Encouraging Organ Donation Signup Intentions: Effects of Highlighting Social Proximity and Message Concreteness

1. Introduction

South Korea suffers from a chronic shortage of donated organs. During the year of 2023, 521 individuals donated their organs, whereas over 51 thousand patients were on the waiting list for organ transplant (Ministry of Health and Welfare, 2024). Due to this stark gap between the demand for and supply of donated organs, patients in Korea, on average, have to wait 48 months to receive an organ transplant. During this period, 8.4 patients die every day because they are not able to receive a transplant in time. Alarmingly, the number of patients on the waiting list and the according death toll continues to rise each year (Ministry of Health and Welfare, 2024, 2025).

Among different reasons for the low organ donation rate, two noteworthy ones are (1) low levels of perceived involvement and (2) vague sense of fear. First, Koreans, in general, have a low level of involvement with organ donation, such that they believe organ donation is personally irrelevant (Ministry of Health and Welfare, 2021); the public rarely considers organ transplants as something that they, or those close to them, would be in need of (Ministry of Health and Welfare, 2011). Due to this psychological distance, they often lack motivation to sign up to a registry to become potential organ donors.

Another hurdle is the vague fear about organ donation. According to a national survey on organ and tissue donation, 30.8% of respondents stated that they are scared of the idea of organ donation yet they were unable to explain the specific reason for this fear. One underlying reason for this unexplainable fear may be the lack of a clear understanding of the process of organ donation or transplant. In fact, only 5.7% of Koreans reported that they are aware of the organ donation process (Ministry of Health and Welfare, 2021). Moreover, among those who were not willing to become an organ donor, 33% associated organ donation with body damage (Korea Disease Control and Prevention Agency, 2018).

Tackling such misconceptions about organ donation is not an issue that is easily solvable (Lee, 2015). Despite continuous effort, organ donation campaigns in Korea have not been particularly successful. Campaigns have often focused on illustrating the heroic aspects of organ donors, or the emotional sense of accomplishment of those who signed up for an organ donation registry (for examples of previous campaigns, see: KDCAkorea, 2019; Ministry of Health and Welfare TV, 2020, 2023). Considering Koreans’ low perceived involvement with organ donation, conveying the heroic stories of posthumous donors and affective benefits of signing up (e.g., feeling good) are likely ineffective in making people feel that organ donation is particularly relevant to them (Ministry of Health and Welfare, 2011, 2021). Moreover, although systematic exploration remains unexamined, existing campaigns appear to rarely deliver concrete information and instructions about organ donation (e.g., where and how to sign up for an organ donor registry, facts about the donation and transplant procedure). This, potentially, is ineffective in increasing the public’s knowledge of organ donation, combating related misinformation, and ultimately, increasing the number of registrants.

Prior research has examined diverse campaign strategies such as framing (gain vs. loss) and emotional versus rational appeals, showing that message design can significantly influence knowledge, attitudes, and intentions regarding organ donation (e.g., Feeley & Moon, 2009; Morgan et al., 2010). However, findings across contexts remain mixed, highlighting the need for further theory-driven investigations that can situate message strategies within particular sociocultural contexts.

In the context of South Korea, pervious studies demonstrated that entertainment media (e.g., national TV programs) could enhance engagement and intentions regarding organ donation by fostering narrative involvement and parasocial relationships (Bae, 2008; Lee, Park, Choi, & Kim, 2009). Studies also examined message design strategies like framing and source characteristics on attitudes and behavioral intentions (Min & Lee, 2023; Park & Lee, 2021; Sun, 2015), which found small to medium effect sizes.

The current study builds on this line of research on organ donation campaigns and examines how message factors such as social distance and concreteness/abstractedness can help encourage organ donation signups in South Korea, based on the construal level theory (CLT; Liberman & Trope, 2008; Liberman, Trope, & Stephan, 2013; Trope & Liberman, 2010). In the sections that follow, we first provide a brief overview of the construal level theory, discuss how the social distance dimension can be particularly relevant in this context. We also introduce the framework and empirical backgrounds regarding message concreteness, and the potential mediating role of issue involvement.

5) Mediating Role of Issue Involvement

Issue involvement refers to an individual’s perceived level of interest, significance, and personal relevance for an event, and their motivation to be engaged in the event (Mittal & Lee, 1989; Olsen, 2007; Zaichkowsky, 1985). It has been recognized as an important factor that influences and mediates various behavioral outcomes (Bae, 2008; Howard & Sheth, 1969; Lai & Chen, 2011; Park, 1996). This is because greater issue involvement encourages more systematic processing of message content and stronger emotional engagement, both of which facilitate behavioral intention (Cho & Boster, 2005; Petty & Cacioppo, 1986).

Prior research suggests that message features that reduce psychological distance - such as focusing on socially proximal others and using concrete language - can increase perceived personal relevance, thereby enhancing issue involvement (Spence, Poortinga, & Pidgeon, 2012; White, MacDonnell, & Dahl, 2011). Applying this to the context of organ donation, messages depicting close others (e.g., family) or using concrete language may make the issue feel immediate and personally consequential, heightening involvement. This heightened involvement is likely to translate into greater motivation to act, thereby increasing intentions to sign up as an organ donor (Bae, 2008; Kang, Cappella, & Fishbein, 2006). Thus, issue involvement is expected to mediate the effects of social distance and message concreteness on intentions to sign up for an organ donor registry.

H4: Involvement with organ donation will mediate the relationship between (a) social distance and intentions to sign up, and the relationship between (b) message concreteness and intentions.

See <Figure 1> for the overall conceptual model.

<Figure 1>

Proposed Conceptual ModelNote. Dotted lines (H4) denote indirect effects of social distance, message concreteness, and their interaction term on intention via involvement

2. Method

3. Results

2) Hypotheses Testing

A 2 × 2 factorial analysis of variance (ANOVA) was conducted to test the impact of social distance, message concreteness, and their interaction on behavioral intention. The analysis did not reveal a significant main effect for social distance, F(1, 262) = .60, p = .44, η² = .002; H1 unsupported. On the other hand, there was a significant main effect for message concreteness, F(1, 262) = 5.67, p = .02, η2 = .02. As predicted, participants who read a concrete message displayed higher behavioral intention to sign up an organ donation registry (M = 4.46, SD = 1.10) than those who read an abstract message (M = 4.13, SD = 1.17; H2 supported). The interaction between social distance and message concreteness was not significant, F(1, 262) = .51, p = .47, η2 = .002 (H3 unsupported). See Appendix C for the means and standard deviations of each experimental condition; see Appendix D for the ANOVA results table.

To test the indirect impact of social distance and message concreteness on behavioral intention via issue involvement (H4), path analyses were conducted using the lavaan package in R (v0.6.19; Rosseel, 2012) with 5,000 bootstrap samples. Overall, indirect effects were nonsignificant (social distance factor → issue involvement → intention: b = -0.06, SE = 0.09, p = .50; message concreteness factor → issue involvement → intention: b = 0.10, SE = 0.10, p = .31). Neither social distance (b = -0.08, SE = 0.12, p = .50) nor message concreteness (b = 0.13, SE = 0.13) nor their interaction (b = -0.11, SE = 0.25, p = .30) was significantly related to issue involvement, whereas issue involvement was positively related to behavioral intention (b = 0.75, SE = 0.05, p < .001). Consistent with the ANOVA results presented above, the total effect of message concreteness on behavioral intention was significant (b = 0.33, SE = 0.14, p = .02), whereas the corresponding direct effect was nonsignificant (b = 0.19, SE = 0.10, p = .07). From this, we can infer that issue involvement explains a noticeable variance of behavioral intentions (albeit not impacted by the message). Both total (b = -0.02, SE = 0.02, p = .19) and direct effects (b = -0.05, SE = 0.10, p = .61) of social distance on behavioral intentions were nonsignificant.

Since message factors were not significantly related to issue involvement, a post-hoc analysis was conducted to examine if the effects of message factors might be mediated by involvement through perceived social distance/message concreteness. That is, we wanted to test the possibility of the messages increasing behavioral intentions through issue involvement, only when they successfully increase the related perceptions. Again, a path analysis was conducted using the lavaan package in R (Rosseel, 2012) to check for serial mediation, visualized in <Figure 2>. Consistent with the manipulation check described above, the social distance message factor increased perceived social distance (b = -0.40, SE = 0.16, p = .02), and the message concreteness factor increased perceived message concreteness (b = -0.28, SE = 0.10, p = .004). In turn, perceived message concreteness (b = 0.39, SE = 0.07, p < .001) was positively related to issue involvement, whereas perceived social distance was not (b = 0.08, SE = 0.05, p = .10).

<Figure 2>

Path Analysis ResultsNotes: *p<.05, **p<.01, ***p<.001. Unstandardized coefficients (b) and standard errors (SE) are reported. Dotted lines indicate non-significant paths

Finally, issue involvement was positively related to behavioral intention (b = 0.76, SE = 0.05, p < .001). Overall, the indirect effect was significant for the ‘message concreteness factor → perceived message concreteness → issue involvement → behavioral intention’ serial mediation (b = 0.08, SE = 0.03, p = .02), but nonsignificant for the ‘social distance factor → perceived social distance → issue involvement → behavioral intention’ mediation (b = -0.03, SE = 0.02, p = .19). Additionally, we also find ‘message concreteness factor → perceived message concreteness → behavioral intention’ mediation to be marginally significant (b = 0.05, SE = 0.03, p = .05).

4. Discussion

The purpose of this research was to examine the effects of highlighting different social distances and the level of message concreteness in the context of organ donation campaigns, partly based on the CLT. Results demonstrate that message concreteness influences behavioral intentions (H2); specifically, concrete messages, compared to abstract ones, resulted in greater intentions to sign up for an organ donation registry. However, it is worth noting that while participants in the abstract message condition had lower mean scores, this still hovered over the midpoint of the 7-point scale, indicating that general intentions were moderately positive across the board. Contrary to what was hypothesized, we did not find main effects of the social distance message factor (H1), nor an interaction between the two message factors (H3).

We also did not find a mediation effect of issue involvement (H4). The nonsignificance of the indirect effects was mainly driven by the nonsignificant impacts of the message factors on issue involvement, although issue involvement was significantly associated with intentions to sign up for an organ donation registry.

Lastly, we conducted a post hoc serial mediation analysis to discern whether the mediating role of issue involvement may differ depending on whether the message factors successfully increased perceptions of social distance/message concreteness. Results suggested that, while the indirect effect of ‘message concreteness factor → issue involvement → behavioral intentions’ tested above was nonsignificant, a serial mediation of ‘message concreteness factor → perceived message concreteness → issue involvement → behavioral intention’ was statistically significant.

In short, results demonstrate that concrete messages have the potential to increase public intentions to sign up for an organ donation registry. Unlike expected, the effect of concrete messages was not mediated by issue involvement. However, the post hoc analyses suggest that when concrete messages successfully increase perceived message concreteness, that in turn, can increase behavioral intentions through issue involvement.

The absence of effects of social distance cues is somewhat contrary to what would be expected by the CLT. There are several possible speculations we offer on why the effects of social distance cues remained nonsignificant despite theoretical expectations. As explained in the Introduction, one of the main barriers to organ donation is related to the unexplainable fear towards it (Ministry of Health and Welfare, 2021). Public perceptions of organ donation are likely associated with various uncertain and abstract concepts such as death and the afterlife, which are likely less addressable by manipulating social distance cues; other psychological factors and types of construal should therefore be considered. As reviewed in the beginning, CLT suggests that mental construal depends on a multitude of dimensions, including social, temporal, spatial, and hypothetical distances. In this study, we focused on social distance as a message factor given its relevance in the organ donation context. However, future research may benefit by examining whether other factors of psychological distance posited by the CLT may have noticeable impacts on attitudes and engagement regarding organ donation. Previous research has also suggested that the applicability of CLT may vary across contexts and individual traits. For instance, factors such as compassion, efficacy, and locus of control have been identified as variables that can impact the dynamics of the theory (e.g., Huang & Zhang, 2023; Tang & Li, 2025).

Additionally, our findings may also be suggesting that members of the Korean public have already developed relatively stable beliefs about the (ir)relevance of organ donation to their own lives, potentially limiting the influence of message-based manipulations. For future research, examination of a more effective approach that can increase the sense of relevancy will be necessary.

Lastly, it is also possible that the null effects observed in this study may simply be due to a message manipulation that is not strong enough - especially to elicit statistically significant effects from a one-time exposure - rather than the inapplicability of social distance cues in the organ donation context.

Additionally, our results did not align with the theoretical expectations of CLT’s matching principle. While this may be due to a lack of statistical power (further discussed in the following paragraph), it may also provide some theoretical implications. The matching principle posits that message persuasiveness increases when message concreteness matches the construal level of the issue/entity. In our study, whether the concrete messages facilitated low-construal processing remains unanswered. While our manipulation check showed that the concrete messages were perceived as more concrete than the abstract messages, participants’ level of construal regarding organ donation as a whole may remain unchanged. Future studies should carefully distinguish construals about a specific communication instance versus issue-as-a-whole, and further examine whether the matching principle holds in the organ donation context.

This study is not without limitations. First, while the study was sufficiently powered to detect small to medium main effects, a simulation-based power analysis suggested that we were potentially underpowered to detect fully attenuated interaction effects. This does not completely undermine our findings, as the sample provided sufficient power to detect a good range of interaction patterns; however, the nonsignificant interaction should be interpreted with caution given the possibility of insufficient power.²⁾

While we employ an experimental design to examine causal relationships, there are inherent limitations to drawing causal inferences, especially when it comes to our mediation models. Although the ordering of the mediation model was theoretically informed, the serial mediation model should be interpreted with caution, given the cross-sectionality of the data. Additionally, while the use of intended actions is established within the field, it is important to note that we do not directly assess whether the messages lead to tangible actions. While intentions are a meaningful precursor to behavioral engagement, they do not always translate to actual actions (Sheeran, 2002).

Message effects in the organ donation context may also be contingent on various factors not accounted for in this study. We encourage future studies to examine the role of potential moderators that may drive differences in message effects, such as prior attitudes, source cues, or individual traits, such as need for cognition or value orientations. We also note that the topic of organ donation can be culturally-sensitive. It is thus important to examine the effectiveness of various messaging factors including message concreteness and social distance in diverse cultural contexts.

Lastly, participants were recruited via quota sampling. While this approach helps approximate national demographic distributions, caution is warranted in generalizing the findings to the entire population, given that it is not a true probability sample.

Consistent with previous studies (e.g., Morgan, Movius, & Cody, 2009), our study highlights the necessity of providing concrete and detailed information on the organ donation process in order to increase public engagement with organ donation. For practitioners, it is suggestible that - instead of abstractly stating the idealistic values of organ donation (e.g., ‘eyeball donation enables patients to see the new world’) or focusing on the emotional rewards (e.g., ‘feel the accomplishment of helping others’) - it would be more effective to provide specific instructions and information about the sign up processes. A step-by-step guideline on the organ donation sign-up process, which individuals can actually follow, could be particularly helpful. Lastly, we would like to note that in real-world campaign design practices, message concreteness is rarely used in isolation but typically operates alongside various other communication factors. To strengthen the practical implications of this line of research, it is important to carefully examine how the effects of message concreteness are amplified (or attenuated) when it is combined with other communication factors.

Acknowledgments

The publication of this work was supported by the Ewha Womans University Research Grant of 2025 and the Korea University Research Grant (Jinri Scholarship) of 2018.

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