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Framing HIV testing messages for urban and rural audiences: evidence from a field experiment in northwest Ethiopia. Mesfin Awoke Bekalu 1,2 (MPhil) Steven Eggermont 1 (PhD) 1 KU Leuven, Belgium 2 Bahir Dar University, Ethiopia. Framing health messages. - PowerPoint PPT Presentation
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Washington D.C., USA, 22-27 July 2012www.aids2012.org
Framing HIV testing messages for urban and
rural audiences: evidence from a field experiment in
northwest Ethiopia
Mesfin Awoke Bekalu1,2(MPhil)Steven Eggermont1 (PhD)
1 KU Leuven, Belgium2 Bahir Dar University, Ethiopia
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Framing health messages• One of the various ways of matching
messages with recipient characteristics.
• Different framing techniques such as temporal (e.g., Bonner & Newell, 2008), personal/relational (e.g., Ko & Kim, 2010) and gain- vs. loss (e.g., Rothman & Salovey, 1997; Schneider, 2006; Rothman et al., 2006
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Framing …• Relatively better empirical evidence for gain- vs.
loss-framed messages – messages that focus on the benefits of performing a recommended behavior and those that focus on the costs of failing to perform the behavior, respectively (Smith & Petty, 1996; Rothman & Salovey, 1997; Schneider, 2006; Rothman et al., 2006; Abhyankar, O’Connor, & Lawton, 2008).
• Framing research has identified differentials in effectiveness of gain- vs. loss-framing based on the type of health behavior promoted –prevention or detection (Rothman & Salovey, 1997)
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Framing …• Prevention behaviors: preventing the onset of
a health problem (e.g., condom use, sunscreen use, etc.) – better promoted by gain-framing.
• Detection behavior: detecting a health problem (e.g., HIV testing, mammography, etc.) – better promoted by loss-framing.
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Framing …• The prevention-detection classification,
although very important, does not always capture individuals’ construal of a given health-related behavior.
• Research focus shifted to specifying the optimum conditions in which gain- and loss-framed messages would be most effective (Devos-Comby & Salovey, 2002; Rothman et al., 2006; Latimer et al., 2007).
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Framing …• Optimum conditions such as direct/personal
experience and issue involvement.• Direct/personal experience – the primary
determinant of how people construe a given health behavior (Rothman et al., 2006).
• People with personal experience of testing for HIV are more likely to construe the behavior as a means of monitoring their health (whatever is the test result), whereas those without are more likely to perceive it as a means of detecting the presence of the virus
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Framing …• Issue involvement:• Prevention behaviors – gain-framed messages tend to be
more effective among individuals with high issue involvement, while loss-framed messages are more likely to be effective among people with low issue involvement (Millar & Millar, 2000;Jung & Villegas, 2011).
• Detection behaviors: loss-framed messages are more likely to be effective among individuals with high issue involvement, while gain-framed messages are more effective among people with low issue involvement (Maheswaran & Meyers-Levy, 1990; Banks et al., 1995; Meyers-Levy & Maheswaran, 2004; Jung & Villegas, 2011).
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Framing …• The prevention-detection classification
becomes particularly difficult when it comes to HIV testing.
• While primarily a detection behavior, HIV testing is being promoted as a prevention behavor across prevention contexts for two main reasons:
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Framing …• Biomedical: HIV testing ART viral load
suppression (e.g., Wilson et al., 2008; Attia et al., 2009).
• Behavioral: knowing status protect oneself and others (e.g., Valdiserri et al., 1999; Summers et al., 2000;Painter, 2001).
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Hypotheses:• Anticipating that HIV testing could be construed as
a prevention behavior, we hypothesized:H1 = A gain-framed HIV testing message will be more
persuasive than a loss-framed message among individuals with high experience with HIV testing.
H2 = A gain-framed HIV testing message will be more persuasive than a loss-framed message among individuals with high concern about and information needs on HIV/AIDS.
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Hypotheses...
• Moreover, we anticipated that urban residents will have much more direct experience and issue involvement with HIV/AIDS and HIV testing than rural residents.
• This assumption was made on two grounds: epidemiological and socio-ecological.
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Hypotheses...• Epidemiological – in most sub-Saharan
African countries, urban prevalence tends to be higher than rural prevalence, except Senegal (UNAIDS, 2009). Ethiopia, according to UNAIDS (2009), the urban-rural ratio was 8:1
• Socio-ecological – in most sub-Saharan African countries urban and rural contexts differ in social/cultural norms, life style, infrastructure, etc.
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Hypotheses...
• So, if urban residents have higher direct experience and issue involvement,
H3 = A gain-framed HIV testing message will be more persuasive than a loss-framed message among urbanites rather than ruralites.
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Methods• Gain- vs. loss-framed brochures were prepared. The
messages in each version were organized around four parallel topics – Gain Version: early actions, longer & healthier life, protecting loved ones from the virus, and peace of mind; Loss Version: delayed actions, shorter & unhealthier life, exposing loved ones to the virus, and worry (format adapted from Van‘t Riet et al., 2010).
• Brochures distributed to 394 participants (199 Urban: 46.2% male, 53.8% female; 195 Rural: 79% male, 21% female). Through pretest-posttest measures of intention to test for HIV, the relative persuasiveness of gain- and loss-framed messages was determined.
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Methods...• Univariate General Linear Model (GLM) was
employed to determine the main and interaction effects of the independent variables on the outcome variable.
• One covariate (Baseline Intention to Test for HIV), four independent variables (Gain- vs. Loss-framing, Experience with HIV Testing, Concern about and Information Needs on HIV/AIDS, and Urbanity vs. Rurality) and three interaction terms (Gain vs. Loss X Experience with HIV Testing, Gain vs. Loss X Concern about and Information Needs on HIV/AIDS, and Gain vs. Loss X Urbanity vs. Rurality) were entered into the model.
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Results
• Urbanity vs. rurality, F(1, 385) = 9.28, p < 0.01, η2 = .02;
• Experience with HIV testing F(1, 385) = 17.20, p < 0.001, η2 = .04;
• Concern about and information needs on HIV/AIDS, F(1, 385) = 18.97, p < 0.001, η2 = .05, significantly moderated the effects of gain- vs. loss-framing on Intention to Test for HIV.
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Results...• While urbanites, participants with more experience
with HIV testing and those with higher concern about and information needs on HIV/AIDS were motivated by gain-framing, ruralites and those with lower concern about and information needs on HIV/AIDS were motivated by loss-framing.
• Both gain-framing and loss-framing led to similar outcomes among individuals with low levels of experience with HIV testing, with a slight advantage for the loss-framed message.
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Results...• Figure 1: Interaction effect of Gain- vs. Loss-framing with Experience with
HIV Testing on Intention to Test for HIV
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
0.45
0.5
Low HIV testing experience High HIV testing experience
Gain
Loss
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Results...• Figure 2:Interaction effect of Gain vs. Loss framing with Urbanity vs. Rurality
on Intention to Test for HIV
0
0.02
0.04
0.06
0.08
0.1
0.12
0.14
0.16
0.18
Rural Urban
Inte
ntio
n to
test
for
HIV
Gain
Loss
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Conclusion
• Urbanites and ruralites are motivated by differently framed prevention messages.
• It was also noted that to the extent recipients are concerned about HIV/AIDS and are familiar with HIV testing, gain-framing is more advantageous, suggesting a possible construal of HIV testing as more of a prevention than a detection behavior in such situations.
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Implication for intervention
• If the findings of this study can be replicated in other contexts, urban and rural contexts may need differently designed (framed) messages.
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Limitation
• The experiment used brochures and thus only literate participants were eligible.
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Acknowledgements:
• KU Leuven • HIV Research Trust (funding the fieldwork
part of this study)
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Thank you!