength in detail, the predicted pro- babilities of taking a donor card as derived from the logistic model were plotted for a range of the IAT values [
In sum, the results show that when both attitude measures are entered simultaneously as predictors, only the explicit attitude measure predicts significantly whether someone takes an organ donor card or not. More importantly, the data provide evidence for the moderating role of attitude strength. Implicit associations were observed more effective predictor of taking a donor card in case of low attitude strength.
The observed results confirmed the proposed moderating impact of attitude strength on the relation between implicit associations and organ donation behaviour. When considered simultaneously with an explicit attitude mea- sure, the implicit measure had no significant impact on behaviour—the explicit remained the only significant predictor. However, congruent with expectation, across three attitude strength indicators consistently the streng- th and the implicit measures interacted: When the attitude strength was weak, increasing positive implicit associations were related to an increased probability of taking a donor card.
Deliberate behaviour requires reliable knowledge and evaluations to come up with a behavioural decision, e.g. [
In line with the results obtained by Perugini [
Contrary to expectation, we found a positive—although small—overall IAT effect. Since we counterbalanced the IAT block order, at least two other explanations than presentation order seem possible. First, our IAT-dona- tion could be contaminated by extra-personal associations [
Some limitations of this contribution should be acknowledged. First, it would be desirable to validate our findings experimentally, e.g. by varying deliberate behaviour conditions. A second shortcoming is the behaviour measure. Taking a donor card, admittedly, does not necessarily indicate signing it. Indeed, to control actual signing behaviours will have been a stronger behaviour measure. Still, anonymously taking an offered organ donor card is a potentially important step that suggests some movement in the direction of becoming an organ donor. Third, to validate the moderating impact of attitude strength on the relationship between implicit attitudes and deliberate behaviours, tests should be performed in domains other than organ donation.
Despite these limitations, the present results suggest that dissociations between implicit attitude measures and deliberate behaviours can be due to attitude strength. While impulsive reactions seem to be used as affective information to form a decision when nonexistent or weak summary evaluations exist, reflective outputs prevail in the case of strong attitudes. However, the present results mirror the predictive power of explicit attitude measures as well.
Our study examined implicit associations in a domain not previously examined—organ donation behaviour. More importantly, the present contribution offers a new explanation as to why implicit associations sometimes do and sometimes do not predict more deliberate behaviours. Additionally, the results offer practical recom- mendations that communication strategies designed to foster attitude strength can help to overcome implicit associations’ impact on the organ donation decision.