Moving beyond the function of the health behaviour: The effect of message frame on behavioural decision-making

Health messages that provide gain- or loss-framed arguments have a differential impact on behavioural decision-making (Rothman & Salovey, 1997). Typically, gain-framed messages more effectively promote preventive health behaviours, which maintain health and minimise the risk of a health problem, whereas loss-framed messages more effectively promote detection behaviours, which involve the risk of finding a health problem. Two experiments tested the thesis that the risk implications of the behaviour are an important determinant of the persuasive impact of gain- and loss-framed appeals. Results revealed that when the risk associated with a health behaviour (either a prevention behaviour in Experiment 1 or a detection behaviour in Experiment 2) was low, participants responded more favourably to gain-framed messages. However, when the risk associated with the health behaviour (either prevention or detection) was high, participants responded more favourably to loss-framed messages. Discussion focuses on the importance of taking into account how individuals construe a behaviour when constructing framed appeals.     

Comparing gain- and loss-framed messages for smoking cessation with sustained-release bupropion: a randomized controlled trial.

Prospect theory suggests that because smoking cessation is a prevention behavior with a fairly certain outcome, gain-framed messages will be more persuasive than loss-framed messages when attempting to encourage smoking cessation. To test this hypothesis, the authors randomly assigned participants (N=258) in a clinical trial to either a gain- or loss-framed condition, in which they received factually equivalent video and printed messages encouraging smoking cessation that emphasized either the benefits of quitting (gains) or the costs of continuing to smoke (losses), respectively. All participants received open label sustained-release bupropion (300 mg/day) for 7 weeks. In the intent-to-treat analysis, the difference between the experimental groups by either point prevalence or continuous abstinence was not statistically significant. Among 170 treatment completers, however, a significantly higher proportion of participants were continuously abstinent in the gain-framed condition as compared with the loss-framed condition. These data suggest that gain-framed messages may be more persuasive than loss-framed messages in promoting early success in smoking cessation for participants who are engaged in treatment.     

Examining the Influence of Self-Efficacy on Message-Framing Effects: Reducing Salt Consumption in the General Population

Health-promoting messages can be framed in terms of the gains associated with healthy behavior or the losses associated with unhealthy behavior. Studies show inconsistent results as to which type of framing is more effective. In this study, we investigated whether participants' self-efficacy to decrease salt intake would moderate the effects of gain- and loss-framed messages promoting a low-salt diet on information acceptance, intention, and behavior. We hypothesized that loss-framed messages would more effectively decrease salt intake than gain-framed messages, but only when participants had high self-efficacy. A total of 575 adults, recruited from an Internet panel, took part in the study. Half of the participants received self-efficacy enhancing information, whereas the other half received no such information. After this self-efficacy manipulation, half of the participants received a gain-framed and half of the participants received a loss-framed message promoting a low-salt diet. Information acceptance and intention were assessed at immediate posttest and salt consumption was assessed at a 3-week follow-up. The results revealed the hypothesized effect on behavior. However, the interaction between self-efficacy and framing on salt consumption was not mediated by measures of information acceptance and intention to reduce salt intake. Our results suggest that messages stressing losses may be more effective than messages stressing gains in decreasing salt intake but only in persons with high self-efficacy to do so.     

Effective communication of risks to young adults: using message framing and visual aids to increase condom use and STD screening

Sexually Transmitted Diseases (STDs)-including HIV/AIDS-are among the most common infectious diseases in young adults. How can we effectively promote prevention and detection of STDs in this high risk population? In a two-phase longitudinal experiment we examined the effects of a brief risk awareness intervention (i.e., a sexual health information brochure) in a large sample of sexually active young adults (n = 744). We assessed the influence of gain- and loss-framed messages, and visual aids, on affective reactions, risk perceptions, attitudes, behavioral intentions, and reported behaviors relating to the prevention and detection of STDs. Results indicate that gain-framed messages induced greater adherence for prevention behaviors (e.g., condom use), whereas loss-framed messages were more effective in promoting illness-detecting behaviors (e.g., making an appointment with a doctor to discuss about STD screening). The influence of the framed messages on prevention and detection of STDs was mediated by changes in participants' attitudes toward the health behaviors along with changes in their behavioral intentions. Moreover, when visual aids were added to the health information, both the gain- and loss-framed messages became equally and highly effective in promoting health behaviors. These results converge with other data indicating that well-constructed visual aids are often among the most highly effective, transparent, fast, memorable, and ethically desirable means of risk communication. Theoretical, economic, and public policy implications of these results are discussed.     

Message framing and color priming: How subtle threat cues affect persuasion

Message framing involves the presentation of equivalent decision outcomes in terms of either gains or losses. Loss-framed messages tend to be more persuasive than gain-framed messages when the decision is perceived to involve uncertainty or threat. The current study examined whether the effectiveness of loss-framed information would be enhanced by the presence of a peripheral threat cue - the color red - which was expected to prime threat via its association with blood and danger. In addition to being primed with the color red or gray (control), male participants (n = 126) read either a gain- or loss-framed pamphlet promoting human papillomavirus vaccination. As predicted, vaccination intentions were higher among participants exposed to a loss-framed message than to a gain-framed message, but only when primed with red (not gray). Findings shed light on the interactive effects of message framing and color priming, and demonstrate that peripheral threat cues may affect processing of persuasive health messages.     

Expectancy of success,subjective task-value,and message frame in the appraisal of value-promoting messages made prior to a high-stakes examination

Previous research has examined how subjective task-value and expectancy of success influence the appraisal of value-promoting messages used by teachers prior to high-stakes examinations. The aim of this study was to examine whether message-frame (gain or loss-framed messages) also influences the appraisal of value-promoting messages. Two hundred and fifty-two participants in Years 12 and 13 read vignettes of fictional students who were high or low in subjective-task value, and expectancy of success, and asked to imagine how that student would appraise either a gain or loss-framed message. A challenge appraisal followed vignettes with high subjective task-value and high expectancy of success whereas a threat appraisal followed vignettes with high subjective task-value and low expectancy of success. A loss-framed message resulted in a stronger threat appraisal, and a gain-framed message in a greater disregarding appraisal for the vignette with high subjective task-value and high expectancy of success. Value-promoting messages can be appraised in different ways depending on combinations of intrapersonal (subjective task-value and expectancy of success) and interpersonal (message-frame) influences.     

Using message framing to motivate HIV testing among low-income, ethnic minority women.

This study compared the effectiveness of 4 videotaped educational programs designed to motivate HIV testing among low-income, ethnic minority women. Four hundred eighty women were assigned randomly to watch one of 2 gain-framed or 2 loss-framed videos. Consistent with prospect theory, participants' perceptions of the certainty of the outcome of an HIV test moderated the effects of framing on self-reported testing behavior 6 months after video exposure. Among participants who reported being certain of the test's outcome, those who saw a gain-framed video reported a higher rate of testing than those who saw a loss-framed message. Among women who perceived the outcome of HIV testing as relatively uncertain, gain- and loss-framed videos led to similar rates of self-reported testing, with some advantage for the loss-framed message.     

Dispositional motivations and message framing: a test of the congruency hypothesis in college students.

The authors examined the congruency hypothesis that health messages framed to be concordant with dispositional motivations will be most effective in promoting health behaviors. Undergraduate students (N=63) completed a measure of approach/avoidance orientation (behavioral activation/inhibition system) and read a gain- or loss-framed message promoting flossing. Results support the congruency hypothesis: When given a loss-framed message, avoidance-oriented people reported flossing more than approach-oriented people, and when given a gain-framed message, approach-oriented people reported flossing more than avoidance-oriented people. Discussion centers on implications for health interventions and the route by which dispositional motivations affect health behaviors through message framing.     

The persuasive effects of framing messages on fruit and vegetable consumption according to regulatory focus theory

According to Regulatory Focus theory (RFT), outcomes in persuasive messages can be framed in four different ways, as gains, non-gains, losses or non-losses. In study 1, the persuasiveness of all four frames was compared and the presence/absence effect that was expected on the basis of the feature-positive effect was verified: Statements about present outcomes (gain, loss) were more persuasive than those about absent outcomes (non-gain, non-loss). However, this study failed to support the prediction that a gain-framed message would be more persuasive than a loss-framed message when promoting a prevention behaviour. Study 2 was designed to examine the latter finding. It was hypothesised that the threat posed by the loss-framed message in study 1 was too low to elicit a defensive reaction. Therefore, in study 2, the personal relevance of the gain and the loss framed message was manipulated. Consistent with predictions, the gain-framed message was more persuasive than the loss-framed message, but only when the message was personalised to increase self-relevance. Moreover, the effect was due to a significant drop in persuasion in the loss condition, probably caused by a defensive reaction. These data shed a new light on the findings of past framing studies.     

The persuasive effects of framing messages on fruit and vegetable consumption according to regulatory focus theory

According to Regulatory Focus theory (RFT), outcomes in persuasive messages can be framed in four different ways, as gains, non-gains, losses or non-losses. In study 1, the persuasiveness of all four frames was compared and the presence/absence effect that was expected on the basis of the feature-positive effect was verified: Statements about present outcomes (gain, loss) were more persuasive than those about absent outcomes (non-gain, non-loss). However, this study failed to support the prediction that a gain-framed message would be more persuasive than a loss-framed message when promoting a prevention behaviour. Study 2 was designed to examine the latter finding. It was hypothesised that the threat posed by the loss-framed message in study 1 was too low to elicit a defensive reaction. Therefore, in study 2, the personal relevance of the gain and the loss framed message was manipulated. Consistent with predictions, the gain-framed message was more persuasive than the loss-framed message, but only when the message was personalised to increase self-relevance. Moreover, the effect was due to a significant drop in persuasion in the loss condition, probably caused by a defensive reaction. These data shed a new light on the findings of past framing studies.     

Message framing and sunscreen use: gain-framed messages motivate beach-goers.

Prospect theory suggests that people respond differentially to factually equivalent messages depending on how these messages are framed (A. Tversky & D. Kahneman, 1981). A. J. Rothman and P. Salovey (1997) relied on prospect theory to predict that messages highlighting potential "gains" should promote prevention behaviors such as sunscreen use best. This experiment compared the effectiveness of 4 differently framed messages (2 highlighting gains, 2 highlighting losses) to persuade 217 beach-goers to obtain and use sunscreen. Attitudes and intentions were measured before and immediately following the delivery of the framed information, and after completing the questionnaire participants were given a coupon redeemable for a small bottle of sunscreen later that same day. People who read either of the 2 gain-framed brochures, compared with those who read either of the 2 loss-framed brochures, were significantly more likely to (a) request sunscreen, (b) intend to repeatedly apply sunscreen while at the beach, and (c) intend to use sunscreen with a sun protection factor of 15 or higher.     

Using message framing to promote acceptance of the human papillomavirus vaccine.

OBJECTIVE: Use of message framing for encouraging vaccination, an increasingly common preventive health behavior, has received little empirical investigation. The authors examined the relative effectiveness of gain-versus loss-framed messages in promoting acceptance of a vaccine against human papillomavirus (HPV)-a virus responsible for virtually all cases of cervical cancer. DESIGN: Undergraduate women (N = 121) were randomly assigned to read a booklet describing the benefits of receiving (gain-framed message) or the costs of not receiving (loss-framed message) a prophylactic HPV vaccine. After reading the booklet, participants indicated their intent to obtain the HPV vaccine. MAIN OUTCOME MEASURE: A 5-item composite representing intentions to obtain the HPV vaccine. RESULTS: The effect of message framing on HPV vaccine acceptance was moderated by risky sexual behavior and approach avoidance motivation. A loss-framed message led to greater HPV vaccination intentions than a gain framed message but only among participants who had multiple sexual partners and participants who infrequently used condoms. The loss-frame advantage was also observed among participants high in avoidance motivation. CONCLUSION: Findings highlight characteristics of the message recipient that may affect the success of framed messages promoting vaccine acceptance. This study has practical implications for the development of health communications promoting vaccination.     

The cultural congruency effect: Culture, regulatory focus, and the effectiveness of gain- vs. loss-framed health messages

The present study contributes a cultural analysis to the literature on the persuasive effects of matching message frame to individuals’ motivational orientations. One experiment examines how members of cultural groups that are likely to differ in their regulatory focus respond to health messages focusing on either the benefits of flossing or the costs of not flossing. White British participants, who had a stronger promotion focus, were more persuaded by the gain-framed message, whereas East-Asian participants, who had a stronger prevention focus, were more persuaded by the loss-framed message. This cultural difference in persuasion was mediated by an interaction between individuals’ self-regulatory focus and type of health message. Thus health messages framed to be culturally congruent led participants to have more positive attitudes and stronger intentions to perform the health behaviors, and the interaction between self-regulatory focus and message frame emerged as the pathway through which the observed cultural difference occurs. Discussion focuses on the integration of individual difference, socio-cultural, and situational factors into models of health persuasion.     

Why are you bringing up condoms now? The effect of message content on framing effects of condom use messages.

According to prospect theory (A. Tversky & D. Kahneman, 1981), messages advocating a low-risk (i.e., easy, low-cost) behavior are most effective if they stress the benefits of adherence (gain framed), whereas messages advocating a risky behavior are most effective if they stress the costs of nonadherence (loss framed). Although condom use is viewed as a low-risk behavior, it may entail risky interpersonal negotiations. Study 1 (N = 167) compared ratings of condom use messages advocating relational behaviors (e.g., discussing condoms) or health behaviors (e.g., carrying condoms). As predicted, loss-framed relational messages and gain-framed health messages received higher evaluations. Study 2 (N = 225) offers a replication and evidence of issue involvement and gender as moderators. Results are discussed with reference to the design of condom use messages.     

A naturalistic study of the impact of message framing on highway speeding

Speeding is the most common road violation, and is one of the main causes of crashes. To protect road users, authorities use sanctions and preventive measures to prompt drivers to observe speed limits. However, the efficacy of prevention messages varies according to a number of factors, among which risk framing is important. We ran a study to test whether gain is more effective than loss (framing effect). Four anti-speeding messages were presented on variable-message signs, along one side of a busy 8-lane highway in France (speed limit: 130 km/h – 80 mph), during 6 weekends. Within a between subject design, the messages differed in orientation (gain vs. loss vs. no message) and theme (crash vs. fuel consumption). The drivers’ speed was recorded on the highway 2 km (1.25 miles) after the sign (6486 recordings of speed). The results showed that speed was lower when a message was displayed than in the control condition, and when the message was gain-framed rather than loss-framed. These effects were stronger on the left lanes (overtaking lanes). Hence, gain framed messages are recommended for prevention campaigns at least when no risk factor is salient.     

When 'fit' leads to fit, and when 'fit' leads to fat: how message framing and intrinsic vs. extrinsic exercise outcomes interact in promoting physical activity

A unique aspect of exercise is that people may choose to engage in it to achieve a variety of outcomes, ranging from extrinsic (appearance, health) to intrinsic (satisfaction, enjoyment). We examined how the impact of gain- vs. loss-framed messages depends on the type of outcome emphasised. Drawing from regulatory focus theory (Higgins, E.T. (1997). Beyond pleasure and pain. American Psychologist, 52, 1280-1300; Higgins, E.T. (2000). Making a good decision: Value from fit. American Psychologist, 55, 1217-1230), we predicted that gain-framed messages would 'fit' with intrinsic outcomes and loss-framed messages would 'fit' with extrinsic outcomes, but the effect of such fit on physical activity would depend on the participants' need for cognition (NC). We tested these hypotheses with a sample of 176 sedentary young adults who read an exercise message with randomly assigned frame (gain/loss) and outcome (intrinsic/extrinsic). Participants provided daily reports of exercise over the following week. The predicted interaction between frame, outcome and NC was found (p=0.001) such that a 'fit' message promoted somewhat, but not significantly, greater exercise for those with high NC, but a 'non-fit' message promoted significantly greater exercise for those with low NC. Furthermore, differences in physical activity were partially mediated by attitudes towards exercise. Findings shed light on how the outcomes and motivations associated with physical activity shape people's behavioural responses to framed health communications.     

Selective exposure and decision framing: The impact of gain and loss framing on confirmatory information search after decisions

When people make decisions, they often prefer to receive information that supports rather than conflicts with their decision. To date, this effect has mainly been investigated in the context of decisions about gains, whereas decisions about losses have received less attention. Based on Prospect Theory, we expected information search to be differently affected by whether people previously have decided about gains or losses. Three studies have revealed that selectivity of information search is stronger after gain-framed rather than after loss-framed decision problems. An investigation of the underlying psychological processes revealed that gain decisions are made with increased subjective decision certainty (i.e. they are easier and less effortful to make), which in turn systematically increases confirmatory information search.     

Examining the Effects of Gain-Framed Messages on the Activation and Elaboration of Possible Sport Selves in Middle-Aged Adults

Using an online cross-sectional randomized design, we explored whether messages emphasizing benefits of sport (sport gain-framed messages) would activate and elaborate hoped-for possible sport selves in 40- to 59-year-olds. One group viewed a video containing sport gain-framed messages, and a comparison group completed a sport and physical activity quiz. Results showed that the message group attended to a health and fitness message most frequently and demonstrated more frequent activation of possible selves than the quiz group. The message group's possible selves also contained more elaborate content related to delaying the effects of aging through sport and the social benefits of sport.     

When ‘fit’ leads to fit,and when ‘fit’ leads to fat: How message framing and intrinsic vs. extrinsic exercise outcomes interact in promoting physical activity

A unique aspect of exercise is that people may choose to engage in it to achieve a variety of outcomes, ranging from extrinsic (appearance, health) to intrinsic (satisfaction, enjoyment). We examined how the impact of gain- vs. loss-framed messages depends on the type of outcome emphasised. Drawing from regulatory focus theory (Higgins, E.T. (1997). Beyond pleasure and pain. American Psychologist, 52, 1280–1300; Higgins, E.T. (2000). Making a good decision: Value from fit. American Psychologist, 55, 1217–1230), we predicted that gain-framed messages would ‘fit’ with intrinsic outcomes and loss-framed messages would ‘fit’ with extrinsic outcomes, but the effect of such fit on physical activity would depend on the participants’ need for cognition (NC). We tested these hypotheses with a sample of 176 sedentary young adults who read an exercise message with randomly assigned frame (gain/loss) and outcome (intrinsic/extrinsic). Participants provided daily reports of exercise over the following week. The predicted interaction between frame, outcome and NC was found (p?=?0.001) such that a ‘fit’ message promoted somewhat, but not significantly, greater exercise for those with high NC, but a ‘non-fit’ message promoted significantly greater exercise for those with low NC. Furthermore, differences in physical activity were partially mediated by attitudes towards exercise. Findings shed light on how the outcomes and motivations associated with physical activity shape people's behavioural responses to framed health communications.     

Using Message Framing to Promote Social Support in Depression: When Misery Makes Better Company

A depressed person may have particular difficulty obtaining social support unless, as previous research indicates, members of the person’s support network believe that their interactions with the depressed person will be rewarding. Continuing this line of research, two studies investigated how message framing influences perceptions of providing social support to someone diagnosed with depression. In Study 1, participants first evaluated a website created by the research team, which emphasized either the rewards of volunteering to help individuals suffering from depression (gain-framed) or the drawbacks of not volunteering (loss-framed). One week later, participants read a vignette about a friend suffering from depression. Participants initially exposed to the gain-framed website indicated that the friend was in greater need of help, and they expressed stronger intentions to help and maintain supportive contact with the friend. The first phase of Study 2 was identical to the first phase of Study 1. However, a week after evaluating the framed website, participants interacted via instant messaging with a confederate posing as a prospective undergraduate student, who disclosed during the conversation that she had been diagnosed with depression. Participants initially exposed to the gain-framed website indicated greater comfort interacting with the prospective student and greater willingness to engage in follow-up interactions with the student (e.g., exchange emails, talk on the phone) compared to participants initially exposed to the loss-framed website. The implications of these findings for increasing the provision of social support to individuals with depression are discussed.