Framing recommendations to promote prevention behaviors among people at high risk: A simulation study of responses to melanoma genetic test reporting
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A CDKN2A/p16 mutation confers 76 % lifetime risk of developing melanoma to US residents, and high-risk individuals are counseled to use sunscreen. Generally, for patients at population risk, gain framing more effectively promotes prevention behaviors; however, it is unknown whether loss frames might more effectively promote behavioral intentions and perceived control over disease risk among high-risk patients. Undergraduates (N = 146) underwent a simulated genetic counseling and test reporting session for hereditary melanoma. Participants watched a video of a genetic counselor providing information in which genetic risk of melanoma (Low: 15 %; High: 76 %) and framed recommendations to use sunscreen (Loss: Risk may increase by 15 % if don’t use sunscreen; Gain: Risk may decrease by 15 % if use sunscreen) were manipulated. Controlling for baseline sunscreen use, high-risk participants given loss frames reported greater beliefs that sunscreen would reduce risk than high-risk participants given gain frames. Further, high-risk participants with fair skin tended to report greater intentions to use sunscreen when given loss frames versus gain frames. Perceived control over risk mediated the effect of message frame and disease risk on intentions to use sunscreen. When counseling patients with elevated cancer risk, genetic counselors may consider framing prevention behavioral recommendations in terms of potential losses.
KeywordsReflection effect Message framing Disease risk Perceived control Melanoma Genetic testing Prevention behavior Sunscreen Intentions Response efficacy
The present study was approved by the University of Utah’s Institutional Review Board, and was carried out in accordance with universal ethical principles. We thank Wendy Kohlmann, M.S., C.G.C. for her assistance in reviewing and editing the script and for portraying the genetic counselor in the videotaped genetic counseling simulation. We also thank Karine Agajanian, Andrew Bouwhuis, John Tobias, and Watcharaporn Pengchit for their assistance, and Carol Werner, Ph. D. for her advice on the qualitative analyses. Finally, we would like to thank Bert Uchino, Ph. D. and David Sanbonmatsu, Ph. D. for their feedback as members of the first author’s supervisory committee for the Masters thesis that was the basis for this manuscript.
Jennifer M. Taber and Lisa G. Aspinwall declare that they have no conflict of interest.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all participants for being included in the study.
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