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Health Message Framing Effects on Attitudes, Intentions, and Behavior: A Meta-analytic Review

  • Original Article
  • Published:
Annals of Behavioral Medicine

An Erratum to this article was published on 29 January 2013

Abstract

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.

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Notes

  1. The present review focuses on a particular type of framing effect defined by Levin and colleagues [90] as “goal framing.” As opposed to “attribute framing”, which involves manipulating the health behavior as either a good thing to engage in (positive frame) or bad thing to engage in (negative frame), “goal framing” works under the assumption that the health behavior is a good thing to do and instead uses the positive frame to describe the gains associated with performing the behavior and the negative frame to describe the losses associated with not performing the behavior.

  2. Unless otherwise specified, we report “behavior” as a combined outcome of self-reported and objective behavioral measures. We note the appropriateness of this approach as the relationship between self-reported and objective measures of behavior for the most commonly cited domains in the present analysis are typically greater than the typical attitude/intention and behavior correlation of 0.50 [9]. Indeed, we see this in the domains of smoking [107, 108], mammography [109113] diet [114], oral health [115118], and physical activity [119121] (all r values of >0.50, sensitivities of >0.90).

  3. The strongest evidence for moderation by timeframe was found among studies that assessed prevention behavior. Although not significant using the more conservative random effects analyses (Q(1) = 1.810, p = 0.178), this moderation was significant in a fixed effects analysis (Q(1) = 6.802, p = 0.009), with behaviors assessed immediately after message presentation showing stronger effects of framing (k = 6, r = 0.150, p = 0.001) than behaviors assessed at a follow-up (k = 26, r = 0.077, p = 0.007). Moderation by timeframe could not be tested for attitudes/intentions as not enough studies assess these outcomes at a delayed follow-up. Furthermore, no moderation by timeframe was found for studies assessing detection behavior.

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The authors have no conflict of interest to disclose.

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Correspondence to Kristel M. Gallagher M.A..

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References marked with an asterisk (*) indicate studies included in the meta-analysis.

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Gallagher, K.M., Updegraff, J.A. Health Message Framing Effects on Attitudes, Intentions, and Behavior: A Meta-analytic Review. ann. behav. med. 43, 101–116 (2012). https://doi.org/10.1007/s12160-011-9308-7

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  • DOI: https://doi.org/10.1007/s12160-011-9308-7

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