Who Delivers the Message Matters: Norm Alignment and Preventive Health Intentions

Cardiovascular disease (CVD) remains the leading cause of death worldwide. Early detection of CVD risk factors through preventive screening programs can substantially reduce adverse outcomes, yet participation rates remain suboptimal. In this paper, we examine whether perceived social closeness between the sender and the recipient of an invitation to a free cardiovascular health check affects health beliefs and willingness to engage in preventive health intentions. Using a survey experiment on a representative sample of approximately 2,588 individuals aged 40-74 in England-the target population for the NHS Health Check program-we randomly assign participants to receive an invitation message from a peer who either shares or does not share their social norms. We study whether social closeness between the messenger and the recipient shapes perceived susceptibility, perceived severity, and perceived benefits, as predicted by the Health Belief Model. The manipulation successfully alters perceptions of social closeness, and the estimated effects are consistent with the hypothesis that socially closer peer messages are more effective in promoting preventive health intentions.