Effects of Message Framing on Cancer Prevention and Detection Behaviors, Intentions, and Attitudes: Systematic Review and Meta-analysis

Abstract

Background With the increasing health care burden of cancer, public health organizations are increasingly emphasizing the importance of calling people to engage in long-term prevention and periodical detection. How to best deliver behavioral recommendations and health outcomes in messaging is an important issue. Objective This study aims to disaggregate the effects of gain-framed and loss-framed messages on cancer prevention and detection behaviors and intentions and attitudes, which has the potential to inform cancer control programs. Methods A search of three electronic databases (Web of Science, Scopus, and PubMed) was conducted for studies published between January 2000 and December 2020. After a good agreement achieved on a sample by two authors, the article selection (κ=0.8356), quality assessment (κ=0.8137), and data extraction (κ=0.9804) were mainly performed by one author. The standardized mean difference (attitude and intention) and the odds ratio (behaviors) were calculated to evaluate the effectiveness of message framing (gain-framed message and loss-framed message). Calculations were conducted, and figures were produced by Review Manager 5.3. Results The title and abstract of 168 unique citations were scanned, of which 53 were included for a full-text review. A total of 24 randomized controlled trials were included, predominantly examining message framing on cancer prevention and detection behavior change interventions. There were 9 studies that used attitude to predict message framing effect and 16 studies that used intention, whereas 6 studies used behavior to examine the message framing effect directly. The use of loss-framed messages improved cancer detection behavior (OR 0.76, 95% CI 0.64-0.90; P=.001), and the results from subgroup analysis indicated that the effect would be weak with time. No effect of framing was found when effectiveness was assessed by attitudes (prevention: SMD=0.02, 95% CI –0.13 to 0.17; P=.79; detection: SMD=–0.05, 95% CI –0.15 to 0.05; P=.32) or intentions (prevention: SMD=–0.05, 95% CI –0.19 to 0.09; P=.48; detection: SMD=0.02, 95% CI –0.26 to 0.29; P=.92) among studies encouraging cancer prevention and cancer detection. Conclusions Research has shown that it is almost impossible to change people's attitudes or intentions about cancer prevention and detection with a gain-framed or loss-framed message. However, loss-framed messages have achieved preliminary success in persuading people to adopt cancer detection behaviors. Future studies could improve the intervention design to achieve better intervention effectiveness.

Conversational Agent Interventions for Mental Health Problems: Systematic Review and Meta-analysis of Randomized Controlled Trials

“…To promote mental health for everyone, everywhere, the World Health Organization’s most recent global mental health report strives to motivate and guide revolutionary action [ 1 , 2 ]. According to estimates by the World Health Organization, in the first year of the COVID-19 pandemic, the incidence of both depression and anxiety disorders increased by more than 25% [ 3 ]. However, mental health services are few and still underutilized globally [ 4 - 6 ].…”

Coding linguistic elements in clinical interactions: a step-by-step guide for analyzing communication form

“…Yet, previous observation protocols focused on the content of communication, and studies assessing form have been mainly experimental rather than observational (e.g. [ 41 , 42 ]). Since little is known about how linguistic elements are used in real-life clinical interactions, this paper introduced a carefully developed coding protocol to quantify communication form.…”

Effects of message framing and risk perception on health communication for optimum cardiovascular disease primary prevention: a protocol for a multicenter randomized controlled study

“…In our previous survey ( 46 ), we observed a baseline proportion of healthy lifestyle adherence at approximately 30% among participants with familiar sample characteristics. For the intervention groups, we anticipate a relative increase of at least 50% ( 47 ), with an expected difference of 25% between the gain- and loss-framed groups ( 39 ). This corresponds to an estimated effect size (W) for Chi-square of 0.20 ( 48 ), aligning closely with recommendations from prior studies ( 38 ).…”

“…However, conflicting findings have emerged regarding the comparative benefits of positive/gain- versus negative/loss-framed messages ( 33 ). For example, loss-framed messages have been confirmed to persuade people to adopt cancer detection behaviors ( 39 ) and diabetes self-care ( 40 ), while gained-framed messages have received considerable empirical support for physical activity and dental hygiene behaviors ( 37 ). In addition, the literature on message framing consistently demonstrated that when a behavior or characteristic of the individual is not taken into account, there is no discernible advantage for gain- or loss-framed messages ( 41 ).…”