We respond differently to the same facts depending on whether it presents either as a gain or a loss; that is what the Prospect Theory says.
We go for the sure gain even if it is perceived as smaller than the much more significant unsure gain. But, we go for the riskier option if we perceive the other option as a sure loss.
Read more about the Daniel Kahneman and Amos Tversky’s Prospect Theory here.
How can we use the Prospect Theory to frame messages?
Consider the following scenario:
Scenario 1:
Tversky and Kahneman presented the following hypothetical scenario to a group of students.
They requested students to think of an impending epidemic that would be expected to cost 600 lives. They also presented two public health interventions to save lives.
However, they frame the two interventions in two frames:
- The survival frame
- Mortality frame.
Survival frame (gain frame):
| Program A | may save 200 people. |
| Program B | may save one-third of all people. |
Mortality frame (loss frame):
| Program A | may die 400 people. |
| Program B | may die two-thirds of all people. |
Kahneman and Tversky found that the students chose program A when the programs were presented in a survival frame (gain-frame).
But, the same group chose program B when the programs were presented in a mortality frame (loss frame).
Message framing in clinical care:
Survival frame or mortality frame for medical doctors
Consider the following scenario;
Scenario 2:
A patient is consulting a doctor for cancer treatment; it carries the following five-year death and survival rates;
- 70 per cent death rate
- 30 per cent survival rate
The doctor uses the following survival frame:
- You will have a 30 per cent survival chance for this treatment.
On the other hand, the doctor can use the death frame as follows:
- You will have a 70 per cent death rate if you choose this treatment.
How to remove this framing effect?
- Give the complete information.
That is what Gerd Gigerenzer of the Harding Centre for Risk Literacy and Centre for Adaptive Behaviour and Cognition, Berlin, suggests. Then, according to him, the framing effect disappears.
Message framing in public health:
As in the above scenario, we can frame our health messages under two frames of reference:
- Gain-framed
- Loss-framed.
Gain-framed messages versus loss-framed messages examples
Following are several examples of gain-framed messages;
| Gain-framed messages | Loss-framed messages |
| If you exercise regularly, you will lose weight. | If you do not exercise regularly, you will gain weight. |
| Mammogram study: If you do mammograms regularly, you are doing your best to detect breast cancer at the earliest stage. (Gain-framed message highlighting a favourable outcome for doing it.) | If you are not doing mammograms regularly, you will miss the chance of detecting breast cancer at its earliest stage. (Loss-framed message highlighting the failure to achieve a favourable outcome for not doing it.) |
| Mammogram study: If you do mammograms regularly, you are doing your best to avoid detecting breast cancer at its late stages. (Gain-framed message that highlights avoiding an unfavourable outcome for doing it.) | If you do not do mammograms regularly, you will end up detecting breast cancer at late stages. (Loss-framed message highlighting an unfavourable outcome for not doing it.) |
| Cancer nursing study: If you eat high in fruits and vegetables, you will have more energy and are more likely to maintain a healthy weight. (Short-term gain-framed message). | If you do not eat high in fruits and vegetables, you will have less energy and be more likely to be overweight. (Short-term loss-framed message) |
| Cancer nursing study: If you eat high in fruits and vegetables, you will have a lower risk of cancer over your lifetime. (Long-term gain-framed message). | If you do not eat high in fruits and vegetables, you are more likely to develop cancer over your lifetime. (Long-term loss-framed message). |
A few more examples can be found in detail in the following two posts;
- Message framing effect on vaccine hesitancy; here, the messages are framed highlighting its benefits to society and the vaccine receiver themselves.
- Message framing effect on climate crisis messages; here, the post reviews research that focused on current versus future outcomes.
Gain-framed messages to promote healthy behaviours
We cannot use all message types in one go. Ideally, we need a pre-test with the above message types. However, researchers have meta-analyzed 94 studies published until 2012 and found the following;
Gain-framed messages appear to be more effective than loss-framed ones in promoting healthy behaviors;
Kristel M. Gallagher, M.A., John A. Updegraff, Ph.D., Health Message Framing Effects on Attitudes, Intentions, and Behavior: A Meta-analytic Review, Annals of Behavioral Medicine, Volume 43, Issue 1, February 2012, Pages 101–116, https://doi.org/10.1007/s12160-011-9308-7
Rothman and Salovey (1997) emphasize salient points we should remember when framing messages to promote healthy behaviours.
- Gains and losses are perceived in terms of the expected outcome relative to a reference point which is determined by the target audience.
- Message framing research invariably compares the two options – either a gain or a loss – hand in hand in terms of the outcome.
The second one is not easy when we attempt in applying the theory. According to them, we need to take a stand on which approaches to use: either gain-framed or loss-framed.
Even when we try to determine the approach what is more important is how the target audience perceives the outcome not the actual likelihood of the occurrence of the outcome.
They cite an example to explain this: consider breast self-examination. By doing this, one has to face the risk of detecting a lump which is a very unpleasant experience: A loss!
We have more evidence of how gain-framed messages promote healthy behaviours in the following domains;
Message framing effect on smoke cessation:
The following image is from research carried out to recruit Latino smokers for a smoking cessation program. They have used the gain-loss framing effect here.
under the CC-BY-2.0 licence.
The prospect theory applies only gain and loss framing effect. However, we can use other cognitive biases in message framing; one is heuristics.
In 1997, Alexander Rothman & Peter Salovey suggested that loss-framed messages would promote disease detection (screening) behaviours. However, more recently, in 2016 another group of researchers argued that this narrative is problematic.
