Comprehensive Exams/Dr. Roxanne Parrott
Nan Yu/March 10, 2008
Discuss theoretical approaches to the concept of message framing. Include a
discussion of the key constructs, predictions, and findings for 1) media framing and
framing analysis, and 2) prospect theory (loss and gain frames). Place particular
emphasis on the predictions and findings related to health.
The term “framing” can have different meanings toward scholars in
communications. For those who concern about how public issues are conceptualized in
the media, framing means the representation and interpretation of public events in the
news or other media outlets. For those who concern about how tailored messages can
influence people’s attitudes or behaviors, framing means one type of systematically
persuasive effect of messages or appeals.
In the following discussion, I will first review the applications of media framing in
the research related to health issues. Then, I will continue the discussion and emphasize
on the theory of message framing, an approach that has been central to the strategic
health communication research.
1) Media framing and framing analysis
Media Framing
In a broad sense, frames are ways people organize their
understandings and make sense about the social world (Pan & Kosicki, 1993; Reese,
2003). Rooted in a social constructionist perspective, frames can be understood as
“organizing principles that are socially shared and persistent over time, that work
symbolically to meaningfully structure the social world ”(Reese, 2003, p.11). In other
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words, studies of media framing provide the socially recognized interpretation of public
issues and allow the whole society to understand the social reality based on these frames.
From this perspective, framing analysis primarily refers to the approach to understand
how different social actors collectively produce these organized ideas that make sense of
the world (Gamson & Moligliani, 1987).
News media has been the focus of framing studies given that they consistently
provide flow of information to the mass audience about a variety of issues and events.
Over the past several decades, scholars have been trying to find out how media uniquely
(or universally) interpret social issues and events through the use of symbolic devices,
such as metaphors, exemplars, visuals, repeated words, quotes, emotional appeals, or
themes (Gamson & Modigliani, 1989). The significance of these researches lies in a sense
that the choices of languages by the media may serve as a basis for the general
understanding of the public issues.
Following this approach, scholars emphasize on how frames manifest themselves
in the text (Entman, 1993). Through framing studies of the media content, scholars can
investigate the patterns in the way issues are presented and discussed in the news or other
media content. Furthermore, by examining these patterns, scholars discover what Gamson
and Modigliani (1989) referred to as “interpretive packages (p. 2).”
Studies of understanding and identifying media frames (interpretive packages)
have normally focused on the salience and media selection of certain frames by looking
at what was included and what was left out, or by look at what was emphasized or
de-emphasized (Entman, 1993; Reese, 2003). Entman (1993) continued to argue that this
selective interpretation of societal events is to “promote a particular problem definition,
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causal interpretation, moral evaluation and/or treatment recommendation (p. 52).”
Another root of media framing studies originates from cognitive science. The
researchers from this approach emphasize at specific effects of frames on audience (e.g.
Iyengar, 1991). For example, Iyengar (1991) proposed that news stories could be either
“episodic” or “thematic.” Episodic frames emphasize on specific cases or events, whereas
thematic frames concentrate on general and background information of the issue. The
author stated that episodic frames might inhibit the understanding about the whole issue
and could reduce the chance alleviate related problems (Iyengar, 1991).
Health issues constantly come into sight in the public debates and media coverage.
Media frames are considered as an important way that media reflect and interact with the
public’s understanding of a health issue (Menashe & Siegel, 1998). Understanding how
an issue is framed in the mass media provides a basis for understanding how the public
perceives an issue, or at least what type of sense-making interpretation may have impacts
on public perceptions of the health issue (Menashe & Siegel, 1998). In the following
discussion, I will review some of the studies in most recent literature pertaining to the
framing of a variety of health problems and issues in the media.
Framing cancer
Cancer has been central to the studies pertaining to the
coverage of health issues in the media. For example, Andsager and Powers (2001)
discovered that U.S. women’s magazines emphasized on frames such as coping strategies,
personal examples and risk factors. In addition, the angels of the reports highlighted the
needs of women.
In addition, Jennifer (2007) discovered five major frames used in cervical cancer
stories in U.S. popular women’s magazines. The frames the author revealed were
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consciousness-raising, confusion in abnormality, controversy, innovation/medicalization,
and differences across identities. However, the study found the coverage of interventions
was little in the magazines.
Some scholars emphasized on investigating the frames that indicate consequences
of cancer. For example, Jae-Hwa and Glen (2006) suggested that the coverage of cancer
concentrated more on individual burdens (e.g. physical, psychological, social, economic
and medical costs of cancers on individuals) rather than social burdens (e.g. economical,
environmental and policy-related costs).
Brown et al. (2001) investigated how the causes of breast cancer were covered in
daily newspapers, newsweeklies, science periodicals, and women’s magazines in the U.S.
The authors revealed that coverage didn’t emphasize on possible environmental causation,
or corporate and governmental responsibility to the increasing of the disease. Most the
coverage emphasized on individual responsibility for diet, age at birth of first child, other
personal behaviors, and genetic causation. In general, the reports in the print media made
the personal responsibility of preventing the disease more salient in the coverage and
de-emphasized the influences of external forces.
Framing smoking
Smoking was another major health problem that has attracted
attention from media scholars. For instance, Menashe and Siegel (1998) did an extensive
examination of the frames in The New York Times and The Washington Post from 1985 to
1996. They discovered that frames that were used to support more controls over tobacco
industry included deceit/manipulate (e.g. smoking ads convincing people that tobacco is
harmless), nonsmokers’ right (e.g. second-hand smoking), smoking kids, and smoking as
a killer. Frames that support the tobacco industry emphasized on positive economic force,
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morality (e.g. smoking is not morally wrong), and free speech/legal products (e.g.
tobacco ads are legal). The authors further argued that the competition of these frames in
the media invoked a public debated over the tobacco issues.
Durrant, Wakefield, McLeod, Clegg-Smith and Chapman (2003) suggested that
the most frequent themes related to smoking issues in national and State capital city
Australian newspapers were second-hand smoking, education, prevention, and cessation
programs and services. The authors also stated that a majority of the coverage showed
positive attitudes towards (i.e. over 60 percent) tobacco control.
Long, Slater and Lysengen (2006) found an opposite pattern among the U.S.
media. After examining the daily newspapers, local and TV newscast, and national news
magazines, they discovered that there was little coverage on the negative effects of
smoking toward health. Therefore, the media didn’t provide a rationale for tobacco
control. In addition, there was little coverage of smoking issues on TVs, but more on the
newspapers.
Framing STDs or HIV/AIDS
The framing of HIV/AIDS and sexually
transmitted diseases (STDs) were constantly investigated by communication scholars
over the past several decades. One of the recent pieces from Davidson and Wallack (2004)
found that U.S. national newspapers in general lacked detailed coverage of STDs
(including HIV/AIDS). More specifically, only fewer than 20 percent of the stories
mentioned the STDs’ cause, transmission, preventions, treatment and symptoms. The
authors also discovered that the news reports of STDs failed to reveal the consequences
of sexual behaviors. The authors suggested that the information in the print media about
STDs was not accurate or detailed enough and could create confusion about the STDs
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(Davidson & Wallack, 2004).
Rogers, Dearing and Chang (1991) provided one of the early evidence on the
coverage of HIV/AIDS in the U.S. news media. They found that the news stories about
government actions for anti-AIDS and those reporting scientific findings about AIDS
were the dominant themes in six of the major mass media outlets in the United States
during 1980s. However, Brodie, Hamel, Brady, Kates & Altman (2004) found the leading
frames were HIV prevention and transmission in a variety of U.S. media outlets.
Some researchers focused on how HIV/AIDS was covered in the media targeting
on specific ethnic groups. For example, Krishnan, Durrah and Winkler (1997)
investigated the coverage of HIV/AIDS in magazines targeting on African Americans.
They discovered that most of the stories emphasized on definitions, trends, prevention
and education of HIV/AIDS and paid less attention to the development of treatments and
new scientific findings related to HIV/AIDS. Also, the people with HIV/AIDS were
depicted as “emphatic and pessimistic (p.285).”
The studies pertaining the framing of HIV/AIDS even went beyond the U.S.
media and included media outlets in foreign countries such as China, Africa, Malaysia,
Portugal, Spain and Brazil (e.g. Wu, 2006; Pratt, Ha, & Pratt, 2002; Lim, 1995; Traquina,
2004). For example, Wu (2006) discovered the different patterns of HIV/AIDS coverage
in the wire stories from news agencies of China (i.e. Xinhua) and U.S. (i.e. AP). The
study revealed that for a long time, AP’s reports concentrated on anti-government frames
such as dishonesty/oppression, human rights abuser, and the incompetent, whereas
Xinhua emphasized on pro-government frames such as the defense, the progress, and the
ambivalence/ambiguity.
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Hoffman-Goetz, Friedman, and Clarke (2005) examined the coverage of
HIV/AIDS in Canada. They revealed that media portrayed the risk factors of getting
infected with HIV/AIDS emphasized more on unprotected sexual intercourse, and much
less on sharing needles for drug uses, blood transfusions, and mother-to-baby
transmissions. Prostitutes, homosexual men, sex sexual abuse victims, prisoners, and
women were portrayed as at-risk groups in the coverage (Hoffman-Goetz, Friedman, &
Clarke, 2005).
Framing new diseases
Scholars also paid lots of attention to the newly emerged
diseases or health risks such as avian influenza or severe acute respiratory syndrome
(SARS). For example, Dudo, Dahlstorm and Brossard (2007) examined the coverage of
avian influenza in the U.S. newspapers. They found out that the coverage of avian
influenza was dominated by episodic frames and sensationalism (e.g. emphasized on
worst-case scenarios and emotionally-charged languages). However, the coverage failed
to present information that could promote self-efficacy (e.g. how to avoid or treat the bird
flu). In another study, Wallis and Nerlich (2005) found out that the UK press framed
SARS as a killer and a plague. Chiang and Duan (2007) also investigated the conceptual
metaphors used for reporting SARS by looking at two newspapers in Taiwan and one
newspaper in mainland China. They found that SARS was portrayed as a natural disaster,
a war, and a political issue rather than medical discourse.
Summary
In sum, studies of media framing related to health issues primarily
followed the social constructionist perspective, in which scholars tried to examine what
information was selected by media and made salient. Scholars often used either
qualitative or quantitative analysis to investigate whether certain frames or themes were
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highlighted and stressed over time. In addition, the research of media framing related to
public health issues suggested that media frames were not static; they could change,
evolve, and shift over time (Menashe & Siegel 1998; Roger & Dearing, 1991).
Furthermore, the framing studies of health issues suggested that the frames used to
illustrate specific health issues might be different in various countries and cultures or
toward different ethnic groups (Wu, 2006; Traquina, 2004).
All of the research summarized above, along with other important research
associated with the media framing of health issues, suggest that mass media have served
as one of the important channels for the public to understand how diseases or health
problems are caused, transmitted, cured or how the medical treatment to illness has
developed (Dearing & Rogers, 1992). The significant and important educational role of
mass media in publicizing the knowledge of health and health problems cannot be
neglected and should be stressed. However, the role of mass media can have opposite
impacts when the coverage of health is biased, unbalanced, stigmatized, or containing
misleading and confusing depictions of the health issues (Davidson & Wallack, 2004;
Jennifer, 2007). Parrott, Efbert, Anderton and Sefcovic (2002) noted that “too often,
health messages intended to arouse fear fail to include message components to address
self-efficacy (p.64).” In other words, messages can educate people about the facts of a
disease but fail to inform people how to deal with it.
Since the idea of solely relying on the coverage of health issues via mass media
may not be completely reliable, health scholars and professionals started to give high
hopes on the strategic health communication campaigns for decades. They expect that the
strategically designed health messages can promote preventions or controls of diseases or
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illness (Parrott, et al., 2002). In the following discussion, I will review the key studies
related to message framing theory, which has attracted substantial attention from health
communication scholars.
2) Prospect theory and message framing
From a psychological perspective, many scholars have contributed their efforts in
investigate particular types of messages that may maximize the persuasive effects of
health information (for a review, see Rothman, Bartels, Wlaschin, & Salovey, 2006).
Message framing theory, developed from the perspective of prospect theory, has been
central to this line of research.
Prospect theory
The framing postulate of prospect theory has been used as a
steer for many studies regarding the persuasive messages and how they may facilitate an
initiation of a healthy behavior or a maintaining of a current healthy behavior.
Prospect theory suggests that people’s behavioral types are sensitive to how
message is framed. More specifically, people tend to avoid risks when potential gains or
benefits are salient, but tend to take risks when potential losses or costs are salient
(Tversky & Kahneman, 1981).
According to prospect theory, people can be either risk-averse or risk-seeking
depending on how their behavioral preferences are motivated. If a message emphasizes
the potential benefits or good outcomes of a particular behavior, people’s inclination to
avoid risks will be motivated. If a message emphasizes the potential losses and negative
consequences of a particular behavior, people’s willingness to take risks will be
motivated (for a review, see Rothman, et al., 2006; Salovey, Schneider, & Apanovitch,
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2002).
Message framing and health behavioral types
The theoretical framework
constructed by prospect theory allows researchers on message framing to predict a
message’s persuasive impact on people’s behavioral decisions.
Traditionally, the concept of “risk” in prospect theory has been operationalized as
“uncertainty” and Rothman et al. (2006) extend this approach in the domain of health.
Behaviors with uncertain outcomes are likely to be perceived as risky, as opposed to
behaviors with known or expected outcomes. In the health context, such uncertain
outcome behaviors are associated with disease detection, whereas certain outcome
behaviors are associated with prevention.
Within this framework, therefore, gain-framed messages are expected to be more
effective when promoting prevention behaviors and loss-framed messages will be more
effective when promoting detection behaviors. Detection behaviors involve a potential
risk of discovering a health problem. For example, making a decision to have a
mammography or HIV-test could be a risky decision; the result might not be pleasant. In
this scenario, loss frames would be more effective in motivating (risk seeking) detection
behaviors. Prevention behaviors involve reducing the risk of getting ill or maintaining
current health conditions. For example, making the decision to use a condom could
prevent or reduce the risk of getting infected with sexually transmitted diseases. In this
scenario, gain frames would be more effective in promoting the use of prevention
behaviors (e.g. to use a condom during sex intercourse) (Rothman et al., 2006).
A series of empirical studies have shown that loss frames are more effective than
gain frames in promoting detection behaviors such as mammography (Banks, et al., 1995),
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breast self-examination (BSE) (Meyerowitz & Chaiken, 1987), skin cancer examinations
(Block & Keller, 1995, Salovey, Pronin, Rothman, Zullo, & Leffell, 2001), HIV-testing
(Kalichman & Coley, 1995), use of plaque-detecting disclosing rinse (Rothman, et
al.,1999), and blood-cholesterol screening (Maheswaran & Meyers-Levy, 1990).
However, the framing effect of loss frames on detection behaviors could be moderated by
factors such as family history (Finney & Iannotii, 2002), race or income (Schneider, et al.
2001, Consedine, Horton, Magai, & Kukafka, 2007), the certainty of the outcome
(Apanovitch, McCarthy, & Salovey, 2003), and perceived risks (Meyerowitz, Wilson, &
Chaiken, 1991).
The advantages of gain frames in promoting preventive behaviors have been
supported by studies of framing effects across several domains, such as the use of
sunscreen to prevent skin cancer (Detweiler et al., 1999; Rothman, et al., 1993), the use
of condoms (Kiene, Barta, Zelenski, & Cothran, 2005), and smoking cessation (Wong &
McMurray, 2002). The persuasive impact of gain frames could also be moderated by
cultural characteristics of uncertainty avoidance (Reardon, et al., 2006), and gender or
issue involvement (Kiene, et al., 2005).
Some research suggested that message framing theory can go beyond the
operationalization of loss and gain frames. Gain frames can either emphasize on the
benefits of attaining a desirable outcome or avoiding an undesirable outcome. Loss
frames can either focus on the cost of accomplishing an undesirable outcome or the
failure to achieve a desirable outcome (Brendl, Higgins, & Lemm, 1995; Detweiler et al.,
1999). However, studies have revealed that no significantly difference was detected
between the two types of gain frames or between the two types of loss frames in terms of
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their effectiveness in the same context (Detweiler, et al., 1999).
Although a number of studies have provided fruitful evidence that gain- or loss
frames would effectively motivate people to either take actions to avoid risks or to seek
risks, some research has found no such effects at all (Lauver & Rubin,1990; Lalor &
Hailey, 1990). Rothman et al. (2006) stated that the mechanism through which loss- and
gain frames function was still unclear.
Moderating the effects of message framing
In this section, I will concentrate
on reviewing several studies that demonstrating the interaction effects between message
framing and other factors (e.g. other message frames, cultural variables, etc.), hoping
these studies could lighten the next steps of testing message framing theories and lead to
a better understanding of the theory.
The role of ethnicity Schneider et al. (2001) suggested that whether messages
containing elements targeting on a specific ethnic group or not (e.g. targeting solely on
Latina vs. targeting on African American, Latina, and White) could interact with
loss-gain frames. They discovered that videotapes with loss-framed messages and
targeting on multicultural groups were the most persuasive. The main effect of message
framing was not significant when the factor of ethnic orientation was introduced into the
message. This study implied that people’s ethnicity could play a role in moderating the
message framing effect.
The role of issue involvement
Rothman et al. (1993) explored the role of issue
involvement in moderating the effects of loss-gain frames. They revealed that for the
health issue like skin examinations to detect skin cancer, women showed more concerns
and thus more involved. Therefore, females and males in this context represented high
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versus low involvement toward the issue. The study found that loss-framed messages
were more persuasive to women (i.e. high involvement), whereas gain-framed messages
were more persuasive to men (i.e. low involvement). The authors further argued that the
loss frames with detection behaviors were more effective for people that were highly
involved in the issue.
The role of regulatory focus
Individuals can be either prevention focused (i.e.
want to feel safe and secure) or promotion focused (i.e. want to feel fulfilled and
accomplished) (Higgins, 1998). This factor is often denoted as regulatory focus and
considered as a personality factor. Apanovitch, McCarthy and Salovey (2002) suggested
that this distinction in personality (i.e. prevention-focused vs. promotion-focused) could
moderate the effect of message framing. More specifically, the authors found the
messages stressing on the benefits (gain frames) of HIV testing were more effective to
women who wanted to seek for desirable outcomes in life (promotion-focused) than to
those who wanted avoid undesirable outcomes in life (prevention-focused).
In addition, the authors discovered that the prevention/detection distinction could
be shifted depending on how people construed the goals of the behavior. For example,
HIV testing is generally considered as an early detection behavior and loss frames should
be more effective if following the predictions of message framing theory. However, this
study found the opposite pattern – the gain frames were more persuasive. The rationale
for this finding was that the female participants indicated that they wanted to take the
HIV testing so as to prevent their partners from getting the disease. In this context, the
HIV testing was not construed as an early detection behavior, but more as a preventive
behavior. Therefore, this finding was still consistent with the basic gain prevention/loss
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detection hypothesis of message framing theory, which predicts that gain frames should
be more effective for activating prevention behaviors (Apanovitch, McCarthy, & Salovey,
2002).
The role of mood
Wegener, Petty, and Klein (1994) indicated that pre-existing
mood would moderate the effect of message framing. More specifically, gain-framed
messages were more effective for people with happy moods, whereas loss-framed
messages were more persuasive for people with sad moods. However, the researchers
called for more studies to better understanding the interactions between mood or affect
and message framing.
The role of self-efficacy
Block and Keller (1995) conducted two studies to
investigate the relationships between perceived efficacy and depth of processing, as well
as perceived efficacy and message framing on the issue of skin cancer. They revealed that
low-efficacy conditions motivate more in-depth processing. In addition, the study showed
that negative frames are more persuasive than positive frames when in-depth processing
occurred. In contrast, when efficacy was high, the valences of the message frames was
less effective because individuals performed less processing for messages with more
certain behaviors.
The role of family history
Finney and Iannotti (2002) conducted a study in a
natural environment in which they tested the interaction effects between message framing
and family history. They sent letters of mammography to 929 randomly selected women
with having either a positive or negative family history of breast cancer. Each of the
women received one of the three letters with different frames (gain frames, loss frames,
or a neutral-valence letter). The authors discovered that the neutral letter was the most
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persuasive among the three especially for women with a positive family history after two
months of the message exposure. In addition, the framed letters (no matter gain- or loss
framed), actually decreased the compliance of mammography (Finney & Iannotti, 2002).
This study provided an example of how the message framing theory can be tested in a
more real and natural surroundings and investigated the role of family history in
moderating the message framing effect.
The role of cultural factors
Reardon, et al. (2006) conducted an experiment in
nine culturally different countries with a sample of over 2000 students. They found that
cultural factors (e.g. uncertainty avoidance: a society’s tolerance for uncertainty and
ambiguity) could moderate the effects of message framing. More specifically, they
suggested that loss-framed messages about the issue of anti-smoking were more
persuasive to young kids with high uncertainty avoidance than gain-framed messages.
The role of exemplars
Cox and Cox (2001) extended the investigation of the
effects of exemplars (anecdotes) by conducting a 2 (anecdotes versus statistics) X 2 (loss
versus gain) experimental study in the context of a health detection issue—the use of
mammography. The findings revealed that a loss-framed anecdotal message appeal is
more effective in promoting the likelihood of performing a mammogram than a
gain-framed anecdotal message appeal. In addition, the study demonstrated that people
that were exposed to the gain-anecdotal message appeal showed significantly less
susceptibility toward breast cancer and more positive emotions. Those who were exposed
to the loss-framed anecdotal message appeal demonstrated more negative emotions, such
as fear. This study is the only, or one of very few, which has investigated the combined
effects of exemplar-statistics and loss-gain message frames.
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The role of temporal frames
Chandran and Menon (2004) tested the interaction
effect of temporal frames and the outcome valence on the issue of heart disease. When
the outcome was framed negatively (e.g. lots of people succumb to heart disease) and it
happened every day, people demonstrated a higher perceived risk and severity toward
heart disease. They also become more anxious, thought the designed messages as more
persuasive, and more inclined to participate in educational and preventive behaviors.
Reverse patterns were discovered when the message framed positively (e.g. lost of people
avert heart disease) and occurred every year. This study is the only, or one of very few,
which has investigated the combined effects of time frames and loss-gain message
frames.
Summary
A substantial amount of research have revealed that the gain-framed
messages would be more effective in promoting prevention behaviors, whereas
loss-framed messages would be more effective in promoting detection behaviors (for a
review, see Rothman et al., 2006). This gain prevention/loss detection hypothesis of
message framing theory is rooted in the prospect theory in which the salience of gain or
loss of an issue will influence the decisions of how to cope with the risk – either to avoid
or seek for risks (Rothman et al., 2006). In addition, the gain frames might be
operationalized as either to achieve desirable outcomes or avoid undesirable consequence
of a health problem, whereas the loss frames could be operationalized as either to attain
undesirable consequences or fail to achieve desirable outcomes. Studies have shown that
the two different sets of operationalization could yield similar effects (Detweiler, et al.,
1999).
Although there were ample evidence demonstrating the compelling main effects
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of loss- or gain frames in activating certain health behaviors, a variety of factors would
interact these effects, such as regulatory focus (Apanovitch, McCarthy and Salovey,
2002), uncertain avoidance (Reardon, et al., 2006), family history (Finney & Iannotti,
2002), issue involvement (Rothman et al.,1993), mood (Wegener, Petty, & Klein, 1994),
or self-efficacy (Block & Keller, 1995). The effect of message framing would also be
influenced when loss- and gain frames were combined with other types of frames, such as
time frames (Chandran & Menon, 2004), ethnic orientation in the message (Schneider et
al., 2001), and statistics - and anecdotes frames (Cox and Cox, 2001). These studies
enriched the understanding of how the effect of message framing in a way that loss- or
gain frames would function differently among people with different personalities or
family background, or within people who were engaged in different moods or had various
levels of involvement with the health issue. These studies also extended the
loss-gain-frame scope and examined the effects of frame combinations within the same
message.
3) Ending notes
In sum, the media framing studies pertaining to health issues provided a basic
overview of how mass media construct a societal understanding of certain illness and
diseases. Studies that followed this perspective revealed a diverse pool of frames that
were existing in the mass media. Most these studies showed that journalists did a poor job
in disseminating the accurate or complete information about health issues. One of the
major criticisms was that mass media could successfully raise the salience or fears toward
a health problem but often failed to provide proper intervention strategies or address the
17
ways to combat the illness in the coverage (Parrott, et al, 2002).
In another scenario, scholars try to investigate the persuasive effects of the
messages that have been strategically designed and targeted on particular types of health
behaviors. The effects of gain- and loss- framed messages have attracted significant
amount of attention from scholars. In general, they suggested that the emphasis of gains
or losses in the message could have impacts on health decisions or behaviors in certain
circumstances. In addition, the effects could be moderated by other factors including
“characteristics of the message recipient, characteristics of the desired behavior, or both
(Rothman, et al., 2006, p. 216).”
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