Digital Media for Behavior Change: Review of an Emerging Field of Study

Digital media are omnipresent in modern life, but the science on the impact of digital media on behavior is still in its infancy. There is an emerging evidence base of how to use digital media for behavior change. Strategies to change behavior implemented using digital technology have included a variety of platforms and program strategies, all of which are potentially more effective with increased frequency, intensity, interactivity, and feedback. It is critical to accelerate the pace of research on digital platforms, including social media, to understand and address its effects on human behavior. The purpose of the current paper is to provide an overview and describe methods in this emerging field, present use cases, describe a future agenda, and raise central questions to be addressed in future digital health research for behavior change. Digital media for behavior change employs three main methods: (1) digital media interventions, (2) formative research using digital media, and (3) digital media used to conduct evaluations. We examine use cases across several content areas including healthy weight management, tobacco control, and vaccination uptake, to describe and illustrate the methods and potential impact of this emerging field of study. In the discussion, we note that digital media interventions need to explore the full range of functionality of digital devices and their near-constant role in personal self-management and day-to-day living to maximize opportunities for behavior change. Future experimental research should rigorously examine the effects of variable levels of engagement with, and frequency and intensity of exposure to, multiple forms of digital media for behavior change.

Brief Summary of Current Digital Health Research
Digital media (i.e., electronic media where data are stored in digital form) are omnipresent in modern life, but the science of how digital media impact behavior is still in its infancy [1]. For example, approximately 45% of the world's population or 3.5 billion people use social media, with the average user spending approximately 3 h of their day overall on social media [2]. These statistics make it critical to understand both how technologies such as social media influence health decision making and behavior and to design and evaluate effective behavior change interventions using social and other digital media platforms (i.e., programs aimed at changing specific behaviors in a population using one or more digital platforms as the delivery channel, including research aimed at assessing the effectiveness of such programs). 2 of 14 There is an emerging evidence base of how to use digital media for behavior change. Strategies to change behavior implemented using digital technology have included a variety of platforms (e.g., text messaging, social media, apps) and program strategies (e.g., social media support groups and tailored coaching), all of which are potentially more effective with increased frequency, intensity, interactivity, and feedback [3]. Overall, the most effective health behavior change interventions use a combination of both digital and face-to-face components, lending credence to the importance of classical social behavior change modalities, including human interaction and in-person accountability [1,4].
The most commonly cited research gap is the use of inconsistent, non-standardized measures (e.g., engagement, reach) to evaluate digital media-related behavior change interventions [5,6]. Other areas highlighted for improvement include clarification of exposure and dose, intensity of intervention delivery, and measurement of long-term outcomes [7]. As noted in multiple systematic reviews, the preponderance of evidence characterizing effective behavior change techniques using digital interventions has been collected through focusing on residents of high-income countries (HICs) [8].
What is the distinctive approach in this domain? The field of digital media for behavior change is characterized by its use of digital device-human interactions as an intervention strategy, as a methodology for data collection and research, and as environmental influences (i.e., the study of infodemiology) that may affect behavior and moderate the effects of interventions aimed at behavior change [9]. This paper focuses primarily on the first of these two approaches and explores case studies to illustrate how they have been applied and studied in recent research aimed at identifying effective strategies to bring about positive, population-level health behavior change.
In fact, social media is a core feature of the current social environment, and researchers need to study it to identify media effects, both positive (potential as a behavior change intervention platform) and negative (the effects of mis-and dis-information on decision-making and health behaviors). For example, social media facilitates access to communities around maladaptive health behaviors (e.g., restrictive or binge eating related to anorexia/bulimia), access to networks for illegal purchases such as guns and illegal drugs; its design features (e.g., such as design of News Feed) affect not only health information, but norms and sense of social support [10]. Social media use has been associated with mental health conditions including loneliness and depression, especially among adolescents and young adults [11]. It is critical to accelerate the pace of research on digital platforms, including social media, to understand and address its effects on human behavior.

Overview of Digital Interventions
As an intervention strategy, digital media for behavior change uses all features of digital devices to communicate and create environmental cues and incentives (i.e., following behavioral economics) that encourage the adoption of new behaviors and the maintenance of existing ones. These approaches may take place on social media, mobile phone apps, chatbots, text, and social messaging (e.g., WhatsApp), as well as many specific modalities of information that can be communicated within them, such as video, memes, website links, and graphic images, among others. Digital interventions have the flexibility to be based on tailored, individual communication and on group-level communication, such as in a Facebook group, enabling group interaction and social support. Peer-to-peer interventions (where the intervention is essentially delivered by the participants) are also possible [12].
Digital platforms such as social media have the inherent feature of interactivity and the potential to engage participants and populations in the context of their social networks, thus building a sense of identification and connection with the intervention. This can be done through 'gamification' features, such as virtual incentives and rewards and through social role modeling by individuals that are appealing and aspirational for the audience. Digital platforms, like social media, provide the opportunity for participant co-creation (i.e., content co-generated by users and investigators). For example, in the US, adolescents developed and disseminated their own sexual health, substance use, and violence risk behavior prevention messages as part of a community-based participatory Latino and Immigrant health intervention [13].

Examples of Digital Health Research
As a data collection and research strategy, digital media may be used in many ways. Social media provides large quantities of available data on registered users (e.g., Facebook analytics) that can be used to identify potential study participants (e.g., individuals who, based on Facebook data, are likely to fit a specific socio-demographic profile, such as young male Latinos). Apps such as Facebook Messenger and other 'chat' functions, may be automated to run surveys through 'chatbots' that deliver questions through individual messages with pre-defined response options for study participants. Such technologies can be used to design randomized controlled trials [14].
Additionally, intervention research may be conducted using the combination of social media technology for remarketing (i.e., delivery of specific content, such as advertising, to an individual user based on previous online activity, such as viewing social media content) and chatbot data collection. Therefore, participants may be recruited into a research study using Facebook advertising (e.g., to join a research study), the data are then collected using chatbot technology, and then the same participants may be exposed to an intervention using remarketing technology, and subsequent data may be collected. This creates the potential for social media based randomized experimental studies to evaluate online behavior change interventions.
Behavior change interventions that rely on social networks for their success are hypothesized to have greater impact, and to generate greater interactivity and feedback, than interventions that rely on changes in individual behavior, due to the amplifying effects of social support and social participation [15,16]. Indeed, social network researchers have measured the impact of interventions beyond those immediately exposed to an intervention. Thus, in addition to the effect of treatment-on-the-treated, social network researchers have measured the effect of treatment on the untreated (e.g., for healthy weight management and weight loss) [17]. Researchers who have evaluated door-to-door campaigns to get out the vote, for example, have measured a smaller, discernable effect of such campaigns on the untreated (i.e., effects on members of the household who are not directly exposed to the canvasser) [18]. This additive effect may be due to effects on social norms and other social influences (e.g., based on the observation of those who receive treatment by those who do not).

Evidence on Digital Media for Behavior Change
A recent study illustrates the state of the evidence for digital media behavior change interventions. In this scoping review, the authors found over 3300 articles that met inclusion criteria such as (1) using some form of digital media in an intervention, and (2) having a focus on behavior change or change in antecedents of behavior [19]. This review aimed to (1) routinely monitor and identify literature around digital media-based behavior change interventions to get insights for future digital media studies, and (2) systematically review relevant literature to identify evidence and areas for improvement in the field. Initial findings confirmed that there is emerging published data on exposure to and evaluations of digital health behavior change interventions, but this research is still in its infancy. However, only some 298 reported original research aimed at establishing the effectiveness of a digital behavior change intervention.
The purpose of the current paper is to describe methods in the field, present illustrative use cases, describe a future agenda, and raise central questions to be addressed in future digital health research for behavior change. The science of digital health and its application to promoting health and preventing disease is in its infancy. But new technologies and opportunities to apply digital media technology for behavior change (e.g., how social media, perhaps the most widespread digital media channel, can be used to promote healthy behaviors) are growing rapidly. Social and behavioral scientists must harness the potential of these technologies and develop this emerging field of study. This paper lays out key considerations in that endeavor informed by the extant literature.

Methods
Digital health for behavior change employs both intervention and research methodologies. In the context of behavior change interventions, there are three main methods: (1) digital media interventions aimed at behavior change, (2) formative research using digital media aimed at aiding in the design of interventions, and (3) digital media used to conduct outcome and impact evaluations. We note that these are methods for conducting digital media practice and research. Below, we provide detailed use cases on the implementation (or results) of such methods.

Examples of Methods to Deliver Digital Media Campaigns for Behavior Change
On social media (the predominant digital communication channel), interventions can be delivered in a variety of ways. Social media (e.g., Facebook, Twitter) can be used as a digital environment for serving ads that can be microtargeted to the individual characteristics of users. Additionally, social media accounts with many followers (e.g., influencers) have been used to promote behavior change messaging with their followers. Social media platforms can also serve as a platform for group-based interventions aimed at behavior change. Several large RCTs have tested the efficacy of randomizing people into private social media groups and then using the groups as the settings for providing education content to users in the form of group posts, including stimulating engagement among users (e.g., polls, questions, conversations) and social support among group members [20][21][22]. These can be supplemented with direct messages to individual users providing additional individualized support or information. Increasingly, there is also an interest in shaping the content of existing groups and pages on social media by having lay health workers either join such groups and post health-promoting content or reach out to group and page administrators requesting them to post such content.
These strategies have potential to create a sense of widespread support for and adoption of specific behaviors. A kind of bandwagon effect may result, leading to behavior change. Theoretically, the effect of such social media campaigns may be to promote a social norm in support of specific health behaviors, such as COVID-19 vaccination, healthy eating and physical activity, or avoidance of nicotine consumption [19]. The following case studies illustrate interventions and research that investigate this hypothesized effect of social media campaigns.

Examples of Digital Media Methods in Formative Research
Another important research opportunity and capability while using digital media is to conduct formative research, or research aimed at helping to design campaigns for behavior change. One example of such efforts was a formative study conducted by Agha and colleagues in Nigeria in 2021. This study applied a behavioral lens to understand drivers of COVID-19 vaccination uptake among healthcare workers (HCWs) in Nigeria. The study used data from an online survey of Nigerian HCWs ages 18 and older conducted in July 2021. Analyses examined the predictors of getting two doses of a COVID-19 vaccine. One-third of HCWs in this study reported that they had gotten two doses of a COVID-19 vaccine. Motivation and ability were powerful predictors of being fully vaccinated: HCWs with high motivation and high ability had a 15-times higher odds ratio of being fully vaccinated. However, only 27% of HCWs had high motivation and high ability. This was primarily because the ability to get vaccinated was quite low among HCWs: only 32% of HCWs reported that it was very easy to get a COVID-19 vaccination. By comparison, motivation was relatively high: 69% of HCWs reported that a COVID-19 vaccine was very important for their health. Much of the recent literature coming out of Nigeria and other LMICs focuses on increasing motivation to get a COVID-19 vaccination. Findings highlight the urgency of making it easier for HCWs to get COVID-19 vaccinations.

of 14
The Agha et al. study is an example of how research using digital media, and specifically social media platforms, has tremendous potential to provide insight into behavior change campaign design and implementation. Findings from this study informed a large scale COVID-19 vaccination campaign that began in Nigeria in late 2021 to continue through early 2023 [CITE]. The purpose of this effort is to use social media delivered by trusted organizations and influencers to promote HCW vaccination and broader population vaccination, in part through the role modeling effects of increased rates of vaccinated HCW. This approach has broad applicability to other social media-based research.

Examples of Digital Media Methods for Evaluation Research
Finally, the outcomes and impact of digital media interventions for behavior change may be evaluated using digital media and social media platforms. The previously mentioned example of virtual lab is a state-of-the-art example in the social media domain. The power of social media to first identity individual users who appear, based on publicly available data, to fit a specific demographic, behavioral, or lifestyle profile (e.g., being a health care provider in a specific country of a certain age range) allows for targeting of recruitment efforts. Facebook advertising, for example, may be used to reach a specified population based on Facebook proprietary data, and then those individuals may be invited through the ads to join a research study. Upon initial expression of interest through the clicking on a link to a survey, additional screening may be done (e.g., through eligibility questions) to confirm study inclusion or exclusion, followed by informed consent.
Such studies may follow multiple designs, including observational, quasi-experimental (e.g., examining the effects of exposure to social media messages on outcomes of interest, such as vaccine hesitancy or vaccination) and randomized controlled studies. In social media, the Facebook Messenger (DM) app is one relatively simple way to deliver surveys, as individual questionnaire items may be delivered as chats DMs in sequence to allow a participant to complete a survey wave. Such surveys may be followed by randomization to study condition to receive a social media and/or other treatment aimed at promoting behavior change and/or other outcomes (e.g., changes in social norms or intentions). Because the participants have provided contact data through the social media platform (e.g., through DM), they may be recontacted for longitudinal data collection. In this way, bespoke panels may be created to run studies. Additionally, surveys, as individual questionnaire items, can be delivered with text messaging and apps, offering real-time assessments (i.e., ecological momentary assessments, EMA) that can monitor time sensitive symptoms or conditions such as urges and cravings related to addiction.
An important advantage of this methodology and technology is that it is relatively low cost [23]. Large scale data collection may be conducted with relatively low marginal costs of initial survey programming and data management. Incentives may be provided through such modes as electronic gift cards or mobile phone use credits, the latter being highly valuable in many low-and middle-income countries (LMIC) where pay-by-use mobile phone plans are common. The following use cases illustrate examples of how these methodologies have been recently applied, and we explore the potential of social media platforms in the future development of digital health research.

Use Cases
In this section, we briefly describe several use cases and their contribution to building the field of digital health for behavior change. These case studies represent results in that they illustrate the application and range of methods in the field, recognizing that there are many other forms that such interventions and research may take.

Use Case #1: Social Media to Deliver Weight Loss Information to Young Adults on University Campuses
Nearly 40% of young adults, ages 20-39 [24], have overweight and obesity. Young adulthood is a pivotal life period, marked by changes in academic and social functioning, food environment and availability, as well as declines in physical activity [25,26]. The availability of weight loss services on university campuses has been delayed in implementation in comparison to other health-risk behaviors [27,28], thus making this an important target for scalable, easy-to-implement interventions. The Healthy Body Healthy U (HBHU) project was designed to examine the differential efficacy of two digitally delivered weight loss treatments compared with a health education control [29]. We will discuss the use of social media for recruitment, consent processes specifically focused on using a commercially available platform (i.e., Facebook) or research purposes, ongoing monitoring and safety procedures, and ways to measure impact.
Participants were young adults (18-35 years) with a body mass index (BMI) of 25-45 kg/m 2 who attended a university within the Washington, DC or Boston area. Additional inclusion criteria specified that those eligible must be an active Facebook user (i.e., having logged into the platform at least in 1 time within the last month), able to send/receive text messages and no health contraindications for participating in physical activity or weight loss.
There were different channels for recruitment using social marketing principles [30], such as placement of materials in high-trafficked areas and standardized branding using study-specific colors, logos, and fonts. Furthermore, technology was used as a specific outreach strategy. The following figures illustrate how these elements of the program were implemented. "Micro targeting" or delivering advertisements through Facebook targeting specific demographics, was used (see Figure 1). Key leaders on campus, such as academic deans, also tweeted or retweeted study-related recruitment efforts (see Figure 2).    After participants responded to the study advertisements, they completed screening to determine eligibility to participate in the study, at which point they were scheduled for an in-person assessment to further review the study commitment and consent to participate [29]. The consent forms highlighted the potential risks of participating in an online group through a commercial platform with unknown follow-participants. We followed procedures as suggested by Moreno and included the following in the consent document [31]: "… while the study team will keep your study information confidential, anything you post on Facebook is technically governed by and can be used by Facebook; therefore, we cannot ensure complete confidentiality of all of your Facebook posts and information" and referred the participant to periodically review the Facebook terms of conditions. We also highlighted the community guidelines and limits to confidentiality based on the presence of others in the group, i.e., "Confidentiality of your identity or information discussed on the Facebook group page cannot be guaranteed by the research staff due to the presence of other research participants. Study volunteers are encouraged to maintain strict confidentiality regarding your information and the information of others who are participating in the program." After participants responded to the study advertisements, they completed screening to determine eligibility to participate in the study, at which point they were scheduled for an in-person assessment to further review the study commitment and consent to participate [29]. The consent forms highlighted the potential risks of participating in an online group through a commercial platform with unknown follow-participants. We followed procedures as suggested by Moreno and included the following in the consent document [31]: " . . . while the study team will keep your study information confidential, anything you post on Facebook is technically governed by and can be used by Facebook; therefore, we cannot ensure complete confidentiality of all of your Facebook posts and information" and referred the participant to periodically review the Facebook terms of conditions. We also highlighted the community guidelines and limits to confidentiality based on the presence of others in the group, i.e., "Confidentiality of your identity or information discussed on the Facebook group page cannot be guaranteed by the research staff due to the presence of other research participants. Study volunteers are encouraged to maintain strict confidentiality regarding your information and the information of others who are participating in the program".
Briefly, the interventions were delivered via private Facebook and SMS text messaging. The participants (n = 459) were randomly assigned to one of two weight loss groups delivered via these channels or a health education contact control. The two weight loss interventions were based on the Diabetes Prevention Program [32,33]. The two weight loss interventions differed in the amount of personalization provided. Specifically, one group (tailored) received personalized information based on their own feedback and high-risk barriers, while the other (targeted) received generic weight loss information specific to young adults.
For programs delivered via digital channels with limited synchronous interactions, participant safety monitoring is critical. For those tailored participants, study staff were alerted to weight losses (or gains) that exceeded three pounds within a one-week period. Furthermore, all participants completed monthly health screens by responding to text messages and all weight loss participants were asked about their rate of weight loss or gain via text. Study staff monitored the Facebook groups for inappropriate or offensive content which was removed or responded to. At 6 months, there was no overall effect of study group for weight loss. There was a moderating effect such that among those with the lowest BMIs (25-27.5 kg/m 2 ), participants who were assigned to the tailored group lost 2.7 kg [−3.86, −0.68] and those in the targeted group lost 1.72 kg [−3.16, −0.29] more than those in the control group after adjustment for covariates [34].
What qualifies as a critical threshold for engagement in digital interventions has yet to be established [30]. Furthermore, frameworks and methods for evaluating the impact of Facebook posts also need to be standardized (Arnold CE reference) [35]. One such framework for examining the impact of messages is McGuire's Model of Communication and Persuasion [36], which can be used to examine characteristics of posts (e.g., informational, lesson-based, poll, study-generated or user-generated). The effect of each post can be calculated using a traditional Facebook engagement equation of impact per post = [(Total Engaged Users / Total Reach) × 100] [37]. Encouraging researchers to proactively plan to collect and measure these characteristics will help future researchers design and implement interventions with effective messaging.

Use Case #2: Nigeria Social Media to Promote COVID-19 Vaccination Impact Evaluation
The Bill & Melinda Gates Foundation (BMGF) has the goal of immunizing at least 500 million health care providers (HCPs) and high-risk people with COVID-19 vaccines worldwide. By achieving this goal, the foundation seeks a return to routine immunization, maternal and child health, and reproductive health services, which is critical to the COVID-19 response and to the strengthening of health systems. This effort focuses especially on low-and middle-income countries (LMIC), which have been disproportionately impacted by the COVID-19 pandemic. Nigeria, the largest country by population in Africa, is an important focus of these efforts.
Recently, BMGF sponsored a social media campaign in Nigeria to promote COVID-19 vaccination, with a primary focus on health care providers (HCP). The theory of change (ToC) of this campaign posits that HCP serve as crucial role models to encourage patients and the broader population to vaccinate. The campaign engaged a widespread group of health and other public-facing organizations, including the private and public sectors, to help design and deliver posts on Facebook, Instagram, and other platforms to promote vaccination. A series of campaigns using these social media platforms ran in 2022 in six targeted states within Nigeria.
In a companion project, Evans and colleagues developed an impact evaluation to evaluate the performance of an associated BMGF investment; Reducing Vaccine Hesitancy among HCP in Nigeria, which is a series of social media behavior change campaigns to reduce vaccine hesitancy amongst HCPs. The impact evaluation aims to determine which campaigns and strategies are effective in reducing vaccine hesitancy among HCPs and at what level of cost-effectiveness. The evaluation analyzes the campaign ToC, based on the 5 "C's" model of vaccination promotion [38], co-developed by Dr. Evans and the campaign implementation team in order to understand the processes and effects of social media in influencing vaccine hesitancy among HCPs.
The evaluation examines the mediating effects of social media engagement metrics and changes in norms and related beliefs about the efficacy and safety of vaccines on COVID-19 vaccine hesitancy, intentions, and uptake. The analysis uses structural equation modeling (SEM) and multi-level modeling (MLM) techniques to test the campaign's ToC for mediation based on changes in attitude, beliefs, and norms about vaccination, and for moderation of environmental, personal characteristics of HCPs, and other social ecological factors on the intervention's effectiveness.
This study uses a novel social media platform for recruitment and data collection, Virtual Lab LLC (https://vlab.digital/ accessed on 22 May 2022), a data collection platform and a tool to enable study design. This platform enables researchers to create bespoke panels of respondents (i.e., a group of participants meeting evaluation eligibility criteria who agree to complete a baseline (BL) survey and to be re-contacted for follow up surveys). Participants may be recruited specifically from the target audiences for a behavioral intervention, such as a health campaign, and stratified by individual-level covariates of interest (e.g., geographic locations where the intervention is conducted, being a certain age, gender, race/ethnicity, or other demographic) and other relevant variables identified by researchers.
The use of the Virtual Lab platform for this study is a major innovation and will advance the field of digital media intervention research. The project will demonstrate (1) how social media recruitment and data collection may be effectively used to support social media interventions, especially as they focus on vaccination promotion, and (2) will demonstrate multiple evaluation strategies including geographic cluster comparisons as well as individual-level randomized controlled trials.
The materials developed in the project include surveys, interview guides, and social media content and metrics on dosage/exposure to the vaccination campaign at the population level. Researchers are compiling a library of such materials to be shared publicly, which will contribute to the design and development of future programs and campaigns, as well as increase the evidence for what works in digital health interventions worldwide.
The project includes substantial data collection, with some 8500 surveys completed in a baseline time point, prior to the campaign in late 2021. Additionally, 4 rounds of in-depth qualitative interviews will be conducted with some 30 social media outreach organizations and influencers that deliver the campaign in Nigeria. These data will be a major resource for building the evidence base on the effectiveness of social media for vaccination promotion and reducing vaccine hesitancy. This dissemination of findings and methodologies will make a substantial contribution to the social and behavioral sciences communities and the field of digital health [39].

Use Case #3: Randomized Controlled Trial to Assess the Efficacy of Facebook Groups for COVID-19 Vaccination Uptake
Another example is a study aimed at promoting COVID-19 vaccination on Facebook. At the time of the study, over 35% of US adults had not received the COVID-19 vaccine [40]. While much had been published about vaccine misinformation on social media, little was known about how to use social media as an intervention platform.
Participants were eligible if they were adults who lived in the US and had not been vaccinated for COVID-19 (not even one dose) and had a Facebook account. While initially we planned to recruit on Facebook, recruitment on Facebook proved to be expensive and we soon shifted to recruiting on Amazon Mechanical Turk (Amazon MTurk). We recruited unvaccinated individuals (N = 353) and randomized them into one of two private Facebook groups (intervention, control) and measured their attitudes and behaviors at baseline and 2, 4, and 6 weeks after enrollment.
The intervention group consisted of novel educational content promoting the COVID-19 vaccine that was delivered daily for 4 weeks and sponsored by the GW Health Communication Corps, while the control group consisted of a referral to the COVID-19 Information Center on Facebook. In the intervention group, group moderators posted twice daily with information about the threat of COVID-19 in the US, and on the efficacy and safety of the COVID-19 vaccine (See Figure 3). Group moderators also used polls and posts to engage group members and encouraged comments and group discussion. Furthermore, moderators took on the role of replying to comments and questions raised by group members and were trained to use an empathic and non-judgmental tone. We compared the efficacy of these strategies across groups on vaccine acceptance, hesitancy, and uptake. In additional waves of the study, we also examined the role of group size and the use of group moderation features (e.g., allowing posting by group members) on group functioning (e.g., violating the group rules) and outcomes of interest. This study demonstrated that a new intervention format and platform for promoting vaccine uptake was feasible. Participants are being followed-up longitudinally to assess the efficacy of the intervention.

Use Case #4: Pilot Randomized Controlled Trial to Evaluation the Efficacy of Anti-Vaping Advertisements
There is a dearth of published research on the effectiveness of social media interventions for behavior change in tobacco control [19]. The objective of a study led by Evans and colleagues was to determine the feasibility of the Virtual Lab platform to recruit participants and assess awareness of an anti-e-cigarette health campaign on Facebook. For this pilot feasibility study, researchers aimed to recruit 300 participants through Facebook using the Virtual Lab platform [14]. In order to recruit participants, we created recruitment ads and delivered them through the Facebook page we created called "Digital Media Experiment". In order to demonstrate the credibility of the page, we posted related content and acquired likes. We used this Facebook page to run recruitment ads in August 2021. The recruitment ads were served to our target audience which included men and women 18-24 years of age who are located in the United States. After recruiting participants, we created another Facebook page called "Consumer Consciousness". This page was used to run the target ads on the recruited participants' Facebook newsfeeds during the study time period. We created this second Facebook page, with a different name, to control for any bias. Although we created two different Facebook Pages, they were both under the same Facebook Business Account, "Digital Health Research".
The intervention group consisted of novel educational content promoting the COVID-19 vaccine that was delivered daily for 4 weeks and sponsored by the GW Health Communication Corps, while the control group consisted of a referral to the COVID-19 Information Center on Facebook. In the intervention group, group moderators posted twice daily with information about the threat of COVID-19 in the US, and on the efficacy and safety of the COVID-19 vaccine (See Figure 3). Group moderators also used polls and posts to engage group members and encouraged comments and group discussion. Furthermore, moderators took on the role of replying to comments and questions raised by group members and were trained to use an empathic and non-judgmental tone. We compared the efficacy of these strategies across groups on vaccine acceptance, hesitancy, and uptake. In additional waves of the study, we also examined the role of group size and the use of group moderation features (e.g., allowing posting by group members) on group functioning (e.g., violating the group rules) and outcomes of interest. This study demonstrated that a new intervention format and platform for promoting vaccine uptake was feasible. Participants are being followed-up longitudinally to assess the efficacy of the intervention. There is a dearth of published research on the effectiveness of social media interventions for behavior change in tobacco control [19]. The objective of a study led by Evans and colleagues was to determine the feasibility of the Virtual Lab platform to recruit participants and assess awareness of an anti-e-cigarette health campaign on Facebook. For this pilot feasibility study, researchers aimed to recruit 300 participants through Facebook using the Virtual Lab platform [14]. In order to recruit participants, we created recruitment ads and delivered them through the Facebook page we created called "Digital Media Experiment". In order to demonstrate the credibility of the page, we posted related content and acquired likes. We used this Facebook page to run recruitment ads in August 2021. The recruitment ads were served to our target audience which included men and The pre-test and post-test surveys were completed using a survey platform called Typeform. Surveys were linked to our Facebook pages using the Virtual Lab interface. This platform allowed our Facebook pages to send automated messages through Facebook Messenger to participants who clicked on the recruitment ads. The two recruitment ads used in this feasibility study were designed using 99design.com. The ads used the text "Take a 15 min survey, get paid $10". See Figure 4. After participants clicked on the study's ad, they were sent a message via Facebook Messenger inviting them to participate in the study. Before beginning the pre survey, participants were sent messages regarding the topic of the survey, compensation, privacy measures regarding collected data, and contact information if they had any questions regarding the study. Following those messages, the participants were sent a message asking if they would like to continue in order to consent to their participation in the study.
The study's Facebook recruitment ads had a reach of 10,309 which is defined as the number of people who saw the ad at least once. The recruitment ad generated 15,718 impressions which is the number of times the ad was displayed on a person's screen, and it was clicked on a total of 790 times. The Link-Click-Through Rate was 4.77% which is the percentage of times a person saw the recruitment ad and clicked on it. The study's Facebook target ads had a reach of 191 people and generated 441 impressions. The target ads were played a total of 353 times and only 11 times where the ads played at 100% of its length.
"Take a 15 min survey, get paid $10". See Figure 4. After participants clicked on the study's ad, they were sent a message via Facebook Messenger inviting them to participate in the study. Before beginning the pre survey, participants were sent messages regarding the topic of the survey, compensation, privacy measures regarding collected data, and contact information if they had any questions regarding the study. Following those messages, the participants were sent a message asking if they would like to continue in order to consent to their participation in the study. The study's Facebook recruitment ads had a reach of 10,309 which is defined as the number of people who saw the ad at least once. The recruitment ad generated 15,718 impressions which is the number of times the ad was displayed on a person's screen, and it was clicked on a total of 790 times. The Link-Click-Through Rate was 4.77% which is the percentage of times a person saw the recruitment ad and clicked on it. The study's Facebook target ads had a reach of 191 people and generated 441 impressions. The target ads were played a total of 353 times and only 11 times where the ads played at 100% of its length.
The development of methods for experimentation within social media platforms is essential for the progress of public health media campaign research, especially in the context of tobacco control. This study demonstrated a new platform that allows for customized recruitment and longitudinal follow-up of participants, as well as the execution of The development of methods for experimentation within social media platforms is essential for the progress of public health media campaign research, especially in the context of tobacco control. This study demonstrated a new platform that allows for customized recruitment and longitudinal follow-up of participants, as well as the execution of survey research within Facebook, which was found to be feasible for media campaign awareness studies [14].

Discussion
The field of digital media for behavior change is growing rapidly, but research is still in its infancy. While a recent review found some 3300 digital media publications related to behavior change, only a fraction of these provided evidence for the effectiveness of a digital intervention in changing behavior. Many studies monitor the digital media landscape, such as "digital listening" projects, and studies of large social media datasets (infodemiology), which are critically important and advance our understanding of the digital landscape. However, rigorous intervention studies on the effectiveness of digital media in actually changing behavior, specifically in public health, remain relatively sparse [41]. The field has tremendous room for growth in the coming years.
Behavior change can take time, and the potential for regression to earlier states is well-known [42]. Future research should include longitudinal follow-up to assess the long-term effect of social media behavioral interventions. Additionally, there was a lack of evidence on the effectiveness of theories of change in social media interventions, and future research should focus on testing the processes of change.
Given the relative dearth of rigorously evaluated digital media interventions for behavior change, more formative research evaluating the feasibility, appropriateness, and acceptability of specific types of projects is needed. A more rigorous application of the principles of program evaluation will help develop targeted, effective digital media interventions.
In particular, digital media interventions need to explore the full range of functionality of digital devices and their near-constant role in personal self-management and day-to-day living to maximize opportunities for behavior change. One area that deserves further attention is the potential for multi-factorial studies that examine the effects of adding and subtracting features of digital devices (e.g., an intervention with and without an app, with and without social media interactivity, etc.) on behavior change. More elaborated research designs that examine how to optimize delivery of digital interventions using the full range of functions of devices such as mobile phones and tablets is needed.
One of the strengths of social media interventions is that objective dosage and exposure data from analytics are available. However, some studies have reported that their social media efforts were effective without clearly reporting quantitative data (e.g., clicks, shares, views, etc.) on social media use [1]. Future research should examine the characteristics of engagement exposure to evaluate dose-response effects-i.e., to determine whether more exposure or exposure of a specific type is associated with successful behavior change. This is important in order to be able to objectively attribute intervention effects to observed behavior changes and build the evidence base in the field.
Another important dimension of digital media for behavior change is health literacy. Digital media represent another dimension of health literacy: the ability to successfully use, navigate, and obtain benefit from health-related information on digital devices [43]. Research should focus on how to make digital media behavior change interventions more sensitive to health literacy needs, and on how to improve the extent to which participants can successfully consume and use digital health information.
Finally, future experimental research should rigorously examine the effects of variable levels of engagement with, and frequency and intensity of exposure to, multiple forms of digital media for behavior change. In particular, longitudinal studies that follow participants over extended periods of time are needed to evaluate more distal outcomes (e.g., beyond immediate content recognition, engagement, and short-term attitudinal outcomes. Studies should also investigate dose-response effects by increasing the number of digital ad exposures over an extended period of time and evaluating varying dose-response curves for different campaign outcomes [42]. Adding greater levels of digital exposure would allow a study to plot possible threshold and drop-off effects of exposure. Such research will inform our understanding of the impact of varying levels of digital ad exposure on longer-term outcomes.

Conclusions
This review provides an overview of the emerging field of digital media for behavior change. The field represents an important, relatively new domain that overlaps digital health, and the broader use of digital media for social change programs. While the evidence base in this field, as illustrated in this paper, is relatively small, the field is growing. Future research and programs should expand the domains of subject matter addressed by digital media for behavior change. More rigorous, controlled, and externally valid studies are needed and the field will need to stay current with rapidly emerging new digital technologies.

Conflicts of Interest:
The authors declare no conflict of interest.


Prevention Village Fund Fraud in Indonesia: Moral Sensitivity as a Moderating Variable

: This study aims to examine the effectiveness of the internal control system, appropriate compensation, and the competency of the village apparatus regarding the prevention of village fund fraud with moral sensitivity as a moderating variable. This research is a quantitative method using hypothesis–inference to answer exploratory, descriptive, explanatory, and predictive analysis questions. Primary data are mainly used in this study. Data were collected using a survey method in a questionnaire with questions given to respondents to collect information. The sample of this research is the village ofﬁce in 16 (sixteen) districts in Sumowono, Semarang Regency, Central Java, Indonesia, with 289 participants. Data analysis was carried out using Warp-PLS 7.0 application software. The results showed that the village apparatus’s internal control system, appropriate compensation, and competency prevented village fund fraud. Furthermore, the novelty of this research is to add a moderating variable, moral sensitivity, which can strengthen the relationship between the internal control system, appropriate compensation, and competency of the village apparatus regarding the prevention of village fund fraud.

Introduction
The village is the Government body closest to the community, and as a result, it aids in implementing village development so that the programs implemented by the village directly benefit the community's economic growth. The village represents the unity of society and becomes an inseparable part of an ordered nation's life. A form of the central Government's commitment to clarifying the functions and village authority and strengthening the position of the village and village community is realized by the birth of Law No. 6 of 2014 concerning villages. To support the implementation of Law No. 60, in 2014, various realizations were published; one of the policies issued is related to village financial management, namely regarding village funds sourced from state revenue and expenditure budget (APBN) ). However, these funds are not always used in accordance with the Government's goals. In several villages in Indonesia, they have been misused by irresponsible people, including both the Village Head and the Village Apparatus. The introduction of Law No. 6/01 manifests the Government's commitment to rural development in Indonesia. The Indonesia Corruption Watch (ICW) found that village fund fraud was one of the most significant contributors to corruption cases, costing the Government 37.2 billion in 2018 out of 96 cases in village funds (Antaranews 2019).
The budget lists state corruption in a total of five corruption cases. This village budget corruption cases came from the infrastructure sector (as many as nine cases with an estimated loss of 1.1 million USD) and the non-infrastructure sector (as many as seven cases with an estimated government loss of 1.4 million USD). The Indonesian Corruption Watch report (2018) shows that corruption cases in villages increase by 100% every year (Antaranews 2019). Since the impact of misappropriating village funds is hazardous, it is necessary to take preventive measures. Corruption and abuse of power are essential issues in village governance (Setiabudhi and Putra 2020). Fraud has become commonplace in Indonesia, as evidenced by the many alleged corruption cases involving various officials at the central and regional levels. The suitability of compensation given to employees can motivate employees to do their jobs correctly and adequately and help reduce fraud. This is an example of fraud in the public sector or Government and has received much media attention at home and abroad. This study focuses on preventing fraud in managing village funds, which is currently a strategic issue. The Indonesian Corruption Watch (ICW) found that there were six cases of corruption in the village budget sector out of a total of 271 corruption cases in 2019. Corruption in the village budget has been proven to have cost the Government up to 2.2 million USD (Kompas.com 2020).
Several factors are believed to prevent the embezzlement of village funds, including the internal control system, the capacity of village officials, and conditions of compensation. Atmadja et al. (2019) on village funds show that the apparatus has adequate power. A good spirit supports a sound internal control system to avoid all forms of fraud in the management of village funds. Salaries commensurate with employees' work can make employees feel accomplished, increasing performance and preventing fraud (Alwi et al. 2021). One of the prevention efforts is to strengthen the village government's internal control system. The internal control system provides procedures tailored to village needs to enable systematic monitoring of the performance of all village government activities. These aspects are designed to minimize the possibility of fraud by irresponsible individuals. Weak supervision has even become an outlet for embezzlement of village funds. To prevent corruption, vigilance must be increased (Lash and Batavia 2019). The strategy to prevent fraud in village financial management is that the village government needs to build an internal control system. To protect village financial managers from fraudulent activities, a sound internal control system is required to prevent all fraudulent activities. Putri and Sujana (2018) noted that the internal control system directly impacted preventing the embezzlement of village funds. Laksmi (2020) argues that in managing village governance, villages need to maintain the sincerity of all parties and provide the broadest possible scope, ensuring that the internal control system reaches all parties. The embezzlement of village budgets is the most significant contributor to corruption cases in Indonesia. It indirectly shows the village government's weak supervision and transparency of village budgets, and it also shows that the community is not involved in monitoring the village budget for appropriate village priority activities. According to Atmadja et al. (2019), other factors that can improve fraud prevention are companies with reasonable internal control in the organization. Internal control is designed to provide reasonable assurance in achieving operational objectives, provide reliable financial reporting, and comply with applicable laws and regulations (Monteiro et al. 2021). Internal control plays a vital role in fraud prevention and detection (Yusrianti et al. 2020). The research findings of Rukmana (2018) and Setiawan (2018) show that the correct internal control system can reduce the possibility of fraud cases and assist in fraud prevention.
Furthermore, village heads can manage their finances properly according to the principles of transparency and accountability because many village heads cannot manage finances correctly and according to applicable standards. According to several previous studies, fraud prevention can include increasing the capacity of human resources. Research by Atmadja et al. (2019) concluded that good equipment skills can improve organizational performance and play a role in professional, tight, and controlled financial supervision and review. Dung and Tuan (2019) argue that human resource capacity is considered adequate if the responsibility is to increase the budget is accompanied by an increase in both the quantity and quality of village financial reports, which can fulfill all obligations correctly and avoid fraud. Meanwhile, Nyide and Lekhanya's (2016) research shows that staff skills with little accounting knowledge can lead to unprofessional financial management, leading to fraud. This means that internal controls and equipment capabilities must work together to prevent fraud. Generally, poor internal management, dishonest employees without a reputation, and governance models with fraudulent behavior are at the root of fraud. Efforts to prevent fraud in village financial management require village heads to be experienced in managing village finances. In addition, improving the quality of internal control can also help prevent fraud. According to Halbouni et al. (2016), good personal integrity also contributes to forming an excellent internal control system. The higher the morale of a person, the more they are attracted to a greater relevance beyond their interests or just the organization's interests. The number of cases of embezzlement of village funds in several villages shows that instances of tax evasion are still relatively high. So, tax compliance becomes low, and the efforts made to instill in taxpayers' a "culture of compliance" and cooperation are needed (Nichita and Bătrâncea 2012;Nichita et al. 2019).
The novelty of this research, when compared to previous research, is placing moral sensitivity as a moderating variable. Previous studies were only limited to examining the relationship between factors that influence village fund fraud, such as the internal control system, appropriate compensation, and the competency of the village apparatus. In some previous studies, there are still weaknesses in the form of inconsistencies in research findings such as those of Kiswanto et al. (2020); Liu (2018); Monteiro et al. (2021);, which show that the internal control system has a positive and significant effect on preventing fraud. The weakness of previous research is that the variables included are pretty small, so additional variables must be developed or further explored to check the consistency of these variables. Based on the gap between the survey results and falsified village funds, the reason for this research is to identify the factors that can prevent the misappropriation of village funds by placing moral sensitivity as a moderating variable.
The urgency of this research is given the increasing prevalence of village fund fraud. So, it is necessary to know what factors influence the prevention of misappropriation of village funds. Morality can be seen from a person's personality and mindset in upholding honesty and justice. This mindset can reduce an individual's desire to commit fraud (Fernandhytia and Muslichah 2020). This is supported by research conducted by Atmadja et al. (2018) that morality is able to prevent fraud. This is in line with research conducted by Putri and Irwandi (2017) and Setiawan (2018) that shows that morality affects fraud prevention. This study aims to examine moral sensitivity as a moderating variable on the relationship between the internal control system, appropriate compensation, and the competence of village officials to prevent village funds fraud.
The rest of this paper is divided into four sections: the literature review is outlined in Section 2. Section 3 presents the methodology and data, describing the variables. Next, Section 4 includes the results and discussion. The conclusion is given in the last part.

Literature Review
This study supports the fraud triangle theory (Cressey 1953), which explains that fraud can be caused by a weak internal control system (Opportunity). Fraud prevention is part of the internal control system that includes efforts to prevent and reduce the risk of potential fraud . Opportunities are a trigger factor for employees to commit fraud. If the opportunity arises, employees who initially have no intention of committing fraud will be more likely to commit fraud. Opportunities arise through weaknesses in the supervision of an agency's internal control system. To be effective, an internal control system must have good quality and be supported by employee compliance with the control system. The results of this study support the triangle fraud theory and support the results of previous studies (Putri and Irwandi 2017;Kiswanto et al. 2020), which shows that the effectiveness of the internal control system affects the occurrence of fraud. Internal control is the benchmark for the success of every organization; if internal control is weak, a lot of fraud has been committed. According to Atmadja et al. (2019), internal control is the first fraud prevention measure. Fraud prevention is generally an activity carried out as part of the definition of policies and systems. Monteiro et al. (2021) developed the control system framework, focusing on formal procedures and information systems capable of maintaining or modifying business models that achieve goals and innovate. These structures are levers of control, namely belief systems, border systems, diagnostic control systems, and interactive control systems that work together for the organization's benefit. Opportunity in Fraud Diamond Theory is an opportunity that exists in an organization that fraud perpetrators exploit to commit fraudulent acts that are supported by a weak internal control system, lack of employee discipline, and weak audit mechanisms (Wolfe and Hermanson 2004). The research results by Laksmi (2020) show that internal control significantly prevents fraud. This indicates that improving the internal control system is an effective fraud prevention measure. Purnomo and Khafid (2017) compensation is what employees/registrar/workers receive in return for their work, which is hourly or fixed compensation designed and managed by the HR department. With compensation conformity, it is hoped that village fund fraud can be avoided and minimized. Compensation can help companies achieve their goals as well as attract and retain employees. On the other hand, if the salary is deemed insufficient, the employee will likely leave. According to Rijsenbilt (2011), compensation is a set of remuneration received by employees for services that employees have provided; in other words, remuneration is a set of remuneration (tangible and intangible) provided by the company. For employee services, compensation can generally be described as compensation for workers' industrial relations performance and productivity. Compensation is referred to as an award form of recognition given to employees in return for their contribution to the company (Rijsenbilt 2011). Appropriate compensation can reduce accounting fraud. Individuals should be satisfied with their balance and not engage in accounting fraud to maximize their gain. According to Appuhami and Bhuyan (2015), remuneration is all income in the form of money and goods received by employees directly or indirectly in return for services provided to the company. If well-managed compensation helps the company achieve its goals and attract and retain employees, it is more likely that other employees will leave the company without adequate compensation. Due to dissatisfaction with payments that are considered inadequate and unfair, performance decreases, complaints increase, and strikes are called, leading to physical and psychological actions such as increased absenteeism and cheating (Abdallah et al. 2016). Mardjono et al. (2020) explain that providing adequate compensation encourages management to act by shareholders' wishes, namely providing the correct information about the company's health. This compensation is intended to reduce the risk of fraud.
Competence can be defined as the capacity of people, organizations, and societies to act successfully, define and achieve their goals, and modify, if necessary, the essential elements for sustainability, development, and progress (Rukmana 2018). Capability in Fraud Diamond Theory is the behavior possessed by fraud perpetrators to commit fraudulent actions supported by existing opportunities. Individual abilities are traits possessed by a person's personality and abilities that encourage fraud perpetrators to execute fraudulent activities (Wolfe and Hermanson 2004). The village apparatus is a determining factor in adequately implementing the assigned tasks. One aspect of increasing the capacity of village managers is the mastery of knowledge, skills, and understanding gained through education, training, learning, and experience. The village head must have three skill levels: (1) basic skills, (2) management skills, and (3) technical skills. The basic skills that the village head must possess include understanding village conventions and knowledge.
The inhibiting factor in implementing village financial management is the village government's low level of human resource education. The understanding of the population in decision making and coaching is still feeble. Wahyudi et al. (2019) identified problems faced by village officials in managing village funds. The main problem that arises is the understanding and knowledge of the village head regarding village financial management.
In addition, there is a lack of assistant staff to help manage the village treasury. Their research examined the vulnerability of fraud in village financial management in Indonesia and how appropriate anti-fraud strategies prevent it. Thus, the results of their study indicate that the possibility of fraud for the Indonesian tax authorities is quite concerning, including in planning, implementation, and reporting. Potential problems exist in regulations and institutions, management, supervision, and personnel. Anti-fraud strategies that can apply include budgeting in village finances, improving the skills of human resource managers, and outlining the role of village financial assistants. The research of Atmadja et al. (2019) examines the effect of changes in the capacity of the apparatus and the internal control system on the prevention of fraud in village financial management with ethical moderating variables. The results showed that the power of the device and the internal control system had a significant effect in preventing fraud in village financial management. Next, it shows the spirit of adjusting the influence of capacity and internal control in the village fraud prevention system.
Ethics include individuals' mental and emotional attitudes as members of social groups in carrying out their duties and loyalty to their groups (Setiawan 2018). Ethical sensitivity refers to the perception of how one's actions affect others. Moral sensitivity includes knowledge of activities and how they may involve stakeholders. Ethical sensitivity includes imaginative situations, understanding of causal chains, empathy, and the ability to take on roles. The four-component deep rest model was first introduced due to research in moral psychology (Jordan 2007). Furthermore, it was developed in Jordan (2007) to model the components that are thought to underlie all righteous actions. Psychological research concerns the study of the consideration of individual moral processes and thought behavior. Rest states that an individual goes through. There are four basic psychological processes for ethical behavior, namely ethical sensitivity, moral judgment, ethical dynamics, and honest character. The cognitive moral theory introduced by Althof and Berkowitz (2006) considers that ethical considerations/reasons can be assessed using a three-level framework consisting of (1) prior agreement, (2) agreement level, and (3) post-agreement.
Good governance contributes to various development goals through internal changes in how power is managed, from the usual state control and command to a new, more balanced way of connecting with different stakeholders (Handayani et al. 2020;Ekananda and Suryanto 2021). Based on this statement, every organization must practice good governance and not rule out the possibility at the village government level. The village fund, if not corrupted, is very beneficial for the village community. For example, it is used for infrastructure development to improve economic performance, increase labor productivity, stimulate trade, increase job opportunities, and encourage rapid economic growth (Elfaki et al. 2021;Khadim et al. 2021). The importance of implementing village government to realize good village governance will also lead to efforts to improve and perfect the government management process to increase government efficiency. To encourage the achievement of good village governance, it is essential to integrate good governance into good village governance (Wahyudi et al. 2019).
Research that shows the relationship between ethics and internal control systems comes from Husnawati et al. (2017), who argue that people with good ethics and internal control systems tend to prevent bookkeeping and fraud. Ethics consists of personal or cultural values, moral codes, or social customs distinguishing good from bad. Therefore, ethics plays a vital role for a public official as an executor of government obligations and creates a constitution for the benefit of the people in a transparent and accountable manner that is not corrupt (Hayati and Amalia 2021). The results of Halbouni et al. (2016) show that ethics has a significant influence on accounting fraud prevention. The higher the morale of the property apparatus, the greater the possibility of government accounting fraud. In another study, Basri et al. (2021) suggest that machine morale strongly influences the tendency to fraud.

Population and Sample
The population in this study is in the Village District Sumowono, Semarang Regency Government, Central Java, Indonesia. In this study, researchers took samples using a sampling technique they could not use with a sampling target, namely sampling with specific criteria. According to Ghozali (2016), the sampling design may not have population items that show the same changes as the sample. The number of the population is unknown, while the objective sample is used to collect specific samples and groups as desired. The criteria used by researchers can provide the desired information. The respondents of this research are village officials who are directly related to the management and reporting of village funds. The village officials include the village head, village secretary, and village assistants because they have the main task of managing village finances; these officials include the Head of the Government & Public Service Section, Head of the Peace, Order & Environment Section, Head of the Community Empowerment Section, and all members of the Village Consultative Body.

Research Design and Data Sources
These studies are quantitative or hypothetical inference methods in response to exploratory, descriptive, explanatory, and predictive research. The data source used in this study is primary data, which comes directly from research subjects' respondents. Data were collected using a survey method in a questionnaire containing a list of reports given to respondents to be completed to obtain information from respondents. We measured respondents' responses using a Likert scale or a summation scale. Secondary data included supporting data from books and other works on the subject under study.

Definition of Transformation Activities
An explanation of the magnitude of change, variation index, and scale is described in Table 1. below:
Principles of good governance 3.
Attitudes and behavior of apparatus 4.
The role of the community apparatus 5.
Mastery of knowledge and expertise ability to work Morality refers to personal or cultural values, codes of ethics, or social customs that distinguish between right and wrong, so that character in an apparatus plays an essential role as a holder of a commitment to the governance and development by the constitution, in favor of the interests of the people, in a manner that is transparent, accountable, and not corrupt.

1.
Moral reasoning is based on rewards (gifts) and self-interest 2.
Do good to be treated well by the environment 3.
Realizing their obligation to implement existing norms and maintain their importance 4.
Moral reasoning is based on laws and regulations 5.
Carry out activities according to actual conditions Source: Primary data processed, 2021.

Data Analysis Method
The data analysis tool in this study used a Structural Equation Modeling (SEM) approach with the Least Partial Squares (PLS) method using Warp-PLS 7.0 partial software (Ned Kock, Texas, USA). PLS-SEM was used to simultaneously examine the relationship between latent structures in linear or nonlinear relationships with multiple indices in reflectance, format, and MIMIC. Unlike conventional multivariate analysis, PLS is more powerful because it can build research models with many variables and indices (Ghozali 2016). This study uses Warp PLS version 7.0 because it offers a variety of flexibility. There are various advantages of Regression in PLS. First, we can use it in theory development to test and validate the exploratory model. Second, it fits in a variety of prediction-oriented research models. Third, it can aid in estimating a model that is complex with a variety of manifest and latent variables. Fourth, it does not require normality. Fifth, it does not require a large sample. Sixth, it can hold formative and reflective indicators as well as measurement models (Ghozali 2016).
PLS is a powerful analysis method (sort modeling) because it eliminates Ordinary Least Square (OLS) regression assumptions, such as requiring the data to be generally distributed in a multivariate manner, and there are no problems related to multicollinearity between exogenous variables. PLS-SEM has the consequence that the test can be carried out even without a strong theoretical basis and various assumptions (non-parametric) and the parameters of the accuracy of the prediction model if one sees a value of the coefficient of determination (R-square).

Descriptive Statistical Analysis Results
This study uses primary data sources from respondents' responses to all questions in the research questionnaire. The distribution of the questionnaires was carried out directly by the author. When completing the questionnaires, the authors also directly collected them from each village office in 16 (sixteen) districts in Sumowono. Altogether, 16 villages completed 20 questionnaires each for a total of 320 questionnaires. This study distributed 320 questionnaires to village officials in Sumowono Regency with a total of 90.31% questionnaires returned (up to 289 questionnaires). A summary of the distribution and return of questionnaires is shown in Table 2, and the statistics descriptions are provided in Table 3. for the average of all indicators on each variable.  The stages of analysis using PLS-SEM are through a six-stage process such as conceptualization of the model, determining the analysis algorithm, determining the resampling method in Table 4, and drawing the path diagram. Results of the latent variable coefficients output are shown in Table 5. Next, we will carry out in two stages evaluation of the model in PLS-SEM: first, the outer model or evaluation of the measurement model; second, the inner model or evaluation of the structural model. The fit index and model quality are shown in Table 6, the output path coefficients and the direct effects of the model are shown in Table 7. Furthermore, the output path coefficients and the model indirect effects are shown in Table 8. The outer model was conducted to assess the reliability and validity of the latent construct forming indicators. In comparison, the inner model aims to predict the relationship between latent variables by seeing how we can explain most of the variance and determine the significance of the p-value. After the model has been estimated and evaluated, the last step is to report and communicate the results of the analysis that has been carried out.

Internal Control System on the Prevention of Village Fund Fraud
Testing the first hypothesis in Table 8 shows that the internal control system positively affects village fund fraud prevention. The findings of this study support the fraud triangle theory, which explains that fraud can be caused by a weak internal control system (Opportunity). When the internal control system is weak, there are opportunities for fraud (Pamungkas et al. 2020). Therefore, a robust internal control system is needed to prevent fraud. This study combines the results of Husnawati et al. (2017) and Laksmi (2020), explaining that the internal control system has a positive effect in preventing village fund fraud. A sound internal control system can eliminate fraudulent practices. Establishing an internal control system is a commitment to creating good corporate governance. A sound internal control system can control and monitor employees to prevent fraud. According to Monteiro et al. (2021), the internal control system includes organizational structure, methods, and coordinated actions to maintain corporate wealth and verify accounting data's accuracy and reliability. Adequate controls can minimize the level of accounting fraud. This study indicates that fraud prevention will increase as the internal control system becomes more effective. The results of this study support the conclusions of Atmadja et al. (2018), who conclude that the internal control system impacts preventing fraud in village financial management. Indeed, it can avoid all types of financial fraud in an organization or Government through an adequate internal control system.
The Government's internal control system affects accountability in the management of village funds because the Government's internal control system can minimize errors or fraud in the management of village funds, bookkeeping data, etc. According to Yusrianti et al. (2020), the opportunity is a situation where opportunities are open to employees that allow fraud to occur. These opportunities are due to weak internal control, weak supervision, and weak law enforcement within the institution. This finding indicates that implementing an increasingly effective internal control system reduces village fund fraud, specifically in Sumowono District, Semarang Regency. An effective internal control system can affect the smooth operation of the finance department. Appropriate division of authority and responsibility, authorization from authorized parties, including supporting documents for transactions, physical inspection of assets, proper recording of each activity, and thorough supervision evaluation of operational activities will reduce the level of fraud in village funds. The implication of the findings of this study is to prevent the trend of fraudulent village funds in village administrations in Sumowono District, Semarang Regency. So, it is necessary to implement an effective internal control system. One of the efforts to prevent fraud is to build an adequate internal control system. Internal control in an agency or organization does cover not only accounting and financial activities but also all operational aspects of the organization.

Appropriate Compensation on Prevention Village Fund Fraud
The results of this study indicate that the appropriate compensation affects fraud in village funds. The results of this study are in line with research conducted by Putri and Irwandi (2017) that the appropriate compensation involves the prevention of village fund fraud. This shows that employees are not satisfied with the payment received, which creates fraud in village funds. Jensen and Meckling (1976) explained that the principal could resolve the problem between the principal and agent by offering adequate compensation to the primary agent by bearing the cost of supervision. Appropriate compensation can minimize fraudulent village funds. This study is similar to the research conducted by Purnomo and Khafid (2017), which explains that the appropriate compensation has a negative effect on preventing village fund fraud. If the compensation received is less, they will tend to cheat village funds.

Village Apparatus Competence on the Prevention of Village Fund Fraud
The results of hypothesis testing show that the competency of the village apparatus has a significant effect on preventing village fund fraud. The results of this study are similar to previous studies by Atmadja et al. (2018), which clearly show that village apparatus competence has a significant effect on village fund fraud. The apparatus must have knowledge, skills, attitudes, and behaviors in the village financial management process to carry out their duties and responsibilities. To improve the competence of village apparatus by attending training courses, consulting or following the district/regency government's training plan, and increasing knowledge and understanding of financial management, the apparatus can attend seminars, workshops, etc. Activities are related to village financial management organized by the authorities. The results of this study are in line with research conducted by Laksmi (2020) that indicate that the device's capacity has a significant effect on preventing village fund fraud. According to Idie Widigdo (2013), tools without accounting knowledge can lead to unprofessional financial management and a high possibility of fraud. With the expertise of competent village officials in Sumowono District, Semarang Regency, the risk of fraud or fraud in managing village funds is lower.
A person's competence can be seen from the level of creativity he has, the innovation he makes, and his ability to solve problems. Competence is generally defined as a form of skill, knowledge, talent, and behavior in carrying out a task. As revealed by Rahmatika et al. (2019) from various sources, among others, competence is a combination of motivation, characteristics, talents, aspects of one's self-image or social role. In other words, competence is any personal trait that can be associated with successful performance (Rukmana 2018). Regulation of the Head of the State Civil Service Agency no. 8 of 2013 concerning Development of Technical Competency Standards for Civil Servants clearly states that technical capacity is the work capacity of every civil servant, which includes knowledge, skills, and work attitudes. They are necessary for the fulfillment of their function. Therefore, competent officials in village fund management will have more potential to prevent fraud in the direction of village funds. The results of this study are in line with the results of research by Lastanti (2020), which confirm that the device's capacity has a significant effect on fraud prevention. These are consistent with the results of Apriliana and Agustina (2017), which confirm that when the capacity of village apparatus human resources, in this case from an educational perspective, is weak, it becomes an obstacle in managing village finances, so fraud is very likely to occur.
With adequate institutional capacity in managing village finances, it is hoped that officials can achieve the economic and social objectives of the village government. Atmadja et al. (2018) argues that the capacity of the apparatus is sufficient if the quantity and quality of responsibilities increases proportionally. Thus, responsibilities are distributed adequately and avoid any fraud. This research is in line with Wang et al. (2017), which indicates the ability of the device to have an anti-fraud effect. Paying attention to the level of skill possessed by the apparatus can prevent fraud because the apparatus has the ability to meet organizational needs and carry out their duties properly according to Standard Operating Procedures. Based on the standard concept of the third fraud triangle, rationalization can create opportunities for fraud to occur because the perpetrator shows an attitude that justifies the actions taken. However, rationalizing attitudes and behavior does not necessarily lead to greedy behavior. Behavior is essentially goal-oriented, in the sense that people's behavior is generally motivated by a desire to achieve specific goals, but these goals are not always realized by the individual concerned; a worker allows for good performance (Widigdo 2013). These personal aspects include traits, motivations, value systems, attitudes, knowledge, and skills where competence will guide behavior, while behavior will drive performance.
The results of Petraşcu et al. (2015) show that human resource capacity significantly influences fraud detection. The study results by Purnamasari and Amaliah (2015) show that competence of the apparatus already have knowledge and understanding about fraud prevention. Based on this concept, it is proven that competence of the apparatus capacity and fraud prevention are directly proportional; if competence of the apparatus is getting better, employees will not cheat. The higher the skill level of human resources, the better the understanding of fraud in fraud prevention and detection efforts, and the lower the possibility of fraud. Therefore, human resource capacity has a positive and significant impact on fraud prevention. The ability or skill of village officials is an essential factor in preventing the misappropriation of village funds. Therefore, the local Government seeks to continue to increase its capacity both through education and training related to the management of village funds.

Moral Sensitivity as Moderating Effect of Internal Control System on Preventing Village Fund Fraud
Based on the results of the hypothesis obtained, individual morality strengthens the influence of the internal control system on preventing fraud in the village government. This is because the morality possessed by the village apparatus is classified as very good. It can improve the implementation of the internal control system in the village government ultimately and adequately prevent fraud. According to Muslih and Umar (2020), the performance of a suitable control environment in the internal control system can prevent corruption. Establishing a conducive control environment is very important in avoiding corruption because the main elements in the control environment are integrity, honesty, and the development of a code of ethics and ethical values. A person with integrity lives their life by upholding and carrying out their principles, code of ethics, and moral values. The results of this study are in accordance with the research of Atmadja et al. (2018), which concluded that morality succeeded in moderating the influence of the internal control system on fraud prevention in village financial management. A reliable internal control system must also support good character and adequate competence of the apparatus to prevent fraud in village financial management by analyzing the belief system. The author explored the vision-mission statement and ascertained that these values guide the implementation of the tasks and deliver the vision, mission, and ideals from superiors to all village officials. Based on the diversity of perceptions of responses from informants to statements about the method of delivering the activities carried out, there may have been obstacles/obstacles in the communication, so it might be ineffective and unable to be achieved. On the other hand, communicating organizational values through direct examples given by the leadership has been quite effective in conveying values to village officials.
The results of this test are in line with the concept of competence. According to Putri and Yadiati (2020), the competence of the apparatus needs to be considered in the prevention of village fund fraud. Competence is the basis of a person's characteristics and indicates how to behave, think, equate situations, and provide support for long periods. In other words, competence is something that a person demonstrates at work every day. When the apparatus has good moral sensitivity and is equipped with good competence, it can prevent fraud. Based on the results of the hypothesis, it is ascertained that individual morality strengthens the influence of village apparatus competence on fraud prevention in village government. This is because the morality possessed by the village apparatus is classified as very good. It can improve the competence of the village apparatus in the village government well and ultimately prevent fraud. The results of this test are in line with previous research conducted by Wahyudi et al. (2021), which stated that competence has a negative effect on the tendency of accounting fraud. This shows that the higher a person's competence, the lower the tendency for accounting fraud to be. The results of this study are also in line with the research of Sawaka K and Ramantha (2020), which states that human resource competence negatively affects the tendency of fraud to occur. The lower the competence of human resources in managing village finances, the higher the tendency for fraud to occur in village financial management.
In managing village finances, human resources must have competence, which means the abilities that an apparatus must have in the form of knowledge, skills, attitudes, and behaviors needed for carrying out their duties. This needs to be done in addition to good financial and village governance, which must coexist and avoid information asymmetry. Village funds are funds provided by the central Government that require professionalism in their management to be right on target and avoid violating predetermined rules. They are adjusted to the interests of the village Government in synergy with the community to achieve optimal village income and enable the village community to prosper. Adequate competence of the apparatus in terms of quantity and quality will increase the accountability of the budget realization report at the village financial level so that all responsibilities can be carried out correctly and all acts of fraud can be avoided. The results of this study are consistent with previous research from Atmadja et al. (2018); Laksmi (2020); and Rukmana (2018), who essentially state that the competence of the apparatus has a significant influence on the fraud prevention process in financial management.
Based on the hypothesis, it is obtained that individual morality strengthens the influence of village apparatus competence on preventing village fund fraud. This means that the higher the competence of the village apparatus, the more likely the individual is to improve his morality, do the right thing, and prevent fraud. It can be said that the higher the individual's morality, the lower his tendency to commit fraud. The human resource factor, namely quality apparatus, is the most crucial. One element that shows how good the quality of the device is in carrying out its duties is how well the machine can understand and apply the values of integrity within each of them. Using these integrity values can prevent corruption because, according to Halbouni et al. (2016), integrity is compatible with what a person says and their actions. The words he says must be in accordance with their ethics and moral values. The results of this study are in line with the research of Atmadja et al. (2018), which concluded that morality managed to moderate the influence of apparatus competence on fraud prevention in village financial management. This is because one's competence or ability to manage finances is often misused to commit fraud accompanied by good morality. The results of this study are in line with previous research conducted by Basri et al. (2021), which stated that morality affects fraud prevention, meaning the stronger the moral sensitivity of the village government apparatus, the higher the competence possessed by the device itself to prevent fraud.

Conclusions
The results of this study are based on each village office in 16 (sixteen) districts in Sumowono. These findings indicate that implementing an increasingly effective internal control system reduces village fund fraud, specifically in the Sumowono District, Semarang Regency. An effective internal control system can affect the smooth operation of the finance department. The study results indicate that internal control, appropriate compensation, and the competency of village apparatus impact the prevention of village fund fraud. In addition, moral sensitivity can strengthen the relationship between internal control, appropriate compensation, and the village apparatus' competency to prevent village fund fraud. With an adequate internal control system, preparing financial reports or accountability reports reduces the risk of error, resulting in quality financial statements or accountability. A sound internal control system is supported by a controlled environment (management actions, policies, and procedures), risk assessment/risk analysis, control, information and communication, and an assessment strategy carried out by the Village Advisory Board. Implementing and maintaining internal controls can reduce fraud in the management of village funds to create targeted, precise, and fast activities and at the same time save costs in managing village funds. An adequate internal control system is believed to have the potential to strengthen efforts to prevent village fund fraud. Since organizations have adequate internal controls to prevent people from acting fraudulently in the face of the temptation to commit fraud, it is the village Government's responsibility to establish and maintain internal control to prevent fraud in the management of village funds. The competency of the village apparatus affects the prevention of village fund fraud. This means that the ability of the village apparatus has a vital role in managing village finances to achieve the common goal of improving the welfare of the community through enhancing the village economy, society, culture, and other fields.

Research Limitations
The current research still has many gaps and limitations; this research is a survey method that uses a questionnaire without interviews or oral questions. Research results cannot be confirmed and explained in more detail, especially for reporting compliance variables. The role of village assistants has not been maximized because of the leadership culture in the village Government environment. There are always inconsistent responses to the questionnaire based on the researcher's observations. Because respondents' answers tend to be less in-depth and there are inconsistencies in the answers to the questionnaire. Researchers can predict this by helping and monitoring respondents in choosing answers so that respondents focus on the answers to the following questions. The results of this study should indicate that the capacity of village officials and financial reporting compliance has a significant influence on preventing village fund fraud. At the same time, the internal control system established trust tools that do not prevent fraud. The use of the ethical vulnerability variable is not a control variable because theoretically, the attitude or behavior of people cannot be measured as a reinforcing or reinforcing variable, weakening the employee's independent variable. Village officials can improve skills through training and technical counseling workshops and subsequently help prevent the fraudulent use of village funds. In addition, it is important to always consider moral or ethical values as a factor in managing village finances.
The variables used in this study were very few: namely, only three variables. Therefore, further research can add other variables related to fraud prevention. The results can provide a broader picture of the factors that influence fraud prevention outside their authority, compliance with financial statements, and internal control systems such as organizational culture or leadership commitment and the role of colleagues. Can use the internal control system developed to prevent fraud. The questionnaire used by the researcher was limited, and the report was full of gaps. The skills of village officials affect the prevention of fraud; the internal control system affects the prevention of fraud as well.