Message Framing and Pap Test Utilization among Women Attending a Community Health Clinic

Effects of Framed Mobile Messages on Beliefs, Intentions, Adherence, and Asthma Control: A Randomized Trial

We aimed to examine the effects of framed mobile messages (messages emphasizing losses or gains because of a behavior) on young adults' beliefs about their daily Inhaled Corticosteroids (ICS), intentions to take their ICS, adherence, and asthma control. College students (18-29 years) who owned a mobile phone and had a diagnosis of asthma with a prescription for an ICS were recruited. Participants (n = 43) were randomized to receive either gain- or loss-framed mobile messages three times per week for eight weeks. Engagement rates with messages were calculated. Outcomes included beliefs, intentions, adherence, and asthma control. Data collection was performed at baseline, week 4, and week 8. Mixed-design ANOVA assessed whether outcomes improved differentially from baseline to week eight between gain- and loss-framed groups. Twenty-two participants were randomly assigned to the gain-framed group and 21 to the loss-framed group. There was a 100% retention rate. The engagement rate with the text messages was 85.9%. There was a significant difference in participants' intentions to take medication and asthma control from baseline. There were no significant changes in other outcomes from baseline. There was no difference in changes in all outcomes between participants receiving gain- versus loss-framed messages. Framed mobile messages improved young adults' asthma control and intentions to take their medication as prescribed.

Video Interventions for Reducing Health Inequity in Cancer Screening Programmes: a Systematic Review

BACKGROUND

Health equity can lead to disparities in cancer screening, treatment, and mortality. This systematic review aims to identify and describe interventions that used video or DVD formats to reduce health inequity in cancer screening and review the effectiveness of such interventions in increasing screening rates compared to usual care conditions.

METHODS

We searched PubMed, Web of Science, Embase, and Cochrane databases for randomized control trials (RCTs) published until 18/01/2023 that compared intervention versus usual care control groups, with the percentage of cancer screening uptake during follow-up as an outcome. The risk of Bias was assessed with the Cochrane Collaboration tool.

RESULTS

After screening 4201 abstracts, 192 full texts were assessed for eligibility and 18 were included that focused on colorectal (n = 9), cervical (n = 5), breast (n = 5), and prostate (n = 1) cancer screening. All were based in the USA except one and most focused on ethnicity/race, while some included low-income populations. Most of the video interventions used to increase cervical cancer screening reported positive results. Studies aimed at increasing mammography uptake were mostly effective only in specific groups of participants, such as low-income or less-educated African American women. Results for colorectal cancer screening were conflicting. Videos that were culturally tailored or used emotive format were generally more effective than information-only videos.

CONCLUSIONS

Video interventions to increase cancer screening among populations with low screening uptake show some positive effects, though results are mixed. Interventions that use individual and cultural tailoring of the educational material should be further developed and investigated outside of the USA.

Message frame and health literacy: Strategies to improve adherence to antihypertensive medications

BACKGROUND

Hypertension and prehypertension is prevalent in about half of the total world population. Experts recommend comprehensive medical treatment for people with underlying diseases or at risk for metabolic syndrome. However, previous studies have found that approximately half of all patients with hypertension stopped taking antihypertensive medication within a year, and this phenomenon was closely related to the low perceived benefit and outcome expectation of taking behavior.

OBJECTIVES

As the initial perception of medication is greatly influenced by the medication message, this study explored the effect of the gain-loss framing of the message of adherence to antihypertensives. Furthermore, the study analyzed the interaction between health literacy and involvement, which is a characteristic of the message recipient, and the message frame and examined how the message strategy should differ according to individual factors.

METHODS

The quasi-experiment via an online survey was conducted from August 9 to 11, 2021. Participants who had the potential for hypertension but had not yet been diagnosed were selected through screening questions. A total of 1200 participants were randomly assigned to each frame group. Data analysis was conducted using descriptive statistics, analysis of covariance for analysis of main effects and interaction effects between variables, and Bonferroni post-hoc for multiple analyses.

RESULTS

Regarding medical adherence intention, the frame did not show a main effect, whereas individual factors showed a main effect. An interaction effect of frame and individual factors were found. Specifically, in the group with low health literacy or low involvement, a significant gain frame advantage effect was observed.

CONCLUSIONS

This study verified the relationship between medication messages and behavior and provides insight into tailoring messages to antihypertensive adherence; it found that individuals' health literacy and involvement must be considered in health communication message strategies.

Social network analysis of Twitter data from Pakistan during COVID-19

Purpose

The use of social media has increased during the COVID-19 pandemic. Social media platforms provide opportunities to share news, ideas and personal stories. Twitter is used by citizens in Pakistan to respond and comment on emerging news stories and events. However, it is not known whether Twitter played a positive or negative role in spreading updates and preventive messages during the COVID-19 pandemic. The purpose of this study is to analyse content from Twitter during the pandemic.

Design/methodology/approach

NodeXL was used to retrieve data using the keyword وائرس کورونا (written in Urdu and which translates to Coronavirus). The first data set (Case Study 1) was based on 10,284 Twitter users from the end of March. The second data set (Case Study 2) was based on 10,644 Twitter users from the start of April. The theoretical lens of effective message framing was used to classify the most retweeted content on Twitter.

Findings

Twitter was used for personal and professional projections and included certain tweets included political motives even during the unfolding health crisis. There appeared to be very few successful attempts to use Twitter as a tool for health awareness and risk communication. The empirical findings indicate that the most retweeted messages were gain-framed and can be classified as personal, informative and political in nature.

Originality/value

The present study provides insights likely to be of interest to researchers, health organizations, citizens, government and politicians that are interested in making more effective use of social media for the purposes of health promotion. The authors also provide novel insights into the key topics of discussions, websites and hashtags used by Pakistani Twitter users during the COVID-19 pandemic.

Shaping Healthy Eating Habits in Children With Persuasive Strategies: Toward a Typology

There is an abundance of evidence that the presentation of unhealthy foods (UHFs) in different media has the power to shape eating habits in children. Compared to this rich body of work with regard to the effects of UHF presentations, studies testing the effects of healthy foods (HFs) are less conclusive. In particular, while the persuasive mechanisms behind HF presentations are well-understood, we lack insights about the role of messages factors, that is, how are (and should) HFs (be) presented in order to foster healthy eating habits in children. This paper tackles this research gap by suggesting the Persuasive Strategies Presenting Healthy Foods to Children (PSPHF) typology, classified along three pillars: (a) composition-related characteristics, (b) source-related characteristics, and (c) information-related characteristics. Against the background of the PSPHF typology, we review the available empirical evidence, outline pressing research gaps, and discuss implications for researchers, health promoters, and program planers.

Effects of Message Framing on Cancer Prevention and Detection Behaviors, Intentions, and Attitudes: Systematic Review and Meta-analysis

Background

With the increasing health care burden of cancer, public health organizations are increasingly emphasizing the importance of calling people to engage in long-term prevention and periodical detection. How to best deliver behavioral recommendations and health outcomes in messaging is an important issue.

Objective

This study aims to disaggregate the effects of gain-framed and loss-framed messages on cancer prevention and detection behaviors and intentions and attitudes, which has the potential to inform cancer control programs.

Methods

A search of three electronic databases (Web of Science, Scopus, and PubMed) was conducted for studies published between January 2000 and December 2020. After a good agreement achieved on a sample by two authors, the article selection (κ=0.8356), quality assessment (κ=0.8137), and data extraction (κ=0.9804) were mainly performed by one author. The standardized mean difference (attitude and intention) and the odds ratio (behaviors) were calculated to evaluate the effectiveness of message framing (gain-framed message and loss-framed message). Calculations were conducted, and figures were produced by Review Manager 5.3.

Results

The title and abstract of 168 unique citations were scanned, of which 53 were included for a full-text review. A total of 24 randomized controlled trials were included, predominantly examining message framing on cancer prevention and detection behavior change interventions. There were 9 studies that used attitude to predict message framing effect and 16 studies that used intention, whereas 6 studies used behavior to examine the message framing effect directly. The use of loss-framed messages improved cancer detection behavior (OR 0.76, 95% CI 0.64-0.90; P=.001), and the results from subgroup analysis indicated that the effect would be weak with time. No effect of framing was found when effectiveness was assessed by attitudes (prevention: SMD=0.02, 95% CI –0.13 to 0.17; P=.79; detection: SMD=–0.05, 95% CI –0.15 to 0.05; P=.32) or intentions (prevention: SMD=–0.05, 95% CI –0.19 to 0.09; P=.48; detection: SMD=0.02, 95% CI –0.26 to 0.29; P=.92) among studies encouraging cancer prevention and cancer detection.

Conclusions

Research has shown that it is almost impossible to change people's attitudes or intentions about cancer prevention and detection with a gain-framed or loss-framed message. However, loss-framed messages have achieved preliminary success in persuading people to adopt cancer detection behaviors. Future studies could improve the intervention design to achieve better intervention effectiveness.

Interventions targeted at women to encourage the uptake of cervical screening

BACKGROUND

This is an update of the Cochrane review published in Issue 5, 2011. Worldwide, cervical cancer is the fourth commonest cancer affecting women. High-risk human papillomavirus (HPV) infection is causative in 99.7% of cases. Other risk factors include smoking, multiple sexual partners, the presence of other sexually transmitted diseases and immunosuppression. Primary prevention strategies for cervical cancer focus on reducing HPV infection via vaccination and data suggest that this has the potential to prevent nearly 90% of cases in those vaccinated prior to HPV exposure. However, not all countries can afford vaccination programmes and, worryingly, uptake in many countries has been extremely poor. Secondary prevention, through screening programmes, will remain critical to reducing cervical cancer, especially in unvaccinated women or those vaccinated later in adolescence. This includes screening for the detection of pre-cancerous cells, as well as high-risk HPV. In the UK, since the introduction of the Cervical Screening Programme in 1988, the associated mortality rate from cervical cancer has fallen. However, worldwide, there is great variation between countries in both coverage and uptake of screening. In some countries, national screening programmes are available whereas in others, screening is provided on an opportunistic basis. Additionally, there are differences within countries in uptake dependent on ethnic origin, age, education and socioeconomic status. Thus, understanding and incorporating these factors in screening programmes can increase the uptake of screening. This, together with vaccination, can lead to cervical cancer becoming a rare disease.

OBJECTIVES

To assess the effectiveness of interventions aimed at women, to increase the uptake, including informed uptake, of cervical screening.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Issue 6, 2020. MEDLINE, Embase and LILACS databases up to June 2020. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field.

SELECTION CRITERIA

Randomised controlled trials (RCTs) of interventions to increase uptake/informed uptake of cervical screening.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed risk of bias. Where possible, the data were synthesised in a meta-analysis using standard Cochrane methodology.

MAIN RESULTS

Comprehensive literature searches identified 2597 records; of these, 70 met our inclusion criteria, of which 69 trials (257,899 participants) were entered into a meta-analysis. The studies assessed the effectiveness of invitational and educational interventions, lay health worker involvement, counselling and risk factor assessment. Clinical and statistical heterogeneity between trials limited statistical pooling of data. Overall, there was moderate-certainty evidence to suggest that invitations appear to be an effective method of increasing uptake compared to control (risk ratio (RR) 1.71, 95% confidence interval (CI) 1.49 to 1.96; 141,391 participants; 24 studies). Additional analyses, ranging from low to moderate-certainty evidence, suggested that invitations that were personalised, i.e. personal invitation, GP invitation letter or letter with a fixed appointment, appeared to be more successful. More specifically, there was very low-certainty evidence to support the use of GP invitation letters as compared to other authority sources' invitation letters within two RCTs, one RCT assessing 86 participants (RR 1.69 95% CI 0.75 to 3.82) and another, showing a modest benefit, included over 4000 participants (RR 1.13, 95 % CI 1.05 to 1.21). Low-certainty evidence favoured personalised invitations (telephone call, face-to-face or targeted letters) as compared to standard invitation letters (RR 1.32, 95 % CI 1.11 to 1.21; 27,663 participants; 5 studies). There was moderate-certainty evidence to support a letter with a fixed appointment to attend, as compared to a letter with an open invitation to make an appointment (RR 1.61, 95 % CI 1.48 to 1.75; 5742 participants; 5 studies). Low-certainty evidence supported the use of educational materials (RR 1.35, 95% CI 1.18 to 1.54; 63,415 participants; 13 studies) and lay health worker involvement (RR 2.30, 95% CI 1.44 to 3.65; 4330 participants; 11 studies). Other less widely reported interventions included counselling, risk factor assessment, access to a health promotion nurse, photo comic book, intensive recruitment and message framing. It was difficult to deduce any meaningful conclusions from these interventions due to sparse data and low-certainty evidence. However, having access to a health promotion nurse and attempts at intensive recruitment may have increased uptake. One trial reported an economic outcome and randomised 3124 participants within a national screening programme to either receive the standard screening invitation, which would incur a fee, or an invitation offering screening free of charge. No difference in the uptake at 90 days was found (574/1562 intervention versus 612/1562 control, (RR 0.94, 95% CI: 0.86 to 1.03). The use of HPV self-testing as an alternative to conventional screening may also be effective at increasing uptake and this will be covered in a subsequent review. Secondary outcomes, including cost data, were incompletely documented. The majority of cluster-RCTs did not account for clustering or adequately report the number of clusters in the trial in order to estimate the design effect, so we did not selectively adjust the trials. It is unlikely that reporting of these trials would impact the overall conclusions and robustness of the results. Of the meta-analyses that could be performed, there was considerable statistical heterogeneity, and this should be borne in mind when interpreting these findings. Given this and the low to moderate evidence, further research may change these findings. The risk of bias in the majority of trials was unclear, and a number of trials suffered from methodological problems and inadequate reporting. We downgraded the certainty of evidence because of an unclear or high risk of bias with regards to allocation concealment, blinding, incomplete outcome data and other biases.

AUTHORS' CONCLUSIONS

There is moderate-certainty evidence to support the use of invitation letters to increase the uptake of cervical screening. Low-certainty evidence showed lay health worker involvement amongst ethnic minority populations may increase screening coverage, and there was also support for educational interventions, but it is unclear what format is most effective. The majority of the studies were from developed countries and so the relevance of low- and middle-income countries (LMICs), is unclear. Overall, the low-certainty evidence that was identified makes it difficult to infer as to which interventions were best, with exception of invitational interventions, where there appeared to be more reliable evidence.

Environmental factors affecting mothers' decision-making about the HPV vaccination for their daughters

OBJECTIVE

This study aimed to investigate environmental factors influencing mothers' decision-making regarding vaccination of the human papillomavirus (HPV) for their daughters.

METHODS

This was a cross-sectional study, with data collected using online surveys from July to September 2018. Participants were 230 mothers of second-year female middle-school students in South Korea. The proportional stratification sampling method was used to reflect the difference in medical level between regions. Independent variables consisted of individual (demographic characteristics, HPV-related characteristics, knowledge, attitude, and subjective norms) and environmental factors (the influence of healthcare providers, school, and community environments) were examined. The potential factors influencing vaccination uptake were determined using hierarchical logistic regression.

RESULTS

The factors influencing mothers' decision-making about the HPV vaccine for their daughters were their attitude toward HPV vaccination (OR = 0.78 p < .001), whether a healthcare provider provided HPV-vaccine-related information (OR = 2.42, p = .030), and presenting positive-framed information (OR = 4.21, p = .020).

CONCLUSIONS

To increase HPV vaccination among the target population, it is necessary to consider environmental factors identified in this study. Healthcare providers should provide accurate information regarding the vaccination. Information emphasizing the vaccination's benefits is particularly important.

COVID-19 Vaccination Attitudes and Intention: Message Framing and the Moderating Role of Perceived Vaccine Benefits

The United States is one of the hardest-hit countries by the COVID-19 pandemic and yet there is widespread hesitancy to take the vaccine. In order to address vaccine hesitancy and foster public understanding of the COVID-19 vaccine, it is necessary to strategize public health messages based on evidence. To this end, we use experimental data to examine the effects of four message frames on participants' attitudes toward the COVID-19 vaccine and their vaccine intention. The primary purposes of this paper are to examine the 1) impact of loss vs. gain frames and individual vs. collective frames and 2) role of perceived benefits on participants' attitudes toward the COVID-19 vaccine and their vaccine intention. Our findings show that participants with higher perceived benefits and exposed to the loss frame showed higher positive attitudes toward the COVID-19 vaccine and greater intention to vaccinate. Similar patterns were revealed in case of the individual frame message. Implications are discussed.

Immediate and Persisting Effects of Controversial Media Information on Young People's Judgement of Health Issues

Whether true or false, media information shapes people’s thinking. False information trigger beliefs which could compromise health behaviour. In this intervention study, the effect of controversial messages on 91 young participants’ judgement of health issues was tested. Held opinions about health-related issues were assessed before, after and one week after viewing a controversial TV-interview. Using pre-interview opinions for baseline, changes in judgements were assessed immediately after and one week after the interview. At both times, the opinions differed statistically significantly from baseline (p < .001). The relationship between opinions immediately- and one week-after viewing the interview was statistically significantly stronger (p < .001) than their association with the baseline. The results provide evidence for immediate change in judgment resulting from controversial information and demonstrate that the change persists for at least one week. The findings can be explained based on the schema theory and suggest that controversial information could have powerful impact on subjective judgement. Consequently, young people need to be educated in health issues and in the evaluation of media information to enable them to make the right choice when the need arises.

Behavioral economics informed message content in text message reminders to improve cervical screening participation: Two pragmatic randomized controlled trials

The objective of the reported research was to assess the impact of text message (SMS) reminders and their content on cervical screening rates. Women invited for cervical screening in Northwest London from February-October 2015 were eligible. 3133 women aged 24-29 (Study 1) were randomized (1, 1) to 'no SMS' (control), or a primary care physician (PCP) endorsed SMS (SMS-PCP). 11,405 women aged 30-64 (Study 2), were randomized (1, 1:1:1:1:1:1) to either: no SMS, an SMS without manipulation (SMS), the SMS-PCP, an SMS with a total or proportionate social norm (SMS-SNT or SMS-SNP), or an SMS with a gain-framed or loss-framed message (SMS-GF and SMS-LF). The primary outcome was participation at 18 weeks. In Study 1 participation was significantly higher in the SMS-PCP arm (31.4%) compared to control (26.4%, aOR, 1.29, 95%CI: 1.09-1·51; p = 0.002). In Study 2 participation was highest in the SMS-PCP (38.4%) and SMS (38.1%) arms compared to control (34.4%), (aOR: 1.19, 95%CI: 1.03-1.38; p = 0.02 and aOR: 1.18, 95%CI: 1.02-1.37; p = 0.03, respectively). The results demonstrate that behavioral SMSs improve cervical screening participation. The message content plays an important role in the impact of SMS. The results from this trial have already been used to designing effective policy for cervical cancer screening. The NHS Cervical Screening Programme started running a London-wide screening SMS campaign which was based on the cervical screening trial described here. According to figures published by Public Health England, after six months attendance increased by 4.8%, which is the equivalent of 13,400 more women being screened at 18 weeks.

The Interplay of Message Framing and Consideration of Future Consequences on Energy Drink Consumption: Focusing on the Underlying Emotional Mechanism

Researchers have examined the relative persuasiveness of gain- versus loss-framing in various health contexts, but factors that moderate the effects as well as the processes through which such interplay produces impacts remain unclear. This study addresses how message-framing effects are moderated by individual differences in considering future consequences and how such interaction effects influence persuasion through two discrete emotions - anticipated regret and anticipated anxiety. Results suggest that gain-framing was more persuasive for those who value future consequences, and such interaction exerted its effect through anticipated regret.

The effects of gain- and loss-framed nutritional messages on children's healthy eating behaviour

OBJECTIVE

Despite extensive research on framing effects in public health communication, there is still a lack of knowledge on how gain frames v. loss frames can encourage healthy eating behaviour among children.

DESIGN

Drawing on the Prospect Theory as well as on the Reactivity of Embedded Food Cues in Advertising Model, an experiment exposed children to an audio-visual cartoon movie with gain-framed nutritional messages about eating fruit (gain condition), loss-framed nutritional messages about eating fruit (loss condition) or a message without any food (control group). Children's fruit intake was measured as the dependent variable. Children's awareness of gain- and loss-framed arguments was treated as mediators, while children's age and parents' self-reported food-related mediation styles were modelled as moderators.

SETTING

Vienna, Austria, in 2018.

PARTICIPANTS

Children aged 6-10 years (N 161).

RESULTS

Children in the gain frame group were more aware of gain-framed arguments, and children in the loss frame group were more aware of loss-framed arguments than those in the control group. However, only the mediator awareness of gain-framed arguments increased fruit intake. Additionally, there was a direct effect of the gain-framed message on fruit intake compared to the control group. The loss condition did not reveal such an effect. Neither parent's food-related mediation styles nor children's age moderated those results.

CONCLUSION

Gain-framing seems to be more effective in influencing children's healthy food choices compared to loss-framing. Implications for health communication strategies aimed at children are discussed.

Tailored texts: An application of regulatory fit to text messages designed to reduce high-risk drinking

This study used the regulatory focus/fit framework to compare the impact of text message wording on college students' drinking behaviors. In this 2 × 3 × 2 pre-test/post-test experiment, participants (N = 279) were randomly assigned to one of the three groups: messages matching regulatory focus (congruent group), messages mismatching regulatory focus (incongruent group), and general health messages (control group). Messages were tailored by regulatory fit (prevention-oriented or promotion-oriented). Mixed factorial analyses of covariance revealed that prevention-oriented individuals who received text messages incongruent with their regulatory focus reported drinking alcohol for more hours and were more likely to consume a higher quantity of drinks than participants in the congruent or control group. These findings suggest that health messages mismatched to a receiver's regulatory focus might exacerbate unhealthy behavior.

An Experimental Test of the Efficacy of Gain- and Loss-Framed Messages for Doping Prevention in Adolescent Athletes

Background: Doping is a prevalent issue, not only among Olympians and professional athletes; young athletes and those at the sub-elite level have reported doping as well. Doping programs have been developed to target adolescent athletes and prevent doping initiation. The efficacy of primary doping prevention initiatives may be enhanced with health communication strategies, such as message framing. To date, there have been very few studies examining message framing among adolescents and none in the context of doping prevention. Objectives: The purpose of this study was to compare the efficacy of gain-framed and loss-framed messages on key psychological antecedents of doping among adolescent athletes. Methods: In a randomized controlled trial, 133 athletes aged 12 to 16 years old (M_age=13.73; 53% boys) from a variety of sports viewed either a gain- or loss-framed video. Intentions, attitudes, self-efficacy, and perceived norms were all assessed immediately before and after the videos. Results: Mixed between-within subjects ANOVAs revealed no differential influence for either message frame on changes in any of the outcomes. Attitudes, self-efficacy, and perceived norms all increased significantly over time for participants in both conditions. Conclusions/Importance: Overall, the findings suggest that a brief messaging intervention may have a beneficial influence on psychosocial constructs related to doping. There is no strong evidence to support definitive recommendations regarding optimal message framing for doping prevention among adolescent athletes.

Message framing and counseling of parents on children's physical activity - an experimental study

How messages are framed (gain or loss frame) modulate the effect of health information on physical activity level in adults. The role of framing of health information messages to parents about their child's physical activity is unknown.

Adult participants (parents) were randomized to see a video that either emphasized the benefits of physical activity (gain frame) or the risks of physical inactivity (loss frame) in children. The primary outcome was the change in the reported level of physical activity for their children between baseline and two-week follow-up.

92 individuals participated in the study and we obtained follow-up data for 48 participants (20 gain frame and 28 loss frame). Using a generalized linear model, we found that the frame presented to parents significantly influenced the trajectory of their child's physical activity (p = 0.03), with the loss frame condition resulting in more favorable trajectory. Both the willingness to pay for organized physical activities and the perceived barriers to physical activity were similar between the two intervention groups.

The change in the reported level of activity of the child over a two-week period was significantly different whether parents were exposed to a loss frame or a gain frame video message.

The Importance of 'Likes': The Interplay of Message Framing, Source, and Social Endorsement on Credibility Perceptions of Health Information on Facebook

Online sources not only permeate the information-seeking environment of the younger generation, but also have profound influence in shaping their beliefs and behaviors. In this landscape, examining the factors responsible for credibility perceptions of online information is fundamental, particularly for health-related information. Using a 2 (frames: gain vs. loss) × 2 (source: expert vs. non-expert) × 2 (social endorsement: high vs. low) randomized between-subjects experimental design, this study examines the effect of health message framing and the moderating effects of social endorsement and source type on credibility perceptions of Facebook posts. Testing across two issues--physical activity and alcohol consumption--findings indicate that the gain-framed message was perceived as most credible. Additionally, significant three-way interactions suggest that social endorsement and source type affect the relationship between message framing and credibility perceptions. Specifically, the findings demonstrate that a gain-framed message from an expert source with high number of 'likes' is considered the most credible message. These findings have significant implications for information gathering from social media sources, such as the influence of 'likes' on health information.

Is It All in a Word? The Effect of Issue Framing on Public Support for U.S. Spending on HIV/AIDS in Developing Countries

The frequency of government foreign aid decisions influenced by pubic opinion has risen dramatically in the past few years.This study looks at the effect of issue framing on support for U.S. spending on HIV/AIDS in developing countries—specifically, at how support changes when the phrase foreign aid is included or omitted from a survey question. Analyses reveal a significant effect of issue framing for women and Democrats. Omitting the phrase foreign aid is associated with increased support for U.S. spending among Democrats and decreased support among women. Regardless of issue framing, blacks, Hispanics, and more educated individuals support U.S. spending on HIV/AIDS in developing countries. However, when forced to decide between funds' going overseas for HIV/AIDS in developing countries or remaining in the United States, all respondents overwhelmingly support monies' being used in the United States.

Message Framing, Perceived Susceptibility, and Intentions to Vaccinate Children Against HPV Among African American Parents

This research examines the interaction effect of message framing (gain vs. loss) and perceived susceptibility (i.e., perceived likelihood that one's child is at risk of contracting HPV) on African American parents' intentions to vaccinate their children against HPV. Results of an experiment (N = 193) in which parents were exposed to either a gain-framed or loss-framed message about HPV vaccination revealed a significant interaction between message framing and perceived susceptibility when parents were required to pay for the vaccine. The specific pattern of interaction suggested that parents who perceived their children to be at high risk of contracting HPV were more persuaded by the gain-framed message, whereas those who believed their children to be at low risk of contracting HPV were more persuaded by the loss-framed message. Implications of the findings for HPV vaccination messaging are discussed.

Persuading People to Drink Less Alcohol: The Role of Message Framing, Temporal Focus and Autonomy

AIMS

Health information can be used to try to persuade people to follow safe drinking recommendations. However, both the framing of information and the dispositional characteristics of message recipients need to be considered. An online study was conducted to examine how level of autonomy moderated the effect on drinking behaviour of gain- and loss-framed messages about the short- vs. long-term consequences of alcohol use.

METHODS

At Time 1, participants (N = 335) provided demographic information and completed a measure of autonomy. At Time 2, participants reported baseline alcohol use and read a gain-framed or loss-framed health message that highlighted either short- or long-term outcomes of alcohol consumption. Alcohol consumption was reported 7 days later.

RESULTS

The results showed a significant three-way interaction between message framing (loss vs. gain), temporal focus (short-term vs. long-term) and autonomy. For low-autonomy (but not high-autonomy) individuals, the loss-framed health message was associated with lower levels of alcohol consumption than was the gain-framed message but only if the short-term outcomes were conveyed.

CONCLUSION

This research provides evidence that the interaction between message framing and temporal focus may depend on a person's level of autonomy, which has implications for health promotion and the construction of effective health communication messages.

SHORT SUMMARY

We examined how autonomy moderated the effect on drinking behaviour of gain- and loss-framed messages about the short- vs. long-term consequences of alcohol use. For low-autonomy individuals, the loss-framed health message was associated with lower alcohol consumption than was the gain-framed message but only if the short-term outcomes were conveyed.

Framing preventive care messaging and cervical cancer screening in a health-insured population in South Africa: Implications for population-based communication?

The impact of health message framing on cervical cancer screening uptake is poorly understood. In a prospective randomized control study with 748 females, aged 21–65 years with no Pap smear in the previous 3 years, they randomly received a loss-framed, gain-framed, or neutral health message (control) regarding cervical cancer screening by email. Screening rate in the control group was 9.58 percent (CI: 9.29%–9.87%), 5.71 percent (CI: 5.48%–6.98%) in the gain-framed group, and 8.53 percent (CI: 8.24%–8.81%) in the loss-framed group. Statistically there was no difference between the three screening rates. Framing of health messages may not be a significant consideration when communicating through emails.

Emphasizing the losses or the gains: Comparing situational and individual moderators of framed messages to promote fruit and vegetable intake

Health messages are a commonly used way to promote changes in dietary habits but their efficacy could be enhanced by strategies such as the way in which the presented arguments are framed. This study aimed to test the effectiveness of framed messages (gain vs. loss) on behavioural intention and fruit and vegetable (FV) intake, comparing predictions based on prominent theoretical perspectives on message framing (function of the health behaviour and recipients' motivational orientation) and by further exploring the role of baseline intentions as a potential moderator of the framing effects. Undergraduate students (N = 180) completed the three assessment points in time. At baseline, individual moderators (motivational orientation and intentions) and fruit and vegetable intake were assessed. One week later, participants were randomly assigned to the loss or gain-framed message and indicated their intentions for FV intake the following week. A week later, FV intake over the previous week was assessed. The gain-frame was not conducive, per se, to higher intentions or behaviour. Having intention as the outcome, only baseline intentions moderated the effects of message frame. When considering FV intake as the outcome, both motivational orientation and baseline intentions moderated the effects of message frame, with the loss-frame promoting higher FV intake among individuals who were prevention-oriented and had higher baseline intentions. Findings suggest that the success of framed messages for FV intake depends upon the recipient's characteristics, such as motivational orientation, baseline intentions, and cultural background, with implications for health communication interventions.

Cognitive biases and heuristics in medical decision making: a critical review using a systematic search strategy

BACKGROUND

The role of cognitive biases and heuristics in medical decision making is of growing interest. The purpose of this study was to determine whether studies on cognitive biases and heuristics in medical decision making are based on actual or hypothetical decisions and are conducted with populations that are representative of those who typically make the medical decision; to categorize the types of cognitive biases and heuristics found and whether they are found in patients or in medical personnel; and to critically review the studies based on standard methodological quality criteria.

METHOD

Data sources were original, peer-reviewed, empirical studies on cognitive biases and heuristics in medical decision making found in Ovid Medline, PsycINFO, and the CINAHL databases published in 1980-2013. Predefined exclusion criteria were used to identify 213 studies. During data extraction, information was collected on type of bias or heuristic studied, respondent population, decision type, study type (actual or hypothetical), study method, and study conclusion.

RESULTS

Of the 213 studies analyzed, 164 (77%) were based on hypothetical vignettes, and 175 (82%) were conducted with representative populations. Nineteen types of cognitive biases and heuristics were found. Only 34% of studies (n = 73) investigated medical personnel, and 68% (n = 145) confirmed the presence of a bias or heuristic. Each methodological quality criterion was satisfied by more than 50% of the studies, except for sample size and validated instruments/questions. Limitations are that existing terms were used to inform search terms, and study inclusion criteria focused strictly on decision making.

CONCLUSIONS

Most of the studies on biases and heuristics in medical decision making are based on hypothetical vignettes, raising concerns about applicability of these findings to actual decision making. Biases and heuristics have been underinvestigated in medical personnel compared with patients.

Influenza vaccination acceptance among diverse pregnant women and its impact on infant immunization

OBJECTIVE

We examined pregnant women's likelihood of vaccinating their infants against seasonal influenza via a randomized message framing study. Using Prospect Theory, we tested gain- and loss-frame message effects and demographic and psychosocial correlates of influenza immunization intention. We also explored interactions among pregnant women who viewed "Contagion" to understand cultural influences on message perception.

METHODS

Pregnant women ages 18-50 participated in a randomized message framing study from September 2011 through May 2012 that included exposure to intervention or control messages, coupled with questionnaire completion. Venue-based sampling was used to recruit racial and ethnic minority female participants at locations throughout Atlanta, Georgia. Bivariate and multivariate analyses were conducted to evaluate key outcomes.

RESULTS

The study population (n = 261) included many lower income (≤ $20,000/yearly household earnings) pregnant participants (69.2%, n = 171) inclusive of Black/African Americans (88.5%, n = 230), Hispanic/Latinas (7.3%, n = 19), and Other/Multicultural women (4.2%, n = 11). Both gain [OR = 2.13, 90% CI: (1.120, 4.048)] and loss-frame messages [OR = 2.02, 90% CI: (1.083, 3.787)] were significantly associated with infant influenza vaccination intention compared with the control condition. Intention to immunize against influenza during pregnancy had a strong effect on intent to immunize infants [OR = 10.83, 90%CI: (4.923, 23.825)]. Those who had seen the feature film "Contagion" (n = 54, 20.69%) viewed gain- and loss-framed messages as appealing (x (2) = 6.03, p = 0.05), novel (x (2) = 6.24, p = 0.03), and easy to remember (x (2) = 16.33, P = 0.0003).

CONCLUSIONS

In this population, both gain- and loss-framed messages were positively associated with increased maternal intent to immunize infants against influenza. Message resonance was enhanced among those who saw the film "Contagion." Additionally, history of immunization was strongly associated with infant immunization intention. :

Health message framing effects on attitudes, intentions, and behavior: a meta-analytic review

BACKGROUND

Message framing has been an important focus in health communication research, yet prior meta-analyses found limited support for using framing to increase persuasiveness of health messages.

PURPOSE

This meta-analysis distinguished the outcomes used to assess the persuasive impact of framed messages (attitudes, intentions, or behavior).

METHODS

One hundred eighty-nine effect sizes were identified from 94 peer-reviewed, published studies which compared the persuasive impact of gain- and loss-framed messages.

RESULTS

Gain-framed messages were more likely than loss-framed messages to encourage prevention behaviors (r = 0.083, p = 0.002), particularly for skin cancer prevention, smoking cessation, and physical activity. No effect of framing was found when persuasion was assessed by attitudes/intentions or among studies encouraging detection.

CONCLUSIONS

Gain-framed messages appear to be more effective than loss-framed messages in promoting prevention behaviors. Research should examine the contexts in which loss-framed messages are most effective, and the processes that mediate the effects of framing on behavior.

Promoting fruit and vegetable consumption: the role of message framing and autonomy

OBJECTIVE

Previous studies have shown that gain-framed messages (vs. loss-framed messages) are more effective when advocating 'low-risk' prevention behaviours (e.g., diet, exercise, dental flossing) that minimize the risk of a health problem.The objective of the reported research was to explore whether autonomy moderated the effectiveness of gain-framed vs. loss-framed messages encouraging fruit and vegetable consumption.

DESIGN

A prospective design was used for this study.

METHOD

At time 1, participants (N = 177) completed a measure of autonomy and read either a gain-framed message (describing the benefits of fruit and vegetable consumption) or a loss-framed message (describing the disadvantages of not eating fruit and vegetables). At time 2, participants reported their fruit and vegetable consumption over the preceding 7 days.

RESULTS

Autonomy moderated the effect of message framing. Gain-framed messages only prompted fruit and vegetable consumption amongst those with high levels of autonomy.

CONCLUSION

The study identifies a key role for autonomy in shaping recipients' responses to framed messages promoting fruit and vegetable consumption.

How does patients' quality of life guide their preferences regarding aspects of asthma therapy?: a patient-preference study using discrete-choice experiment methodology

BACKGROUND AND OBJECTIVE

Previous work has suggested that people with poor health-related quality of life (HR-QOL) as a result of asthma are willing to pay the most for successful therapy. There is also evidence that preferences are an important influence on adherence to therapy. We report a patient preference study using a discrete-choice experiment (DCE) to elicit willingness to pay (WTP) of patients with asthma in Spain, the Netherlands, and the UK.

METHODS

The DCE survey included different attributes of asthma therapy (days with symptoms, days needing reliever medication, asthma attacks [none, attack that does not require doctor/emergency room {ER} visit, attack that requires doctor/ER visit], risk of adverse effects, number of preventer inhalers, and monthly out-of-pocket costs). Participants indicated which attribute combinations they preferred. The questionnaire survey included the mini Asthma Quality of Life Questionnaire (mAQLQ). The validity of the choice experiment has been supported by two pilot studies conducted in the UK. Preferences and WTP were estimated using a random effects probit model. Symptom days and asthma attack attributes were segmented by mAQLQ score.

RESULTS

Demographic and clinical data were compared between the three country samples (UK, n = 124; Spain, n = 86; the Netherlands, n = 269). All study attributes were independently significant predictors of choice. People were willing to pay €35 per month to avoid a day with symptoms, and €109 per month (year 2005 values) to avoid experiencing asthma attacks that required emergency visits to their doctor or hospital. People with the worst HR-QOL were willing to pay the least to avoid days with symptoms and asthma attacks that required visits to their doctor/ER. This was not an income-related effect.

CONCLUSION

Patients who reported higher HR-QOL were willing to pay more to avoid days with symptoms and asthma attacks that required visits to their doctor/ER. Hypotheses were explored to explain this effect. It is possible that people with the least impairment of HR-QOL place the greatest value on avoiding the effects of asthma and so are most willing to alter their behavior. People with the worst HR-QOL may be exhibiting a response shift type of effect whereby their internal values are shifted down by the burden of their disease. These findings may help to illuminate why there are differences in asthma treatment adherence.

Cervical cancer screening, diagnosis and treatment interventions for racial and ethnic minorities: a systematic review

OBJECTIVES

To systematically review the literature to determine which interventions improve the screening, diagnosis or treatment of cervical cancer for racial and/or ethnic minorities.

DATA SOURCES

Medline on OVID, Cochrane Register of Controlled Trials, CINAHL, PsycINFO and Cochrane Systematic Reviews.

STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS

We searched the above databases for original articles published in English with at least one intervention designed to improve cervical cancer prevention, screening, diagnosis or treatment that linked participants to the healthcare system; that focused on US racial and/or ethnic minority populations; and that measured health outcomes. Articles were reviewed to determine the population, intervention(s), and outcomes. Articles published through August 2010 were included.

STUDY APPRAISAL AND SYNTHESIS METHODS

One author rated the methodological quality of each of the included articles. The strength of evidence was assessed using the criteria developed by the GRADE Working Group.

RESULTS

Thirty-one studies were included. The strength of evidence is moderate that telephone support with navigation increases the rate of screening for cervical cancer in Spanish- and English-speaking populations; low that education delivered by lay health educators with navigation increases the rate of screening for cervical cancer for Latinas, Chinese Americans and Vietnamese Americans; low that a single visit for screening for cervical cancer and follow up of an abnormal result improves the diagnosis and treatment of premalignant disease of the cervix for Latinas; and low that telephone counseling increases the diagnosis and treatment of premalignant lesions of the cervix for African Americans.

LIMITATIONS

Studies that did not focus on racial and/or ethnic minority populations may have been excluded. In addition, this review excluded interventions that did not link racial and ethnic minorities to the health care system. While inclusion of these studies may have altered our findings, they were outside the scope of our review.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

Patient navigation with telephone support or education may be effective at improving screening, diagnosis, and treatment among racial and ethnic minorities. Research is needed to determine the applicability of the findings beyond the populations studied.

How do perceptions about cessation outcomes moderate the effectiveness of a gain-framed smoking cessation telephone counseling intervention?

The distinction between prevention and detection behaviors provides a useful guideline for appropriately framing health messages in terms of gains or losses. However, this guideline assumes that everyone perceives the outcomes associated with a behavior in a consistent manner, as prevention or detection. Individuals' perceptions of a behavior vary, and so the effects of framed messages may be optimized by considering individuals' perceptions rather than the prevention or detection function of the behavior. The authors tested this message-framing paradigm in a secondary analysis of data from a trial evaluating gain-framed smoking cessation counseling delivered through a state quitline (Toll et al., 2010 ). Smokers (N = 2,032) who called a state quitline received either gain-framed or standard care messages. Smokers' beliefs about the positive consequences of stopping smoking (outcome expectancies) were evaluated at baseline. Smoking status and self-efficacy were assessed at 3 months. Outcome expectancies moderated the framing effects among men but not among women. Men in the gain-framed counseling condition who had positive outcome expectancies were more likely to quit and had more confidence in their ability to quit or to remain abstinent than men who were uncertain of the positive outcome of smoking cessation. Among men, self-efficacy mediated the moderated framing effects of the intervention on quit status. These findings suggest that it may be useful to consider sex and individual differences in outcome expectancies when delivering gain-framed smoking cessation messages in the context of a state quitline.

Formative research for a community-based message-framing intervention

OBJECTIVE

To inform a community-based message framing intervention encouraging physical activity and fruit and vegetable consumption among medically underserved adults.

METHOD

Key informant interviews, focus groups, and a survey were conducted with limited-literacy Hispanics in the northeastern United States.

RESULTS

Barriers to healthy lifestyle behaviors exist at individual, community, and policy levels. A strong degree of networking among local organizations and elected officials exists that can be used to encourage healthy lifestyle initiatives.

CONCLUSIONS

Community-based health communication interventions must address neighborhood realities, the literacy levels of the target population, and existing networks of providers and consumers.

Exploring the interaction of patient activation and message design variables: message frame and presentation mode influence on the walking behavior of patients with type 2 diabetes

Examining interpersonal (physician-patient) communication strategies for promoting walking exercise to patients with type 2 diabetes assigned to primary care clinics, the study evaluated two message design variables--frame and presentation mode--as influencers of communication and adoption success. The single-site, four-week, prospective intervention study followed a 2×3 factorial, non-equivalent comparison group quasi-experimental design. Results showed frame was significantly related to steps walked; however, when including patient activation as an interaction, frame was non-significant. The model including patient activation interactions, however, detected significant mode effects on behavior. Results provide evidence that statistics are most effectively used with activated patients.

An Initial Investigation into Naturally Occurring Loss- and Gain-Framed Memorable Breast Cancer Messages

Memorable message research examines interpersonal messages "…remembered for extremely long periods of time and which people perceive as a major influence on the course of their lives" (Knapp, Stohl, & Reardon, 1981, p. 27). They can also guide actions, such as health behaviors. This exploratory research examined self-reported memorable messages about breast cancer to determine if they were framed, emphasizing either the benefits (gain-framed) or the costs (loss-framed) of a behavior. About one-fourth of the messages were framed, with most being gain-framed. The messages tended to emphasize early detection actions. Study limitations and implications for future research are discussed.

Effects of gain- and loss-framed messages on the sun safety behavior of adolescents: the moderating role of risk perceptions

This study examined how message framing effects can be moderated by two types of risk: (a) perceived effectiveness in preventing a risk and (b) perceived susceptibility to the risk. The results indicate that the perceived effectiveness moderated framing effects on the intention to use sunscreen such that a loss-framed message was more effective when perceived effectiveness was low, whereas a gain-framed message was more effective when perceived effectiveness was high. In addition, perceived susceptibility to skin cancer moderated framing effects on the intention to use sunscreen and the intention to wear long pants such that a loss-framed message was more effective when perceived susceptibility was high.

Framing of health information messages

BACKGROUND

The same information about the evidence on health effects can be framed either in positive words or in negative words. Some research suggests that positive versus negative framing can lead to different decisions, a phenomenon described as the framing effect. Attribute framing is the positive versus negative description of a specific attribute of a single item or a state, for example, "the chance of survival with cancer is 2/3" versus "the chance of mortality with cancer is 1/3". Goal framing is the description of the consequences of performing or not performing an act as a gain versus a loss, for example, "if you undergo a screening test for cancer, your survival will be prolonged" versus "if you don't undergo screening test for cancer, your survival will be shortened".

OBJECTIVES

To evaluate the effects of attribute (positive versus negative) framing and of goal (gain versus loss) framing of the same health information, on understanding, perception of effectiveness, persuasiveness, and behavior of health professionals, policy makers, and consumers.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, issue 3 2007), MEDLINE (Ovid) (1966 to October 2007), EMBASE (Ovid) (1980 to October 2007), PsycINFO (Ovid) (1887 to October 2007). There were no language restrictions. We reviewed the reference lists of related systematic reviews, included studies and of excluded but closely related studies. We also contacted experts in the field.

SELECTION CRITERIA

We included randomized controlled trials, quasi-randomised controlled trials, and cross-over studies with health professionals, policy makers, and consumers evaluating one of the two types of framing.

DATA COLLECTION AND ANALYSIS

Two review authors extracted data in duplicate and independently. We graded the quality of evidence for each outcome using the GRADE approach. We standardized the outcome effects using standardized mean difference (SMD). We stratified the analysis by the type of framing (attribute, goal) and conducted pre-planned subgroup analyses based on the type of message (screening, prevention, and treatment). The primary outcome was behaviour. We did not assess any adverse outcomes.

MAIN RESULTS

We included 35 studies involving 16,342 participants (all health consumers) and reporting 51 comparisons.In the context of attribute framing, participants in one included study understood the message better when it was framed negatively than when it was framed positively (1 study; SMD -0.58 (95% confidence interval (CI) -0.94 to -0.22); moderate effect size; low quality evidence). Although positively-framed messages may have led to more positive perception of effectiveness than negatively-framed messages (2 studies; SMD 0.36 (95% CI -0.13 to 0.85); small effect size; low quality evidence), there was little or no difference in persuasiveness (11 studies; SMD 0.07 (95% CI -0.23 to 0.37); low quality evidence) and behavior (1 study; SMD 0.09 (95% CI -0.14 to 0.31); moderate quality evidence).In the context of goal framing, loss messages led to a more positive perception of effectiveness compared to gain messages for screening messages (5 studies; SMD -0.30 (95% CI -0.49 to -0.10); small effect size; moderate quality evidence) and may have been more persuasive for treatment messages (3 studies; SMD -0.50 (95% CI -1.04 to 0.04); moderate effect size; very low quality evidence). There was little or no difference in behavior (16 studies; SMD -0.06 (95% CI -0.15 to 0.03); low quality evidence). No study assessed the effect on understanding.

AUTHORS' CONCLUSIONS

Contrary to commonly held beliefs, the available low to moderate quality evidence suggests that both attribute and goal framing may have little if any consistent effect on health consumers' behaviour. The unexplained heterogeneity between studies suggests the possibility of a framing effect under specific conditions. Future research needs to investigate these conditions.

Preaching to the choir? The influence of personal relevance on the effects of gain- and loss-framed health-promoting messages

This article examines the moderating influence of personal relevance on the persuasive effects of gain- and loss-framed messages. We assessed current behaviour as a proxy for personal relevance, provided 169 participants with gain- and loss-framed messages advocating skin self-examination (SSE) and assessed intention to engage in SSE as the outcome measure. The results showed that loss-framed information was more persuasive than gain-framed information, but only for low-relevance participants. This suggests that loss-framed information might be mainly effective for recipients who need little persuading and, in fact, runs the risk of ‘preaching to the choir’.

Pre-existing beliefs and expectations influence judgments of novel health information

The present study examined whether health information is judged differently depending on pre-existing beliefs and expectations. People's initial beliefs and expectations were assessed by a questionnaire about acupuncture and a trustworthiness and preference rating task of doctors' faces. Then, newspaper headlines about novel acupuncture treatment were shown and rated for their feasibility in a normal and framed condition. The judged feasibility of the newspaper headlines correlated strongly with initial beliefs about acupuncture in the normal condition, and with initial expectations towards a doctor's face in the framed condition. Thus, as suggested by Bayes Theorem, pre-existing beliefs and expectations influence judgments of novel health information.

Interventions targeted at women to encourage the uptake of cervical screening

BACKGROUND

World-wide, cervical cancer is the second most common cancer in women. Increasing the uptake of screening, alongside increasing informed choice is of great importance in controlling this disease through prevention and early detection.

OBJECTIVES

To assess the effectiveness of interventions aimed at women, to increase the uptake, including informed uptake, of cervical cancer screening.

SEARCH STRATEGY

We searched the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Issue 1, 2009. MEDLINE, EMBASE and LILACS databases up to March 2009. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field.

SELECTION CRITERIA

Randomised controlled trials (RCTs) of interventions to increase uptake/informed uptake of cervical cancer screening.

DATA COLLECTION AND ANALYSIS

Two review authors independently abstracted data and assessed risk of bias. Where possible the data were synthesised in a meta-analysis.

MAIN RESULTS

Thirty-eight trials met our inclusion criteria. These trials assessed the effectiveness of invitational and educational interventions, counselling, risk factor assessment and procedural interventions. Heterogeneity between trials limited statistical pooling of data. Overall, however, invitations appear to be effective methods of increasing uptake. In addition, there is limited evidence to support the use of educational materials. Secondary outcomes including cost data were incompletely documented so evidence was limited. Most trials were at moderate risk of bias. Informed uptake of cervical screening was not reported in any trials.

AUTHORS' CONCLUSIONS

There is evidence to support the use of invitation letters to increase the uptake of cervical screening. There is limited evidence to support educational interventions but it is unclear what format is most effective. The majority of the studies are from developed countries and so the relevance to developing countries is unclear.

Toward a new methodological paradigm for testing theories of health behavior and health behavior change

OBJECTIVE

Traditional theory testing commonly applies cross-sectional (and occasionally longitudinal) survey research to test health behavior theory. Since such correlational research cannot demonstrate causality, a number of researchers have called for the increased use of experimental methods for theory testing.

METHODS

We introduce the multi-methodological theory-testing (MMTT) framework for testing health behavior theory.

RESULTS

The MMTT framework introduces a set of principles that broaden the perspective of how we view evidence for health behavior theory. It suggests that while correlational survey research designs represent one method of testing theory, the weaknesses of this approach demand that complementary approaches be applied. Such approaches include randomized lab and field experiments, mediation analysis of theory-based interventions, and meta-analysis.

CONCLUSION

These alternative approaches to theory testing can demonstrate causality in a much more robust way than is possible with correlational survey research methods. Such approaches should thus be increasingly applied in order to more completely and rigorously test health behavior theory.

PRACTICE IMPLICATIONS

Greater application of research derived from the MMTT may lead researchers to refine and modify theory and ultimately make theory more valuable to practitioners.

A field test of the effects of instruction design on colorectal cancer self-screening accuracy

A field experiment tested whether instruction design improves accurate adherence to instructions for medical do-it-yourself tests like the Fecal Occult Blood Test (FOBT). As part of an outreach campaign, 16,073 participants received FOBTs with instructions that were (i) human factored, (ii) motivational, (iii) human factored/motivational combined, or (iv) the standard used in the past. Among all test results returned (N = 2483), only the human factors instructions reduced errors in filling out result cards. However, after post-validating result cards that had errors, the human-factored, motivational and merged instructions reduced errors. The present findings show that medical instructions designed with human factors and persuasion principles increase accurate adherence. These design principles provide simple and cost-effective ways to increase test taking accuracy and FOBT effectiveness. Better screening instructions can improve the chances of detecting colorectal cancer early, which may help to decrease cancer mortality.

Persuasion factors influencing the decision to use sustainable household water treatment

Solar water disinfection (SODIS) is a sustainable water treatment method. With the help of the sun and plastic bottles, water is treated and illnesses prevented. This paper aims to identify the factors influencing SODIS uptake, that is, why someone may become a SODIS user. This uptake decision can be influenced by persuasion. From behaviour theory, variables are recognised which have been proven to influence intention and behaviour and simultaneously can be influenced by persuasion. A total of (n = 878) structured interviews were conducted in a field study in Zimbabwe. Linear and binary logistic regressions showed that several of the initially proposed persuasion variables have significant influence. Persuasion factors have a stronger influence on the uptake of SODIS use and on intention to use SODIS in the future than on the amount of SODIS water consumed. Ideas are presented for using the effective variables in future SODIS campaigns and campaigns in other fields.

Healthy choices in context: How contextual cues can influence the persuasiveness of framed health messages

Research has shown that framing messages in terms of benefits or detriments can have a substantial influence on intended behavior. For prevention behaviors, positively framed messages have been found to elicit stronger behavioral intentions than negatively framed messages. Research also seems to indicate that certain contextual features contribute to the persuasiveness of a message. In the present research we test how message framing, contextually presented affect and the number of argument factors interact and contribute to the persuasiveness of a health related message. Consistent with our hypothesis, we found that, in our prevention focused task, increasing the number of arguments increased behavioral intentions (BI) for positively framed messages when subjects were cued, via negative affect, to be attentive to the message. This resulted in a significant framing effect for messages with the maximum number of arguments and a negative background picture. An account of contextual influence in persuasive health messages is discussed.

Prospect theory, reference points, and health decisions

In preventative health decisions, such as the decision to undergo an invasive screening test or treatment, people may be deterred from selecting the test because its perceived disutility relative to not testing is greater than the utility associated with prevention of possible disease. The prospect theory editing operation, by which a decision maker’s reference point is determined, can have important effects on the disutility of the test. On the basis of the prospect theory value function, this paper develops two approaches to reducing disutility by directing the decision maker’s attention to either (actual) past or (expected) future losses that result in shifted reference points. After providing a graphical description of the approaches and a mathematical proof of the direction of their effect on judgment, we briefly illustrate the potential value of these approaches with examples from qualitative research on prostate cancer treatment decisions.

Guides d’activité physique pour les Canadiens : stratégies de diffusion des messages, attentes réalistes pour le changement et évaluationCet article est tiré d’un supplément intitulé Advancing physical activity measurement and guidelines in Canada: a scientific review and evidence-based foundation for the future of Canadian physical activity guidelines (Favoriser les lignes directrices et la mesure de l’activité physique au Canada: examen scientifique et justification selon les données probantes pour l’avenir des lignes directrices de l’activité physique canadienne) publié par Physiologie appliquée, nutrition et métabolisme et la Revue canadienne de santé publique. On peut aussi mentionner Appl. Physiol. Nutr. Metab. 32 (Suppl. 2F) ou Can. J. Public Health 98 (Suppl. 2)

Les directives relatives à la pratique de l’activité physique proposent des comportements types qui diminuent le risque de morbidité et de mortalité si on y adhère. En fait, les directives indiquent le quoi faire, mais ni le pourquoi ni le comment. Par conséquent, pour favoriser la pratique de l’activité physique, les messages issus des directives ne devraient pas seulement donner la quantité d’activité physique à faire et pourquoi, mais aussi comment le faire. Les guides d’activité physique canadiens sont une mise en application de ces directives. Dans cet article, nous présentons un bref aperçu des défis créés par la publication de ces guides et nous relevons les aspects pratiques et les observations empiriques à prendre en compte dans le futur pour élaborer et diffuser des messages congruents. Nous nous inspirons des succès passés pour bien communiquer les directives relatives aux objectifs de la pratique de l’activité physique et nous nous référons à la littérature scientifique récente en matière de promotion pour faire des recommandations. Pour motiver les gens à atteindre les objectifs véhiculés dans les directives, il faut formuler des messages à caractère informatif, incitatif et convaincant. On devrait diffuser ces messages auprès du public au moyen d’une campagne de promotion en plusieurs étapes, soigneusement planifiée et soumise à une évaluation rigoureuse.