Message Framing and Pap Test Utilization among Women Attending a Community Health Clinic Using message framing to motivate HIV testing among low-income, ethnic minority women. Message framing, dispositional optimism, and follow-up for abnormal Papanicolaou tests. How Should the Impact of Different Presentations of Treatment Effects on Patient Choice Be Evaluated? A Pilot Randomized Trial Monitoring styles in women at risk for cervical cancer: Implications for the framing of health-relevant messages The (Ir)Relevance of Framing Nutrition Education Messages Cancer Patients' Decision Making and Trial-entry Preferences Message framing and sunscreen use: gain-framed messages motivate beach-goers. Loss-framed minimal intervention increases mammography use. The Effect of How Outcomes Are Framed on Decisions about Whether to Take Antihypertensive Medication: A Randomized Trial The effect of message frames and CVD risk factors on behavioral outcomes. An experimental test of question framing in health state utility assessment. Effect of Framing as Gain versus Loss on Understanding and Hypothetical Treatment Choices: Survival and Mortality Curves Framing Procedural Risks to Patients: Is 99% Safe the Same as a Risk of 1 in 100? The Discrepancy between Risky and Riskless Utilities Message Framing and Mammography Screening: A Theory-Driven Intervention Effects of framing and level of probability on patients' preferences for cancer chemotherapy. The impact of mailing psychoeducational materials to women with abnormal mammograms. The effects of message framing on mammography utilization. Context framing to enhance HIV-antibody-testing messages targeted to African American women. The effects of framing and action instructions on whether older adults obtain flu shots. Risky Decision Making Across Three Arenas of Choice: Are Younger and Older Adults Differently Susceptible to Framing Effects? Framing of nutrition education messages in persuading consumers of the advantages of a healthy diet. The language of uncertainty in genetic risk communication: framing and verbal versus numerical information. Assessing Preferences about the DNR Order Framing effects on expectations, decisions, and side effects experienced: the case of influenza immunization. Motivating smoking reductions by framing health information as safer smoking tips. A randomized trial of three videos that differ in the framing of information about mammography in women 40 to 49 years old
In a r and omized experiment , women ( N = 441 ) watched either a loss- or gain-framed video emphasizing the prevention or detection functions of the Pap test to test the hypothesis that loss- and gain-framed messages differentially influence health behaviors depending on the risk involved in performing the behavior . As predicted , loss-framed messages emphasizing the costs of not detecting cervical cancer early ( a risky behavior ) and gain-framed messages emphasizing the benefits of preventing cervical cancer ( a less risky behavior ) were most persuasive in motivating women to obtain a Pap test This study compared the effectiveness of 4 videotaped educational programs design ed to motivate HIV testing among low-income , ethnic minority women . Four hundred eighty women were assigned r and omly 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 The effects of alternatively framed messages and dispositional optimism on follow-up for abnormal Papanicolaou tests were studied . Participants ( N = 116 ) had a mean age of 24 ; 94 % were black , 67 % had a high school education , and 82 % received public assistance .  A message about losses without follow-up or gains with follow-up was r and omly given . Optimism was measured with the Life Orientation Test and attendance was defined as coming or not coming within 6 weeks of contact . Logistic regressions of attendance on framing and optimism did not reveal significant relationships . Exploratory analyses revealed that personal and familial history of disease were related to attendance . Explanations for the findings and implication s for research are delineated Background Different presentations of treatment effects can affect decisions . However , previous studies have not evaluated which presentations best help people make decisions that are consistent with their own values . We undertook a pilot study to compare different methods for doing this . Methods and Findings We conducted an Internet-based r and omized trial comparing summary statistics for communicating the effects of statins on the risk of coronary heart disease ( CHD ) . Participants rated the relative importance of treatment consequences using  visual analogue scales ( VAS ) and category rating scales ( CRS ) with five response options . We r and omized participants to either VAS or CRS first and to one of six summary statistics : relative risk reduction ( RRR ) and five absolute measures of effect : absolute risk reduction , number needed to treat , event rates , tablets needed to take , and natural frequencies ( whole numbers ) . We used logistic regression to determine the association between participants ' elicited values and treatment choices . 770 participants age 18 or over and literate in English completed the study . In all , 13 % in the VAS-first group failed to complete their VAS rating , while 9 % of the CRS-first group failed to complete their scoring ( p = 0.03 ) . Different ways of weighting the elicited values had little impact on the analyses comparing the different presentations . Most ( 51 % ) preferred the RRR compared to the other five summary statistics ( 1 % to 25 % , p = 0.074 ) . However , decisions in the group presented the RRR deviated substantially from those made in the other five groups . The odds of participants in the RRR group deciding to take statins were 3.1 to 5.8 times that of those in the other groups across a wide range of values ( p = 0.0007 ) . Participants with a scientific background , who were more numerate or had more years of education were more likely to decide not to take statins . Conclusions Internet-based trials comparing different presentations of treatment effects are feasible , but recruiting participants is a major challenge . Despite a slightly higher response rate for CRS , VAS is preferable to avoid approximation of a continuous variable . Although most participants preferred the RRR , participants shown the RRR were more likely to decide to take statins regardless of their values compared with participants who were shown any of the five other summary statistics . Trial Registration Controlled-Trials.com IS RCT We explored the interaction effects of individual attentional style ( high versus low monitoring ) and the framing of informational messages on the responses of women undergoing diagnostic follow-up ( colposcopy ) for precancerous cervical lesions . Prior to the colposcopic procedure , patients ( N=76 ) were r and omly assigned to one of three preparatory conditions : ( a ) Loss-framed message , which emphasized the cost of nonadherence to screening recommendations ; ( b ) Gain-framed message , which emphasized the benefit of adherence ; and ( c ) Neutrally-framed message . It was hypothesized that low monitors ( who are more positively biased about their health ) would show a more adaptive pattern of response to loss-framed information than high monitors ( who are more negatively biased about their health ) . The results of a series of hierarchical multiple regression analyses were consistent with this prediction . Low monitoring was associated with greater knowledge retention ( β=.61 , p<.05 ) and less canceling/rescheduling of follow-up appointments in the loss condition than in the neutral condition ( β=.82 , p<.002 ) . High monitoring , however , was associated with greater intrusive ideation when information was presented in the loss-oriented frame as compared to the neutral frame ( β=.99 , p<.01 ) . Knowledge retention and screening adherence were not affected by the framing manipulation . The differences between high versus low monitors as a function of loss or neutral frame suggest an interaction effect , wherein both the type of framing message and the individual 's attentional style lead to distinctive cognitive-affective and behavioral patterns . The findings may have clinical implication s for the tailoring of health messages to the individual 's signature style Persuasive health education messages can either stress the positive consequences of performing a healthy behaviour ( gain-frame ) or the negative consequences of not performing a healthy behaviour ( loss-frame ) . Based on studies on topics such as sun protection and breast self-examination there is evidence that messages in different action frames may differ in persuasive effects . Three r and omised controlled trials were conducted to test framing effects in nutrition education on specific nutrition-related attitudes and intentions . In study 1 , effects of gain-framed and loss-framed messages were studied among 152 adult education students on attitudes and intentions related to fat , fruit and vegetable consumption . In study 2 we confronted 149 regular students with differently framed messages related to a ( more or less fictive ) preventive dietary behaviour that was expected to be unknown to the study population , intake of flavonoids and risk for chronic disease . The impact on attitudes and intentions to use flavonoid-enriched spreads was studied . In study 3 we studied the effects of differently framed messages on attitudes and intentions related to more immediate and more personally relevant diet nutrition behaviour :  folic acid supplement use before and during pregnancy among 100 female students . No significant differences in attitudes or intentions to perform the preventive nutrition behaviours were found between the gain-frame conditions and the loss-frame conditions in all three studies . The ( lack of ) effects were not moderated by factors such as perceived personal relevance , credibility or novelty of the information , or the perceived importance of the topic addressed . The results of the present studies suggest that action-frame choice has a very limited impact on the effectiveness of nutrition education in changing pre caution ary motivation The study purpose was to determine whether the framing of treatment information influenced patients ' reported preferences  for participating in treatment decision making and for trial entry .  Ninety cancer patients  read either neutrally- , positively- , or negatively-framed infor mation about a chemotherapeutic treatment , then indicated their preferences for participating in the treatment decision , and whether they would participate in a clinical trial incorporating this protocol . There was no difference across information groups in preferences for partici pating in treatment decision making or willingness to enter such a clinical trial . Preference for participation in treatment decision making was significantly related to age ( t = 2.54 ; p = 0.022 ) , sex ( x2 = 3.89 ; p = 0.05 ) , and education ( t = 2.54 ; p = 0.018 ) ; trial entry preferences were unrelated to these demographic variables . These results imply that , in this clinical context , attitudes towards participation in treatment decision making may be asso ciated with characteristics of the patient , and attitudes towards trial entry may be dependent upon the clinical characteristics of a particular trial , but neither set of attitudes is influenced by the framing of protocol information . Key words : framing effect ; patients ' preferences ; quality of life ; decision making ; clinical trials . ( Med Decis Making 1995;15:4 - 12 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 question naire 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 INTRODUCTION Although mammography is the most effective early detection breast cancer screening technology available , it is underutilized . This study was conducted to test the effectiveness of a loss-framed minimal intervention to increase mammography use .  Loss-frame refers to a communication strategy in which messages are framed from the perspective of what a person has to lose by not taking a particular behavioral action . METHODS Participants were medically un- and underinsured women 50 - 64 years old who called one of two urban clinics r and omly selected based on demographic statistical equivalency . The women who participated telephoned to inquire about a mammogram during the 6-month study period . The group r and omly design ated as the experimental group received a loss-framed message conveyed by trained staff telephonically . Members of the comparison group received the " usual " communication , also conveyed telephonically . In the experimental group , 31 of 112 ( 27 % ) women who inquired received mammograms , whereas 157 of the 992 ( 16 % ) comparison group women who inquired received mammograms . RESULTS The odds of a mammogram , adjusted for race and breast cancer symptoms , significantly increased for the experimental ( odds ratio [ OR ] = 1.914 , chi2 = 7.48 , p = .0063 , 95 % confidence interval [ CI ] 1.20 - 3.05 ) versus comparison group . CONCLUSIONS A loss-framed , in-reach , minimal intervention approach holds promise as a mammography promotion strategy Background We conducted an Internet-based r and omized trial comparing three valence framing presentations of the benefits of antihypertensive medication in preventing cardiovascular disease ( CVD ) for people with newly diagnosed hypertension to determine which framing presentation result ed in choices most consistent with participants ' values . Methods and Findings In this second in a series of televised trials in cooperation with the Norwegian Broadcasting Company , adult volunteers rated the relative importance of the consequences of taking antihypertensive medication using visual analogue scales ( VAS ) . Participants viewed information ( or no information ) to which they were r and omized and decided whether or not to take medication . We compared positive framing over 10 years ( the number escaping CVD per 1000 ) ; negative framing over 10 years ( the number that will have CVD ) and negative framing per year over 10 years of the effects of antihypertensive medication on the 10-year risk for CVD for a 40 year-old man with newly diagnosed hypertension without other risk factors . Finally , all participants were shown all presentations and detailed patient information about hypertension and were asked to decide again . We calculated a relative importance score ( RIS ) by subtracting the VAS-scores for the undesirable consequences of antihypertensive medication from the VAS-score for the benefit of CVD risk reduction . We used logistic regression to determine the association between participants ' RIS and their choice . 1,528 participants completed the study . The statistically significant differences between the groups in the likelihood of choosing to take antihypertensive medication in relation to different values ( RIS ) increased as the RIS increased . Positively framed information lead to decisions most consistent with those made by everyone for the second , more fully informed decision . There was a statistically significant decrease in deciding to take antihypertensives on the second decision , both within groups and overall . Conclusions For decisions about taking antihypertensive medication for people with a relatively low baseline risk of CVD ( 70 per 1000 over 10 years ) , both positive and negative framing result ed in significantly more people deciding to take medication compared to what participants decided after being shown all three of the presentations . Trial Registration International St and ard R and omised Controlled Trial Number Register IS RCT N OBJECTIVES To examine the interactive effects of message frames and CVD risk factors on  women 's knowledge , beliefs , efficacy , and behavioral intentions . METHODS In a r and omized experiment , women ( n = 395 ) read either a loss- or gain-framed heart disease prevention message to test differential effects by risk factor status . RESULTS Messages significantly increased knowledge , self-efficacy and intervention efficacy beliefs , and behavioral intentions . Frames had significantly different effects on self-efficacy and behavioral intent to engage in detection behaviors by parental risk factor status . CONCLUSIONS Further study is warranted to assess effects of frames on behavioral outcomes among women at elevated CVD risk In the st and ard gamble and time trade-off methods of health state  utility  assessment , a specified health state and an alternative are compared . This alternative can be framed in terms of a loss or a gain in reference to the first health state . In this paper , we test whether this framing affects the estimated health state utilities . The experiment was carried out on a group of pharmacy students , r and omly divided between the loss or gain version ( n = 182 ) . The null hypothesis of no difference between the loss and gain versions is rejected for the st and ard gamble method , but not for the time trade-off method Background . Presentation of information using survival or mortality ( i.e. , incidence ) curves offers a potentially powerful method of communication because such curves provide information about risk over time in a relatively simple graphic format . However , the effect of framing as survival versus mortality on underst and ing and treatment choice is not known . Methods . In this study , 451 individuals awaiting jury duty at the Philadelphia City Courthouse were r and omized to receive 1 of 3 question naires : ( 1 ) survival curves , ( 2 ) mortality curves , or ( 3 ) both survival and mortality curves . Each question naire included a brief description of a hypothetical treatment decision , survival curve graphs and /or mortality curve graphs presenting the outcome of the treatment , and questions measuring underst and ing of the information contained in the graphs and preference for undergoing treatment . After completing a brief practice exercise , participants were asked to answer questions assessing their ability to interpret single points on a curve and the difference between curves , and then to decide whether they would choose to undergo  preventive surgery  for 3 different scenarios in which the benefit of surgery varied . Results . Participants who received only survival curves or who received both survival and mortality curves were significantly more accurate in answering questions about the information than participants who received only mortality curves ( P < 0.05 ) . For 2 of the 3 treatment presentations , participants who received only mortality curves were significantly less likely to prefer preventive surgery  than participants who received survival curves only or both survival and mortality curves ( P < 0.05 ) . The effect of framing on underst and ing was greatest among participants with less than a college education and among non-Caucasian participants . Conclusion . Framing graphic risk information as chance of death over time results in lower levels of underst and ing and less interest in preventive surgery than framing as chance of survival over time Purpose A patient 's willingness to consent to a procedure may be influenced by various factors , including the patient 's rapport with the physician , nonverbal cues he or she receives during the discussion of risks , and other elements of the discussion of risks . Previous reports address these influences , but the effect of the actual wording used to describe risks is unclear . The purpose of this study was to better underst and how framing the risk involved in a procedure affects a patient 's likelihood to consent to the procedure . Method In a 1997 study at the Clevel and Clinic Foundation , the authors r and omly assigned 116 patients to view one of two short videos describing angioplasty and its associated risks . Sixty-three participants viewed the first video , which framed the procedure as 99 % safe , and 53 viewed the second , which framed the likelihood of complication as 1 in 100 . Participants were then asked to rate their consent to two hypothetical treatment scenarios on a four-point Likert-type scale ( 1 = definitely , 4 = definitely not ) . Results When asked to consent to a treatment scenario that would relieve chest pain but offer no survival benefit , respondents who viewed the first video were more likely to consent than were those who viewed the second ( p < .001 ) . There was no significant difference in the two groups ' likelihoods to consent when the potential health benefit was to reduce the risk of future heart attack . Conclusion This study 's finding provides evidence that how a physician describes a procedure 's risks when obtaining a patient 's informed consent significantly influences the likelihood of consent . This fact should be considered when teaching communication skills , including interviewing and patient education skills , so that patients will be more likely to make health care decisions that are consistent with their own values and beliefs Utilities differ according to whether they are derived from risky ( gamble ) and riskless ( visual analog scale , time-tradeoff ) assessment methods . The discrepancies are usu ally explained by assuming that the utilities elicited by risky methods incorporate atti tudes towards risk , whereas riskless utilities do not . In ( cumulative ) prospect theory , risk attitude is conceived as consisting of two components : a decision-weight function ( attentiveness to changes in , or sensitivity towards , chance ) and a utility function ( sen sitivity towards outcomes ) . The authors ' data suggest that a framing effect is a hitherto unrecognized and important factor in causing discrepancies between risky and riskless utilities . They collected  risky evaluations with the gamble method , and riskless evalu ations with difference measurement .  Risky utilities were derived using expected-utility theory and prospect theory . With the latter approach , sensitivity towards outcomes and sensitivity towards chance are modeled separately . When the hypothesis that risky utilities from prospect theory coincide with riskless utilities was tested , it was rejected ( n = 8 , F(1,7 ) = 132 , p = 0.000 ) , suggesting that a correction for sensitivity towards chance is not sufficient to resolve the difference between risky and riskless utilities . Next , it was assumed that different gain/loss frames are induced by risky and riskless elicitation methods . Indeed , identical utility functions were obtained when the gain/loss frames were made identical across methods ( n = 7 ) , suggesting that framing was operative . The results suggest that risky and riskless utilities are identical after correc tions for sensitivity towards chance and framing . Key words : utility assessment ; de cision making ; risk attitude ; framing ; risky and riskless utilities . ( Med Decis Making 1999;19:435 - 447 Abstract Although the rising incidence of breast cancer has prompted a surge of intervention strategies aim ed 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 design ed to increase women 's adherence to recommendations for annual mammography screening . They sent 1 of 3 reminder letters ( positive frame , negative frame , or st and ard hospital prompt ) to 929 r and omly 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 setting Although most clinicians agree that patients should be informed about treatment alternatives , little is known about the way patients perceive probabilistic information about treatment outcomes and how it influences the choices they make . The purpose of this study was to examine the influence of level and framing of probability on preferences for cancer treatment alternatives in which tradeoffs between quantity and quality of life are made . 129 healthy volunteers and 154 cancer patients indicated their preferences for a toxic treatment over a non-toxic treatment at varying survival probabilities . Subjects responded to questions in one of three r and omly assigned conditions : ( 1 ) a positive frame in which the probability of survival was given ; ( 2 ) a negative frame in which the probability of dying was given ; and ( 3 ) a mixed frame in which the probability of surviving and dying were both given . The cancer patients ' preferences for the more effective toxic treatment was significantly stronger than the healthy volunteers . Both groups were significantly influenced by the level of probability that was presented . Preferences for the toxic treatment were weaker when the chance of survival dropped below 50 % . This weakening preference below 50 % survival was enhanced for subjects who responded in the negative frame . A negative frame or probability level below 0.5 would seem to stimulate a " dying mode " type of value system in which quality of life becomes more salient in decision making than quantity of life . The implication s in eliciting informed consent from patients are discussed A r and omized trial was conducted to evaluate the impact of mailed psychoeducational material s on adherence to subsequent annual mammography among women with prior abnormal mammograms . The results showed a 13 % increment in adherence among women who received this intervention . This effect was independent of all sociodemographic and medical variables examined . We conclude that mailed psychoeducational material s may be an effective mechanism to improve adherence among women with abnormal mammogram results This experiment compared the effectiveness of gain-versus loss-framed messages to persuade  women to obtain mammography screening . One hundred and thirty-three women 40 years and older and not adhering to current guidelines for obtaining mammography screening were assigned r and omly to view either gain-framed ( emphasizing the benefits of obtaining mammography ) or loss-framed ( emphasizing the risks of not obtaining mammography ) persuasive videos that were factually equivalent . Attitudes and beliefs were measured before and immediately following the intervention . Mammography utilization was assessed 6 and 12 months later . Consistent with predictions based on prospect theory , women who viewed the loss-framed message were more likely to have obtained a mammogram within 12 months of the intervention . These findings suggest that loss-framed messages may have an advantage in the promotion of detection behaviors such as mammography African American women ( N = 100 ) recruited from an urban clinic were r and omly assigned to view 1 of 3 experimental videotapes promoting HIV testing : ( a ) an ethnicity-matched information control videotape ; ( b ) the same ethnicity-matched videotape presented by an African American woman ( gender-ethnicity-matched control condition ) ; or ( c ) an experimental videotape with a culturally relevant context that embedded HIV-testing information within a frame of reference emphasizing personal loss . Consistent with D. Kahneman and A. Tversky 's ( 1979 ) prospect theory , women who viewed the context -framing videotape were most likely to have been tested during a 2-week follow-up interval . Among women who expressed intentions to get tested after viewing the videotapes , 63 % of those in the message-framing condition were tested for HIV during a 2-week period compared with 23 % in the gender-ethnicity-matched condition , and none in the ethnicity-matched condition The authors tested the effects of cues to action -- messages intended to increase flu immunizations .  North Dakota counties were r and omly assigned to reminder letters , action letters , or no letters . Within the reminder-letter counties , Medicare recipients received either ( a ) a reminder from the state peer review organization ( PRO ) to obtain a flu shot or ( b ) a reminder from the PRO , framed either in terms of the loss associated with failing to get a shot or ( c ) the benefits associated with getting a shot . Within the action-letter counties , Medicare recipients leaned where and when to receive a flu shot . Reminder type failed to differentially affect the immunization rate ( overall M = 24.5 % ) . However , the action messages  worked better ( 28.2 % ) than no message ( 19.6 % ) In the present study , the authors investigated the effects of framing of options on  risky decision making in groups of younger adults ( M = 23.8 years , n = 192 ) and older adults ( M = 69.1 years , n = 192 ) . The participants were assigned to one of three scenarios varying in the goods at stake ( human lives , paintings , money ) . The authors observed a majority preference in favor of the risky options after negative , but not positive framing . They also found , as they had predicted , that the type of framing effect varied across scenarios , with a bidirectional framing effect for the life-death scenario and unidirectional ( risk averse ) framing effects when public property ( paintings ) or personal property ( money ) were at stake . It is important to note that these choice preference patterns were highly similar across the age groups , which reinforced the conclusion that younger and older adults are equally susceptible to framing effects BACKGROUND Educational dietary messages can stress either the positive consequences of performing a recommended dietary behaviour ( positive frame ) or the negative consequences of not performing a recommended dietary behaviour ( negative frame ) . From studies on other health behaviours , there is evidence that positive frames have a stronger impact in encouraging preventive behaviours than negative frames . The main hypothesis of the present study was therefore that positively framed messages on eating a low-fat diet and eating enough fruit and vegetables ( F & V ) are more persuasive than negatively framed messages . METHODS In a 2 ( Frame : positive vs. negative ) x 2 ( Dietary behaviour : fat vs. F & V ) design , 152 adult respondents r and omly received one of four messages . Subsequently , they completed a question naire measuring cognitive attitude , affective attitude and intention to change the dietary behaviours . RESULTS No significant differences in attitudes and intentions were found between the positive frame conditions and the negative frame conditions . CONCLUSIONS Based on the current study no advice can be given yet to dietitians and other nutrition educators about whether they should emphasize the positive consequences of a dietary change or the negative consequences of not making the dietary change Within a group of 300 medical students , two characteristics of risk communication in the context of a decision regarding prenatal diagnosis for cystic fibrosis are manipulated : verbal versus numerical probabilities and the negative versus positive framing of the problem ( having a child with versus without cystic fibrosis ) . Independently of the manipulations , most students were in favor of prenatal diagnosis . The effect of framing was only significant in the conditions with verbal information : negative framing produced a stronger choice in favor of prenatal diagnosis than positive framing . The framing effect in the verbal conditions and its absence in the numerical conditions are explained by the dominance of the problem-occurrence orientation in health matters as well as a recoding process which is more likely to occur in the numerical ( the probability " 1-P " switches to its counterpart " P " ) than in the verbal conditions . The implication s for the practice of genetic counseling are discussed Despite increasing emphasis on advance directives , there has been little method ologic work to assess preferences about the  " do not resuscitate " ( DNR ) order .  This developmental work assessed , in a non-patient group , the performance of a probability-trade-off task design ed to assess DNR attitudes , in terms of framing effects and stability of preferences . 105 female nursing students each completed one of two versions of the task . In version I ( n = 58 ) , the trade-off moved to increasingly negative descriptions of the outcomes of resuscitation ( de creasing chance of survival and increasing risk of brain death ) , whereas in version II ( n = 47 ) , the trade-off moved to increasingly positive descriptions . One week later , repeat as sessments were obtained for versions I ( n = 35 ) and II ( n = 28 ) . The DNR preference scores were lower and more stable when the task moved to increasingly positive descriptions ; perhaps this version of the task tends to weaken risk aversion . These results imply that care should be used in applying a probability trade-off task to the assessment of DNR preferences , since artefactual effects could be induced . Key words : patients ' decision making ; prefer ences ; trade-offs ; resuscitation ; anchoring effect . ( Med Decis Making 1995;15:209 - 216 OBJECTIVE To examine the effects of using positive or negative frames to describe influenza vaccine benefits and side effects on patients ' expectations , decisions , decisional conflict , and reported side effects . METHODS 292 previously unimmunized patients with chronic respiratory or cardiac disease were r and omly assigned to receive benefit/risk information that was framed : ( 1 ) positively as the percentage who remain free of influenza and have no vaccine side effects , or ( 2 ) negatively as the percentage who acquire influenza and have vaccine side effects . Question naires elicited expectations , decisions , and decisional conflict . Vaccines were telephoned 3 days later for a self-report of local and systemic side effects and work absenteeism . RESULTS Both groups had similar immunization rates and decisional conflict scores . The positive frame group had lower and more realistic expectations of vaccine side effects , fewer systemic side effects , and less work absenteeism ( p < 0.05 ) . CONCLUSION In contrast to previous studies of health care workers , framing did not influence patients ' decisions , possibly due to the patients ' awareness of their higher risk of influenza complications and greater desire to follow recommendations . The common practice of using negative frames when describing probabilities of side effects may need to be reexamined , considering its deleterious influence on self-reported side effects and work absenteeism Explored the hypothesis that framing health information as safer smoking tips might motivate change in cigarette smokers . Daily smokers were r and omly assigned to a control condition or to an intervention condition in which respondents were asked if they knew about a range of different safer smoking tips .  Respondents ( 43 daily smokers , 18 years or older , 58 % male ) who received safer smoking tips reported a small reduction in the number of cigarettes smoked ( p=.05 ) by the 3-month follow-up as compared to respondents in the control condition . This pilot result is encouraging but requires replication before considering the value of including safer smoking tips in health messages for smokers in the general population OBJECTIVE : To assess the effect of providing structured information about the benefits and harms of mammography in differing frames on women ’s perceptions of screening . DESIGN : R and omized control trial . SETTING : General internal medicine academic practice . PARTICIPANTS : One hundred seventy-nine women aged 35 through 49.INTERVENTION : Women received 1 of 3 5-minute videos about the benefits and harms of screening mammography in women aged 40 to 49 . These videos differed only in the way the probabilities of potential outcomes were framed ( positive , neutral , or negative ) . MEASUREMENTS AND MAIN RESULTS : We measured the change in accurate responses to questions about potential benefits and harms of mammography , and the change in the proportion of participants who perceived that the benefits of mammography were more important than the harms . Before seeing the videos , women ’s knowledge about the benefits and harms of mammography was inaccurate ( 82 % responded incorrectly to all 3 knowledge questions ) . After seeing the videos , the proportion that answered correctly increased by 52 % , 43 % , and 30 % for the 3 knowledge questions , respectively , but there were no differences between video frames . At baseline , most women thought the benefits of mammography outweighed the harms ( 79 % positive frame , 80 % neutral frame , and 85 % negative frame ) . After the videos , these proportions were similar among the 3 groups ( 84 % , 81 % , 83 % , P=.93 ) . CONCLUSIONS : Women improved the accuracy of their responses to questions about the benefits and harms of mammography after seeing the videos , but this change was not affected by the framing of information . Women strongly perceived that the benefits of mammography outweighed the harms , and providing accurate information had no effect on these perceptions , regardless of how it was framed
BACKGROUND The same information about the evidence on health effects can be framed either in positive words or in negative words .
Some research suggests that positive versus negative framing can lead to different decisions , a phenomenon described as the framing effect .
Attribute framing is the positive versus negative description of a specific attribute of a single item or a state , for example , " the chance of survival with cancer is 2/3 " versus " the chance of mortality with cancer is 1/3 " .
Goal framing is the description of the consequences of performing or not performing an act as a gain versus a loss , for example , " if you undergo a screening test for cancer , your survival will be prolonged " versus " if you do n't undergo screening test for cancer , your survival will be shortened " .
OBJECTIVES To evaluate the effects of attribute ( positive versus negative ) framing and of goal ( gain versus loss ) framing of the same health information , on underst and ing , perception of effectiveness , persuasiveness , and behavior of health professionals , policy makers , and consumers .