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Using Message Framing in Health-Related Persuasion

Theory and Evidence

Xiaoli Nan

Defining Message Framing

Developing effective messages is central to the planning of public communication campaigns (see Chapter 24, this volume). Many communication campaigns address public health issues. One of the most important aspects of designing health messages is to determine how to present information in a way that achieves maximum persuasive impact. Research on message framing conducted in the past fifteen years or so has shown that factually equivalent information, when presented in different formats, can lead to different persuasive outcomes. Gain-framed health messages that focus on the advantages of adopting the recommended behavior (e.g., “if you apply sunscreen, your skin will be protected from the sun's relentless ultraviolet rays”) can differ systematically in their persuasiveness from loss-framed messages that emphasize the disadvantages of not engaging in the health behavior (e.g., “if you don't apply sunscreen, your skin will be harmed by the sun's relentless ultraviolet rays”).

However, there is no general agreement as to which message frame is consistently more persuasive. The relative persuasiveness of gain- versus loss-framed health messages appears to be influenced by an array of message- and audience-related factors, including the type of health behavior advocated (Rothman & Salovey, 1997), message recipients' involvement with the health issue (Maheswaran & Meyers-Levy, 1990), message recipients' approach/avoidance tendency (Mann, Sherman, & Updegraff, 2004; Nan, 2008), and desirability of the end-state emphasized in the message (Lee & Aaker, 2004; Nan, 2007a). This chapter will provide a review of theory and evidence surrounding each of these factors as moderators of message framing effects and conclude with an assessment of the current state of research and directions for future studies. Practical implications and social significance of this body of research are also briefly discussed.

Framing is an important construct in communication research. The notion that how information is framed systematically influences message processing and attitude formation has spawned several streams of research with distinct operationalizations of framing. Research on attribute framing, for example, examines the persuasive effects of focusing on the positive versus negative attribute of an advocated position or object. For instance, an advertisement for a brand of ground beef can either focus on the positive attribute (e.g., “75% lean”) or highlight the negative attribute (e.g., “25% fat”). Typically, messages with positive attribute framing receive better evaluations and are more persuasive than those with negative attribute framing (Levin & Gaeth, 1988). Another type of commonly studied framing is news framing, which is often examined in the context of political communication (see Chapter 3). On the subject of healthcare, for instance, a news story can frame it as an ethical issue versus a material issue (Shah, Domke, & Wackman, 1996) or use a thematic frame that focuses on collective trends versus an episodic frame that highlights personal experiences (Iyengar, 1990). The use of different news frames often leads to distinct cognitive processing and attitudes (Scheufele, 1999).

Message framing as reviewed in this chapter shares similarities with other types of framing but also has its distinct features. The three types of framing (i.e., attribute framing, news framing, and message framing) share an important feature in that they all involve subtle language alteration of some sort. But they also have significant differences. First, the three types of framing are different in whether the frames try to maintain factually equivalent information. In this regard, message framing and attribute framing are similar in that the frames contain factually equivalent information. News framing, on the other hand, does not share this feature as different news frames typically convey different information (e.g., ethical topics are factually different from material topics). Second, message framing and attribute framing are different in their operationalizations. In message framing, both gain and loss frames supply reasons why people should comply with the advocacy. In attribute framing, however, a positive frame stresses the fact that the advocacy is good (e.g., the beef is 75% lean), whereas a negative frame highlights the fact that the advocacy is bad (e.g., the beef is 25% fat), although the intention is really to show how people should dismiss this fact (e.g., the beef has only 25% fat).

Differences in framing operationalizations imply that the underlying psychological mechanisms through which framing influences persuasion may be different. For attribute framing, it has been suggested that focusing on the negative attribute of an object leads to activations of unfavorable associations, whereas highlighting the positive attribute activates favorable associations (Levin & Gaeth, 1988). Positive attribute framing, therefore, is often more persuasive than negative attribute framing. The effects of news framing are also grounded in the activation of different thoughts and associations (Pan & Kosicki, 1993; Price & Tewksbury, 1997). Depending on the nature of the thoughts and associations activated (positive or negative), different news frames can result in different attitudes.

Compared to attribute framing and news framing, message framing appears to work through different psychological mechanisms. Examining the moderators of the relative persuasiveness of gain- versus loss-framed messages reveals important psychological processes at work. But first, a review of the original body of research that inspired investigations of message framing is necessary.

The Origins of Message Framing

Research on message framing is rooted in the Nobel Prize-winning work of economists Amos Tversky and Daniel Kahneman. Classic economic theories assume that human beings are rational. People's preferences, therefore, should not be affected by variations in irrelevant features of options or outcomes. However, this assumption was challenged by Tversky and Kahneman, who demonstrate that preferences are influenced by how the options are framed, a seemingly irrelevant feature (Tversky & Kahneman, 1981). Specifically, an individual's preference for a solution that will lead to an uncertain outcome (i.e., a risky solution) versus one that will result in a certain outcome (i.e., a non-risky solution) is predictably influenced by the framing of the outcome (Kahneman & Tversky, 1979). In one of their studies (Tversky & Kahneman, 1981), participants were asked to imagine a disease that would kill 600 people. They were then asked to choose between two plans that could alleviate the situation. Plan A had a certain outcome and thus was a non-risky solution, whereas Plan B had an uncertain outcome and thus was a risky choice. Plan A was either gain-framed (“if Plan A is adopted, 200 people will be saved”) or loss-framed with an equivalent outcome (“if Plan A is adopted, 400 people will die”). Similarly, Plan B was either gain-framed (“if Plan B is adopted, there is a one-third probability that 600 people will be saved and a two-thirds probability that no people will be saved”) or loss-framed with an equivalent outcome (“if Plan B is adopted, there is a one-third probability that nobody will die and a two-thirds probability that 600 people will die”). The most interesting finding was that when facing the gain-framed plans, participants preferred the non-risky solution (i.e., Plan A), but when facing the loss-framed plans, they preferred the risky solution (i.e., Plan B).

Tversky and Kahneman explained the findings with prospect theory, which posits that the observed preference reversal is due to different value functions that are associated with decision-making involving gains versus losses. Specifically, the value function in the domain of gains is typically concave, representing a tendency for being risk averse, while the value function in the domain of losses is convex, suggesting a tendency for being risk-seeking. The theory also postulates that people have a greater tendency to avoid a loss than to seek a gain with the same amount of expected value. For example, avoiding losing one hundred dollars in a gambling game may be perceived as being more important than winning one hundred dollars. This claim is represented by a steeper value function in the domain of losses than in the domain of gains.

Research on Message Framing: An Overview

Inspired by framing effects observed in the domain of decision-making, persuasive communication researchers explore whether similar framing effects can be observed in the area of persuasion. Instead of focusing on people's choice behaviors under the influence of framing, persuasive communication researchers examine whether people's compliance with a persuasive message is affected by how the message is framed. The majority of studies on message framing have been conducted in health-related contexts.

A seminal study on message framing effects was Meyerowitz and Chaiken's (1987) inquiry on women's compliance with a health message encouraging the performance of breast self-examination (BSE). The researchers showed two groups of female participants two different versions of the health message. One version of the health message was gain-framed (e.g., “research shows that women who do BSE have an increased chance of finding a tumor in the early, more treatable stage of the disease”), while the other version was loss-framed (e.g., “research shows that women who do not do BSE have a decreased chance of finding a tumor in the early, more treatable stage of the disease”). It was found that participants who read the loss-framed message manifested more positive BSE attitudes, intentions, and behaviors than those who read the gain-framed message.

Following Meyerowitz and Chaikens (1987) original research, numerous studies have investigated the relative persuasiveness of gain- versus loss-framed messages. In a recent meta-analysis, O'Keefe and Jensen (2006) identified over a hundred published articles, dissertations, and conference papers reporting findings on message framing effects. Despite the abundance of research, there is no general consensus as to whether one frame is more persuasive than the other. In fact, O'Keefe and Jensen's (2006) meta-analysis concludes that gain- and loss-framed messages do not generally differ in their persuasiveness. The lack of a main effect of message framing indicates two possibilities, (1) gain- and loss-framed messages truly do not have differential persuasive effects, (2) the two frames do exert different persuasive impact, with one frame being more persuasive under certain circumstances and the other frame being more effective under other situations. In the latter case, the meta-analysis would not able to detect an overall effect of message framing because the opposing effects of message framing observed in different studies could have been cancelled out.

It appears that the second possibility is a promising one as research has shown that gain- and loss-framed messages do differ systematically in their persuasiveness when certain conditions are met. Indeed, a number of moderators in the relative persuasiveness of gain- versus loss-framed messages have been identified. These include the type of health behavior (Rothman & Salovey, 1997), issue involvement (Maheswaran & Meyers-Levy, 1990), approach/avoidance motivation (Mann et al., 2004; Nan, 2008), and desirability of end-states (Lee & Aaker, 2004; Nan, 2007a). The next section provides a review of research on each of these moderators, focusing on both theory and evidence.

Moderators of Message Framing Effects

Type of Health Behavior

According to Rothman and his colleagues (Rothman, Kelly, Hertel, & Salovey, 2003; Rothman & Salovey, 1997), health behaviors can be categorized into three broad classes. Detection behaviors are performed to provide information about the presence or absence of a potential undesirable health outcome. Prevention behaviors focus on averting the onset or development of a health problem. Finally, recuperative behaviors are any interventions undertaken to correct or alleviate an existing health problem. Drawing upon prospect theory (Kahneman & Tversky, 1979), the researchers argue that, “the effect of a particular frame on people's willingness to perform a behavior is contingent on whether the option under consideration is perceived to reflect a risk-averse or risk-seeking course of action” (Rothman et al., 2003, p. 281). Because detection behaviors can inform people that they may be sick, to initiate the behavior can be considered a risky decision. It then follows that loss frames will be more effective in promoting detection behaviors than gain frames. On the other hand, because prevention and recuperative behaviors forestall or help the recovery of a health problem, they provide a relatively certain, desirable outcome. Thus, gain frames are expected to be more effective in promoting prevention and recuperative behaviors than loss frames.

Several studies have shown that loss-framed messages are more persuasive than gain-framed messages in promoting detection behaviors, including breast self-examination (e.g., Meyerowitz & Chaiken, 1987), mammography (e.g., Cox & Cox, 2001; Finney & Iannotti, 2002), and colorectal cancer screening (e.g., Myers et al., 1991). While no study has found gain-framed messages to be more effective than loss-framed messages in advocating cancer-screening behaviors (Rothman, Bartels, Wlaschin, & Salovey, 2006), a number of studies failed to detect any persuasive difference between the two frames (e.g., Lalor & Hailey, 1990; Lauver & Rubin, 1990). A recent meta-analysis (O'Keefe & Jensen, 2009) showed that loss-framed messages are slightly more effective than gain-framed messages in promoting detection behaviors, although the advantage of loss-framed messages over gain-framed messages was mainly found for breast cancer detection behaviors.

With regard to prevention behaviors, several studies have shown that gain-framed messages are more effective than loss-framed messages in promoting such behaviors, including sunscreen use (e.g., Rothman, Martino, Bedell, Detweiler, & Salovey, 1999; Rothman, Salovey, Antone, Keough, & Martin, 1993), exercise (e.g., Jones, Sinclair, & Courneya, 2003), and safe driving (e.g., Millar & Millar, 2000). A meta-analysis (O'Keefe & Jensen, 2007) indicates that gain-framed messages have a small advantage over loss-framed messages in advocating prevention behaviors, although the advantage primarily occurs for messages promoting dental hygiene behaviors.

Overall, Rothman and colleagues' prospect theory-based explanation of message framing effects provides a reasonable account for the observed evidence. In addition, the notions that gain frames work better for promoting prevention behaviors and that loss frames are more effective when advocating detection behaviors offer a useful conceptual map to health professionals when they make decisions about the type of information to be emphasized in a health message. However, their prediction that gain frames will be more effective than loss frames in promoting prevention behaviors often fails to receive support when the prevention act advocated is a type of vaccination behavior. In fact, several studies found loss-framed messages to be more effective in promoting various types of vaccination, including MMR vaccination (e.g., Abhyankar, O'Connor, & Lawton, 2008), flu vaccination (Ferguson & Gallagher, 2007), and human papillomavirus (HPV) vaccination (e.g., Gerend & Shepherd, 2007; Gerend, Shepherd, & Monday, 2008). One study found no difference in persuasiveness between the two frames (McCaul, Johnson, & Rothman, 2002). No study to date has shown gain-framed messages to be more effective than loss-framed messages in promoting vaccination.

What is unique about vaccination compared to other prevention behaviors that renders loss-framed messages particularly effective? One possibility is that, unlike other prevention behaviors such as using sunscreen and exercising that seem to be safe and harmless, vaccination frequently engenders safety concerns (Ball, Evans, & Bostrom, 1998). The general public may recognize the benefits of vaccination, but at the same time may be cautious about possible side effects. Choosing to get vaccinated thus could be considered a risky choice. Thus, loss-framed messages should be expected to be more effective than gain-framed messages when promoting vaccination. Consequently, rather than making predictions about the relative effectiveness of gain- versus loss-framed messages based on the function of the health behavior (i.e., prevention, detection, or recuperative), there appears to be particular utility to base our predictions on whether the outcome of performing the health behavior is risky or uncertain.

Issue Involvement

Other than the type of behavior promoted by a health message, message recipients' level of involvement with the health issue appears to be another factor that determines the relative persuasiveness of gain- versus loss-framed messages. Maheswaran and Meyers-Levy (1990) argue that loss frames will be more effective than gain frames when issue involvement is high, whereas the reverse will be true when issue involvement is low. Theoretical basis of these predictions is built upon dual-process theories of persuasion. Two prominent members of this theory family are the elaboration likelihood model (ELM; Petty & Cacioppo, 1986) and the heuristic systematic model (HSM; Chaiken, Liberman, & Eagly, 1989). Both theories share the core assumption that people process information in two qualitatively different ways. One processing mode is more superficial or effortless, referred to as peripheral processing in the ELM and heuristic processing in the HSM. The other processing mode is more deliberative and effortful, named as central processing in the ELM and systematic processing in the HSM. According to both models, high motivation and ability to process information will lead to central or systematic processing. Under this situation, people will elaborate on the substantive content of a persuasive message that addresses the true merits of the central topic. Because negative information is often more powerful than positive information, a loss frame is expected to be more persuasive than a gain frame when message recipients are highly involved with the health issue. Indeed, research on information processing has documented a consistent asymmetric effect of negative versus positive information on people's cognitive and affective reactions (see Taylor, 1991). Negative versus positive information is often perceived as being more diagnostic and weighted more in people's judgments (Anderson, 1965; Dreben, Fiske, & Hastie, 1979; Fiske & Taylor, 1991; Kanouse & Hanson, 1972). The notion that negative information receives more weight in judgment than positive information is also consistent with the idea of loss aversion specified in prospect theory (Kahneman & Tversky, 1979).

When motivation or ability to process information is low, peripheral or heuristic processing will occur. Instead of elaborating on the substantive content of a persuasive message, people with low motivation or ability to process information will only attend to salient cues in the persuasive message, such as attractiveness of the endorser or the valence of the message. The positive valence of gain frames presumably leads to more favorable persuasive outcomes than the negative valence of loss frames (Maheswaran & Meyers-Levy, 1990).

Several studies supported the moderating role of issue involvement in the relative effects of gain- versus loss-framed messages (e.g., Maheswaran & Meyers-Levy, 1990; Meyers-Levy & Maheswaran, 2004). While Maheswaran and Meyers-Levy emphasize the importance of issue involvement, Rothman and Salovey (1997) suggest that depth of processing (i.e., the degree to which message recipients engage in careful message scrutiny) is the true moderating variable and any variable (including issue involvement) that influences depth of processing is expected to play a moderating role. These variables may be related to the message, the audience, or the recommended health behavior. For example, research has found that unexpected information stimulates message processing (Baker & Petty, 1994; Maheswaran & Chaiken, 1991; Smith & Petty, 1996). Schwarz, Bless, and Bohner (1991) demonstrate that negative moods motivate systematic processing, whereas positive moods induce heuristic processing. In addition, Block and Keller (1995) have shown that perceived efficacy associated with a recommended health behavior (i.e., the degree of confidence that following the recommended health behavior will lead to the desired outcome) is negatively associated with depth of processing. They further demonstrate that when perceived efficacy is low, loss-framed messages are more effective, whereas when perceived efficacy is high, both frames are equally persuasive.

Overall, issue involvement or, more specifically depth of processing, is an important variable to consider when predicting the relative effects of gain- versus loss-framed messages. When depth of processing is minimal, message framing may have no impact on persuasion because the message is not processed adequately to have any impact on message recipients. When depth of processing is low, gain frames may have persuasive advantage over loss frames as message valence is often taken as a peripheral cue when forming judgment under this processing mode. Finally, when depth of processing is high, loss frames may be more effective than gain frames due to negativity bias (Taylor, 1991). However, it is also necessary to take into account the type of health behavior promoted when depth of processing is high. Rothman and his colleagues (Rothman et al., 1993) found that gain frames have more favorable impact than loss frames on females' sun protection behaviors, even though for females skin protection is typically a high involvement issue.

Approach/Avoidance Motivation

Another message recipient-related factor that potentially influences the relative persuasiveness of gain- versus loss-framed messages is an individual's approach/avoidance motivation. In general, motivation theories posit two orthogonal motivation systems: behavioral inhibition system (BIS) and behavioral activation system (BAS) (Carver, Sutton, & Scheier, 2000; Elliot & Covington, 2001). The BIS system produces avoidance motivations, rendering individuals highly sensitive to punishment or threat cues. The BAS system leads to approach motivations, which heighten sensitivity to reward or incentive cues. Overall, people with BAS are responsive to the presence or absence of positive outcomes, whereas those with BIS are sensitive to the presence or absence of negative outcomes.

The contrast between BAS and BIS is also evident in regulatory focus theory (Higgins, 1997, 2002), which distinguishes between two basic types of self-regulatory orientations toward goal pursuit: promotion focus and prevention focus. “A promotion focus represents goal pursuit in terms of hopes and aspirations (ideals) and entails an orientation toward accomplishment and a sensitivity to the presence and absence of gain/nongain outcomes. A prevention focus represents goal pursuit in terms of duties and obligations (oughts) and entails an orientation toward security and a sensitivity to the presence and absence of nonloss/loss outcomes” (Cesario, Grant, & Higgins, 2004, p. 389). Although an individual can hold both a promotion and prevention focus, one orientation may be more salient or accessible than the other. Individuals who are predominantly promotion focused are more sensitive to the presence or absence of positive outcomes; those who are predominantly prevention focused are more sensitive to the presence or absence of negative outcomes.

A number of studies have demonstrated that message recipients' salient motivations (approach or avoidance) and orientations toward goal pursuit (promotion focus or prevention focus) have systematic impact on the relative persuasiveness of gain- versus loss-framed messages (Cesario et al., 2004; Lee & Aaker, 2004; Mann et al., 2004; Nan, 2008). Overall, the findings support the congruity hypothesis in that a health message is most persuasive when the frame and the motivation are congruent (i.e., a loss frame matched with an avoidance motivation or a prevention focus, a gain frame matched with an approach motivation or a promotion focus). Mann et al. (2004), for instance, measured participants' approach/avoidance motivation with the BIS/BAS scale. The participants were presented with a health message promoting dental flossing that was either gain-framed (e.g., “flossing your teeth daily removes particles of food in the mouth, avoiding bacteria, which promotes great breath”) or loss-framed (e.g., “if you do not floss your teeth daily, particles of food remain in the mouth, collecting bacteria, which causes bad breath”). It was found that the loss-framed message worked better for people high in avoidance motivation, whereas the gain-framed message was more effective for those high in approach motivation.

Similarly, Lee and Aaker (2004) showed that people who differ in their regulatory focus respond differently to gain- versus loss-framed messages. The researchers demonstrate that loss-framed messages are generally more effective than gain-framed messages for individuals who are prevention focused. On the other hand, gain-framed messages are more persuasive than loss-framed messages for those who are promotion focused. Nan (2008) showed that matching the framing of a public service announcement with message recipients' regulatory focus (a gain frame with a promotion focus, a loss frame with a prevention focus) can improve the persuasiveness of the message. Similar results were found by Cesario et al. (2004). In explaining the findings supporting the congruity hypothesis, scholars cited the notion of regulatory fit posited in regulatory focus theory (Higgins, 1997, 2002). Regulatory fit occurs when one's goal is matched with a strategy that is conducive of that goal. The theory argues that there is a natural fit between promotion-focused goals and pursuing these goals with eager means (e.g., achieve gains, avoid nongains), and between prevention-focused goals and pursuing these goals with vigilant means (e.g., avoid losses, ensure nonlosses). When the goal and means of goal pursuit fit with each other, people will experience a positive affect, which can be best characterized as a “feeling good” experiential state. Importantly, this positive affect may be transferred to message evaluations (Cesario et al., 2004). Lee and Aaker (2004) further argue that regulatory fit enhances message-processing fluency (i.e., the ease with which people process messages), which has a positive impact on message responses and evaluations. Gain-framed messages, by highlighting an eager means of goal pursuit, fit promotion-focused goals. Loss-framed messages, which emphasize a vigilant means of goal pursuit, fit prevention-focused goals. For these reasons, gain-framed messages are expected to be more persuasive than loss-framed messages for message recipients who are promotion focused, whereas loss-framed messages are expected to be more effective for those who are prevention focused.

The moderating role of motivation and the moderating role of the type of health behavior promoted in message framing effects might be regulated by the same psychological mechanism (Rothman et al., 2006). To the extent that thinking about detection behavior induces a prevention mindset, health messages promoting detection behaviors may generally foster a prevention focus. To the extent that thinking about prevention behaviors engenders a promotion mindset, health messages that encourage the adoption of prevention behaviors may serve to induce a promotion focus. As a result, gain-framed messages, due to their strategic fit with promotion-focused concerns, are more effective than loss-framed messages when the advocated actions are prevention behaviors. Loss-framed messages, due to their strategic fit with prevention-focused concerns, are more persuasive when the advocated acts are detection behaviors.

Desirability of End-States

One more important moderator of message framing effects that has been proposed in the literature is the way in which message framing can be operationalized. Specifically, research suggests that there exist at least two distinct operationalizations of message framing. The first involves desirable end-states. Under this condition, a gain-framed message focuses on the desirable end-state achieved through compliance (e.g., “if you floss regularly, you will increase the likelihood that your gum is kept healthy in the long run”). A loss-framed message highlights the desirable end-state foregone through noncompliance (e.g., “if you do not floss regularly, you will decrease the likelihood that your gum is kept healthy in the long run”). The second operationalization involves undesirable end-states. Under this situation, a gain-framed message emphasizes the undesirable end-state avoided through compliance (e.g., “if you floss regularly, you will decrease the likelihood that your gum suffers from bacterial erosion in the long run”) and a loss-framed message stresses the undesirable end-state suffered through noncompliance (e.g., “if you do not floss regularly, you will increase the likelihood that your gum suffers from bacterial erosion in the long run”).

The distinction between the two operationalizations of message framing appears to be similar to the difference between the two self-regulatory foci posited in regulatory focus theory (Higgins, 1997, 2002). Operationalizations focusing on desirable end-states are aligned with a promotion focus, whereas operationalizations focusing on undesirable end-states are consistent with a prevention focus. However, it is important to note that the difference between a promotion focus and a prevention focus is primarily a variation in message recipients with regard to their relatively stable dispositions. In comparison, whether a desirable or an undesirable end-state constitutes the focus of a persuasive message reflects a variation in message feature.

A few studies have shown that operationalizing message framing either in terms of desirable end-states or undesirable end-states can have systematic impact on the relative persuasiveness of gain- versus loss-framed messages (Lee & Aaker, 2004; Nan, 2007a; Zhao & Pechmann, 2007). Lee and Aaker (2004) for example, demonstrate that a gain-framed advertisement promoting Welch's grape juice worked better than its loss-framed counterpart when both frames were operationalized in terms of desirable end-states (e.g., the gain frame: “Get Energized;” the loss frame: “Don't Miss Out on Getting Energized”). On the other hand, the loss-framed message was more effective when both frames were operationalized in terms of undesirable end-states (e.g., the gain frame: “Prevent Clogged Arteries;” the loss frame: “Don't Miss Out on Preventing Clogged Arteries”). In another study, Zhao and Pechmann (2007) further showed that the most effective message was the one that matched the frame with an appropriate type of end-state as well as message recipients' regulatory focus. Specifically, they found that prevention-focused individuals were most persuaded by loss-framed messages anchored by undesirable end-states, whereas promotion-focused individuals were most persuaded by gain-framed messages operationalized in terms of desirable end-states. Nan (2007a) found a similar pattern of results, but only among individuals who were highly motivated to process the messages. Even though a number of individual studies have identified desirability of end-states as a significant moderator of message framing effects, O'Keefe and Jensen's (2006) metaanalysis suggests that operationalizing message framing differently in terms of desirable or undesirable end-states does not appear to make much difference in the relative persuasiveness of gain- versus loss-framed messages.

Conclusions

Understanding the relative persuasiveness of gain- versus loss-framed messages is of both theoretical and practical importance. Current literature on message framing has shed significant insight on how and when message framing influences persuasion. The majority of the literature focuses on message framing effects in the context of health communication. Four moderating variables have garnered most research attention. These include type of health behavior, issue involvement, approach/avoidance motivation, and desirability of end-states. Each line of research proposes specific ways in which the key variable moderates the relative effectiveness of gain- versus loss-framed messages and offers explanation for the underlying psychological mechanism. First, drawing upon prospect theory (Kahneman & Tversky, 1979), scholars have argued that gain-framed messages should be generally more effective than loss-framed messages when the promoted health behavior is used to prevent the onset of a health problem, whereas loss-framed messages should be more persuasive when the advocated health behavior aims to detect the presence of an illness (Rothman et al., 2003; Rothman & Salovey, 1997). Second, dual-process models (Chaiken et al., 1989; Petty & Cacioppo, 1986) inform the moderating role of issue involvement. It has been suggested that people with high issue involvement are persuaded more by loss-framed messages, whereas those with low issue involvement are persuaded more by gain-framed messages (Maheswaran & Meyers-Levy, 1990). Finally, regulatory focus theory (Higgins, 1997, 2002) suggests that the fit between the type of goals (approach or avoidance) and the means through which to pursue them (eager or vigilant) produces a sense of feeling right, which can be transferred to the evaluation of messages or facilitate message processing. With this reasoning, a number of scholars have argued that gain-framed messages are more effective than loss-framed messages when the messages are anchored by desirable end-states (Lee & Aaker, 2004; Nan, 2007a) or when the message recipients have approach motivations (Mann et al., 2004). On the other hand, loss-framed messages should enjoy a persuasive advantage when the messages focus on undesirable end-states or the message recipients hold avoidance motivations.

In conclusion, multiple psychological processes regulate the relative persuasiveness of gain- versus loss-framed messages. To date, these psychological processes have been investigated in isolation. There is in general a lack of effort to integrate the different theoretical perspectives into a broad theoretical framework based on which the relative effects of message framing can be understood. To what extent do these processes differ qualitatively from each other? Is there a common mechanism underlying all four processes? Scholars have argued that a similar psychological mechanism may be at work with regard to the moderating role of the type of health behavior and the moderating role of desirability of end-states (Rothman et al., 2006). This common mechanism is regulatory fit. Health messages promoting detection behaviors may naturally induce prevention mindsets, whereas those advocating prevention behaviors are likely to prime promotion mindsets. Thus, gain-framed prevention messages are more effective than loss-framed prevention messages. On the other hand, loss-framed detection messages are more persuasive than gain-framed detection messages. Further, the moderating role of desirability of end-states and the moderating role of approach/avoidance motivation are both predicted by the principle of regulatory fit. If regulatory fit explains three of the four moderating variables that have been documented, what role does issue involvement play in this big picture? Rothman and Salovey (1997) argue that for message framing to have any effect, the message must be processed with some depth. Thus, the principle of regulatory fit in message framing effects may only hold when people have sufficient motivation and ability to process the message. When motivation or ability to process the message is minimal, message framing should make no difference in persuasion. When motivation or ability to process the message is low, Maheswaran and Meyers-Levy (1990) argue that people actually have a tendency to respond more favorably to gain-framed messages as the positivity of message valence appears to serve as a peripheral cue in attitude formation.

Recent developments in message framing research suggest that peripheral processing may not be the only mechanism that leads to a persuasive advantage of gain-framed messages. Another psychological process involving psychological reactance may play a role in inducing more negative responses to loss-framed messages relative to gain-framed messages. The theory of psychological reactance (Brehm, 1966; Brehm & Brehm, 1981; Wicklund, 1974) suggests that people like to have the freedom to do certain things. When the freedom to engage in or not engage in a certain behavior is threatened or eliminated, individuals will experience reactance, a motivational state that leads them to restore their freedom. In the context of persuasive communication, freedom restoration often involves message derogation, source derogation, negative thoughts, anger, and boomerang effects (i.e., adopting the forbidden act). Recent studies have shown that loss-framed messages are often perceived as a greater threat to freedom and induce more psychological reactance than gain-framed messages (Nan, 2007b; Quick, Bates, & Wang, 2008; Reinhart, Marshall, Feeley, & Tutzauer, 2007; Zhao & Nan, 2010). For these reasons, loss-framed messages have been found to be less effective than their gain-framed counterparts (Nan, 2007b; Quick et al., 2008; Reinhart et al., 2007).

Overall, extant research on message framing has generated significant insight into the important inquiry of the relative persuasiveness of loss- versus gain-framed messages. The implications of the theory of psychological reactance for the study of message framing have only begun to be explored. More research is needed to further our understanding of how psychological reactance may play a role in message framing effects. More importantly, more research is needed to integrate the different theoretical perspectives that have been cited to explain message framing effects. An integrated view based on regulatory focus theory, dual-process theories, and the theory of psychological reactance appears to be promising. However, whether and how prospect theory offers explanatory power over and above these theories still needs to be determined. Recent studies showing a greater persuasive advantage for loss- versus gain-framed messages demonstrate strong applicability of prospect theory in message framing (Abhyankar et al., 2008; Ferguson & Gallagher, 2007; Gerend & Shepherd, 2007; Gerend et al., 2008). The extent to which prospect theory can be integrated into the broad framework needs to be considered. In line with the effort of developing a more integrated framework, empirical studies that examine the role of multiple moderating variables in a single design will provide appropriate tests for such a framework. Finally, how message framing can be strategically used in promoting recuperative behaviors calls for more systematic inquiry. Investigating message framing effects in promoting a complete spectrum of health behaviors and appreciating the differences within each broad type of health behaviors (e.g., vaccination versus exercise as prevention behaviors) will offer important theoretical insights into how message framing works in health communication.

While research on message framing effects offers a number of guidelines for how to construct effective health messages, to be able to truly follow these guidelines in practice would require significant formative research designed to pretest and evaluate alternative messages before the launch of a full-scale communication campaign. Formative research will provide insights into which framing executions are effective for particular combinations of topics and message recipient-related characteristics. Health communication has been increasingly recognized as an important component to comprehensive national/local programs that seek to protect and promote public health. Whether in the area of healthcare delivery or in the realm of health promotion, effective communication is often key to success. Applying what we know about persuasive communication in general, and message framing effects in particular, to the development of health communication messages is a critical step toward improving communication effectiveness and, ultimately, individual health and well-being.

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