The effects of message framing on self-management behavior among people with type 2 diabetes: A randomized controlled trial.

ABSTRACT

BACKGROUND: Message framing describes how information is communicated and demonstrated to influence its effect on future attitudes and behaviors. Message content can be structured as 'gain-framed', emphasizing the benefits of engagement as recommended, whereas 'loss-framed' describes the negative consequences of not engaging as recommended. However, the impact of message framing on behavior change in people with chronic diseases like diabetes is not well understood. OBJECTIVE: Analyze the impact of message framing in diabetes education on self-management in people with type 2 diabetes, and identify potential moderating effects of patient activation on message framing. DESIGN: A three-arm randomized controlled trial was performed. SETTING(S) Participants were recruited from inpatients in the endocrine and metabolic unit of a university-affiliated hospital in Changchun. PARTICIPANTS: A total of 84 adults with type 2 diabetes were equally randomized into gain-, loss-, or no-message framing groups and received a 12-week intervention. METHODS: Both the message framing groups received 30 video messages. One group of participants received the gain-framed messages emphasizing desirable outcomes from effective diabetes self-care. The other group of participants received the loss-framed messages emphasizing the undesirable consequences of ineffective diabetes self-care. The control group received 30 videos about diabetes self-care without message framing. Self-management behavior, self-efficacy, patient activation, diabetes knowledge, attitudes, and quality of life were measured at baseline and 12 weeks. RESULTS: Compared with the control group, participants who watched either gain or loss-framed messages had significant increases in self-management behavior and quality of life after the intervention. The scores of self-efficacy, patient activation, knowledge, and attitudes of the loss-framing group were considerably higher than the control group. Further analysis revealed an interaction between patient activation and message framing (P = 0.002), with gain and loss message framing interventions more effective in increasing self-management behaviors in people with type 2 diabetes who had a higher and lower activation level, respectively. CONCLUSIONS: Using message framing in diabetes education is a promising strategy to build and foster self-management behavior. It also suggests that appropriate message framing be chosen to enhance self-management behavior based on the level of patient activation. REGISTRATION NUMBER ChiCTR2100045772.