Message Framing and Mammography Screening: A Theory-Driven Intervention

Abstract

Although the rising incidence of breast cancer has prompted a surge of intervention strategies aimed at increasing women's use of mammography screening, the majority of patient-directed interventions have not been driven by relevant theoretical work on persuasive health communication. The authors evaluated an intervention derived from prospect theory that was designed to increase women's adherence to recommendations for annual mammography screening. They sent 1 of 3 reminder letters (positive frame, negative frame, or standard hospital prompt) to 929 randomly selected women who were due for mammography screening and had been identified as having either a positive or negative family history of breast cancer. The primary hypothesis that women with a positive history would be more responsive to negatively framed messages, whereas women with a negative history would be more responsive to positively framed letters, was not confirmed. The lack of support for predictions derived from prospect theory raises important questions about the generalizability of laboratory research to natural settings.

How to Reduce the Effect of Framing on Messages About Health

“…In line with Kahneman and Tversky's 7,8 conclusion that people show risk aversion under gain framings and risk-seeking behaviors under loss framings, several authors 2,4,6,11,[13][14][15] suggested that gain frames might be more effective in promoting disease prevention behaviors, whereas loss frames might be more effective for disease detection behaviors. In line with this hypothesis, gain frames have been more effective when promoting exercise, 16 reduced alcohol use, 17 parental use of children's car seat restraints, 18,19 skin cancer prevention behaviors, 20,21 and use of condoms to prevent HIV 22 ; loss frames have been more effective at encouraging individuals to engage in breast self-examination, 23,24 mammography screenings, [25][26][27][28][29][30] blood-cholesterol screenings, 31 HIV screenings, 32,33 and skin cancer detection. 20,34 Finally, for decisions about surgical procedures and treatments, gain frames (probability of success or survival) induce greater compliance than loss frames (probability of failure or death 10,[35][36][37][38] ).…”

Effects of Information Framing on Human Papillomavirus Vaccination

“…Message framing has been shown to influence a myriad of health decisions, such as HIV testing, cancer screening, flu shots, sunscreen use, and safe driving. [24][25][26][27][28][29] The introduction of a vaccine to prevent HPV, an STI and a common cause of cancer, could be a potential breeding ground for political and moral debate and an opportunity to study the effects of information framing on vaccination decisions. Gerend and Shepherd 30 found that women presented with a loss-framed message (emphasizing the costs of not receiving a vaccine) reported higher vaccine acceptance than women presented with a gain-framed message (emphasizing the benefits of vaccination), but only among women who engaged in risky sexual behavior and women with a tendency to avoid negative outcomes.…”

“…The Advisory Committee on Immunization Practices (ACIP) recommends the vaccine for girls aged 11 and 12 but it is approved for use in females aged [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. 16 This decision could be considered controversial, as many conservatives cited fears that vaccinating adolescents could send a message condoning sexual activity before marriage.…”

Nicotine vaccines: Will smokers take a shot at quitting?

“…Frames can also offer a particular way to understand an issue and can create and shape individuals' thoughts and opinions on particular issues (Entman, 1993;Kinder, 1998). Framing has been shown to influence a myriad of health decisions, such as HIV testing, cancer screening, flu shots, sunscreen use, and safe driving (Apanovitch, McCarthy, & Salovey, 2003;Detweiler, Bedell, Salovey, Pronin, & Rothman, 1999;Finney & Iannoti, 2002;McCall, Johnson, & Rothman, 2002;Meyerowitz & Chaiken, 1987;Millar & Millar, 2000;O'Keefe & Jensen, 2006). In our study, framing the cause of nicotine addiction as either genetically or environmentally influenced could affect smokers' intentions to try a nicotine vaccine if one becomes available.…”