Enhancing Type 2 diabetes risk communication with message framing and tailored risk feedback: an online randomised controlled trial

Effectiveness of Message Framing Interventions on Improving Health Outcomes for Individuals in Diabetes Health Education Communication: A Systematic Review

OBJECTIVES

To identify the effects of message-framing interventions on improving health outcomes of individuals in diabetes health education communication.

METHODS

Four electronic databases including Web of Science, PubMed, EMBASE, and the Cochrane Library were the search engines used. The period of literature search was from their inception until December 2023. Randomized controlled trials (RCTs) and quasi-experimental trials reporting the effects of message-framing interventions for diabetes were included.

RESULTS

The review included 10 studies. Many studies have investigated multiple health outcomes. Of the seven studies that evaluated behavioral health-related outcomes, all studies (7/7, 100%) found a positive effect, and four studies (4/7, 57.1%) found that there was no significant difference between gain and loss framing. Of the seven studies that assessed nonbehavioral health-related outcomes, six studies (6/7, 85.7%) reported a positive postintervention effect, whereas four studies (4/7, 57.1%) found that loss-framed messages were more effective. One study (1/7, 14.3%) reported that there was no effect of the message framing on mental health-related outcomes.

CONCLUSIONS

In diabetes health education communication, message framing of gain and loss framing has a positive effect on health outcomes for individuals. The advantage of the loss framing is more significant in improving nonbehavioral health-related outcomes.

PRACTICE IMPLICATIONS

When constructing a message to promote health outcomes for patients with diabetes, the message framing is worth applying, and the advantages of loss framing can be considered more.

TRIAL REGISTRATION

PROSPERO registration ID: CRD42023445074. https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=445074.

Codesigning a Digital Type 2 Diabetes Risk Communication Tool in Singapore: Qualitative Participatory Action Research Approach

BACKGROUND

Diabetes is a serious public health concern worldwide. Despite public health efforts encouraging early screening and improving knowledge of effective interventions for those at increased risk of type 2 diabetes (T2D), the incorporation of preventative behaviors into an individual's daily life remains suboptimal. Successfully and accurately increasing risk perception has been demonstrated to increase behavioral intention.

OBJECTIVE

The study aims to codesign a T2D risk communication tool by engaging public participants to (1) identify key characteristics that contribute to an effective risk communication tool and (2) test and iterate to develop a culturally sensitive and meaningful risk communication tool that can motivate T2D preventative behaviors.

METHODS

We adopted a novel methodology, "Patient and Public Involvement (PPI) Hawkers," where we approached patrons at hawker centers and public eateries frequented by all local residents to evaluate and test 3 prototypes for the tool. The three prototypes were (1) "Diabetes Onset"-estimated age of diabetes onset of T2D based on one's risk factors, (2) "Relative Risk"-the relative risk of T2D is presented in a 1-10 scale indicating where one's risk score lie in relation to others, and (3) "Metabolic Age"-the median age of the risk category based on one's risk factors, presented to be compared against their chronological age. We gathered reactions and feedback through rapid testing and iteration to understand which risk result presentation would be received the best. All the collected data were revisited and analyzed using an inductive thematic analysis to identify the key characteristics contributing to an effective risk communication tool.

RESULTS

We engaged with 112 participants (female: n=59, 56%) across 6 hawker centers. The key characteristics that were important to participants emerged in four main themes: (1) appeal and user experience, in terms of format and readability; (2) trust and validity of the institution providing the tool and the accuracy of the risk result; (3) threat appraisal: salience of risk information, which influenced their risk perception; and (4) coping appraisal: facilitators for behavior change, which impacted their intention for implementing T2D preventative behaviors. The predictive nature of the prototype entitled "Diabetes Onset" was poorly received and removed after the first iteration. The Relative Risk prototype was valued for being straightforward but feared to be boring. The Metabolic Age prototype was anticipated to be more motivating for behavior change, but there were some concerns that the terminology may not be understood by everyone.

CONCLUSIONS

Participants were divided on which of the 2 prototypes, "Metabolic Age" or "Relative Risk," they would favor adopting. Further testing is now required to determine which prototype will be more effective in motivating behavior change. This study's insights on the design process and valued characteristics of a risk communication tool will inform future development of such interventions.

The Effects of Anthropomorphism, Message Framing, and Voice Type on Unhealthy Sleep Behavior in Young Users: The Mediating Role of Risk Perception

Insufficient sleep is a severe social public health problem that can adversely affect the physical and mental health of young people. This study examined risk perceptions for unhealthy sleep behaviors and intentions for healthy sleep behaviors under different combinations of anthropomorphism, message framing, and voice type in cartoons. We used a three-factor between-subject experiment of two (anthropomorphism: anthropomorphic vs. non-anthropomorphic) × two (message framing: positive frame vs. negative frame) × two (voice type: cartoon child voice vs. adult female voice) design. We examined the effects of different audiovisual combinations of cartoon attitude, risk perception, and behavioral intention and the mediating role of risk perception. The research results show that (1) the integration of anthropomorphic design elements can positively impact users’ attitudes toward cartoons; (2) when the interface information is presented in a negative frame, anthropomorphism can more positively influence users’ attitudes toward cartoons than non-anthropomorphism; and (3) anthropomorphism, message framing, and voice type in cartoons significantly interact with risk perception. In addition, risk perception mediates the influence of anthropomorphism, message framing, and voice type on behavioral intention.