An Updated Meta-Analysis on Goal Message Framing for Encouraging Healthy Behavioral Attitudes, Behavioral Intentions, and Behaviors – Investigating Health Behavioral Characteristics Moderators and Cultural-Level Moderators

Health goal message framing refers to ways information about favorable consequences of healthy behaviors and unfavorable consequences without engaging in healthy behaviors can be presented in influencing attitudes, intentions, and behaviors (Rothman et al., 2006). Some findings have been mixed and sometimes contradictory while hundreds of studies have been conducted since the previous large-scale meta-analysis on health message framing (Gallagher & Updegraff, 2012). This project includes three-level meta-analyses for message framing studies that aim to encourage healthy attitudes, intentions, and behaviors, with 836 effect sizes, 307 studies and 273 reports from 23 countries. When comparing pleasure-framing (benefits and/or problems prevented through healthy behaviors) and pain-framing (benefits forgone and/or potential problems without engaging in healthy behaviors), we found inconclusive evidence of pleasure-framed advantage for health promotion and/or illness prevention and found support for very small pain-framed advantage (g = -0.09) for health detection. Furthermore, we found evidence for moderation of behavioral frequency, with a very small pleasure-framed advantage for frequently repeated behaviors. When comparing gain-framing (benefits through healthy behaviors) and loss-framing (detriments without healthy behaviors), we found substantial cultural differences, with loss-framing outperforming gain-framing for people from non-western, collectivistic, and survival-oriented regions (gs = -0.27 to -0.28). Findings showed inconclusive evidence for moderations of indulgence-restraint, power distance, and dialecticism. Implications and directions, including culturally-congruent health communication (Betsch et al., 2016), more analyses and research on real-world benefits, costs, and risks of message framing choices as well as more realistic effect size expectations for sample size determination, were discussed. We also called for more multi-regional studies, experiments that tease apart confounds, and studies on mechanisms.Keywords: message framing, health behavior, behavioral function, cultural moderation, meta-analysis