However we found mixed results for the belief in

However, we found mixed results for the belief in importance factor. In some cases, such as speaking to a health care professional, it neuronal nitric oxide synthase predicted greater likelihood of future action. However, in other cases such as speaking to family and friends and a message grabbing the individual’s attention, it predicted lesser likelihood of the action. One interpretation is that this indicates belief in importance calls for stronger and more definitive action on the part of the individual. In any case, increasing belief in the importance of clinical preventive services appears to be an importance objective, but how best to accomplish it? Our experiment was designed to investigate the influence of different frames on message receptivity, understanding, and belief in importance of guidelines. As such, it was a study of the comparative effectiveness of messages. We found that the loss frame was associated with increased intentions to speak to family and friends about preventive services. Given that family and friends would presumably be among the “first stops” as an individual becomes more informed about guidelines and preventive services, this may indicate the loss-framing increases contemplation (rather than action) to make informed decision and follow guidelines in personal care. Following the Transtheoretical model, promoting contemplation is an important step, but an early one that would not alone be sufficient to change behavior (Prochaska, DiClemente, & Norcross, 1992). Also, a balanced message frame was associated with likelihood to follow U.S. Preventive Services Guidelines. However, no other framing effects were observed in the experimental study, and no effects were observed over time in change of beliefs relative to treatment groups. The lack of other significant framing effects suggests two competing hypotheses that deserve further investigation. First, the relatively information-poor, briefly presented, text-only messages used in this experiment are insufficiently persuasive and informative to lead to behavioral effects. Previous research suggests that graphic, interactive, and repeat presentation (ie, higher dosage) of messages is required to produce meaningful effects (Evans et al., 2009; Hornik, Jacobsohn, Orwin, Piesse, & Kalton, 2008). Because there is scant evidence in the preventive services and informed decision making literature on these points (Evans et al., 2009), more research is needed to test whether enhanced, information rich messages would have greater effects on preventive services outcomes. Second, it is possible that messaging in simple text mode, without elaboration or other sources of stimuli, is simply insufficient to have behavioral effects. Based on work in public health promotion, such as tobacco control (Centers for Disease Control and Prevention, 2015; Evans, Davis, & Farrelly, 2008), it may be that multiple types of interventions involving the various levels of social ecology (e.g., interpersonal, community, media, policy) are required to produce meaningful effects on preventive services outcomes. Field based studies to examine larger campaigns to change health care consumer behavior would be needed to examine this important hypothesis.
Conclusion Prior research demonstrates that health care consumers generally are not well informed about evidence-based care and that they hold beliefs and values that interfere with optimal decisions, including the belief that more care is almost always better (Kivinieme & Hay, 2012; Allen, Solberg Nes, Marnach, Polga, & Jenkins, 2012). Additionally, attempts to inform consumers about treatments and tests that are overused and often unnecessary (such as the Choosing Wisely campaign) face the difficult challenge of telling people “what not to do.” (Briss, Rimer, & Reilley, 2004) In other areas of health behavior and health care promotion, use of elaborated messaging using graphic, video, and narrative story (e.g., a doctor and patient communicating successfully about guidelines) and case study methods have been shown to be highly effective (Harmon, 2011). Yet no such approach has been applied in promotion of preventive services guidelines in health care (Lantz et al., 2016). Further, no comparative effectiveness research has been conducted on the relative benefits of specific enhancements and elaborations, such as video versus narrative text-based messages to promote patient-provider communication about preventive services (Andrade, Evans, Edberg, Cubana, & Cleary, 2015). This study starts the process of filling those gaps and demonstrate comparative effectiveness of messages for PSA screening and Pap test decision making (Hoffman, Elmore, Fairfield, & Gerstein, 2014).