Effects of Positive-Negative Message Framing on Health-Related Attitudes, Intentions, and Behaviors: A Meta-Analytic Review with particular focus on Health Behavioral Characteristics Moderators and Cultural-level Moderators

AbstractHealth message framing refers to ways information about favorable consequences of adhering to health recommendations and unfavorable consequences without adhering to health recommendations can be presented in influencing attitudes, intentions, and behaviors related to health (Cesario et al., 2013; Rothman et al., 2006; Joyal-Desmarais et al., 2022). 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 included three-level meta-analyses on message framing studies that aim to encourage healthy attitudes, intentions, and behaviors, with 1027 effect sizes, 350 studies and 318 reports from 72 countries. When comparing positive-framing (benefits and/or problems prevented through healthy behaviors) and negative-framing (benefits forgone and/or potential problems without engaging in healthy behaviors), we found tentative evidence of positive-framed advantage for health promotion and/or illness prevention and found support for very small negative-framed advantage (g = -0.08) for health detection. Furthermore, we found inconclusive evidence for moderation of behavioral frequency, with a very small positive-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-white, collectivistic, and survival-oriented cultures/samples (gs = -0.28 to -0.29), and tentative evidence for gain-framing advantage for western-white and individualistic cultures (g = 0.09). 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 examining mechanisms.Keywords: message framing, health behavior, behavioral function, cultural moderation, meta-analysisPublic Significance StatementResearchers, policy makers, and healthcare providers are confronted with challenging decisions when selecting message frames to promote different healthy behaviors among individuals from diverse cultural backgrounds. Our meta-analysis found that negative-framing slightly outperforms positive-framing for health detection, and loss-framing was more effective than gain-framing for people from non-white, survival-oriented, and collectivistic cultures/samples. We discussed implications and recommendations for researchers and practitioners in recognizing potential impact of culturally-congruent framing, while assessing the potential benefits, costs, and risks of message choices.