Intentions to use hormonal male contraception: The role of message framing, attitudes and stress appraisals

Framing Slogans for Responsible Gambling Campaigns: A Tale of Two Models

This study investigates the persuasive mechanism of slogans employed in responsible gambling campaigns. We analyse slogans from official posters in the U.S., Singapore, and Macau, focusing on two domains. First, the Theory of Planned Behaviour is applied to examine the intention to gamble expressed in the slogans to reveal how gambling is positioned in social contexts. Second, two framing devices-i.e., conceptual metaphors and the frame of gains/losses-are examined to understand how these framing devices reinforce the persuasive message while interacting with each other. Two models of persuasion emerge from our data-one encouraged 'grounded games' for enjoyment, while the other discouraged gambling due to its potentially 'harmful' consequences. We advocate for a gestalt view on the theoretical constructs that contribute to the overall effectiveness of persuasive messaging. These constructs should be integrated into an analytical framework, with particular attention given to the framing effect of conceptual metaphors and the gain/loss frame, and their interplay.

Effect of Information Framing on Wearing Masks During the COVID-19 Pandemic: Interaction With Social Norms and Information Credibility

Objective

The main objectives of this study were to use the effect of information framing (different expressions of the same issue, e.g., positive messages and negative messages) to explore key factors that influence the attitude of and intention of the public toward wearing masks and to understand the internal and external factors of intervention on information framing perception.

Methods

This study performed an online questionnaire survey to explore the influence of demographic characteristics, information framing, social norms, and information credibility on the attitude of the public toward masks and their intention to wear them.

Results

(1) Information framing had a significant impact on the attitudes of people toward masks and their intention to wear them, and the persuasion effect of gain-framed messages was higher than that of loss-framed messages. (2) Gender, income, occupation, educational background, and residence have no significant difference in attitude and intention to wear masks. There was a significant correlation between age and wearing of masks (p = 0.041 < 0.05). (3) Social norms affected people's perception of information framing and their attitude toward wearing masks, but only the impact of loss-framed messages on intention was significant. (4) Information framing affected people's perception of information credibility, which had a positive impact on their intention to wear masks; however, information credibility only had a significant impact on attitude toward wearing masks under the gain-framed messages and played an intermediary role.

Conclusion

The impact of information framing on the attitude of people toward masks and their intention to wear them varies. Individuals involved in the publicity of health information related to this issue should pay attention to the influence of information framing and content on the public wearing masks as a means of enhancing public health awareness.

Getting Intentional about Intention to Use: A Scoping Review of Person-Centered Measures of Demand

In recent years, there has been much reflection on the measures used to assess and monitor contraceptive programming outcomes. The meaning and measurement of intention‐to‐use (ITU) contraception, however, has had less attention and research despite its widespread inclusion in many major surveys. This paper takes a deeper look at the meaning and measurement of ITU around contraception. We conducted a scoping review guided by the following questions: What is the existing evidence regarding the measurement of ITU contraception? What definitions and measures are used? What do we know about the validity of these measures? We searched databases and found 112 papers to include in our review and combined this with a review of the survey instruments and behavioral theory. Our review found growing evidence around the construct of ITU in family planning programming and research. However there are inconsistencies in how ITU is defined and measured, and this tends not to be informed by advances in behavioral theory and research. Further work is needed to develop and test measures that capture the complexity of intention, examine how intention differently relates to longer‐range goals compared to more immediate implementation, and demonstrate a positive relationship between ITU and contraceptive use.

Will Men Use Novel Male Contraceptive Methods and Will Women Trust Them? A Systematic Review

Novel male contraceptives have been in development for almost as long as female methods, yet there are no products available on the market. Hormonal approaches tested clinically to date include the use of oral, injectable, implant and transdermal methods. The study of attitudes toward male contraception has been inconsistent and there have been no systematic reviews drawing these data together. We conducted a systematic review of the available evidence for male and female acceptability of novel male contraception. We identified 32 studies and present a narrative synthesis of quantitative data and a thematic synthesis of qualitative data. In novel drug trials, the proportion of male participants willing to use a male contraceptive ranged from 34.0% to as high as 82.3%. In studies regarding hypothetical drugs, male willingness to use ranged from 13.6% to 83.0%. High proportions of women (42.8%-94.0%) reported willingness to use a novel male method in both hypothetical studies and actual drug trials. In qualitative studies, both men and women expressed the desire to share responsibility for contraception. There is consistent interest among both men and women in novel male contraceptive methods and willingness to use them. The systematic review was registered with PROSPERO: CRD42020173281.

Message Framing in Vaccine Communication: A Systematic Review of Published Literature

Suboptimal vaccination rates are a significant problem in many countries today, in spite of improved access to vaccine services. As a result, there has been a recent expansion of research on how best to communicate about vaccines. The purpose of the present article is to provide an updated review of published, peer-reviewed empirical studies that examined the effectiveness of gain versus loss framing (i.e., goal framing) in the context of vaccine communication. To locate studies, we examined the reference list from the previous meta-analytic review (O'Keefe & Nan, 2012), and we conducted systematic searches across multiple databases. We included 34 studies in the qualitative synthesis. The relative effectiveness of goal-framed vaccine messages was often shown to depend on characteristics of the message recipient, perceived risk, or situational factors, yet most effects were inconsistent across studies, or simply limited by an insufficient number of studies. Methodological characteristics and variations are noted and discussed. The review points to several directions concerning moderators and mediators of framing effects where additional rigorous studies would be needed.

The Impact of Gain- and Loss-Framed Messages on Young Adults' Sexual Decision Making: An Experimental Study

Messages that frame a target behavior in terms of its benefits (gain frame) or costs (loss frame) have been widely and successfully used for health promotion and risk reduction. However, the impact of framed messages on decisions to have sex and sexual risk, as well as moderators of these effects, has remained largely unexplored. We used a computerized laboratory task to test the effects of framed messages about condom use on young adults' sexual decision making. Participants (N = 127) listened to both gain- and loss-framed messages and rated their intentions to have sex with partners who posed a high and low risk for sexually transmitted infections (STIs). The effects of message frame, partner risk, participant gender, ability to adopt the messages, and message presentation order on intentions to have sex were examined. Intentions to have sex with high-risk partners significantly decreased after the loss-framed message, but not after the gain-framed message, and intentions to have sex increased for participants who received the gain-framed message first. Yet, participants found it easier to adopt the gain-framed message. Results suggest that loss-framed messages may be particularly effective in reducing intentions to have sex with partners who might pose a higher risk for STIs, and that message presentation order may alter the relative effectiveness of gain- and loss-framed messages on sexual decision making. Future studies should examine the precise conditions under which gain- and loss-framed messages can promote healthy sexual behaviors and reduce sexual risk behaviors.

Social norms in promoting family planning: a study in Niger

Despite the progress made in the domain of family planning, the practice of the latter remains a current issue around the world, particularly in emerging and developing countries. This study examines the impact of traditional values and norms regarding family planning in Niger. Self-reported data were gathered – by means of a questionnaire – as to the variables likely to influence family planning practices (through contraceptive use). Participants were married females ( N = 200), between 21 and 50 years of age. The data were analysed using SPSS 15.0 software. The findings suggest that subjective norms have a direct effect on contraceptive use among women with no formal schooling, living in either rural or urban settings. For women with some formal schooling, it was their attitude towards family planning that had a direct effect on family planning practices. Suggestions for devising targeted family planning messages based on cultural values and norms have been proposed.

Tackling student binge drinking: Pairing incongruent messages and measures reduces alcohol consumption

OBJECTIVES

Excessive alcohol consumption is a persistent problem in Northern European cultures. Across a 2-week period, we tested the effect of varying message frames, message types, and response measures, in reducing alcohol consumption.

DESIGN

Three hundred and twenty-three respondents were allocated to a 2 (message frame: gain vs. loss) × 2 (message type: health vs. social) × 2 (response type: engaging vs. refraining) mixed design.

METHOD

Binge drinking and units consumed were measured at Time 1 and Time 2 (2 weeks later). Participants read (following Time 1) a gain- or loss-framed message on binging emphasizing either social or health consequences and answered engaging in or refraining from drinking attitude measures.

RESULTS

No main effects were identified. The key finding was that gain-framed messages, when used in conjunction with engage response measures (an incongruous pairing), were highly effective in reducing alcohol consumption 2 weeks later compared with the other message frame/response measure combinations.

CONCLUSIONS

We suggest that for prevention behaviours, gain-framed messages, when paired with engage response measures, initiate an inconsistency resolution process. Together, our findings emphasize the importance of message frame and response type when seeking to reduce alcohol consumption using persuasive health messages.

Message framing in social networking sites

Online social networking sites represent significant new opportunities for Internet advertisers. However, results based on the real world cannot be generalized to all virtual worlds. In this research, the moderating effects of need for cognition (NFC) and knowledge were applied to examine the impact of message framing on attitudes toward social networking sites. A total of 216 undergraduates participated in the study. Results reveal that for social networking sites, while high-NFC individuals form more favorable attitudes toward negatively framed messages than positively framed messages, low-NFC individuals form more favorable attitudes toward positively framed messages than negatively framed messages. In addition, low-knowledge individuals demonstrate more favorable attitudes toward negatively framed messages than positively framed messages; however, the framing effect does not differentially affect the attitudes of high-knowledge individuals. Furthermore, the framing effect does not differentially affect the attitudes of high-NFC individuals with high knowledge. In contrast, low-NFC individuals with low knowledge hold more favorable attitudes toward positively framed messages than negatively framed messages.

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.

Attitudes towards the male contraceptive pill: psychosocial and cultural explanations for delaying a marketable product

Even though years of research on the male contraceptive pill have been conducted, a marketable product is still absent from the arsenal of male and female products of contraception. In this paper, the following psychosocial and cultural factors have been elicited from the literature in order to reveal explanations for this delay: acceptability, trust, fear of side-effects, perceptions of contraceptive responsibility and fear of losing connotations of masculinity. Regardless of cultural variation, overall there seems to be a positive attitude towards the acceptability of male contraceptive for both males and females, especially males in stable relationships. Some indication shows that the media have played an important role in distorting the results of research regarding male and female trust. Ongoing and future researches into several projects on psychosocial and cultural factors are described.

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.

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.

Living organ donation: the effect of message frame on an altruistic behaviour

Objective: This experimental study investigates the impact of message frame and risk perceptions upon willingness to consider living organ donation. Design: A 2 (gain vs. loss) by 2 (liver vs. kidney) by 2 (involved vs. not involved) between-group study was conducted. Method: Eighty-seven participants completed a questionnaire after reading a vignette designed to invite participants to consider living kidney or liver donation. Results: Within a gain frame scenario, willingness to donate was significantly higher when the risk of donating was lower. Conclusion: The results have important implications for the generalizability of framing theories and the promotion of living organ donation.

Predicting participation in ultrasound hip screening from message framing

The use of ultrasound (US) screening for developmental dysplasia of the hip (DDH) is an innovation in preventive child health care in the Netherlands. What is not known is whether parents will accept this screening method and will actually participate in it. It is widely known that health behaviors can be influenced by the framing of information. The objective of this study was to examine the influence of a gain- versus loss-framed brochure on parental participation in US screening for DDH. In total, 4150 parents of infants born between August 2007 and December 2008 received either a gain-framed or a loss-framed brochure. Parents could participate in the screening when their infant was 3 months old. The participation rate in the US screening was 74.3%. In contrast to the predictions of prospect theory, the results indicated that parents who had received the gain-framed message were more likely to participate in the screening compared to parents who had received the loss-framed message. This effect may be explained by the low risk perception of parents and by the possibility that the screening was perceived as a health-affirming behavior rather than an illness-detecting behavior. To increase participation rates, it is recommended that parents be informed about the positive aspects of partaking in screening for DDH.

The effect of message framing on self-management of chronic pain: a new perspective on intervention?

This study examines framed messages as a novel approach to promote self-management of chronic pain. Primary care patients reporting chronic pain (pain rated ≥ 4 on 0-10 NRS-I for ≥3 months) were randomly assigned to receive a gain- or loss-framed message promoting self-management of pain. Impact of the framed message on behavioural self-management (including communicating with providers, relaxation, activity pacing, pleasant activities and healthy lifestyle) was assessed. Post-message, individuals in the loss-frame condition reported significantly greater interest in and more knowledge gained from the information presented in the message (p≤0.03). Loss-frame participants were significantly more likely to express confidence that they would practice relaxation (p≤0.03). Pain readiness to change, pain self-efficacy and message frame independently influenced motivation to engage in relaxation as a self-management strategy. Across all behaviours assessed, there were no observed interactions between message frame and either pain self-efficacy or pain readiness to change (p>0.05). Framing may be useful to promote pain self-management; larger trials are needed to fully evaluate its potential and to further assess the applicability of framed communication to impact a broader range of chronic conditions.

Message framing with respect to decisions about vaccination: The roles of frame valence, frame method and perceived risk

People respond differently when information is framed either positively or negatively (frame valence). Two prominent models propose that the effects of valence are moderated by (1) the method of framing (attributes vs. goals: Levin, Schneider, & Gaeth, 1998) and (2) perceived risk (Rothman & Salovey, 1997). This experiment (N=200) explores the joint influence of both of these moderators with respect to decisions about a flu vaccination. The study extends previous work by integrating these two models and exploring the moderating effects of two different aspects of perceived risk (personal outcome effectiveness and procedural risk). The results show that personal outcome effectiveness indirectly links frames to intentions. Procedural risk moderates the relationship between valence and method in a manner consistent with predictions from Levin et al.. Partial support for the model proposed by Rothman and Salovey are observed for goal frames only.

Attitudes towards the male contraceptive pill in men and women in casual and stable sexual relationships

BACKGROUND AND METHODOLOGY

Men's and women's attitudes towards the male contraceptive pill and their trust in the effective use of the male pill were investigated, as well as the associated variables of reported health behaviours, perceived self-efficacy and type of sexual relationship, using a questionnaire survey.

RESULTS

Although both sexes had a favourable attitude towards the male pill, females had a more positive attitude than men. Conversely, women had less trust that men would use the male pill effectively. Males in stable sexual relationships were more positive about the male pill than those in casual sexual relationships. Gender, relationship type and trust in the effective use of the male pill reliably predicted attitude towards the male pill. High perceived self-efficacy was related to engaging in more health behaviours, and in men a positive association between health behaviours and attitude towards the male pill has been found.

DISCUSSION AND CONCLUSIONS

A positive attitude towards the male pill does not automatically imply that the individual is confident about its effective use. Once the male pill is widely available, promotional campaigns could target not only men but also their female partners, as the latter tend to come into contact with health services more frequently. In order to increase confidence in effective implementation, a variety of presentations of the male pill should be made available in line with individual needs and lifestyles.

Message framing for smoking cessation: the interaction of risk perceptions and gender

Because quitting smoking is clearly linked to preventing health problems such as lung cancer, research on health message framing based on prospect theory suggests that gain-framed messages (i.e., emphasizing the benefits of quitting smoking) would be more persuasive in promoting cessation than loss-framed messages (i.e., emphasizing the costs of continuing to smoke). However, because women tend to anticipate greater perceived risk from quitting smoking than men, this may affect how receptive they are to specific message framing interventions. Data from 249 participants (129 females, 120 males) in a clinical trial of message framing for smoking cessation with bupropion were used to examine how gender differences in perceptions of the risks associated with quitting influence the effects of framed interventions using number of days to smoking relapse as the criterion. Perceived risk of quitting scores were dichotomized using a median split for the entire sample. Women reported a higher perceived risk of cessation than men. Participants who anticipated high risks associated with quitting smoking reported fewer days to relapse. Further, females in the gain-framed condition who reported low perceived risks of cessation had a greater number of days to relapse, as opposed to females in the loss-framed condition. These findings suggest that message framing interventions for smoking cessation should consider the influence of gender and risk perceptions associated with quitting on the effectiveness of framed interventions.

EFFECT OF FRAMING ON RISKY CHOICE: ONE CASE STUDY IN CHINA

The effect of framing on Chinese undergraduates was explored using Tversky and Kahneman's (1981) well-known Asian Disease Problem. Participants were divided into three groups with different formats: positive, negative, and balanced format, respectively. There was a significant difference between the Chinese sample and Tversky and Kahneman's American sample under positive format, but no difference under the negative format. Chinese students were more prone to risky options. Results of the Chinese sample showed that the type of framing effect was unidirectional, characterized by predominant risk seeking under both framing conditions, with more risk seeking under the negative frame than the positive frame. The framing effect was evaluated using the balanced format condition as an objective measure of the existing risk preference. Results suggest that the military participants were influenced by both positive format and negative format, and in the Chinese civil sample the negative format had an important effect. These findings expand the literature on risk decision by demonstrating the framing effect and comparing results from Chinese and American participants.

Pilot study in the development of an interactive multimedia learning environment for sexual health interventions: a focus group approach

In the UK there are high rates of sexually transmitted infections and unintended pregnancies amongst young people. There is limited and contradictory evidence that current sexual health education interventions are effective or that they improve access to appropriate sexual health services. This paper describes the outcome of focus group work with young people that was undertaken to inform the design of an Interactive Multimedia Learning Environment that incorporates message framing, intended for use in sexual health promotion. The focus group work addressed sexual attitudes, behaviour, risk perception, and knowledge of sexual health and sexual health services in Nottingham. The results provided new insights into young peoples' sexual behaviour, and their diversity of knowledge and beliefs. Common themes expressed regarding sexual health services included concerns about confidentiality, lack of confidence to access services and fear of the unknown. The results showed that while the adolescents are reasonably knowledgeable about infection, they do not know as much about the relevant services to treat it. This work emphasizes the need for user involvement throughout the design and development of a sexual health intervention, and will form the basis of the next part of the project.