The Interplay between Message Framing and Message Recipients' Regulatory Focus in Promoting HPV Prevention Strategies

Limited awareness and low uptake rate of Human papillomavirus (HPV) prevention strategies among females require the development of more effective educational interventions. Regulatory focus theory posits the matching of framing valence with the recipients' regulatory focus increases persuasiveness. Following regulatory focus theory, we examined how individual regulatory focus changed the effects of gain- and loss-framed messages on promoting consistent condom use and HPV DNA testing for HPV prevention. We also explored whether this interaction effect impacts the influences of target individuals' initial attitudes about condom use and HPV DNA testing on post attitudes and intentions. Results of Study 1 showed that, in general, the gain-framed message fit with regulatory focus (i.e., promotion focus) promoted more positive attitudes about consistent condom use than the gain-framed message nonfit with their regulatory focus (i.e., prevention focus).Nevertheless, the gain-framed message nonfit with regulatory focus (i.e., prevention focus) strengthened the negative relationship between initial attitudes and intentions, which promoted the intentions to use condom consistently among people who initially held negative attitudes toward consistent condom use. In Study 2, we did not observe a significant interaction effect of message framing and regulatory focus in the HPV DNA testing context. However, we observed that the gain-framed message nonfit with regulatory focus (i.e., prevention focus) led to the changes in the significance of the initial attitudes - post attitudes relationship from significant to non-significant. Thus, the reliance on initial negative attitudes about HPV DNA testing in decision-making decreased. Theoretical and practical implications of our research were discussed.

Customizing Your Demons: Anxiety Reduction via Anthropomorphizing and Destroying an "Anxiety Avatar"

Character customization is a prominent feature in digital games, affording users the ability to tailor one’s virtual self-representation (avatar) to match aspects of their actual or ideal self, influencing psychological well-being. The mental health implications of character customization can be partially explained by self-discrepancy theory, which argues that achieving congruence with one’s avatar reduces cognitive dissonance. However, the role of undesirable self-concepts such as mental health ailments have largely been overlooked in this context despite forming part of one’s identity. In theory, customization of an avatar representing undesirable self-concepts presents a self-regulatory paradox: individuals desire to reduce discrepancies with a self-representation, yet they also desire to enlarge discrepancies with a disliked-self. To reconcile this, two experiments explored the psychological implications of imbuing avatars with undesirable self-concepts. In Study 1 (N = 90), participants customized an avatar to represent anxiety within themselves (i.e., an anxiety avatar). Customization significantly reduced state anxiety compared to a control group, supporting the proposed discrepancy-reduction mechanism. Study 2 (N = 122) employed a 2 (customization: yes, no) × 2 (destruction: yes, no) between-subjects design, with participants either destroying or observing an anxiety avatar. Destruction of customized anxiety avatars resulted in the largest reduction in anxiety among all conditions, supporting the proposed discrepancy-enlargement mechanism. Theoretical and practical implications for the use of avatar-based e-mental health interventions are discussed.

Serious Gaming During Multidisciplinary Rehabilitation for Patients With Chronic Pain or Fatigue Symptoms: Mixed Methods Design of a Realist Process Evaluation

BACKGROUND

Serious gaming could support patients in learning to cope with chronic pain or functional somatic syndromes and reduce symptom burdens.

OBJECTIVE

To realize this potential, insight is needed into how, why, for whom, and when it works in actual treatment circumstances.

METHODS

Following a realist approach, process evaluations were performed before, during, and after a two-armed, natural quasi-experiment (n=275). A group of patients with interfering chronic pain or fatigue symptoms received a short additional blended mindfulness-based serious gaming intervention during a multidisciplinary rehabilitation program. A control group only received the regular rehabilitation program. During two sessions before and one session after the experiment, expectations about serious gaming processes were discussed in focus groups with local care providers, implementers, and experts. Patients participated in a survey (n=114) and in semistructured interviews (n=10). The qualitative data were used to develop tentative expectations about aspects of serious gaming that, in certain patients and circumstances, trigger mechanisms of learning and health outcome change. Hypotheses about indicative quantitative data patterns for tentative expectations were formulated before inspecting, describing, and analyzing-with regression models-routinely collected clinical outcome data. An updated program theory was formulated after mixing the qualitative and quantitative results.

RESULTS

Qualitative data showed that a subset of patients perceived improvement of their self-awareness in moments of daily social interactions. These results were explained by patients, who played the serious game LAKA, as a "confrontation with yourself," which reflected self-discrepancies. Important characteristics of serious gaming in the study's context included innovation factors of relative advantage with experiential learning opportunity, compatibility with the treatment approach, and the limited flexibility in regard to patient preferences. Perceived patient factors included age and style of coping with stress or pain. Learning perceptions could also depend on care provider role-taking and the planning and facilitating (ie, local organization) of serious gaming introduction and feedback sessions in small groups of patients. Quantitative data showed very small average differences between the study groups in self-reported depression, pain, and fatigue changes (-.07<beta<-.17, all 95% CI upper bounds <0), which were mediated by small group differences in mindfulness (beta=.26, 95% CI .02-.51). Mindfulness changes were positively associated with patient involvement in serious gaming (n=114, beta=.36, P=.001). Acceptance of serious gaming was lower in older patients. Average health outcome changes went up to a medium size in patients that reported lower active coping with stress and lower pain coping before serious gaming. Mindfulness changes and gaming acceptance perceptions covaried with group structure and immediate feedback sessions after serious gaming.

CONCLUSIONS

This study developed transferable insight into how and why serious gaming can facilitate additional learning about coping in order to reduce burdens of chronic pain or fatigue symptoms in certain patients and in actual treatment circumstances. Future studies are needed to continue the development of this fallible theory. Such research will further support decisions about using, designing, allocating, and tailoring serious gaming to optimize important patient health benefits.

TRIAL REGISTRATION

Netherlands Trial Register NTR6020; https://www.trialregister.nl/trial/5754.

Choose Your Words Wisely: The Impact of Message Framing on Patients' Responses to Treatment Advice

Other people's words can have a powerful influence on how we interpret our environment, what we expect and experience, what we value, how we feel, what we choose, and how we behave. Placebo (and nocebo) effects are a dramatic example of this. The way in which healthcare professionals discuss, describe, and inform patients about the characteristic effects of a given disease and it prevention, diagnosis and treatment influence patients' feelings and expectations which in turn affects their psychobiological responses to, and subjective experiences and outcomes of the disease and its treatment effects. The effect of clinicians' words on patients' responses to treatments and procedures, both active and inert or sham is nothing less than incredible. The way in which information about treatment effects is delivered to patients can even reverse the clinically proven effects of an active treatment, or increase the adverse effects of it. In this chapter, we begin by presenting the data on the impact of message framing on affect and expectations of health care in experimental situations followed by the evidence that indicates how various patient, disease and clinician related factors modify framing effects in the clinic. Finally we discuss how framing effects affect clinical practice. They can be leveraged to enhance placebo effects and minimize nocebo effects. They can provide strategies to assist shared-decision making in the face of complex uncertainty. Going forward, automation of health care and artificial intelligence may change the delivery of health care but patients will continue to be humans seeking health gains while avoiding health losses and how the information is presented will always be susceptible to framing effects.