The effects of health behaviours and beliefs based on message framing among patients with chronic diseases: a systematic review

Media bias in portrayals of mortality risks: Comparison of newspaper coverage to death rates

Chronic diseases are the leading cause of death in the United States, yet effective preventive measures receive minimal healthcare funding. This disparity may stem from public underestimation of these diseases' impact and controllability, with distorted media coverage overemphasizing sensational risks and underemphasizing chronic illnesses. This study compares media coverage of mortality risks to objective measures of death rates to investigate such distortions. Data were collected on 14 mortality risks, including monthly US deaths from CDC Wonder and 823,406 relevant articles from major US newspapers via LexisNexis. Regression analyses and qualitative evaluations using natural language processing tools were performed. From 1999 to 2020, a significant disconnect was found between the deadliest risks and their media coverage. Media coverage fluctuations correlated with death rate changes, yet only 1.7-2.8% of the coverage was explained by these rates. Chronic illnesses were described neutrally as individual challenges, while sensational risks were depicted negatively as collective problems. These results illustrate how the media depict a skewed view of the risks facing the public, with disproportionate coverage of sensational risks while comparatively ignoring chronic diseases. Consumers may consequently come to a distorted understanding of the most threatening risks they face and how to combat them.

Effectiveness of self-management program for gastric cancer patients: A randomized controlled trial comparing gain vs. loss message framing

OBJECTIVE

This study aims to evaluate the effectiveness of a self-management program using gain/loss-framed messages in patients with gastric cancer.

METHODS

In this randomized controlled trial, 69 patients with gastric cancer who underwent gastrectomy at a university hospital were assigned to the gain- or loss-framed message group. The self-management program consisted of: 1) face-to-face education, 2) gain/loss-framed text messages, and 3) self-monitoring of health behaviors. Health outcomes (i.e., nutritional status, physical activity, exercise intensity, and distress), and health behaviors (i.e., dietary habits, physical activity performance, and distress management) were measured, and a generalized estimating equation was used for the analysis.

RESULTS

Nutritional status and dietary habits in the loss framed message group were statistically higher after the intervention compared to the counterpart (β = -1.72, p = .049; β = 0.36, p = .033, respectively). There was no time-group interaction effect on physical activity, exercise intensity, physical activity performance, distress or distress management.

CONCLUSIONS

A self-management program employing loss-framed messages was effective in promoting nutrition-related self-management among patients with gastric cancer.

PRACTICE IMPLICATIONS

Message-framing is an effective communication technique that can be easily used in clinical settings, and a loss-message-framing strategy may enhance nutrition-related self-management in patients with gastric cancer.

A review of factors influencing the uptake of prostate cancer treatment in Nigeria

BACKGROUND

The uptake of prostate cancer (PCa) treatment determines the disease course, but is influenced by several factors. This review assessed the factors that influence the uptake of PCa treatments in Nigeria, with a view to providing evidence for policies and other interventional approaches that enhance treatment uptake and PCa outcomes.

METHODS

A review of relevant articles retrieved from electronic databases of Web of science, PubMed, Google scholar, African Journals online and Hinari was performed using relevant keywords. Relevant studies were also extracted from the bibliographic references of the identified studies. Peer-reviewed published articles that reported any associated factor to the uptake or utilisation of PCa treatment options from 2000 to 2023 were considered eligible, and the most pertinent reports were extracted and incorporated into this review.

RESULTS

The uptake of PCa treatment options was observed to be dependent on several factors which could be grouped as economic, system-related and patient-related factors. Among these were the availability of treatment options and targeted therapies, cost and financial constraints, system-related barriers, funding gaps and lack of insurance coverage, patients' beliefs and perceptions, access to radiotherapy services and access to PCa screening.

CONCLUSION

Several influencing factors posed barriers to the timely uptake of PCa treatment. Policies and strategies aimed at reducing or preventing these barriers are solicited from relevant stakeholders.

Effects of message framing and risk perception on health communication for optimum cardiovascular disease primary prevention: a protocol for a multicenter randomized controlled study

Background

Although several guidelines for cardiovascular disease (CVD) management have highlighted the significance of primary prevention, the execution and adherence to lifestyle modifications and preventive medication interventions are insufficient in everyday clinical practice. The utilization of effective risk communication can assist individuals in shaping their perception of CVD risk, motivating them to make lifestyle changes, and increasing their willingness to engage with preventive medication, ultimately reducing their CVD risks and potential future events. However, there is limited evidence available regarding the optimal format and content of CVD risk communication.

Objective

The pilot study aims to elucidate the most effective risk communication strategy, utilizing message framing (gain-framed, loss-framed, or no-framed), for distinct subgroups of risk perception (under-perceived, over-perceived, and correctly-perceived CVD risk) through a multi-center randomized controlled trial design.

Methods

A multi-center 3 × 3 factorial, observer-blinded experimental design was conducted. The participants will be assigned into three message-framing arms randomly in a 1:1:1 ratio and will receive an 8-week intervention online. Participants are aged 20-80 years old and have a 10-year risk of absolute CVD risk of at least 5% (moderate risk or above). We plan to enroll 240 participants based on the sample calculation. The primary outcome is the CVD prevention behaviors and CVD absolute risk value. Data collection will occur at baseline, post-intervention, and 3-month follow-up.

Discussion

This experimental study will expect to determine the optimal matching strategy between risk perception subgroups and risk information format, and it has the potential to offer health providers in community or clinic settings a dependable and efficient health communication information template for conducting CVD risk management.Clinical trial registration: https://www.chictr.org.cn/bin/project/edit?pid=207811, ChiCTR2300076337.

Informational Postcards Increase Engagement with Remote Monitoring Among Veterans with Pacemakers and Implantable Cardioverter-Defibrillators: a Stepped-Wedge Randomized Controlled Trial

BACKGROUND

Remote monitoring (RM) of pacemakers and implantable cardioverter-defibrillators (ICDs) reduces morbidity and mortality. However, many patients are not adherent to RM.

OBJECTIVE

To test the effect of informational postcards on RM adherence.

DESIGN/PATIENTS

Stepped-wedge randomized controlled trial among Veterans with pacemakers and ICDs.

INTERVENTION

In wave 1, Veterans who had sent at least 1 transmission within the past 2 years but had become non-adherent were randomly assigned to receive a postcard or no postcard. Those receiving postcards were randomized to 1 of 2 messages: (1) a"warning" postcard describing risks of non-adherence or (2) an "encouraging" postcard describing benefits of adherence. In wave 2, Veterans who had either not received a postcard in wave 1 or had since become non-adherent were mailed a postcard (again, randomized to 1 of 2 messages). Patients who did not send an RM transmission within 1 month were mailed a second, identical postcard.

MAIN MEASURES

Transmission within 70 days.

KEY RESULTS

Overall, 6351 Veterans were included. In waves 1 and 2, postcards were mailed to 5657 Veterans (2821 "warning" messages and 2836 "encouraging" messages). Wave 1 included 2178 Veterans as controls (i.e., not mailed a postcard), some of whom received a postcard in wave 2 if they remained non-adherent. In wave 2, 3473 postcards were sent. Of the 5657 patients mailed a postcard, 2756 (48.7%) sent an RM transmission within 70 days, compared to 530 (24.3%) of 2178 controls (absolute difference 24.4%, 95% confidence interval [CI] 22.2%, 26.6%). Of those who sent a transmission, 71.8% did so after the first postcard. Transmission rates at 70 days did not significantly differ between "warning" and "encouraging" messages (odds ratio 1.04, 95% CI 0.92, 1.18).

CONCLUSIONS

Informational postcards led to a 24.4% absolute increase in adherence at 70 days among Veterans with pacemakers and ICDs who were non-adherent to RM.

Strengthening Clinician-Researchers' Communication and Knowledge Translation Skills: An Innovative Game Model From the Breathe Well Group

Communication is a core component of a clinician's role; however, when clinicians conduct research, communicating the emerging findings and recommendations to different types of stakeholders can be unfamiliar territory. Communicating research to advocate for change can be even more challenging. Clinician researchers seeking to be agents for change need to conceive and craft specific, evidence-based messages and communicate these effectively to different stakeholders to negotiate action. As part of a global health research program, we developed and tested a novel game-based model to strengthen the communication skills of clinician researchers, from 4 countries, for improving services for chronic obstructive pulmonary disease. This model focused on communication with 3 key stakeholder groups for knowledge translation: Patients/carers, healthcare providers and policy makers/healthcare managers. Delivered through a series of facilitated, online meetings, this model consisted of 2 parts: developing and rehearsing advocacy messages with coaching support, and then testing them with a panel of 3 representative stakeholders, and an audience of fellow researchers. All the country teams reported increased confidence in crafting advocacy messages for specific stakeholders and have applied lessons learned from the model. Delivering this model within a global health research program requires mentoring, time, commitment, resources and translation support to address language barriers. It offers an exemplar to build the communication skills of clinician and non-clinician researchers so that they can go beyond dissemination toward translation of evidence into policy and practice.

A Qualitative Exploration of Perceived Medication Adherence Determinants Conducted Among Older Adults with HIV and Type 2 Diabetes Mellitus

Background

People living with HIV (PLWH) are at higher risk of developing type 2 diabetes (T2DM). Both chronic conditions require individuals to adhere to medication regimens, yet few studies have sought to explore medication-taking behaviors among individuals with comorbid HIV and T2DM (HIV+T2DM).

Objective

This qualitative study sought to: 1) identify and compare perceived determinants of medication adherence for HIV and, separately, for T2DM, and 2) explore how participants prioritize conditions.

Methods

Between October 2022 and January 2023, we conducted in-depth interviews with individuals aged 50 or older, living with comorbid HIV+T2DM. Participants were prescribed oral medications to treat their conditions and had recent clinical measures indicating probable challenges with medication adherence. Interviews with consented participants from a large academic health center in the Midwest were conducted remotely. Questions largely drew from the Theoretical Domains Framework (TDF), a widely used implementation science framework. Additional questions explored the prioritization of conditions. Analysis employed the Framework Method and a side-by-side comparison of key determinants of medication adherence by condition.

Results

A total of 19 interviews were audio recorded, transcribed, and analyzed. Participants were an average age of 61, mostly male (89.5%), and Non-Hispanic White (47.4%). Although results revealed many commonalities between perceived determinants of medication adherence for HIV and for T2DM, differences relating to two TDF domains were noted: nature of the behavior (taking medications as prescribed), and motivations and goals. Many participants viewed their conditions as equally important, though they suggested T2DM was more difficult to manage, largely due to lifestyle modifications.

Conclusion

As individuals with HIV develop chronic conditions, such as T2DM, they may require additional medication adherence support. Attention should be paid to offering support early. Disease perceptions may differ by condition, and as such, one's motivations to take medication as prescribed may also differ by condition.

The effects of message framing on self-management behavior among people with type 2 diabetes: A randomized controlled trial

BACKGROUND

Message framing describes how information is communicated and demonstrated to influence its effect on future attitudes and behaviors. Message content can be structured as 'gain-framed', emphasizing the benefits of engagement as recommended, whereas 'loss-framed' describes the negative consequences of not engaging as recommended. However, the impact of message framing on behavior change in people with chronic diseases like diabetes is not well understood.

OBJECTIVE

Analyze the impact of message framing in diabetes education on self-management in people with type 2 diabetes, and identify potential moderating effects of patient activation on message framing.

DESIGN

A three-arm randomized controlled trial was performed.

SETTING(S)

Participants were recruited from inpatients in the endocrine and metabolic unit of a university-affiliated hospital in Changchun.

PARTICIPANTS

A total of 84 adults with type 2 diabetes were equally randomized into gain-, loss-, or no-message framing groups and received a 12-week intervention.

METHODS

Both the message framing groups received 30 video messages. One group of participants received the gain-framed messages emphasizing desirable outcomes from effective diabetes self-care. The other group of participants received the loss-framed messages emphasizing the undesirable consequences of ineffective diabetes self-care. The control group received 30 videos about diabetes self-care without message framing. Self-management behavior, self-efficacy, patient activation, diabetes knowledge, attitudes, and quality of life were measured at baseline and 12 weeks.

RESULTS

Compared with the control group, participants who watched either gain or loss-framed messages had significant increases in self-management behavior and quality of life after the intervention. The scores of self-efficacy, patient activation, knowledge, and attitudes of the loss-framing group were considerably higher than the control group. Further analysis revealed an interaction between patient activation and message framing (P = 0.002), with gain and loss message framing interventions more effective in increasing self-management behaviors in people with type 2 diabetes who had a higher and lower activation level, respectively.

CONCLUSIONS

Using message framing in diabetes education is a promising strategy to build and foster self-management behavior. It also suggests that appropriate message framing be chosen to enhance self-management behavior based on the level of patient activation.

REGISTRATION NUMBER

ChiCTR2100045772.

Designing mindfulness information for interaction in social media: The role of information framing, health risk perception and lay theories of health

In the post-pandemic era, our health is facing unprecedented challenges, and people are more willing to obtain health-related information or interact with each other than ever before. In this context, people’s interest in mindfulness information is also growing. However, not enough attention has been paid to the relationship between mindfulness information design and information interaction. The purpose of this study is to assess the impact of information design based on the gain and loss framework on people’s willingness to interact with mindfulness information, and to identify the framework for achieving better results. Through two experimental studies, we find that information design based on the framework of gains and losses can produce different effects. Specifically, the findings of the first experiment (N = 282) shows the individuals are more willing to interact mindfulness information when they are exposed to gain-framed information rather than loss-framed. In the second experiment (N = 308), we find that loss framing, compared with gain framing, led to greater health risk perception, which in turn make participants more likely to interact with mindfulness information with others. Additionally, our results show that the lay theories of health plays a moderating role in the direct effect of information framework on willingness to interact with mindfulness information in social media. When individuals hold incremental lay theories, they are more willing to interact with mindfulness information under the gain-framed information condition compared with the loss-framed information condition. However, when individuals are in entity condition, there is no significant difference in the willingness to interact with mindfulness information between the gain-framed and loss-framed information. Our studies of integrating information framework into designing mindfulness information suggest a promising strategy of health information interaction in social media.

Designing mindfulness information for interaction in social media: The role of information framing, health risk perception and lay theories of health

In the post-pandemic era, our health is facing unprecedented challenges, and people are more willing to obtain health-related information or interact with each other than ever before. In this context, people's interest in mindfulness information is also growing. However, not enough attention has been paid to the relationship between mindfulness information design and information interaction. The purpose of this study is to assess the impact of information design based on the gain and loss framework on people's willingness to interact with mindfulness information, and to identify the framework for achieving better results. Through two experimental studies, we find that information design based on the framework of gains and losses can produce different effects. Specifically, the findings of the first experiment (N = 282) shows the individuals are more willing to interact mindfulness information when they are exposed to gain-framed information rather than loss-framed. In the second experiment (N = 308), we find that loss framing, compared with gain framing, led to greater health risk perception, which in turn make participants more likely to interact with mindfulness information with others. Additionally, our results show that the lay theories of health plays a moderating role in the direct effect of information framework on willingness to interact with mindfulness information in social media. When individuals hold incremental lay theories, they are more willing to interact with mindfulness information under the gain-framed information condition compared with the loss-framed information condition. However, when individuals are in entity condition, there is no significant difference in the willingness to interact with mindfulness information between the gain-framed and loss-framed information. Our studies of integrating information framework into designing mindfulness information suggest a promising strategy of health information interaction in social media.

What Causes Health Information Avoidance Behavior under Normalized COVID-19 Pandemic? A Research from Fuzzy Set Qualitative Comparative Analysis

Affected by the normalization of the COVID-19 pandemic, people's lives are subject to many restrictions, and they are under enormous psychological and physical pressure. In this situation, health information may be a burden and cause of anxiety for people; thus, the refusal of health information occurs frequently. Health-information-avoidance behavior has produced potential impacts and harms on people's lives. Based on more than 120,000 words of textual data obtained from semi-structured interviews, summarizing a case collection of 55 events, this paper explores the factors and how they combine to lead to avoidance of health information. First, the influencing factors are constructed according to the existing research, and then the fuzzy set qualitative comparative analysis (fsQCA) method is used to discover the configuration relationship of health-information-avoidance behavior. The results show that the occurrence of health-information avoidance is not the result of a single factor but the result of a configuration of health-information literacy, negative emotions, perceived information, health-information presentation, cross-platform distribution, and the network information environment. These findings provide inspiration for reducing the adverse consequences of avoiding health information and improving the construction of health-information service systems.