I believe a person’s tolerance for restrictions are unique and a multitude of underlying factors can increase susceptibility to experiencing reactance. Across my research, it seems that personal support for organ donation, as would be expected, buffers against reactance towards opt-out organ donation legislation. However, other factors including trait reactance (people who have an inflated desire for self-determination and are inherently sensitive to impingements on their freedom), trust in the government, or their alignment with the political party seen as being responsible for implementing a particular legislation, may also play a role.

You could reasonably expect people with higher trait reactance for example, to be more likely to have experienced reactance to opt-out organ donation following COVID-19 related restrictions. However, it may also be that notions of restricted freedom in response to COVID-19 are perceived differently than threat to freedom experienced in relation to opt-out organ donation. In line with reactance theory, it seems that people often feel that restrictions on their freedom are more justified, and they subsequently experience less reactance when the negative consequences of not engaging in the desired behaviour (compliance with lockdown for example) could have serious repercussions for society. The reactance literature has enjoyed a resurgence recently so this is definitely an important area for future research.

Ideally, a combination of neutral, non-commanding low threat terminology used within the media would be best, e.g. “If you do not want to donate your organs, you can always choose to opt-out”. However, as you say, the media often use sensationalist high threat messaging.

There is some evidence that a few specific messaging strategies can mitigate reactance.

The first, restoration postscript messaging, is designed to mitigate reactance by reaffirming the reader’s autonomy after exposure to a freedom threatening message. For example, explicitly stating “Organ donation remains a personal choice”. The second, inoculation messaging, forewarns the reader of a potential perception of threat to freedom as a way of decreasing the likelihood of negative reactant responses. Both methods have had variable success across health communication literature, including campaigns designed to decrease alcohol consumption and increase physical activity however, no research has assessed these strategies for opt-out consent.

Aside from direct messaging techniques…

A number of participants within the qualitative interviews I conducted also felt that recording an opt-out decision would be purposely prohibitive: “they will make it as awkward as possible to opt-out in my opinion”. Expecting these difficulties when trying to opt-out arguably may contribute towards perceptions of coercion and may increase perceptions of threat to freedom. So, a relatively simple way of minimising this would be to ensure the pathway for registering an opt-out decision is very clearly communicated, and the opportunity to register an opt-out decision as straightforward and accessible as possible. While this sounds very simple, quite often only registration is promoted. Now that the UK has moved to opt-out, it’s vital that where appropriate, we communicate both.