Leveraging Crowdsourcing for Human Immunodeficiency Virus Testing Posters: A Visual Content Analysis and Cognitive Responses among Chinese Men Who Have Sex with Men

Introduction Extensive marketing and advertising research has informed a deep understanding of the link between visual design and consumer behaviors, providing a useful framework for assessing associations between human immunodeficiency virus (HIV)-related health posters and viewer responses. Methods Crowdsourced posters included finalist submissions from a series of nationwide crowdsourcing contests. Centers for Disease Control (CDC) images were sampled from an online poster database maintained by the National Center for acquired immune deficiency syndrome (AIDS). Once coded according to a set of 27 visual features, posters were shown to an online sample of Chinese men who have sex with men- A group currently experiencing the highest HIV incidence in China-to assess their viewer response. Results The CDC posters were more likely to use positive facial expressions (65%; 95% confidence interval [CI], 40.9-83.7] vs 12.5%; 95% CI, 2.2-4%) and an educational messaging style (85%; 95% CI, 61.1-96% vs 31.3%; 95% CI, 12.1-58.5). Crowdsourced posters exhibited better craftsmanship than CDC posters (more design simplicity, image diversity, color choice, design quality, and moderate use of text) used more visual metaphors (56.3%; 95% CI, 30.6-79.2 vs 5%; [95% CI, 0.2-26.9%]). Several differences in visual complexity were identified but these lacked statistical significance. Conclusion Crowdsourced posters were of higher craftsmanship, possibly due to their ability to recruit skills of professional designers. The CDC posters' use of positive visual reinforcement (smiling faces) and educational messaging may be a legacy of their role in the early days of the epidemic in disseminating basic HIV/AIDS knowledge and dispelling misinformation. Crowdsourcing posters' used more metaphors, suggesting better ability to leverage in-group codes and language.