A Study of a Hypothetical Pandemic by Climate Change: Focusing on Construal Level Theory of Psychological Distance with Insights from EPPM and Moral Foundations

Introduction to CLT

Construal Level Theory (CLT) posits that the psychological distance between an individual and an event influences how the event is mentally represented and cognitively processed. Events perceived as more distant—whether in terms of time, space, social distance, or hypotheticality— are represented at a higher, more abstract level, while events perceived as closer are represented at a lower, more concrete level (Trope & Liberman, 2010, 2012). This principle implies that as psychological distance increases, people tend to focus on the overarching, essential qualities of the event, rather than its specific, situational details. For instance, the concept of climate change may be viewed in terms of global temperature increases and long-term environmental impact (abstract), whereas a heatwave experienced in one’s hometown presents immediate, tangible consequences like unbearable heat or health risks for vulnerable populations (concrete).

Psychological distance expands one’s mental horizon, enabling abstract thinking that emphasizes the essential and unchanging features of an event, such as the universal moral implications or strategic goals it invokes. Conversely, proximate events demand detailed, context-specific processing. Consider a polar bear’s plight due to melting ice caps as a result of climate change. When framed as an abstract, distant phenomenon—“Polar bears are losing habitat in the Arctic”—the event prompts general moral reflections about biodiversity and environmental stewardship. However, if a specific story about a starving polar bear on a melting ice floe circulates on social media, it evokes concrete emotional reactions and urgent calls for action. This contrast exemplifies how the framing of psychological distance alters cognitive and emotional engagement (Henderson et al., 2011).

The abstraction process inherent in higher construal levels significantly impacts perceptions, attitudes, and behaviors. When considering distant events, individuals are likely to prioritize overarching goals or principles, such as collective responsibility for environmental conservation or future-oriented strategies to mitigate climate change (Liberman et al., 2007). For instance, during the COVID-19 pandemic, abstract messaging often highlighted global solidarity: “Stay home to protect others and flatten the curve.” These messages emphasized broad, moral responsibilities to safeguard public health.

However, localized and concrete messaging, such as reports of ICU bed shortages in specific hospitals or the infection of a known community member, elicited more immediate, actionable responses like mask-wearing or vaccination (Trope & Liberman, 2010).

CLT’s application in health communication underscores its effectiveness in shaping public responses to abstract threats like climate change-induced pandemics. Framing these threats through a psychologically distant lens enables communication strategies to evoke higher-level moral considerations, such as collective responsibility and long-term risk mitigation (Henderson et al., 2011). For example, messaging about rising sea levels might emphasize distant consequences like the eventual submersion of island nations, appealing to broader moral imperatives to act for the sake of global equity. However, reducing psychological distance by focusing on immediate, localized threats—like flooding in a nearby city—can enhance perceived urgency, prompting concrete adaptive behaviors such as evacuation or the construction of flood defenses (Trope & Liberman, 2010).

Regarding moral judgment, CLT asserts that higher perceived distance fosters higher-level moral reasoning, emphasizing abstract values like justice and care (Eyal & Liberman, 2012). For instance, when climate change is framed in terms of distant, abstract consequences (e.g., future generations suffering from resource scarcity), people may reflect on their moral duty to uphold justice for those who are not yet born. Conversely, framing the same issue with a focus on vulnerable populations currently facing extreme weather— like subsistence farmers losing crops due to drought—can prompt concrete judgments and actions aimed at providing immediate aid. This dynamic demonstrates how CLT can be leveraged to design health messages that resonate with both abstract moral values and immediate, tangible concerns, thereby enhancing compliance with public health directives.

Application of CLT in Prior Research

Construal Level Theory (CLT) has been extensively applied to understand how psychological distance influences perceptions, emotions, and behaviors in various contexts. In climate change research, for instance, psychological distance has been shown to affect perceived threat and engagement. Chu and Yang (2019, 2020) demonstrated that greater psychological distance—whether temporal, spatial, social, or hypothetical—reduces the perceived urgency of climate action. This is because distant events are processed abstractly, emphasizing overarching principles over immediate details. Conversely, framing climate change impacts as proximate and local increases perceived threat and motivates pro-environmental behaviors (Brügger, 2020; Henderson et al., 2011).

Similar findings are evident in health communication contexts, where reducing psychological distance enhances engagement with health messages. Studies on the COVID-19 pandemic illustrate this effect. Blauza et al. (2023) observed that perceiving the virus as geographically close intensified cognitive and emotional responses, leading to greater compliance with preventive measures such as mask-wearing and vaccination. Sharples et al. (2023) highlighted that messages emphasizing temporal immediacy and personal relevance were particularly effective in promoting adaptive health behaviors, suggesting that blending abstract and concrete messaging at critical points can sustain engagement. Chu and Liu (2023) explored vaccine hesitancy, finding that parents perceiving vaccines as distant had more general safety concerns, leading to lower vaccination intentions. Abstract thinking correlated with global concerns and lower intentions, while emphasizing the immediacy and relevance of vaccines, such as COVID-19, increased vaccination intentions. These studies collectively suggest that reducing psychological distance by framing health threats as immediate and personal can effectively enhance public compliance with health guidelines and proactive health behaviors.

CLT also offers insights into how psychological distance interacts with moral judgment and public health behaviors. Eyal and Liberman (2012) noted that greater distance fosters abstract moral reasoning, emphasizing principles like justice and collective responsibility. For example, viewing climate change as a distant, global issue may invoke broader moral obligations to future generations. However, narrowing the distance by focusing on immediate, localized impacts— such as a severe heatwave affecting vulnerable populations—can elicit stronger emotional engagement and prompt urgent actions (Henderson et al., 2011).

Psychological Distance in Health and Climate Contexts

Psychological distance, a central construct in CLT, encompasses four dimensions: temporal, spatial, social, and hypothetical (Chu & Yang, 2020; Trope & Liberman, 2010). These dimensions collectively influence how abstract or concrete an individual’s mental construal of events becomes. Higher psychological distance encourages abstract processing, focusing on overarching principles, while lower distance fosters concrete engagement with detailed and immediate implications (Liberman & Trope, 1998).

In the context of climate change, psychological distance plays a pivotal role in shaping public perceptions and behavioral intentions. Chu and Yang (2019) demonstrated that as temporal and spatial distances increase, individuals are less likely to perceive climate risks as urgent. For example, viewing climate change as a global issue (“distant” frame) leads to generalized moral reflections, whereas framing it as a local issue (“proximate” frame) increases perceived severity and engagement (Brügger, 2020; Henderson et al., 2011).

In health communication, reducing psychological distance is critical to enhancing engagement with public health messages. Chu and Liu (2023) showed that framing vaccine safety concerns within a temporally and spatially proximate context increased vaccination intentions. Similarly, Blauza et al. (2023) found that health compliance improved when threats were perceived as geographically close, emphasizing the utility of psychological proximity in crisis messaging.

Building on these principles, this study investigates how psychological distance affects perceptions of health risks and compliance behaviors in the context of a hypothetical pandemic induced by climate change. Specifically, it examines how psychological distance influences perceived threat, self-efficacy, and health compliance intentions—key constructs that are further conceptualized within the framework of the Extended Parallel Process Model (EPPM).

Extended Parallel Process Model (EPPM)

The Extended Parallel Process Model (EPPM) posits that individuals respond to fear-inducing messages through one of two types of processing: danger control or fear control, depending on the relationship between perceived threat and self-efficacy (Witte, 1992). Specifically, EPPM explains the dynamic interaction between perceived threat and self-efficacy in health-related persuasive messages. When perceived threat and self-efficacy are high, individuals are involved in danger control processing, leading to health compliance intentions. Conversely, when perceived threat is high but self-efficacy is low, individuals engage in fear control processing, which leads to rejecting the health-related behaviors promoted in the message (Witte, 1994).

Perceived Threat

Perceived threat is defined as the combination of perceived severity (how serious the threat is) and perceived susceptibility (how likely the individual is to be affected) (Witte, 1996). For this study, perceived threat is operationalized as the degree to which participants perceive the hypothetical pandemic as a serious and personally relevant health risk. Drawing from Witte’s (1996) Risk-Behavior Diagnosis Sclae (RBDS) framework, this construct is measured using items that assess both severity and susceptibility in hypothetical pandemic which can be caused by climate change, such as “I recognize the health threats posed by the climate crisis as a serious problem.”

Self-Efficacy

Self-efficacy refers to an individual’s belief in their ability to take effective actions to mitigate the threat (Witte, 1992, 1994). In the context of this study, self-efficacy is operationalized as the confidence participants have in their ability to engage in health compliance behaviors, such as adhering to public health guidelines. This construct is also measured using modified version of Witte (1996)’s RBDS in the context of hypothetical pandemic caused by climate change, with items such as “Participating in environmentally friendly practices can help prevent the spread of pandemics caused by climate change.

Health Compliance Intentions

Health compliance intentions (HCI) reflect participants’ willingness to adopt behaviors recommended by public health authorities (Witte, 1992, 1996). While EPPM provides foundational measures for self-efficacy and threat perception, HCI in the current study extends this framework by capturing intentions to act in the context of climate change-induced pandemics. These intentions are measured using items developed for this study, such as “I will participate in community efforts to ensure that all neighbors, regardless of economic status, have the means to cope with a pandemic” or “I will actively participate in local environmental initiatives and adhere to community guidelines for pandemic prevention.”

Application of EPPM in Health Emergencies

Empirical studies have extensively applied the EPPM to understand how individuals respond to health emergencies. For example, Lin and Chen (2021) investigated disease prevention behaviors during the COVID-19 pandemic, finding that perceived threat significantly increases fear arousal, which in turn promotes preventive behaviors. Their study also highlighted the moderating role of self-esteem, where individuals with high self-esteem exhibited lower fear arousal compared to those with low self-esteem. Similarly, Lithopoulos et al. (2021) found that perceived threat and efficacy are critical predictors of protective behaviors, with demographic factors such as age and gender influencing these relationships. These studies underscore the effect of perceived threat and efficacy in shaping health compliance intentions. When perceived threat is high and self-efficacy is also high, individuals are more likely to engage in protective behaviors, consistent with the danger control process described by EPPM. In contrast, when perceived threat is high but self-efficacy is low, individuals may reject health-related behaviors due to fear control processing.

Hypotheses and Research Questions based on CLT and EPPM

Based on constructs and definitions of CLT and EPPM, the study examines their interrelationships within the framework of CLT and EPPM:

• H1a. Higher psychological closeness in climate crisis narratives will increase perceived threat concerning the impacts of a hypothetical pandemic.
• H1b. Higher perceived threat will lead to increased health compliance intention.
• H2a. Perceived psychological distance (construal level) will negatively predict self-efficacy related to mitigating pandemic impacts.
• H2b. Perceived psychological distance (construal level) will negatively predict perceived threat related to mitigating pandemic impacts.
• H2c. Perceived psychological distance (construal level) will negatively predict health compliance intention.

The hypotheses are grounded in established research on CLT and EPPM. H1a and H1b are based on findings that proximity increases perceived threat and engagement (Blauza et al., 2023; Chu & Yang, 2019, 2020). H1a was formulated to serve as a manipulation check, aimed at validating the effectiveness of the spatially close versus distant framing in influencing perceived psychological distance. This hypothesis tests whether the manipulated framing significantly alters participants’ psychological construal of climate change-induced pandemics. H2a, H2b, and H2c extend these insights by examining the direct effects of psychological distance on self-efficacy and compliance intentions, as suggested by Witte (1996) and Henderson et al. (2011).

MFT and Health Behaviors

Moral Foundations Theory (MFT) is rooted in evolutionary psychology, proposing that humans possess an innate set of moral intuitions that guide judgments of right and wrong (Graham et al., 2013). These moral intuitions function as heuristics, enabling rapid evaluations of social behaviors, but they are shaped and emphasized differently across cultures and individual experiences. While cultural and experiential factors individualize moral judgments, MFT identifies five universal moral foundations: care, fairness, loyalty, authority, and purity (Graham et al., 2011; Haidt & Graham, 2007).

Each of these foundations underpins distinct aspects of moral reasoning, influencing responses to health-related behaviors in nuanced ways. For example, care emphasizes harm prevention and nurturing, often evoking empathy in response to suffering. In health communication, this foundation is critical for driving compliance with behaviors that protect others, such as vaccination or mask-wearing (Atari et al., 2022; Graham et al., 2013). Purity relates to disgust and contamination concerns, making it especially salient during pandemics where pathogen avoidance behaviors (e.g., handwashing, social distancing) align with moral intuitions about bodily sanctity (Fincher et al., 2008; Malik et al., 2021).

Although all five foundations play roles in shaping moral judgment, care and purity are uniquely relevant in public health emergencies. Empirical studies have repeatedly demonstrated the prominence of these foundations in contexts involving disease prevention and pathogen-related fears (Atari et al., 2022; Malik et al., 2021). For instance, Atari et al. (2022) found that purity concerns heightened disgust responses to perceived violations of hygiene norms during the COVID-19 pandemic. Similarly, the care foundation was linked to heightened empathy and prosocial behaviors, such as adherence to health guidelines to protect vulnerable populations.

While this study acknowledges the existence of fairness, loyalty, and authority as critical components of MFT, their relevance in the specific context of climate change-induced pandemics is comparatively less direct. Fairness, for example, may be more prominent in discussions about resource allocation during pandemics (e.g., equitable vaccine distribution) but is less central to the immediate behavioral intentions targeted in this study. Loyalty emerges in collectivist societies or when group allegiance is emphasized but plays a secondary role in individual-level health compliance behaviors. Authority, while relevant in contexts involving hierarchical decision-making or mandates, is not the primary driver of behaviors linked to moral intuitions about disease prevention.

Thus, this study focuses on care and purity as moderators within the Extended Parallel Process Model (EPPM). These intuitions are most relevant for understanding the psychological mechanisms underpinning compliance with health behaviors, as they influence how individuals perceive threat and efficacy in the context of pandemic risk.

Pathogen Prevalence Hypothesis and MFT

Building on the Pathogen Prevalence Hypothesis (Fincher et al., 2008), the study further integrates MFT to explore how purity concerns interact with perceived contamination risks and how care moderates prosocial behaviors in response to perceived threats. These constructs align with the broader objectives of understanding how moral intuitions shape compliance with public health directives, particularly in hypothetical pandemic scenarios driven by climate change.

Moral Foundations and Public Health Responses

Human responses to pathogens have historically been intertwined with moral and social judgments. The purity foundation, which emphasizes the avoidance of contamination and maintenance of physical sanctity, plays a particularly central role in pathogen-related reactions (Atari et al., 2022). For example, the spread of infectious diseases often elicits feelings of disgust and concerns about bodily contamination, as seen during the COVID-19 pandemic (Malik et al., 2021). Similarly, the care foundation, which prioritizes preventing harm to others, influences empathetic behaviors, such as adhering to public health guidelines to protect vulnerable populations.

Moral Foundations in Pandemic Contexts

Pandemics, which threaten large populations, evoke a unique interplay between individual moral judgments and collective public health responses. Ahn and Noh (2021) applied the Extended Parallel Process Model (EPPM) to the COVID-19 pandemic in South Korea, demonstrating that morality acts as a significant moderator in shaping public health behaviors. Their findings indicated that moral intuitions influence whether individuals engage in danger control or fear control processes, which determine health compliance intentions. For instance, individuals driven by the care foundation are more likely to adopt adaptive behaviors, such as mask-wearing or vaccination, to prevent harm to others.

Building on this, Ahn and Noh (2023) introduced the COVID-19 Blue Scale, highlighting that emotional reactions to pandemics often involve both psychological and moral considerations, particularly in how individuals respond to social non-compliance or public health violations. This dual emotional response underscores the complexity of moral reasoning in health crises, where personal and societal moral considerations converge.

Integration with EPPM and Study Hypotheses

MFT provides a complementary framework to EPPM, offering deeper insights into how moral intuitions moderate relationships between perceived threat, self-efficacy, and health compliance intentions. For instance, the purity foundation amplifies perceived threat by linking disease spread to moral violations, while the care foundation reinforces self-efficacy through collective action and empathy. These dynamics are pivotal in predicting public health behaviors during pandemics.

To address these theoretical connections, the study hypothesizes:

• H3a. General moral intuition will moderate the relationship between self-efficacy and threat on health compliance intention.
• H3b. Care intuition will moderate the relationship between self-efficacy and threat on health compliance intention.
• H3c. Purity intuition will moderate the relationship between self-efficacy and threat on health compliance intention.
• H4a. Higher scores on the general moral intuition will predict higher health compliance intentions.
• H4b. Higher scores on the care intuition will predict higher health compliance intentions.
• H4c. Higher scores on the purity intuition will predict higher health compliance intentions.
• H5a. General moral intuition will moderate the relationship between perceived distance on health compliance intention.
• H5b. Care intuition will moderate the relationship between perceived distance on health compliance intention.
• H5c. Purity intuition will moderate the relationship between perceived distance on health compliance intention.

By grounding the hypotheses in MFT and integrating insights from EPPM, this study seeks to clarify how moral intuitions intersect with psychological distance, self-efficacy, and perceived threat to shape health compliance behaviors during pandemics. The inclusion of these constructs offers a more comprehensive understanding of the cognitive and emotional mechanisms driving public health responses.

Participant and Procedure

Participants were recruited by a professional research company in South Korea from May 2 to May 9, 2024. A total of 300 participants were selected using quota sampling based on the resident, registered population of South Korea as of May 2024. The quotas were based on gender and age, targeting individuals in their 20s to 50s (see Table 1). This sampling method ensured a representative distribution of participants across these demographic groups.

Table 1.

Participant Distribution by Gender and Age

Data collection was supported by a research communication association in South Korea as part of a collaborative project with a professional research firm. Participants provided informed consent before participating in the study, and the research adhered to ethical guidelines for human subjects.

Participants were randomly assigned to one of two groups, each of which received a different stimulus designed to manipulate psychological proximity (close vs. distant framing). This random assignment created a between-subjects design for the study.

Demographics

The sample consisted of 300 individuals, equally divided into two groups with matched quotas for gender and age. The detailed distribution is shown in Table 1.

The demographics of the participants are as follows: First, the sample was evenly split between males (n = 150, 50.0%) and females (n = 150, 50.0%). Next, participants ranged in age from 20 to 59 years, with a mean age of 39.56 years (SD = 10.503). Age categories were distributed as follows: 75 participants in their 20s, 75 in their 30s, 75 in their 40s, and 75 in their 50s. Finally, participants were distributed across different regions of South Korea, with the largest representation from Seoul (n = 90, 30.0%) and Gyeonggi Province (n = 80, 26.7%). Other areas included Busan, Daegu, Incheon, and others, as shown in Table 2.

Table 2.

Health Compliance Intention (HCI) Items

Participants were stratified by gender and age to ensure equal representation in each group. Group 1 and Group 2 received stimuli framed to create either psychological closeness or distance.

Data Collection Process and Response Rate

The research company used a pool of registered panelists who met the study’s demographic criteria. A total of 609 potential participants were contacted via email and invited to participate in the study. Of these, 300 participants completed the survey, resulting in a response rate of 49.3%. Of the total 300 participants, three were screened out as ineligible, 210 exceeded the quota, 26 were deemed invalid due to straight lines on scales, and 70 provided partial responses. Participants were incentivized with reward points upon completion of the survey. The groups were not revealed to participants during the survey to ensure random assignment to either the psychological closeness or distance framing conditions.

Stimuli - Generative AI and Public Health Narratives

Validation of AI-generated Narratives in Current Study

The overall process involved several AI tools and phases to create the stimuli. Generative AI technologies, such as Novel AI and DALLE-3, were employed to develop the narratives and corresponding images. The entire process was divided into five phases: Narrative Brainstorm, Novel AI Text Generation, Graphic Novel Style Scene Breakdown, Image and Text Placement, and Close/Distant Frame Stimuli Differentiation. Each phase contributed to ensuring that the stimuli were engaging, contextually relevant, and methodologically sound (see Figure 2 below).

Figure 2.

Stimuli Development Procedure Using Generative AI and Psychological Distance Framing

Narrative Brainstorm Phase. In the initial brainstorming phase, prompts were created to frame the narratives in psychologically close and distant contexts. The narratives were set in South Korea and South Africa, respectively, and focused on a hypothetical malaria pandemic caused by climate change. This disease was chosen because of its relevance and recognition among the South Korean public and its noted exacerbation by climate change (Mora et al., 2022; Venkatesan, 2024). Although malaria is often associated with regions such as Southeast Asia and Africa, recent WHO reports have highlighted its increasing prevalence in temperate zones, including South Korea, especially during heatwave seasons exacerbated by climate change (Venkatesan, 2024). This aligns with public awareness and fear regarding climate-sensitive diseases in South Korea, where malaria cases have shown seasonal surges. Thus, malaria serves as an effective proxy to examine health compliance intention in a context both scientifically credible and emotionally impactful. Both versions of the narrative were designed to evoke fear and relate to the care domain of moral foundation theory, which is specifically concerned with physical harm and caring for vulnerable beings (Haidt & Joseph, 2007).

Novel AI Text Generation Phase. Novel AI was used to generate detailed text narratives. The “Kayra” AI module was used with the “Fresh Coffee” preset, which included words from the moral foundation dictionary to guide the narrative. This phase produced a comprehensive narrative text of 807 words, including introductory prompts, chapter titles, and author’s notes.

Graphic Novel Style Scene Breakdown Phase. The text narrative was then restructured into a graphic novel style with 8 different cuts. DALLE-3 was used to generate images for each scene based on detailed prompts that ensured visual consistency and thematic relevance. The scenes were designed to ensure that both spatially close and distant versions clearly depicted the malaria pandemic.

Image and Text Placement Phase. The final step was to integrate the text and images using Canva. Graphic novel style frames were used to assemble the stimuli, and independent researchers reviewed the content to ensure clarity and coherence. This step ensured that the narratives were easy to read and visually appealing.

Close/Distant Frame Stimuli Differentiation. The stimuli for the psychologically near frame were created first. The images were then manipulated to change the appearance of the malaria patients from South Korean to South African for the far frame. This was done using GPT-4’s area generation feature to maintain visual consistency. Text descriptions were kept identical except for geographic names to ensure comparability.

Measures

Moral Intuition

Moral intuition was measured using the abbreviated version of the Moral Foundation Questionnaire (MFQ-20) by Graham et al. (2011). The MFQ-20 consists of two parts. In Part 1, participants rated the relevance of considerations (e.g., “whether some people are treated differently than others”) to moral judgments on a 6-point scale (0 = not at all relevant, 5 = extremely relevant). Part 2 required participants to indicate their agreement with statements (e.g., “Compassion for those who are suffering is the most important virtue”) on a 6-point scale (0 = strongly disagree, 5 = strongly agree). For this study, the five moral intuitions (care, fairness, loyalty, authority, and purity) were averaged into a general moral intuition composite (α = .87, M = 2.91, SD = .63), which was used in the analyses.

Figure 3.

Narrative Stimulus Depicting a Spatially and Socially Close Pandemic Scenario

Health Compliance Intention

Initially, 20 items were developed to measure health compliance intention in a pandemic situation. Through confirmatory factor analysis (CFA) and iterative model fit testing, the scale was refined to 13 items demonstrating strong internal consistency and validity. The final HCI scale demonstrated strong internal consistency (α = .951, M = 5.17, SD = .94). The confirmatory factor analysis results indicated a good model fit: χ²/df = 3.12, CFI = .95, TLI = .95, RMSEA = .08, and SRMR = .04. These indices confirm the reliability and validity of the HCI scale for measuring health compliance intentions in the context of environmental and pandemic concerns.

Figure 4.

Narrative Stimulus Depicting a Spatially and Socially Distant Pandemic Scenario

Analysis Plan

Results

EPPM and MFT Hypothesis

Hypothesis 3a suggested that general moral intuition will moderate the relationship between self-efficacy and threat on health compliance intention. To test H3a, this study used PROCESS Macro 4.2 downloaded from processmacro.org website (model = 2, CI = 95, bootstrap = 5000, X = moral intuition, Y = health compliance intention, W = self-efficacy, Z= perceived threat, moderation conditioning values = -1, 0, +1 SD). The regression analysis using PROCESS Model 2 showed that the overall model was significant, R²= .70, F(5,294) = 136.26, p < .001. Moral intuition (B = .76, p < .01, 95% C.I. = .28, 1.25) and self-efficacy (B = .66, p < .01, 95% C.I. = .24, 1.08) both significantly predicted health compliance intention. However, perceived threat was not a significant predictor (B = .20, p = .32, 95% C.I. = -.20, .60). The interaction term between moral intuition and self-efficacy was marginally significant (B = -.13, p =.07, 95% C.I. = -.26, .01), while the interaction term between moral intuition and perceived threat was not significant (B = .06, p = .42, 95% C.I. = -.08, .19). The conditional effects analysis revealed that moral intuition significantly predicted HCI at all levels of self-efficacy and perceived threat. Specifically, when self-efficacy was at its mean or -1 SD, moral intuition significantly predicted health compliance intention at all levels of perceived threat. However, when self-efficacy was 1 SD above the mean, the significance was only maintained for medium and high levels of perceived threat. Therefore, H3a was partially supported.

Table 3.

Correlations between Perceived Psychological Distance and Discrete Emotions(N = 300)

Hypothesis 3b suggested that care intuition will moderate the relationship between self-efficacy and threat on health compliance intention. To test H3b, this study used PROCESS Macro 4.2 downloaded from processmacro.org website (model = 2, CI = 95, bootstrap = 5000, X = care intuition, Y = health compliance intention, W = self-efficacy, Z= perceived threat, moderation conditioning values = -1, 0, +1 SD). The regression analysis using PROCESS Model 2 showed that the overall model was significant, R²= .69, F(5,294) = 129.80, p < .001. Care intuition (B = .22, p = .27, 95% C.I. = -.17, .69) did not significantly predict health compliance intention. Also, the interaction term between care intuition and self-efficacy (B = -.03, p =.51, 95% C.I. = -.13, .06), nor the interaction term between care intuition and perceived threat (B = .03, p =.54, 95% C.I. = -.06, .13) was significant. Therefore, H3b was not supported.

Hypothesis 3c suggested that purity intuition will moderate the relationship between self-efficacy and threat on health compliance intention. To test H3c, this study used PROCESS Macro 4.2 downloaded from processmacro.org website (model = 2, CI = 95, bootstrap = 5000, X = purity intuition, Y = health compliance intention, W = self-efficacy, Z= perceived threat, moderation conditioning values = -1, 0, +1 SD). The regression analysis using PROCESS Model 2 showed that the overall model was significant, R²= .69, F(5,294) = 130.68, p < .001. Purity intuition (B = .56, p < .01, 95% C.I. = .20, .92) significantly predicted health compliance intention. However, the interaction term between purity intuition and self-efficacy (B = -.05, p =.33, 95% C.I. = -.16, .06), nor the interaction term between purity intuition and perceived threat (B= -.02, p =.73, 95% C.I. = -.12, .08) was significant. Therefore, H3c was not supported.

Hypothesis 4a suggested that higher general moral intuition will predict higher HCI. The result of linear regression analysis was found to be significant, F(1, 298) = 148.44, p < .001, R²= .33. Specifically, it was found that increase in moral intuition led to more health compliance intention (B = .86, p < .001). Therefore, H4a was supported. Hypothesis 4b suggested that higher care intuition will predict higher HCI. The result of linear regression analysis was found to be significant, F(1, 298) = 112.85, p < .001, R²= .28. Specifically, it was found that increase in care intuition led to more health compliance intention (B = .63, p < .001). Therefore, H4b was supported.

Hypothesis 4c suggested that higher purity intuition will predict higher HCI. The result of linear regression analysis was found to be significant, F(1, 298) = 69.08, p < .001, R²= .19. Specifically, it was found that increase in moral intuition led to more health compliance intention (B = .51, p < .001). Therefore, H4a was supported. Hypothesis 5a suggested that general moral intuition will moderate the relationship between perceived distance on health compliance intention. Also, H2c suggested that higher construal level thinking will negatively predict health compliance intention. To test H5a and H2c, PROCESS Macro was used (model = 1, CI = 95, bootstrap = 5000, X = perceived distance, Y = health compliance intention, W = moral intuition, moderation conditioning values = -1, 0, +1 SD). The result of PROCESS Model 1 showed that the overall model was significant, R²=.43, F(3,296) = 136.26, p < .001. Moral intuition (B = .47, p < .001, 95% C.I. = .20, .73) and perceived distance (B = -.61, p < .001, 95% C.I. = -.85, -.36) both significantly predicted health compliance intention; the unconditional interaction effect of moral intuition and perceived distance was also significant (B = .14, p < .001, 95% C.I. = .06, .21). Specifically, it was found that the effect size of perceived distance on HCI was strongest (B = -.30) at the lowest level of moral intuition (m = 2.28; -1 sd) and weakest (B = -.13) at the highest level of moral intuition (m = 3.54; +1 sd). In other words, higher moral intuition decreased the CLT effect on HCI. Overall, H5a and H2c were supported.

Hypothesis 5b suggested that care intuition will moderate the relationship between perceived distance on health compliance intention. To test H5b, PROCESS Macro was used (model = 1, CI = 95, bootstrap = 5000, X = perceived distance, Y = health compliance intention, W = care intuition, moderation conditioning values = -1, 0, +1 SD). The result of PROCESS Model 1 showed that the overall model was significant, R²= .33, F(3,296) = 50.42, p < .001. Care intuition (B = .33, p < .001, 95% C.I. = .10, .57) and perceived distance (B = -.46, p < .001, 95% C.I. = -.69, -.22) both significantly predicted health compliance intention; the unconditional interaction effect of care intuition and perceived distance was also significant (B = .10, p < .01, 95% C.I. = .03, .17). Specifically, it was found that the effect size of perceived distance on HCI was strongest (B = -.23) at the lowest level of care intuition (m = 2.21; -1 sd) and weakest (B = -.08) at the highest level of moral intuition (m = 3.78; +1 sd). In other words, higher care intuition decreased the CLT effect on HCI. Overall, H6b was supported.

Table 6.

Conditional Effects of Care Intuition between Perceived Distance on HCI

Table 7.

Conditional Effects of Purity Intuition between Perceived Distance on HCI

Hypothesis 5c suggested that purity intuition will moderate the relationship between perceived distance on health compliance intention. To test H5c, PROCESS Macro was used (model = 1, CI = 95, bootstrap = 5000, X = perceived distance, Y = health compliance intention, W = purity intuition, moderation conditioning values = -1, 0, +1 SD). The result of PROCESS Model 1 showed that the overall model was significant, R²= .32, F(3,296) = 46.43, p < .001. Purity intuition (B = .07, p = .55, 95% C.I. = -.15, .29) did not significantly predictd HCI, while perceived distance (B = -.68, p < .001, 95% C.I. = -.89, -.46) significantly predicted HCI; the unconditional interaction effect of purity intuition and perceived distance was significant (B = .16, p < .001, 95% C.I. = .10, .22). Specifically, it was found that the effect size of perceived distance on HCI was strongest (B = -.35) at the lowest level of purity intuition (m = 2.08; -1 sd) and weakest (B = -.09) at the highest level of moral intuition (m = 3.68; +1 sd). In other words, higher purity intuition decreased the CLT effect on HCI. Overall, H5c was supported.

Dual Interpretation Based on Construal Level Theory

Previous research suggests that higher construal levels, characterized by more abstract thinking, are associated with increased moral judgment (Agerström & Björklund, 2009; Eyal & Liberman, 2012; Eyal et al., 2008). However, the descriptive statistics in this study indicate that participants were generally operating at a lower construal level (mean perceived distance = 2.77). Studies by Gong and Medin (2012) and Žeželj and Jokić (2014) suggest that more concrete thinking (lower construal level) can also enhance moral judgments under certain conditions. The overall low mean of perceived psychological distance supports this alternative view, suggesting that in some contexts, concrete and immediate framings may be more effective for eliciting moral and behavioral responses.

The results of this study indicate that spatially close versus distant framing did not produce significant differences in perceived psychological distance. One possible explanation is the inherently global nature of climate change, which may have rendered spatial distinctions less salient. Climate change is widely recognized as a global threat, transcending geographical boundaries and affecting populations worldwide (Chu & Yang, 2019; Cooper & Nagel, 2022). Thus, participants may have perceived both the domestic and international scenarios as universally relevant, rendering spatial framing less impactful. In other words, the global, all-encompassing nature of climate change may have made spatial distinctions relatively inconsequential, leading participants to construe both conditions at a similarly low construal level.

However, another critical factor may be the highly controlled nature of the experimental stimuli. The two conditions were designed to be nearly identical in text structure, narrative flow, and scene composition, with only minor changes in geographic location and patient racial identity. This design choice, while intended to maintain experimental control, may have unintentionally reduced the effectiveness of the psychological distance manipulation. Participants may have perceived both conditions as functionally equivalent, leading to null findings in the manipulation check.

This outcome aligns with the broader principles of CLT, which suggest that psychological distance emerges not only from physical proximity but also from subjective perceptions of vulnerability and relevance. While this study initially intended the manipulated framing to serve as a straightforward test (H1a) and a manipulation check, its failure to produce differences in perceived distance led this study to rely primarily on the measured distance metric for examining the more complex relationships in H2a-H2c and beyond. This finding suggests that, in future research, stronger psychological distance manipulations should be considered. Variations in healthcare infrastructure, local policy responses, or cultural differences in health narratives could be incorporated to create more perceptible distinctions between conditions. Additionally, the inclusion of temporal or hypothetical distance manipulations may yield more robust effects, given their demonstrated influence on construal level processing (Trope & Liberman, 2010). Furthermore, conducting pilot studies to refine stimuli and confirm the effectiveness of manipulations before full-scale implementation would enhance the internal validity of experimental studies in this domain.

Moral Licensing Effect in Climate Change and Pandemic Diseases

Second and more importantly, the results of H4 has found that as self-efficacy increases, the effect of moral intuition on health compliance intention decreased, indicating that individuals with higher self-efficacy rely less on moral intuitions to drive their health compliance behaviors. This is in line with Ahn & Noh (2021), which also found that effect of self-efficacy on HCI diminished as morality increased. Also, the results of H6 found that higher moral intuition decreases the effect of perceived distance on HCI. The observed patterns in both Ahn & Noh (2021) and the current study indicate a decrease in health compliance intention (HCI) as self-efficacy increases, even when moral intuition remains high (see Table 4 and Table 5). This counterintuitive result can be interpreted through several theoretical lenses, with moral licensing being a particularly compelling explanation.

Table 4.

Conditional Effects of Morality between Self-efficacy and Perceived Threat on HCI

Table 5.

Conditional Effects of General Moral Intuition between Perceived Distance on HCI

Moral licensing theory posits that when individuals engage in or even think about morally laudable actions, they may feel a subsequent sense of moral license, reducing the perceived need to act further in line with those moral beliefs (Blanken et al., 2015). In the context of current findings, individuals with high self-efficacy and high moral intuition might feel that their moral awareness and perceived capability to address the issue suffice, leading to a decrease in actual health compliance behaviors. Essentially, these individuals may think, “I recognize the moral importance of addressing climate change and pandemics, and I am confident in my ability to act. This recognition and confidence make me feel that I have already contributed enough to the cause.”

The findings suggest that high self-efficacy and strong moral intuitions interact in a complex manner. While moral intuition alone strongly predicts health compliance, its effect is moderated by self-efficacy levels. High self-efficacy appears to dampen the influence of moral intuition on compliance behavior, likely due to moral licensing effects where individuals feel they have already ‘done enough’ by recognizing and feeling capable of addressing the issue.

The findings of the current study suggests several practical implications for health communication in the context of climate change and/or pandemic disease when designing effective health compliance promotion messages. For high self-efficacy individuals, emphasizing the need for ongoing engagement and tangible actions to counteract the moral licensing effect. For low self-efficacy individuals, focusing on building self-efficacy while framing actions within a moral context to drive compliance can be more effective.

Limitations

This study acknowledges several limitations that could impact the interpretation of its findings. One of the most significant constraints was the lack of manipulation checks. Due to logistical constraints, a separate pre-study or manipulation check phase was not conducted. The manipulation of spatially close vs. distant framing did not result in significant differences in perceived psychological distance.

A notable limitation was the difficulty in achieving a robust manipulation of psychological distance through simple spatial framing. While generative AI tools were employed to create visually and contextually distinct stimuli, the inherently global nature of climate change may have diminished the salience of these spatial cues. However, another key limitation was that the experimental stimuli were designed to be nearly identical except for minor location and racial identity differences. This may have inadvertently reduced the effectiveness of the psychological distance manipulation, as participants perceived both conditions as fundamentally similar situations rather than distinct psychological contexts. Future studies should explore more pronounced variations in stimuli, such as differences in infrastructure, healthcare system responses, or cultural elements, to create stronger psychological distance effects. Additionally, alternative dimensions of psychological distance, such as temporal or hypothetical distance, could be explored for their potential to yield stronger manipulative effects. Furthermore, conducting pilot tests to validate and refine the experimental stimuli before full-scale data collection could help ensure stronger manipulative effects.

This limitation may have impacted the testing of hypotheses related to psychological distance, including H1a. Given the universality and salience of climate change threats, participants may have interpreted both near and distant scenarios as equally pressing, thereby diminishing the effectiveness of our spatial manipulation. This finding offers a valuable insight: in the context of global environmental risks, subjective perceptions of distance may be less responsive to simple location-based framings and more contingent on individuals’ pre-existing beliefs, moral intuitions, and perceived vulnerability. Future studies should consider alternative approaches to manipulating and measuring psychological distance to strengthen the internal validity of experiments.

Furthermore, while this study aimed to explore health compliance intention in a climate-induced hypothetical pandemic context, the use of AI-generated narratives and specific disease framing (malaria) might limit generalizability to other public health scenarios. Future research should consider a broader range of stimuli and incorporate manipulation checks to strengthen the empirical rigor.

Summary and Conclusion

This study expands to the existing literature by highlighting the significance of considering moral intuition and psychological distance in health communication strategies, especially in the context of climate change and pandemics. By integrating CLT, EPPM, and MFT, this research provides a comprehensive understanding of the psychological mechanisms driving health compliance intentions. Although this study’s attempt to manipulate psychological distance through geographic framing did not produce significant differences, this result itself underscores the notion that climate change represents a universally perceived risk. It suggests that psychological distance in such global contexts may be shaped more by subjective perceptions and moral considerations than by spatial cues alone. This aligns with CLT’s broader premise that distance is multifaceted and situationally contingent, especially for threats as pervasive as climate change. Moreover, the innovative use of generative AI technologies, such as DALLE-3 and Novel AI, to create experimental stimuli demonstrates the potential of these tools in advancing public health research. The findings reveal the complex interplay between self-efficacy, moral intuition, and psychological distance, underscoring the need for tailored health communication interventions. Understanding these interactions is critical for designing effective public health interventions that enhance compliance behaviors, thereby contributing to both methodological and theoretical advancements in the field.

Acknowledgement

This work was supported by the Korea Health Communication Association and Macromill Embrain for survey data collection in 2024 (Document No. KHCA 2024-04-003). The study was presented at the 2024 Spring Conference (June 15, 2024) of the Korea Health Communication Association.