A Qualitative Study Exploring Malaysian Women’s Preferences for Authority or Emotional Appeals in Public Health Messages Promoting Breast Cancer Screening

Sep 22, 2026

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Persuasive health communication supports breast cancer screening, yet guidance on message framing remains incomplete. A qualitative study explored Malaysian women’s preferences and perceptions of public health messages using seven appeals: authority, hope, social, humour, fear, sadness, and shame-guilt. In-depth interviews involved 41 women aged 40+ with no prior breast cancer or other cancers. Most participants favoured hope, authority, or fear appeals, citing personalised authority effects and emotional reactions that shaped cognitive appraisal. Humour, sadness, and shame-guilt appeals were least preferred due to weakened persuasive impact and negative framing; further work should test effects on real behaviour change.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Study purpose and rationale

Persuasive health communication and framing

Message appeal types

Authority, hope, fear

Humour, sadness, shame-guilt

Social appeal

Methods

Participants and recruitment criteria

Qualitative interviews

Thematic analysis approach

Findings and interpretation

Preferred appeals and mechanisms

Disliked appeals and reasons

Implications and future research

[www. nature.com/scientificreports](www. nature.com/scientificreports) OPEN A qualitative study exploring Malaysian women’s preferences for authority or emotional appeals in public health messages promoting breast cancer screening Nicholas Yee Liang Hing1􀀍, Pei Xuan Kuan1, Emma Mirza Wati Mohamad2, Ching Ee Loo1, Komathi Perialathan3, Aimi Nadiah Mohamad Norzlen3, Yan Yee Yip1, Wan Mohd Shariffuddin Zainudin4, Shazimah Abdul Samad4, Zakiah Mohd Said4 & Wen Yea Hwong1 Persuasive health communication is key to promoting breast cancer screening. Due to existing gaps over how public health messages should be framed, a study was conducted to explore the preferences and perceptions of Malaysian women towards messages that incorporate different types of appeals to promote breast cancer screening. In-depth qualitative interviews were conducted among Malaysian women aged 40 and above with no previous history of breast cancer or other cancers. They were exposed to messages that promoted breast cancer screening using seven different appeals; authority, hope, social, humour, fear, sadness, and shame-guilt. Qualitative expressions for preferences and perceptions were analysed using interpretive thematic analysis. 41 Malaysian women were interviewed. The majority preferred messages that incorporated hope, authority, or fear appeals. Messages with an authority appeal were favoured for their personalised and authoritative effect. Messages using hope and fear appeals elicited emotional reactions and cognitive appraisals that contributed to their favourability. In contrast, humour, sadness, and shame-guilt were the most disliked appeals. The humour appeal was generally disliked because it caused interpretations that weakened the persuasive impact of the advocated behaviour in the message. Messages incorporating sadness and shame-guilt appeals were disliked primarily due to their negative framing. In conclusion, public health messages incorporating hope, authority, or fear appeals show promising potential to motivate breast cancer screening among Malaysian women, and their effectiveness in influencing actual behaviour change should be further explored. Keywords Health communication, Authority appeal, Emotional appeals, Breast cancer screening, In-depth interview, Public health Breast cancer is the most common cancer in Malaysia, with as high as 17.6% of all malignancies reported. Most breast cancer cases are detected at an advanced stage, with increasing trends from 43.2% in 2007 to 2011, 48.0% in 2012 to 2016, and 50.5% in 2017 to 20211. Early detection and diagnosis of breast cancer are crucial to improve prognostic outcomes2. This is achievable by attending regular breast cancer screening procedures, such as clinical breast examinations (CBE) and mammograms3. 1Institute for Clinical Research, National Institutes of Health, Ministry of Health, Block B4, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia. 2Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia. 3Institute for Health Behavioural Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia. 4Family Health Development Division, Ministry of Health, Putrajaya, Malaysia. 􀀍 email: [nicholas.hingyl@gmail.com](nicholas.hingyl@gmail.com) [www. nature.com/scientificreports/](www. nature.com/scientificreports/) Alarmingly, breast cancer screening uptake rates in Malaysia remain poor. Data from the National Health Informatics Centre have shown low participation rates for CBE at healthcare clinics, with an attendance rate of less than 30%4. Several studies found poor uptake of mammograms among eligible populations, including high-risk women5,6. The National Health & Morbidity Survey (NHMS) reported that only 25% of women had ever undergone a mammogram, and only 21% of women aged 40 and above had a mammogram within the past three years4. Given these low screening

FAQs

What was the study designed to examine?

The study examined Malaysian women’s preferences and perceptions for public health messages framed with different emotional or authority appeals to promote breast cancer screening.

Which appeal types were most preferred by the participants?

Most participants preferred messages incorporating hope, authority, or fear appeals, describing authority appeals as personalised and authoritative, and hope/fear as eliciting emotional reactions that supported favourable cognitive appraisals.

Why were humour, sadness, and shame-guilt appeals disliked?

Humour was generally disliked because it prompted interpretations that weakened the persuasive impact of the advocated behaviour, while sadness and shame-guilt were disliked mainly due to negative framing.

Sep 22, 2026

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