Finding the Perfect Frame
Finding the Perfect Frame
However or wherever we acquire health information, understanding and remembering what we learn is only part of the story. Once we've navigated through the menus, clicked on the graphics, and landed in front of some text—a health news story, a set of recommendations for preventing cancer—how do the words we read influence our medical decision making?
That's where Alex Rothman's work comes in. Rothman, a professor of psychology, has spent years studying the kinds of messages that help consumers make good decisions about their health. The wording of a message, his research suggests, can make the difference between dental appointments kept and missed, between HIV tests taken and avoided, between tumors detected in their early stages and those found only after they've metastasized.
Rothman has focused, in particular, on people's responses to messages promoting healthy behaviors. He's found that when people see a medical procedure as something that could bring bad news—a diagnostic or screening test such as a mammogram, an HIV test, a prostate exam, for example—they are more likely to risk the procedure if they've been warned of the potential losses if they do not have it. “Decision-making work has shown that when faced with loss-framed information, people are more risk-seeking,� he says.
In other words, women are more likely to get mammograms, for example, if they hear “breast cancer could kill you if you don't get a regular mammogram� than “a regular mammogram is the best way to stay healthy.�
On the other hand, when we see healthy behaviors as relatively risk-free—unlikely to yield bad news—we're more likely to do them when we're told what we'll gain, Rothman says. People are more likely to lather up with sunscreen when they're promised healthy skin than when they're warned of the risks of not doing so; and they are more likely to brush and floss when they are promised a dazzling smile than to do so when they're warned of rotten teeth.
Rothman's work has important implications for people who communicate about health issues—everyone from doctors and dentists to public health officials to reporters working health beats. By framing messages promoting healthy behavior in ways that are tailored to the degree of risk people associate with the behavior, communicators of medical advice can increase the likelihood of compliance.
But that's not as easy as it sounds. “To the extent that there's great consensus, then one message might work,� says Rothman. “If we socialize people to think about mammography as an illness-detection behavior, then a message emphasizing the potential consequences of failing to get a mammogram will work pretty uniformly. On the other hand, to the extent that there's diversity in the way that people construe the behavior, then a single message doesn't work well.�
Take the dental visit, for example. For Rothman and those whose teeth have seen the sharp side of the dentist's drill, going to the dentist is a screening behavior—there's a risk that they'll get bad news. But for those who have never had a cavity, going to the dentist is a health-affirming behavior, an opportunity to get your teeth cleaned and your smile brightened.
That's why, for behaviors that are likely to be seen differently by different people, personalized communications may ultimately be more effective than one-size-fits all messaging. So Rothman has been looking recently at the impact of messages on reminder cards. “Within clinics, in theory, you can tailor the reminder card to what you know about your individual patient—especially in the age of
electronic records,� he says. So, for example, if a dentist has a savvy computer program and electronic records, her patients with a history of cavities will receive messages emphasizing the negative consequences of not getting their teeth cleaned, and those without cavities would receive messages emphasizing the benefits of continued dental check-ups. Both groups would end up in her waiting room in high numbers.
Rothman's findings are a testament to the double-edged nature of the rise of information technology. By enabling hundreds of channels and millions of Web sites, technology fragments us—we're socialized in hundreds of idiosyncratic media worlds, making one-size-fits-all messages difficult and ineffective. But even as it fragments us, technology has the potential to use our individual differences to get us to act in the same healthy ways.
- by Danny LaChance