To Motivate Healthy Behavior, It's Often Not What You Say, But How You Say It

Psychologists find that framing health messages a certain way makes a difference in cancer prevention efforts.

Findings

Every year, millions of dollars are spent on public service and advertising campaigns to promote healthy behavior. Why is it that some of these attempts effectively motivate behavior change whereas others do not? The answer may lay not so much in the content of the messages bur rather in how the messages in these campaigns are crafted. Certain behaviors may be more effectively encouraged if they are framed in terms of the benefits versus the costs of that behavior, called gain-framing and loss-framing, respectively. Furthermore, some people seem to respond better when messages are individualized, or tailored, to the way they tend to personally process health information.

In a series of field experiments, psychologist Peter Salovey, PhD, and his colleagues in the Health, Emotion, and Behavior (HEB) Laboratory at Yale University have investigated the effects of framing and tailoring health messages. Their work has been funded by The National Cancer Institute, the American Cancer Society, and the Ethel Donaghue Women's Health Investigator Program. Framing messages involves highlighting either the gains (i.e., benefits or advantages) or losses (i.e., risks or disadvantages) anticipated when a behavior is adopted, while keeping the information factually equivalent. For example, gain-framed messages for cancer prevention might be "Use sunscreen lotion to decrease your risk of getting skin cancer" or "Use sunscreen to help your skin stay healthy." Loss-framed messages could be "Without sunscreen you increase your risk of developing skin cancer" or "Without sunscreen you cannot guarantee the health of your skin."

Salovey and his colleagues have conducted their experiments on beaches, in public housing developments, and at community clinics. These experiments compare videos, brochures, and posters with identical information but different message framing. Experiments were conducted using persuasive messages designed to promote a variety of cancer prevention and detection behaviors, such as mammography utilization, pap testing, sunscreen use, and smoking cessation. The results from these experiments suggest that messages framed as gains are more effective for cancer prevention behaviors, while loss-framed messages are more persuasive for cancer detection behaviors. Gain-framed messages were more effective when targeting prevention behavior, such as sunscreen use (see, Detweiler et al., 1999). In contrast, loss-framed messages were more effective when targeting detection behaviors, such as mammography utilization (see, Banks et al., 1995; Schneider et al., 2001a).

Encouraged by these findings, this research team sought to discover other ways persuasive health messages may be crafted. Another series of experiments tested the hypothesis that psychologically-tailored messages are more effective in producing health-relevant behavior change than are other types of messages. Tailoring involves making a message more relevant to a recipient by using information known about an individual or a group to which the recipient belongs. Tailored messages tend to be more personally relevant and thus attract more attention (Kreuter, Farrell, Olevitch & Brennan, 2000).

In these studies, cancer-relevant behaviors like mammography screening and fruit and vegetable consumption were the targeted behaviors. The messages were tailored to individual differences in health information processing styles in three domains, such as: (a) need for cognition, the tendency for individuals to enjoy mulling things over in their minds (Cacioppo, Petty, Feinstein, & Jarvis, 1996), (b) health locus of control, which refers to whether individuals believe that the responsibility for their health and health outcomes lies with themselves or with others, such as a physician (Wallston, Wallston, & DeVallis, 1978), and (c) monitoring and blunting styles, which refer to the tendency for individuals to seek and attend to health information, or avoid and "blunt" it, respectively (Miller, 1987). In general, when recipients received messages tailored to their personal information processing style, they were later more likely to engage in the desired behavior advocated in the message (Williams-Piehota et al., 2003, 2004a, 2004b, in press-a, in press-b).

Significance

These studies demonstrate how creating messages based on psychological information can motivate individuals to adopt behavior relevant to cancer prevention and early detection of cancer.

Practical Application

Public service campaigns advocating a variety of health behaviors are benefiting from designing their persuasive messages in ways that take account of the psychological characteristics of the desired behavior and of the information-processing style of the people who are targeted for those messages. This simple strategy leads to readily crafting more persuasive messages, which in turn, increase adoption of healthy behaviors that can reduce disease risk, enhance public health, and ultimately, save lives. For example, the Connecticut Department of Health conducted a highly successful loss-framed public information campaign in the 1990's promoting mammography screening for breast cancer that was consistent with the work of Dr. Salovey and his colleagues.

Cited Research

Banks, S.M., Salovey, P., Greener, S., Rothman, A.J., Moyer, A., Beauvais, J., & Epel, E. (1995). The effects of message framing on mammography utilization. Health Psychology, Vol. 14, pp. 178-184.

Cacioppo, J. T., Petty, R. E., Feinstein, J. A., & Jarvis, W. B. G. (1996). Dispositional differences in cognitive motivation: The life and times of individuals varying in need for cognition. Psychological Bulletin, Vol. 119, pp. 197-253.

Detweiler, J.B., Bedell, B.T., Salovey, P., Pronin, E., & Rothman, A.J. (1999). Message framing and sunscreen use: Gain-framed messages motivate beach-goers. Health Psychology, Vol. 18, pp. 189-196.

Kahneman, D., & Tversky, A. (1979). Prospect theory: An analysis of decisions under risk. Econometrica, Vol. 47, pp. 263-291.

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Kreuter, M. W., Farrell, D., Olevitch, L., & Brennan, L. (2000). What is tailored communication? In J. Bryant and D. Zillmann (Eds.). Tailoring health messages: Customizing communication with computer technology (pp. 1-23). Mahwah, NJ: Lawrence Erlbaum Association.

Miller, S. M. (1987). Monitoring and blunting: Validation of a questionnaire to assess styles of information seeking under threat. Journal of Personality and Social Psychology, Vol. 52, pp. 345-353.

Rivers, S.E., Pizarro, D.A., Schneider, T.R., Pizarro, J., & Salovey. P. (2005). Message framing and pap test utilization among women attending a community health clinic. Journal of Health Psychology, Vol. 10, pp. 67-79.

Schneider, T.R., Salovey, P., Apanovitch, A.M., Pizarro, J., McCarthy, D., Zullo, J., & Rothman, A.J. (2001a). The effects of message framing and ethnic targeting on mammography use among low-income women. Health Psychology, Vol. 20, pp. 256-266.

Schneider, T.R., Salovey, P., Pallonen, U., Mundorf, N., Smith, N.F., & Steward, W.T. (2001b). Visual and auditory message framing effects on tobacco smoking. Journal of Applied Social Psychology, Vol. 31, pp. 667-682.

Wallston, K. A., Wallston, B. S. & DeVellis, R. F. (1978) Development of the Multidimensional Health Locus of Control (MHLC) scales. Health Education Monographs, Vol. 6, pp. 160-170.

Williams-Piehota, P., Cox, A., Silvera, S.N., Mowad, L., Garcia, S., Katukak, N., & Salovey, P. (2004a). Casting health messages in terms of responsibility for dietary change: Increasing fruit and vegetable consumption. Journal of Nutrition Education and Behavior, Vol. 36, pp. 114-120.

Williams-Piehota, P., Pizarro, J., Navarro, S., Mowad, L., & Salovey, P. (in press-a). The impact of messages tailored to need for cognition on increasing fruit and vegetable intake among callers to the cancer information service. Health Communication.

Williams-Piehota, P., Pizarro, J., Schneider, T.R., Mowad, L., & Salovey, P. (In press-b). Matching health messages to monitor-blunter coping styles to motivate screening mammography. Health Psychology.

Williams-Piehota, P., Schneider, T.R., Pizarro, J., Mowad, L., & Salovey, P. (2003). Matching health messages to information processing styles: Need for cognition and mammography utilization. Health Communication, Vol. 15, pp. 375-392.

Williams-Piehota, P., Schneider, T.R., Pizarro, J., Mowad, L., & Salovey, P. (2004b). Matching health messages to locus of control beliefs for promoting mammography utilization. Psychology and Health, Vol. 19, pp. 407-423.


American Psychological Association, December 9, 2004

Additional Sources

Rothman, A.J., Kelly, K.M., Hertel, A.W., & Salovey, P. (2003). Message framing and illness representations: Implications for interventions to promote and sustain healthy behavior. In L.D. Cameron & H. Leventhal (Eds.), The self-regulation of health and illness behavior. Reading, England: Routledge, Taylor and Francis Group.

Rothman, A.J., & Salovey, P. (1997). Shaping perceptions to motivate healthy behavior: The role of message framing. Psychological Bulletin, Vol. 121, pp. 3-19.

Salovey, P., Schneider, T.R., & Apanovitch, A.M. (2002). Message framing in the prevention and early detection of illness. In J.P. Dillard & M. Pfau (Eds.), The persuasion handbook: Theory and practice (pp. 391-406). Thousand Oaks, CA: Sage Publications.

Salovey, P., & Wegener, D.T. (2003). Communicating about health: Message framing, persuasion, and health behavior. In J. Suls & K.A. Wallston (Eds.), Social psychological foundations of health and illness. Malden, MA: Blackwell Publishing.

Salovey, P., & Williams-Piehota, P. (2004). Field experiments in social psychology: Message framing and the promotion of health protective behaviors. American Behavioral Scientist, Vol. 47, pp. 488-505.