The marketing of health messages — how the messages are worded, or framed — does not appear to make a difference in our resulting behavior, according to a review of nearly three dozen studies.
The findings by researchers at the University at Buffalo and other institutions contradict the premise of the “framing effect” on making health decisions. Framing is a cognitive bias in which people tend to reach conclusions based on the “framework” within which a situation was presented.
The framing effect is supported by “prospect theory,” for which Princeton University psychologist Daniel Kahneman was awarded the 2002 Nobel Prize for economics and which describes decisions between alternatives that involve risk.
The study is published in the Cochrane Database of Systematic Reviews.
Investigators reviewed synthesized data from 35 studies of 16,342 participants.
“We found that, in general, framing may have little, if any, effect on health consumers’ behavior,” said Elie A. Akl, MD, PhD, lead author.
The study was designed to systematically review all empirical evidence about how the framing effect influences health consumers.
“There is a widely held belief in the medical and public health communities that the framing of health messages can affect the behaviors of health-care consumers,” Akl said.
“If true, then clinical and public health practitioners could develop health messages that are framed in ways that would positively affect the health behaviors of consumers. Framing would provide clinical and public health practice with an easy to use, inexpensive tool that could actually improve public health.”
Although this concept appears logical, the results fail to support this type of effect.
“While framing may improve a patient’s perceptions of a specific screening test, or his or her intentions to undergo it, there are a multitude of other factors that come into play and end up affecting behavior,” Akl said.
Indeed, the complexity of enacting health behavioral change include other factors related to language, such as how much information was provided, how personalized the message was, and the use of visual and statistical information.
Furthermore, other factors that may have a bearing on the behavior of health consumers include the availability and accessibility of health services.
The 35 studies included in this systematic review covered a very broad range of health behaviors. They included decisions regarding the use of sunscreen to combat skin cancer, taking antihypertensive medications for high blood pressure and the use of condoms to prevent sexually transmitted diseases.
They also included studies of people who were making decisions about regular exercise, follow-up appointments after abnormal Pap tests, and screening for HIV, prostate cancer or mammography, among others.
So, what is the best way for clinicians to discuss such decisions with their patients?
“The current state of science doesn’t allow clear guidance on whether or how clinicians and public health workers should frame their health-care messages,” Akl conceded.
The paper says: “In the absence of evidence for the superiority of one frame over the other, a balanced presentation when producing patient information or decision aids is likely to be the safest approach.”
Akl notes that while language in general probably makes some difference, framing is only one part of the language equation.
“There might be specific but yet undetermined conditions, for example, the type of health message or the specific health conditions being discussed, under which framing may have an impact,” he said. “Future research needs to investigate these conditions.”
Source: University of Buffalo