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

A study on the factors influencing the intention to receive booster shots of the COVID-19 vaccine in China based on the information frame effect

Introduction

In the response to and prevention and control of the Novel coronavirus pneumonia, the COVID-19 vaccine does not provide lifelong immunity, and it is therefore important to increase the rate of booster shots of the COVID-19 vaccine. In the field of information health science, research has found that information frames have an impact in changing individual attitudes and health behaviors.

Objective

This study focuses on the effects of different influencing factors on the public's willingness to receive the booster shots of the COVID-19 vaccine under two information frameworks.

Methods

An online questionnaire was conducted to explore the effects of demographic characteristics, personal awareness, social relationships, risk disclosure, perceived booster vaccination protection rate, and duration of protection under the assumption of an information framework. T test and one-way analysis were used to testing the effect of variables.

Results

(1) The persuasion effect under the gain frame is higher than that under the loss frame (B = 0.863 vs. B = 0.746); (2) There was no significant difference in subjects' intention of booster vaccination in terms of gender, age, income, occupation, educational background and place of residence. Whether family members received booster vaccination was strongly correlated with their intention of vaccination under the loss framework (p = 0.017, M = 4.63, SD = 0.664). (3) The higher the understanding of COVID-19, the higher the degree of compliance with the government's COVID-19 prevention and control measures, and the higher the willingness to strengthen vaccination; (4) Risk disclosure has a significant impact on people's willingness to receive COVID-19 booster shots (M = 2.48, under the loss framework; M = 2.44, under the gain framework); (5) Vaccine protection rate and duration of protection have an impact on people's willingness to vaccinate. Increased willingness to vaccinate when the protection rate of booster vaccine approaches 90% (M = 4.76, under the loss framework; M = 4.68, under the gain framework). When the vaccine protection period is 2 years, people are more willing to receive a booster vaccine; and the willingness to receive a booster shot is stronger under the loss framework (M = 4.60, SD = 0.721, p = 0.879).

Conclusion

The impact of the information framework on COVID-19 vaccination intentions is different, and the disclosure of relevant health information should focus on the impact of the information framework and content on the public's behavior toward strengthening vaccination. Therefore, in the face of public health emergencies, public health departments, healthcare institutions, and other sectors can consider adopting the Gainful Information Framework tool to disseminate health information to achieve better persuasion and promote public health behavior change enhancing public health awareness, and promoting universal vaccination.

How Should Doctors Frame the Risk of a Vaccine's Adverse Side Effects? It Depends on How Trustworthy They Are

BACKGROUND

How health workers frame their communication about vaccines' probability of adverse side effects could play an important role in people's intentions to be vaccinated (e.g., positive frame: side effects are unlikely v. negative frame: there is a chance of side effects). Based on the pragmatic account of framing as implicit advice, we expected that participants would report greater vaccination intentions when a trustworthy physician framed the risks positively (v. negatively), but we expected this effect would be reduced or reversed when the physician was untrustworthy.

DESIGN

In 4 online experiments (n = 191, snowball sampling and n = 453, 451, and 464 UK residents via Prolific; Mage≈ 34 y, 70% women, 84% White British), we manipulated the trustworthiness of a physician and how they framed the risk of adverse side effects in a scenario (i.e., a chance v. unlikely adverse side effects). Participants reported their vaccination intention, their level of distrust in health care systems, and COVID-19 conspiracy beliefs.

RESULTS

Physicians who were trustworthy (v. untrustworthy) consistently led to an increase in vaccination intention, but the way they described adverse side effects mattered too. A positive framing of the risks given by a trustworthy physician consistently led to increased vaccination intention relative to a negative framing, but framing had no effect or the opposite effect when given by an untrustworthy physician. The exception to this trend occurred in unvaccinated individuals in experiment 3, following serious concerns about one of the COVID vaccines. In that study, unvaccinated participants responded more favorably to the negative framing of the trustworthy physician.

CONCLUSIONS

Trusted sources should use positive framing to foster vaccination acceptance. However, in a situation of heightened fears, a negative framing-attracting more attention to the risks-might be more effective.

HIGHLIGHTS

How health workers frame their communication about a vaccine's probability of adverse side effects plays an important role in people's intentions to be vaccinated.In 4 experiments, we manipulated the trustworthiness of a physician and how the physician framed the risk of adverse side effects of a COVID vaccine.Positive framing given by a trustworthy physician promoted vaccination intention but had null effect or did backfire when given by an untrustworthy physician.The effect occurred over and above participants' attitude toward the health care system, risk perceptions, and beliefs in COVID misinformation.

I Will Get Myself Vaccinated for Others: The Interplay of Message Frame, Reference Point, and Perceived Risk on Intention for COVID-19 Vaccine

The purpose of this study is to seek an effective strategy to promote COVID-19 vaccination among young adults. Given that COVID-19 is less deadly for young adults, this study explores whether highlighting potential benefits or disadvantages that others may experience as a result of one's vaccination increases young adults' intention to get vaccinated, particularly for those who have low perceived risk of COVID-19. To test this idea, we conducted an experiment and analyzed the effect of interaction between message frame (gain vs. loss) and reference point (self vs. others) on intention for vaccination by one's perceived risk (low vs. high). The results show that for those with low perceived risk of COVID-19, messages about potential negative consequences to others (e.g., family, friends, community members) from one's failure to get vaccinated led to message elaboration and favorable attitude toward vaccination, which in turn promoted one's intention to get vaccinated. We discuss practical implications of the findings for message strategies that target populations experiencing COVID-19 disparities.

The impact of side effect framing on COVID-19 booster vaccine intentions in an Australian sample

OBJECTIVE

To evaluate the effect of presenting positively attribute-framed side effect information on COVID-19 booster vaccine intention relative to standard negatively-framed wording and a no-intervention control.

DESIGN AND PARTICIPANTS

A representative sample of Australian adults (N = 1204) were randomised to one of six conditions within a factorial design: Framing (Positive; Negative; Control) × Vaccine (Familiar (Pfizer); Unfamiliar (Moderna)).

INTERVENTION

Negative Framing involved presenting the likelihood of experiencing side effects (e.g., heart inflammation is very rare, 1 in every 80,000 will be affected), whereas Positive Framing involved presenting the same information but as the likelihood of not experiencing side effects (e.g., 79,999 in every 80,000 will not be affected).

PRIMARY OUTCOME

Booster vaccine intention measured pre- and post-intervention.

RESULTS

Participants were more familiar with the Pfizer vaccine (t(1203) = 28.63, p <.001, Cohen's d_z = 0.83). Positive Framing (M = 75.7, SE = 0.9, 95% CI = [73.9, 77.4]) increased vaccine intention relative to Negative Framing (M = 70.7, SE = 0.9, 95% CI = [68.9, 72.4]) overall (F(1, 1192) = 4.68, p =.031, η_p² = 0.004). Framing interacted with Vaccine and Baseline Intention (F(2, 1192) = 6.18, p =.002, η_p² = 0.01). Positive Framing was superior, or at least equal, to Negative Framing and Control at increasing Booster Intention, irrespective of participants' pre-intervention level of intent and vaccine type. Side effect worry and perceived severity mediated the effect of Positive vs. Negative Framing across vaccines.

CONCLUSION

Positive framing of side effect information appears superior for increasing vaccine intent relative to the standard negative wording currently used.

PRE-REGISTRATION

See: aspredicted.org/LDX_2ZL.

The Individuals’ Willingness to Get the Vaccine for COVID-19 during the Third Wave: A Study on Trust in Mainstream Information Sources, Attitudes and Framing Effect

Different inner and external determinants might explain an individual’s willingness to get the vaccine for COVID-19. The current study aims at evaluating the effects of trust in mainstream information sources on individuals’ willingness to get the vaccine and the moderator role of the message framing. Six hundred and thirty-four participants (68.5% females and 31.5% males) were enrolled in an online survey. Participants filled out a questionnaire assessing: trust in mainstream information sources and vaccinal attitude (trust in vaccine benefit, worries over unforeseen future effects, concerns about commercial profiteering, and preference for natural immunity). In addition, participants were randomly exposed to one of four conditions of framing information about the vaccine (gain-probability; gain-frequency; loss-probability; loss-frequency). Results showed that trust in vaccine benefit (b = 9.90; 95% CI: 8.97, 11.73) and concerns about commercial profiteering (b = −4.70; 95% CI: −6.58, −2.81) had a significant effect on the intention to get the vaccine. Further, a significant interaction was observed between loss-gain and trust in vaccine benefit and between frequency-probability and concerns about commercial profiteering. Future vaccination campaigns should consider the individuals’ concerns about vaccine benefit and economic profits to efficaciously deliver frequency-framed or probability-framed information.

Healthcare workers' acceptability of influenza vaccination nudges: Evaluation of a real-world intervention

Nudges have been proposed as an effective tool to stimulate influenza vaccination uptake in healthcare workers. However, the success of such nudges in practice is heavily reliant on their acceptance by the intended healthcare worker population, which has not been thoroughly examined to date. This study investigated healthcare workers’ acceptability of diverse influenza vaccination nudges implemented in a real-world vaccination campaign and explored the relationship between nudge acceptability and vaccination uptake. A cross-sectional study was conducted among 244 Dutch hospital employees, following a hospital-wide influenza vaccination nudging intervention. A survey assessed healthcare workers’ perceived acceptability of ten distinct influenza vaccination nudges, along with their vaccination status and relevant covariates (e.g., general perceptions regarding influenza vaccination of healthcare workers). Influenza vaccination nudges in general were deemed acceptable, with reward-based nudges being the least accepted, while digital vaccination forms, a mobile vaccination post, peer vaccination, and digital vaccination reminders were most appreciated. A higher overall acceptance of these nudges was associated with a greater likelihood of being vaccinated, particularly in healthcare workers with favorable perceptions of influenza vaccination usefulness. Our findings suggest that influenza vaccination nudges are an accepted means to systematically promote immunization of healthcare workers, and thus present a viable strategy for public health policies aimed at this group.

Identifying effective message-framing techniques in behaviour change communication for healthy diets: An experimental study of promoting biofortified maize adoption in Ethiopia

There is an increasing interest in using insights from behavioural economics and psychology to influence people's decisions. However, little is known as to how to leverage these insights to inform educational campaigns in the context of nutrition-sensitive agriculture. We help to fill this void by investigating the effect of framed messages (gain vs loss) in stimulating demand for nutritionally enhanced crops. We conducted a field experiment with 648 farmers and found the following key results. First, nutrition education stimulates demand for nutritionally enhanced crops among smallholder farmers. Without nutrition education, farmers are less likely to switch from producing conventional maize to nutritionally enhanced maize. Second, gain-framed messages are slightly more effective: they result in a higher willingness to pay for nutritionally enhanced maize than loss-framed messages. Third, motivational orientations and risk perceptions of individuals moderate the effect of the framed messages.

When do persuasive messages on vaccine safety steer COVID-19 vaccine acceptance and recommendations? Behavioural insights from a randomised controlled experiment in Malaysia

INTRODUCTION

Vaccine safety is a primary concern among vaccine-hesitant individuals. We examined how seven persuasive messages with different frames, all focusing on vaccine safety, influenced Malaysians to accept the COVID-19 vaccine, and recommend it to individuals with different health and age profiles; that is, healthy adults, the elderly, and people with pre-existing health conditions.

METHODS

A randomised controlled experiment was conducted from 29 April to 7 June 2021, which coincided with the early phases of the national vaccination programme when vaccine uptake data were largely unavailable. 5784 Malaysians were randomly allocated into 14 experimental arms and exposed to one or two messages that promoted COVID-19 vaccination. Interventional messages were applied alone or in combination and compared against a control message. Outcome measures were assessed as intent to both take the vaccine and recommend it to healthy adults, the elderly, and people with pre-existing health conditions, before and after message exposure. Changes in intent were modelled and we estimated the average marginal effects based on changes in the predicted probability of responding with a positive intent for each of the four outcomes.

RESULTS

We found that persuasive communication via several of the experimented messages improved recommendation intentions to people with pre-existing health conditions, with improvements ranging from 4 to 8 percentage points. In contrast, none of the messages neither significantly improved vaccination intentions, nor recommendations to healthy adults and the elderly. Instead, we found evidence suggestive of backfiring among certain outcomes with messages using negative attribute frames, risky choice frames, and priming descriptive norms.

CONCLUSION

Message frames that briefly communicate verbatim facts and stimulate rational thinking regarding vaccine safety may be ineffective at positively influencing vaccine-hesitant individuals. Messages intended to promote recommendations of novel health interventions to people with pre-existing health conditions should incorporate safety dimensions.

TRIAL REGISTRATION NUMBER

NCT05244356.

Positive Attribute Framing Increases COVID-19 Booster Vaccine Intention for Unfamiliar Vaccines

Positive framing has been proposed as an intervention to increase COVID-19 vaccination intentions. However, available research has examined fictitious or unfamiliar treatments. This pre-registered study (aspredicted#78369) compared the effect of standard negatively framed EU patient information leaflets (PILs), with new positively framed PILs, on booster intentions (measured pre- and post-intervention) for AstraZeneca, Pfizer, and Moderna COVID-19 vaccines. A representative sample of 1222 UK-based adults was randomised to one of six groups in a factorial design with framing (Positive vs. Negative) and vaccine familiarity (same (as previous), familiar, unfamiliar) as factors. The benefit of positive framing was hypothesised to be strongest for the least familiar vaccine (Moderna). Framing was moderated by familiarity, where only the unfamiliar vaccine showed a benefit of positive relative to negative Framing. Framing and familiarity also interacted with baseline Intention with the effect of framing on the unfamiliar vaccine especially pronounced at low baseline Intent. Conversely, standard negative framing appeared to increase intentions for familiar vaccines at low baseline intent. Findings provide important evidence that positive framing could improve vaccine uptake globally when switches or new developments require individuals to receive less familiar vaccines. Positive framing of familiar vaccines, however, should be treated with caution until better understood.

Effectiveness of message framing in changing COVID-19 vaccination intentions: Moderating role of travel desire

This research examines the effectiveness of message framing, message appeal and information content in changing respondents' COVID-19 vaccination intentions through influencing their vaccine risk perceptions. Furthermore, the moderating effect of travel desire on the relationship between vaccine risk perceptions and changing vaccination intentions is examined. In doing so, two rounds of data that were collected from the same respondents. The first survey recorded respondents' vaccination intentions, travel desire and socio demographics. A follow up survey tested cause-and-effect relationships on the proposed relationships using a 2 (message frame: gain, loss) x 2 (message appeal: rational, emotional) ×2 (information content: subjective, objective) between-subjects online experimental design. Findings suggest that loss-framed messages are more effective than gain-framed and emotional-rational messages in reducing risk perceptions and, thus, changing vaccination intentions. Travel desire is found to moderate the effect of vaccine risk perception on vaccination intentions by weakening the negative effect of vaccine risk perception on vaccination intention. Findings show the importance of travel desire along with message framing and message appeal on changing individuals' COVID-19 vaccination intentions in public health communications.

The Influence of Message Framing on Residents' Waste Separation Willingness-The Mediating Role of Moral Identity

With serious environmental problems increasing, waste separation has drawn much attention. Message framing is an important way to popularize separation knowledge and increase people's separation willingness. Message framing was classified into positive and negative frames in this study, and then based on moral identity theory from the social cognitive perspective, two dimensions of moral identity were introduced as mediating variables to construct a mechanism model of the influence of message framing on waste separation willingness. After a comparative study of three groups of subjects (N = 604), the following conclusions were drawn: (1) message framing positively influenced moral identity and waste separation willingness; (2) both positive and negative message framing positively influenced waste separation willingness through the partial mediating role of moral identity symbolization and internalization; and (3) the mediating role of symbolization was stronger in the effect of positive message framing on waste separation willingness, while the mediating role of internalization was stronger in the effect of negative message framing on waste separation willingness. The findings provide significant information for organizations to effectively carry out message strategies.

Facts Tell, Stories Sell? Assessing the Availability Heuristic and Resistance as Cognitive Mechanisms Underlying the Persuasive Effects of Vaccination Narratives

Online vaccine-critical sentiments are often expressed in appealing personal narratives, whereas vaccine-supporting information is often presented in a non-narrative, expository mode describing scientific facts. In two experiments, we empirically test whether and how these different formats impact the way in which readers process and retrieve information about childhood vaccination, and how this may impact their perceptions regarding vaccination. We assess two psychological mechanisms that are hypothesized to underlie the persuasive nature of vaccination narratives: the availability heuristic (experiment 1, N = 418) and cognitive resistance (experiment 2, N = 403). The results of experiment 1 showed no empirical evidence for the availability heuristic, but exploratory analyses did indicate that an anti-vaccination narrative (vs. expository) might reduce cognitive resistance, decrease vaccination attitudes and reduce attitude certainty in a generally pro-vaccination sample, especially for those who were more vaccine hesitant. Preregistered experiment 2 formally tested this and showed that not narrative format, but prior vaccine hesitancy predicts cognitive resistance and post-reading attitudes. Hesitant participants showed less resistance toward an anti-vaccine text than vaccine-supporting participants, as well as less positive post-reading attitudes and attitude certainty. These findings demonstrate belief consistency effects rather than narrative persuasion, which has implications for scientific research as well as public health policy.

Stability of Risk Perception Across Pandemic and Non-pandemic Situations Among Young Adults: Evaluating the Impact of Individual Differences

Previous research suggests a higher perceived risk associated with a risky behavior predicts a lower likelihood of involvement in that behavior; however, this relationship can vary based on personality characteristics such as impulsivity and behavioral activation. During the COVID-19 pandemic, individuals began to re-evaluate the level of risk associated with everyday behaviors. But what about risks associated with "typical" risk-taking behaviors? In the present study, 248 undergraduate student participants completed measures of impulsivity, behavioral activation and inhibition, propensity to take risks, numeracy, and perceptions of and involvement in both risk-taking behavior and health promoting behavior (e.g., blood donation, registering as an organ donor, vaccination). Our study revealed that higher behavioral inhibition and greater propensity to take risks predicted greater likelihood of involvement in COVID-19-related risk behaviors, even after accounting for perceived risks and benefits of the behavior. Greater likelihood of involvement in social risk behaviors was predicted by greater numeracy and risk-taking propensity. Identifying as male, a greater propensity to take risks, and greater impulsivity predicted increased health/safety risk behaviors. Younger age, lower risk-taking propensity, and lower impulsivity were associated with a greater likelihood of donating blood. For the likelihood of registering to become an organ donor, increasing risk perception, both before and during the pandemic, was associated with greater likelihood of registering, but greater risk-taking propensity was associated with a decreased likelihood of organ donation registration. For flu vaccination, a greater propensity to take risks was associated with a greater likelihood of flu vaccination during the 2020-2021 flu season. Both cognitive and personality factors can predict involvement in risk-taking and health-promotion behaviors, warranting their continued examination.

Cultural Variability in the Attribute Framing Effect

An intriguing phenomenon that arises from decision making is that the decision maker’s choice is often influenced by whether the option is presented in a positive or negative frame, even though the options are, de facto, identical to one another. Yet, the impact of such differential framing of equivalent information, referred to as the attribute framing effect, may not be the same for every culture; rather, some cultures may be more readily influenced by the differentially valenced frames than others (i.e., showing a greater difference in evaluation in a positive vs. negative frame). The present study investigates to what extent and why cultures may differ in their sensitivity to the attribute framing effect. Participants were recruited from South Korea and the United States, cultures characterized by their focus on prevention and promotion, respectively, to test for the cultural variability in the attribute framing effect. The results revealed that Korean participants were markedly more influenced by the valence of the frame than North American participants. Regulatory focus explained why Koreas showed a greater sensitivity toward the attribute framing effect than North Americans. Specifically, a greater prevention (vs. promotion) orientation of Korean participants led them to show a greater evaluation gap in the positive and negative frames. Implications for cultural significance on the attribute framing effect are discussed.

Information Framing Effect on Public's Intention to Receive the COVID-19 Vaccination in China

The aims of the study were (1) to explore information framing effect on the public's intention to receive the COVID-19 vaccination and (2) to understand the key factors influencing the intention of COVID-19 vaccinations in China. An online questionnaire survey was conducted to explore the influence of demographic characteristics, individual awareness, social relationship, risk disclosure, perceived vaccine efficacy, and protection duration under the assumptions of information framing. The results showed that (1) the persuasion effect under loss frame was higher than that under gain frame (B = 0.616 vs. 0.552); (2) there was no significant difference between sex, age, income, occupation, educational background and residence for the participants' intention to be vaccinated; whether family members/friends were vaccinated had a strong correlation with their vaccination intention under the gain frame; (3) the higher the understanding of COVID-19 and the compliance with government COVID-19 prevention and control measures were, the higher the vaccination intention was; (4) risk disclosure had the greatest impact on people's COVID-19 vaccination intention; (5) perceived vaccine effectiveness and duration of protection had little effect on people's intention to receive vaccination. The influence of information framing on the intention of COVID-19 vaccination is different. The publicity of relevant health information should pay attention to the influence of information framing and contents on the behavior of public vaccination, so as to enhance public health awareness and promote the vaccination of the whole population.

What Strategy Is Better for Promoting COVID-19 Vaccination? A Comparison Between Gain-Framed, Loss-Framed, and Altruistic Messages

BACKGROUND/OBJECTIVE

Vaccination is an efficient public health strategy for controlling infectious diseases like the COVID-19 pandemic. Therefore, this study evaluates the effect of gain-framed, loss-framed, and altruism messages on willingness to get a COVID-19 vaccine and confirms the best strategy for promoting vaccination.

METHODS

Herein, we designed an online survey experiment, including a control (exposure to non-framed information) and three experimental (exposure to gain-framed, loss-framed, or altruistic messages) groups, to assess the vaccination willingness. All participants (n = 1316) were randomly assigned into one of the four groups.

RESULTS

The individuals exposed to gain-framed, loss-framed, or altruism messages exhibited a higher willingness to get a COVID-19 vaccine than those exposed to non-framed information. Moreover, the loss-framed information effect on vaccination willingness was more substantial than the other two messages. However, no significant difference was observed between the gain-framed and altruism messages.

CONCLUSION

This study suggests that a loss-framed information dissemination strategy could be preferable to motivate vaccination willingness against COVID-19.

African American Parents' Perceived Vaccine Efficacy Moderates the Effect of Message Framing on Psychological Reactance to HPV Vaccine Advocacy

This experiment assessed how the frame of promotional vaccine messages elicited psychological reactance differently for African American parents according to their level of perceived vaccine efficacy. We found that those with low perceived HPV vaccine efficacy experienced more psychological reactance in response to loss-framed messages compared to gain-framed messages, whereas message framing made little difference for those with high perceived HPV vaccine efficacy. In addition, the interaction between frame and perceived HPV vaccine efficacy indirectly affected parents' intentions to vaccinate their child for HPV via reactance. These results support current theorizing about framing effects under defensive message processing specifically as it applies to psychological reactance.

Countering Vaccine Hesitancy among Pregnant Women in England: The Case of Boostrix-IPV

This study explored the effects of message framing on vaccine hesitancy for the antenatal whooping cough vaccine. The study also assessed whether the Theory of Planned Behaviour (TPB) constructs had any explanatory utility for vaccine intentions and behaviours in pregnant women. A between-subjects, cross-sectional design was employed. Participants (n = 282) were women who were pregnant (mean = 28 weeks, SD = 7.0), living in England and between 18 and 44 years of age. A self-report web-based survey was used to collect data. Participants were randomly assigned to read either (i) disease risk, (ii) myth busting, or (iii) control information before answering questions based on the TPB. No significant effects of message framing were found. Attitudes (Beta = 0.699; p < 0.001) and subjective norms (Beta = 0.262, p < 0.001) significantly predicted intention to vaccinate but perceived behavioural control did not. The TPB constructs accounted for 86% and 36% of the variance in vaccine intention and vaccine history respectively. Disease risk information did not influence vaccine acceptability in this sample of English pregnant women. The study offered preliminary evidence that interventions targeting constructs from the TPB may promote vaccine acceptability among pregnant women.

The Impact of Narrative Strategy on Promoting HPV Vaccination among College Students in Korea: The Role of Anticipated Regret

Human papillomavirus (HPV) vaccine hesitancy contributes to unsatisfactory vaccination coverage in Korea despite its high efficacy in preventing various diseases including cervical cancer. To enhance HPV vaccine uptake, effective communication with the public is key. To develop effective health promotion messages, this study examined the effects of message format on attitudes and intentions toward HPV vaccination, specifically focusing on anticipated action and inaction regrets. It employed a randomized experimental message design format (narrative versus didactic messages). A total of 222 Korean undergraduate students who had not received the HPV shot participated in the experiment. The results showed that didactic messages produce greater anticipated inaction regret, which further influences HPV vaccination attitudes and behaviors. Anticipated regret could potentially explain mixed narrative effects across health behaviors as described in existing literature.

Limits of the social-benefit motive among high-risk patients: a field experiment on influenza vaccination behaviour

Background

Influenza vaccine uptake remains low worldwide, inflicting substantial costs to public health. Messages promoting social welfare have been shown to increase vaccination intentions, and it has been recommended that health professionals communicate the socially beneficial aspects of vaccination. We provide the first test whether this prosocial vaccination hypothesis applies to actual vaccination behaviour of high-risk patients.

Methods

In a field experiment at a tertiary care public hospital in Istanbul, Turkey, we compare the effects of two motivational messages for promoting vaccination. Using a between-subjects single-blind experimental design patients were randomly assigned to frames emphasizing the vaccine’s benefits to self (n = 125) or social benefits (n = 119). Free influenza vaccination was offered to each patient.

Results

Among 222 patients who were not vaccinated for the season prior to the study (72% medically assessed to be at high risk), 42% in the self-benefit frame chose to receive a vaccination compared with 34% in the social-benefits frame, but the difference was not statistically significant (aOR = 1.63, 95% CI 0.90 to 2.95, p = 0.108). Reasons for vaccination focused primarily on self-benefit (67%) rather than social-benefit (5%). Exploratory analysis showed that the effect of messages depended on patient perception of risk group membership (aOR_High / aOR_Low = 5.59, 95% CI 1.30 to 24.05, p = 0.021). In particular, emphasis on self-benefit was more influential among patients who perceived themselves to be in the risk group (aOR = 6.22, 95% CI 1.69 to 22.88, p = 0.006).

Conclusions

In contrast to the literature observing intentions of low-risk populations, we found no evidence that social-benefit motivates actual vaccination behaviour among a high-risk patient population. Instead, those who self-categorize as being in the high risk group are more motivated by the self-benefit message. Our results suggest that a stratified approach can improve coverage: even if an emphasis on social-benefit could be effective among low-risk groups, an emphasis on self-benefit holds more promise for increasing vaccination in medical organizational settings where high-risk groups are prevalent.

Trial registration

ClinicalTrials.gov NCT04230343 Retrospectively registered on the 13th January 2020.

Effects of Message Framing on Influenza Vaccination: Understanding the Role of Risk Disclosure, Perceived Vaccine Efficacy, and Felt Ambivalence

The current study examined the effects of framing in promotional health messages on intention to vaccinate against seasonal influenza virus. The findings of an experimental study (N = 86) indicated that exposure to both benefits and side effects of vaccination (gain-framed with risk disclosure message) led to lower intention to receive the flu vaccine. This relationship was mediated by both perceived vaccine efficacy and felt ambivalence in a serial order, revealing the underlying psychological mechanisms important for understanding health-related behaviors. Theoretical implications of constructing sub-framed messages are discussed and the concept of second-order framing is introduced.

Gain-Framed Messages Were Related to Higher Motivation Scores for Sugar-Sweetened Beverage Parenting Practices than Loss-Framed Messages

Parents play an important role in promoting healthy beverage intake among children. Message-framing approaches, where outcomes are described as positive (gain) or negative (loss) results, can be used to encourage parenting practices that promote healthy beverage intakes. This study tested the effectiveness of message framing on motivation for parenting practices targeting reductions in child sugar-sweetened beverage (SSB) intake (controlling availability, role modeling) and dispositional factors moderating effectiveness. Parents (n = 380) completed a survey to assess motivation after viewing gain- and loss-framed messages to engage in parenting practices, usual beverage intake, and home beverage availability. Paired t-tests were used to examine differences in motivation scores after viewing gain- vs. loss-framed messages for all parents and by subgroups according to low vs. high SSB intake and home availability, and weight status. Gain- versus loss-framed messages were related to higher motivation scores for both parenting practices for all parents (n = 380, p < 0.01) and most subgroups. No differences were observed by message frame for parents in low home SSB availability or normal and overweight BMI subgroups for controlling availability. Gain- versus loss-framed messages were related to higher motivation scores, therefore gain-framed messages are recommended for parent interventions intended to decrease child intake of SSBs.

Flu vaccination communication in Europe: What does the government communicate and how?

INTRODUCTION

The Flu vaccine is the most effective measure to prevent influenza. Yet, vaccination rates remain at sub-optimal levels, with 10%-29% coverage rates in the general population of the EU. As mistrust in vaccines has increased, effective strategies are needed and one is communication. The aim of this research is to identify vaccination recommendations of the health ministries in 5 European Member States and to investigate the communication strategies used.

METHODS

Two methods were employed in this study. A review of flu vaccination recommendations in the European Union and five Members States (Austria, Germany, Malta, Ireland and United Kingdom). Next a content analysis was conducted of flu vaccination communication in those six contexts.

RESULTS AND DISCUSSION

All countries recommend flu vaccination as a primary protection tool, but they differed in their recommendations for various target audiences. Channels for communication included seven websites and 42 other materials. The main messages used were gained framed promoting protection, either for oneself, family or patients. Most communications provided basic information replying on providing facts and knowledge about the flu and the benefits of vaccination. No information on the development of the communication or its effects were found.

CONCLUSION

Communicating flu vaccination as a protective tool is common across countries and is consistent with the benefits of vaccination. Furthermore, the communications in the countries were not consistent with their recommendations. As the recommendations vary across and within countries, communication becomes a challenge. They should, at a minimum, be consistent with EU and country specific recommendations.

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.

A comparison of the efficacy of three intervention trial types: postal, group, and one-to-one facilitation, prior management and the impact of message framing and repeat messages on the flock prevalence of lameness in sheep

The aim of this study was to evaluate the effectiveness of three knowledge-transfer intervention trial types (postal, group, one-to-one) to promote best practice to treat sheep with footrot. Further aims were to investigate whether farmer behaviour (i.e. management of lameness) before the trial was associated with uptake of best practice and whether the benefits of best practice framed positively or negatively influenced change in behaviour. The intervention was a message developed from evidence and expert opinion. It was entitled "Six steps to sound sheep" and promoted (1) catch sheep within three days of becoming lame, (2) inspect feet without foot trimming, (3) correctly diagnose the cause, (4) treat sheep lame with footrot or interdigital dermatitis with antibiotic injection and spray without foot trimming, (5) record the identity of treated sheep, (6) cull repeatedly lame sheep. In 2013, 4000 randomly-selected English sheep farmers were sent a questionnaire, those who responded were recruited to the postal (1081 farmers) or one-to-one intervention (32 farmers) trials. A random sample of 400 farmers were invited to join the group trial; 78 farmers participated. A follow-up questionnaire was sent to all participants in summer 2014. There were 72%, 65% and 91% useable responses for the postal, group and one-to-one trials respectively. In both 2013 and 2014, the prevalence of lameness was lower in flocks managed by LC1 farmers than LC2 and LC3 farmers. Between 2013 and 2014, the reduction in geometric mean (95% CI) period prevalence of lameness, proportional between flock reduction in lameness and within flock reduction in lameness was greatest in the one-to-one (7.6% (7.1-8.2%) to 4.3% (3.6-5.0%), 35%, 72%) followed by the group (4.5% (3.9-5.0%) to 3.1% (2.4-3.7%), 27%, 55%) and then the postal trial (from 3.5% (3.3-3.7%) to 3.2% (3.1-3.4%), 21%, 43%). There was a marginally greater reduction in lameness in farmers using most of Six steps but slow to treat lame sheep pre-trial than those not using Six steps at all. There was no significant effect of message framing. The greatest behavioural change was a reduction in therapeutic and routine foot trimming and the greatest attitude change was an increase in negative attitudes towards foot trimming. We conclude that all three intervention trial approaches were effective to promote best practice to treat sheep with footrot with one-to-one facilitation more effective than group and postal intervention trials. Results suggest that farmers' behaviour change was greater among those practising aspects of the intervention message before the trial began than those not practising any aspect.

Rethinking Risk: Prospect Theory Application in Health Message Framing Research

Although prospect theory conceptualizes risk as uncertainty, health message framing research based on the theory typically conceptualizes risk as severity. This study reports the results of two experiments designed to explore these alternative conceptualizations of risk and their effect on health decision making. Participants (N₁ = 768, N₂ = 532) were randomly assigned to one of four conditions that presented a hypothetical scenario of a sexually transmitted disease (STD) outbreak. The conditions were defined by message prompt (deadly vs. easily curable STD) and response option frame (gain vs. loss). Participants selected which of two programs (certain outcome vs. uncertain outcome) they would prefer to combat the outbreak. Across both experiments, participants expressed strong preferences for certain (low risk) outcomes in the gain-framed conditions and no preferences in the loss-framed conditions. These differences held regardless of the consequence severity of the scenario. We discuss the theoretical and practical implications of these results and offer directions for future research.

A randomized trial of maternal influenza immunization decision-making: A test of persuasive messaging models

OBJECTIVE

We sought to examine the effectiveness of persuasive communication interventions on influenza vaccination uptake among black/African American pregnant women in Atlanta, Georgia.

METHODS

We recruited black/African American pregnant women ages 18 to 50 y from Atlanta, GA to participate in a prospective, randomized controlled trial of influenza immunization messaging conducted from January to April 2013. Eligible participants were randomized to 3 study arms. We conducted follow-up questionnaires on influenza immunization at 30-days post-partum with all groups. Chi-square and t tests evaluated group differences, and outcome intention-to-treat assessment utilized log-binomial regression models.

RESULTS

Of the 106 enrolled, 95 women completed the study (90% retention), of which 31 were randomly assigned to affective messaging intervention ("Pregnant Pause" video), 30 to cognitive messaging intervention ("Vaccines for a Healthy Pregnancy" video), and 34 to a comparison condition (receipt of the Influenza Vaccine Information Statement). The three groups were balanced on baseline demographic characteristics and reported health behaviors. At baseline, most women (63%, n = 60) reported no receipt of seasonal influenza immunization during the previous 5 y. They expressed a low likelihood (2.1 ± 2.8 on 0-10 scale) of obtaining influenza immunization during their current pregnancy. At 30-days postpartum follow-up, influenza immunization was low among all participants (7-13%) demonstrating no effect after a single exposure to either affective messaging (RR = 1.10; 95% CI: 0.30-4.01) or cognitive messaging interventions (RR = 0.57; 95% CI: 0.11-2.88). Women cited various reasons for not obtaining maternal influenza immunizations. These included concern about vaccine harm (47%, n = 40), low perceived influenza infection risk (31%, n = 26), and a history of immunization nonreceipt (24%, n = 20).

CONCLUSION

The findings reflect the limitations associated with a single exposure to varying maternal influenza immunization message approaches on vaccine behavior. For this population, repeated influenza immunization exposures may be warranted with alterations in message format, content, and relevance for coverage improvement.

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.

Using Behavioral Insights to Increase Vaccination Policy Effectiveness

Even though there are policies in place, and safe and effective vaccines available, almost every country struggles with vaccine hesitancy, that is, a delay in acceptance or refusal of vaccination. Consequently, it is important to understand the determinants of individual vaccination decisions to establish effective strategies to support the success of country-specific public health policies. Vaccine refusal can result from complacency, inconvenience, a lack of confidence, and a rational calculation of pros and cons. Interventions should, therefore, be carefully targeted to focus on the reason for non-vaccination. We suggest that there are several interventions that may be effective for complacent, convenient, and calculating individuals whereas interventions that might be effective for those who lack confidence are scarce. Thus, efforts should be concentrated on motivating the complacent, removing barriers for those for whom vaccination is inconvenient, and adding incentives and additional utility for the calculating. These strategies might be more promising, economic, and effective than convincing those who lack confidence in vaccination.

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.

Effective messages in vaccine promotion: a randomized trial

OBJECTIVES

To test the effectiveness of messages designed to reduce vaccine misperceptions and increase vaccination rates for measles-mumps-rubella (MMR).

METHODS

A Web-based nationally representative 2-wave survey experiment was conducted with 1759 parents age 18 years and older residing in the United States who have children in their household age 17 years or younger (conducted June-July 2011). Parents were randomly assigned to receive 1 of 4 interventions: (1) information explaining the lack of evidence that MMR causes autism from the Centers for Disease Control and Prevention; (2) textual information about the dangers of the diseases prevented by MMR from the Vaccine Information Statement; (3) images of children who have diseases prevented by the MMR vaccine; (4) a dramatic narrative about an infant who almost died of measles from a Centers for Disease Control and Prevention fact sheet; or to a control group.

RESULTS

None of the interventions increased parental intent to vaccinate a future child. Refuting claims of an MMR/autism link successfully reduced misperceptions that vaccines cause autism but nonetheless decreased intent to vaccinate among parents who had the least favorable vaccine attitudes. In addition, images of sick children increased expressed belief in a vaccine/autism link and a dramatic narrative about an infant in danger increased self-reported belief in serious vaccine side effects.

CONCLUSIONS

Current public health communications about vaccines may not be effective. For some parents, they may actually increase misperceptions or reduce vaccination intention. Attempts to increase concerns about communicable diseases or correct false claims about vaccines may be especially likely to be counterproductive. More study of pro-vaccine messaging is needed.

Does perceived risk influence the effects of message framing? A new investigation of a widely held notion

Health-promoting messages can be framed in terms of the beneficial consequences of healthy behaviour (gain-framed messages) or the detrimental consequences of unhealthy behaviour (loss-framed messages). An influential notion holds that the perceived risk associated with the recommended behaviour determines the relative persuasiveness of gain- and loss-framed messages. This 'risk-framing hypothesis', as we call it, was derived from prospect theory, has been central to health message framing research for the last two decades, and does not cease to appeal to researchers. The present paper examines the validity of the risk-framing hypothesis. We performed six empirical studies on the interaction between perceived risk and message framing. These studies were conducted in two different countries and employed framed messages targeting skin cancer prevention and detection, physical activity, breast self-examination and vaccination behaviour. Behavioural intention served as the outcome measure. None of these studies found evidence in support of the risk-framing hypothesis. We conclude that the empirical evidence in favour of the hypothesis is weak and discuss the ramifications of this for future message framing research.

Socioecological and message framing factors influencing maternal influenza immunization among minority women

OBJECTIVE

A suboptimal level of seasonal influenza vaccination among pregnant minority women is an intractable public health problem, requiring effective message resonance with this population. We evaluated the effects of randomized exposure to messages which emphasize positive outcomes of vaccination ("gain-frame"), or messages which emphasize negative outcomes of forgoing vaccination ("loss-frame"). We also assessed multilevel social and community factors that influence maternal immunization among racially and ethnically diverse populations.

STUDY DESIGN

Minority pregnant women in metropolitan Atlanta were enrolled in the longitudinal study and randomized to receive intervention or control messages. A postpartum questionnaire administered 30 days postpartum evaluated immunization outcomes following baseline message exposure among the study population. We evaluated key outcomes using bivariate and multivariate analyses.

RESULTS

Neither gain- [OR=0.5176, (95% CI: 0.203,1.322)] nor loss-framed [OR=0.5000, 95% CI: (0.192,1.304)] messages were significantly associated with increased likelihood of immunization during pregnancy. Significant correlates of seasonal influenza immunization during pregnancy included healthcare provider recommendation [OR=3.934, 95% CI: (1.331,11.627)], use of hospital-based practices as primary source of prenatal care [OR=2.584, 95% CI: (1.091,6.122)], and perceived interpersonal support for influenza immunization [OR=3.405, 95% CI: (1.412,8.212)].

CONCLUSION

Dissemination of vaccine education messages via healthcare providers, and cultivating support from social networks, will improve seasonal influenza immunization among pregnant minority women.

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.

The placebo phenomenon: implications for the ethics of shared decision-making

Recent research into the placebo effect has implications for the ethics of shared decision-making (SDM). The older biomedical model views SDM as affecting which therapy is chosen, but not the nature or likelihood of any health outcomes produced by the therapy. Research indicates, however, that both the content and manner in which information is shared with the patient, and the patient's experience of being involved in the decision, can directly alter therapeutic outcomes via placebo responses. An ethical tension is thereby created between SDM aimed strictly and solely at conveying accurate information, and "outcome engineering" in which SDM is adapted toward therapeutic goals. Several practical strategies mitigate this tension and promote respect for autonomous decision-making while still utilizing the therapeutic potential of SDM.

Acceptability of the H1N1 vaccine among older adults: the interplay of message framing and perceived vaccine safety and efficacy

This study examines the relative effectiveness of using gain- versus loss-framed messages to promote H1N1 vaccination among older adults, focusing on the moderating roles of perceived vaccine safety and efficacy. An experiment was conducted with older adults recruited from senior centers in the state of Maryland. Results show that older adults who perceived low vaccine efficacy developed greater intentions to receive the vaccine when presented with a loss-framed message (versus a gain-framed message). For those who perceived high vaccine efficacy, message framing did not make a difference in postexposure intentions. Evidence regarding the interaction between message framing and perceived vaccine safety is limited. Theoretical and practical implications of the findings are discussed.

Communicating to young adults about HPV vaccination: consideration of message framing, motivation, and gender

This research examines the influence of message framing (gain vs. loss), motivational orientation (approach vs. avoidance), and gender on intentions to receive human papillomavirus (HPV) vaccination and HPV-/HPV vaccine-related risk perceptions among young adults ages 18-26 years. Results of an experiment show an interaction between message framing and motivational orientation in predicting intentions to receive HPV vaccination. Loss-framed messages are more persuasive than gain-framed messages for avoidance-oriented individuals, whereas both frames are equally effective for approach-oriented individuals. Gender differences in intentions to get HPV vaccination and worry about vaccine safety are found.

The relative persuasiveness of gain- and loss-framed messages for promoting vaccination: a meta-analytic review

Vaccination against disease is a powerful public health tool, and persuading people to be vaccinated is a correspondingly important challenge. A number of studies have compared the effectiveness of gain-framed and loss-framed appeals in this domain, often expecting gain-framed appeals to be more persuasive. A meta-analytic review (k = 32, N = 11,814), however, finds no significant difference in the persuasiveness of gain- and loss-framed appeals for encouraging vaccination. This conclusion is unaffected by differences in the phrasing of the outcomes invoked or by differences in the specific vaccination advocated. But the results contain a hint that parents might be more persuaded to vaccinate their children by loss-framed than by gain-framed appeals. Implications and directions for future research are discussed.

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.