Health Care Choices Uninfluenced by “Framing Effect” in Messages

Common sense tells us that how we say things matters at least as much as what we say. This may not be the case, however, with messages regarding health care options, according to Elie A. Akl, MD, PhD, the study’s lead author and an assistant professor of medicine, family medicine and social and preventive medicine.

Akl led a large-scale review, synthesizing data from 35 studies involving 16,342 participants to determine how framing—presenting the same option in different ways—affects health consumers’ choices.

If framing strongly influenced such decisions, it “would provide clinical and public health practice with an easy to use, inexpensive tool that could actually improve public health,” he says.

The study found the opposite: Framing shows “little if any consistent effect on behavior” in making a wide range of health choices, including using sunscreen, taking antihypertensive medications, using condoms, making follow-up appointments after abnormal Pap tests, scheduling mammograms and getting screened for HIV and prostate cancer.

The study results tally with other systematic reviews investigating what psychologists call the “framing effect.”

“While framing may improve a patient’s perceptions of a specific screening test, or his or her intentions to undergo it,” Akl says, “a multitude of other factors come into play and end up affecting behavior.”

How much information the patient gets, how personalized a message is and the use of statistics and visual information also shape our choices, as well as other factors, such as health services’ accessibility.

Concentrating on framing may obscure other avenues for improving patients’ understanding of and compliance with treatment, Akl says. The paper urges “a balanced presentation when producing patient information or decision aids,” emphasizing potential risks and benefits equally. Without “evidence for the superiority of one frame over the other,” patients may be best served by more broad-based messaging strategies.

Akl suggests that framing might have a more noticeable effect in certain circumstances, such as discussing particular health conditions. “Future research needs to investigate these conditions,” he says.

The study, “Framing of Health Information Messages”, appears in the Cochrane Database of Systematic Reviews.