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Mesfin Awoke Bekalu 1,2 (MPhil) Steven Eggermont 1 (PhD) 1 KU Leuven, Belgium PowerPoint Presentation
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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.

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slide1
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, Belgium

2 Bahir Dar University, Ethiopia

framing health messages
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
framing
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)
framing1
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.
framing2
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).
framing3
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
framing4
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).
framing5
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:
framing6
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).
hypotheses
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.

hypotheses1
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.
hypotheses2
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.
hypotheses3
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.

methods
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.
methods1
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.
results
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.
results1
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.
results2

0.5

0.45

0.4

0.35

0.3

Gain

0.25

Loss

0.2

0.15

0.1

0.05

0

Low HIV testing experience

High HIV testing experience

Results...
  • Figure 1: Interaction effect of Gain- vs. Loss-framing with Experience with HIV Testing on Intention to Test for HIV
results3

0.18

0.16

0.14

0.12

0.1

Gain

Loss

0.08

Intention to test for HIV

0.06

0.04

0.02

0

Rural

Urban

Results...
  • Figure 2:Interaction effect of Gain vs. Loss framing with Urbanity vs. Rurality on Intention to Test for HIV
conclusion
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.
implication for intervention
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.
limitation
Limitation
  • The experiment used brochures and thus only literate participants were eligible.
acknowledgements
Acknowledgements:
  • KU Leuven
  • HIV Research Trust (funding the fieldwork part of this study)