The Effectiveness of Gain-Framed Messages for Encouraging Disease Prevention Behavior: Is All Hope Lost?

This article discusses a series of research findings on gain- and loss-framed messaging. The article illustrates with the example of loss-framed messages emphasising health cost (e.g., disease - not financial cost) and gain-framed messages emphasising health benefits. As stated here, a meta-analysis of 93 studies showed a small but significant advantage for gain-framed over loss-framed messages for encouraging disease prevention behaviours, but only in dental hygiene behaviour. Thus, the authors pose the question: "Should researchers and practitioners abandon efforts to enhance prevention messages through gain-framing?"


This survey of evidence on gain-framed messaging suggests that "accumulating evidence provides direction for strengthening gain-framing effects and for advancing theory." The research considers individuals’ construal of a behaviour and individuals’ dispositional sensitivity to favourable or unfavourable outcome. The authors suggest that risk implications are a factor in whether to use gain- or loss-framed messages. Their examples are dental hygiene, construed as a prevention behaviour with certain outcomes, and getting a flu shot, which may be construed as a prevention behaviour with less certain outcomes. They propose using gain-framing for perceived certain outcomes and loss-framing for the uncertain outcomes. An experiment using patient perception of the outcomes of West Nile virus vaccine was tested as to effectiveness of gain- and loss-framed messages, and confirmed the authors' proposition.


Based on this outcome and the outcome of messaging in a smoking cessation study, the importance of establishing how individuals construe the target behaviour when evaluating the influence of gain-framed health messages is recognised. An additional factor is an individual’s tendency to orient his or her behaviour toward favourable or unfavourable outcomes. Those oriented towards favourable outcomes tend to respond to gain-framed messages; those oriented towards unfavourable outcomes tend to respond to loss-framed messages. "This dispositional variation in motivational style is captured by the two distinct yet conceptually similar theoretical constructs of approach: avoidance motivation - the tendency to seek out favorable outcomes or to avoid unfavorable outcomes; and regulatory focus - the tendency to act in ways that ensure the presence of positive outcomes or the absence of negative outcomes. A consistent pattern of findings has emerged demonstrating that individuals who are motivated by the presence of positive outcomes are persuaded to engage in disease prevention behaviors by gain-framed messages. Loss-framed messages persuaded individuals who are motivated by the absence of negative outcomes to engage in disease prevention behaviors....Evidently, to obtain a full understanding of the impact of gain-framed appeals, researchers and practitioners must aim to deliver and evaluate framed messages suited to the individual."


The authors discuss the effects, often seemingly small, of mass media messaging campaigns, using the example of a large "multimillion dollar mass media campaign promoting physical activity for children", which showed that the effect sizes (classified by the authors as small) at the 2-year follow-up ranged from r=.06 to .12, which are "the largest effects documented for a physical activity campaign". The authors conclude with hopes that "investigators take these meta-analytic findings not as a sign to abandon efforts to optimize the persuasiveness of framed disease prevention messages, but rather as motivation to work to refine and advance current message framing postulates to specify more precisely when gain- versus loss-framed messages will be most effective."