Accentuate the negative: ‘Loss framing’ improves habits in osteoarthritis over positivity
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Warning patients with osteoarthritis of potential negative consequences of inaction may be more effective in changing behaviors than urging positive action, according to a speaker at the 2022 OARSI World Congress.
“Successful treatment of osteoarthritis is strongly dependent on health behaviors,” Jeanne M.H. Oomen, MA, of Sint Maartenskliniek hospital in the Netherlands, told attendees.
She stressed that it is essential to find ways to help patients with OA improve in two types of behaviors: Physical activity and pain medication adherence.
The current study began with 638 patients aged 40 years or older enrolled at multiple sites across the Netherlands. Ultimately, 154 patients were included in the analysis. The cohort was 71% women.
“They were slightly overweight,” Oomen said, and noted that many had experienced OA symptoms for more than 5 years and often demonstrated more than one comorbidity.
Participants were stratified to receive brief messaging interventions aimed at improvement in the targeted behavior domains. There were eight key messages overall, each with subtle differences in tone and content.
Some of the differences pertained to “loss framing” vs. “gain framing.” Loss framing is explaining the negative consequences that may occur if the patient did not adhere to a physical activity or medication program, according to Oomen. Gain framing, meanwhile, is explaining the positive impacts that may come from adherence.
“Gain framing has previously been found to promote physical activity in older adults,” Oomen said.
Other differences in the messaging included testimonials from other patients vs. facts and information.
“Patients listen to the experience of other patients,” Oomen said. “We wanted to see whether use of such a testimonial could enhance their beliefs [on the targeted behaviors]. Patient testimonials can engage the reader. They are difficult to disagree with.”
The intention of patients to change or improve behaviors were assessed using a seven-point Likert scale. The researchers also used the Treatment beliefs in knee and hip OsteoArthritis (TOA) questionnaire.
According to Oomen, the results showed that, overall, patients generally agreed with the messaging, regardless of how it was framed.
However, the researchers found that loss framing had more positive impacts on patient intention than gain framing in attitudes about both physical activity and medication adherence.
“Loss framing is creating more positive beliefs than gain framing,” Oomen said.
She then offered some practical advice for clinicians: “It might be better to say, ‘If you don’t use your pain medications, your condition will get worse,’ rather than, ‘If you do use your medications, you will feel better.’”
It is important to consider that gain framing is still widely used in doctor-patient communications, according to Oomen.
“We found the opposite is actually more effective,” she said.
Regardless of the content of the communication with a patient, Oomen stressed another important take-home message of the study.
“It showed that even subtle changes in what you say to your patients can have a significant effect,” she said, noting that the intervention in the current study was only about 10 minutes. “Even a short consultation can make a significant difference in what a patient eventually believes.”
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Oomen JMH. Babs on a mission: An experimental study on the effects of message framing and exemplification on treatment intentions of osteoarthritis patients. Presented at: OARSI 2022 World Congress on Osteoarthritis; April 7-10; Berlin, Germany (virtual meeting).
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