Does message framing affect changes in behavioural intentions in people with psoriasis? A randomized exploratory study examining health risk communication

Figures & data

Figure 1. Health messages randomly assigned to participants.

Figure 2. Study flow diagram.

Table 1. Demographics of participants randomized.

Variable	N (%)
Gender^1
Male	75 (34.6)
Female	126 (58.1)
Did not state	16 (7.4)
Age^2 M (SD), Range	41.23 (14.31), 15–83
0–19	3 (1.4)
20–39	94 (43.3)
40–59	70 (32.3)
60–79	23 (10.6)
80>	1 (.5)
Did not state	20 (9.2)
Ethnicity
White British	178 (82)
White Irish	6 (2.8)
Mixed – White/Asian	2 (.9)
Asian or Asian British –Pakistani	1 (.5)
Asian or Asian British – Indian	5 (2.3)
Melanesian	1 (.5)
Mixed – Hispanic European	1 (.5)
White – Dutch	1 (.5)
Other White	1 (.5)
White European	2 (.9)
Welsh	1 (.5)
Chinese	2 (.9)
Did not state	26 (12)
Age of Pso diagnosis
<16	71 (32.7)
16–22 (early onset)	54 (24.9)
23–39	62 (28.6)
40–57	19 (8.8)
57> (late onset)	5 (2.3)
Self-reported Pso severity
Current
Mild	83 (38.2)
Mild to moderately severe	64 (29.5)
Moderately severe	42 (19.4)
Moderately severe to severe	13 (6)
Severe	9 (4.1)
Ever
Mild	18 (8.3)
Mild to moderately severe	24 (11.1)
Moderately severe	49 (22.6)
Moderately severe to severe	70 (32.3)
Severe	49 (22.6)
Did not state	6 (2.8)
Diagnosis of PsoA	40 (18.4)
Smoker
Ever	113 (52.1)
Current	42 (17)
Did not state	4 (1.8)
Meeting DOH guidelines for physical activity^3
Achieve this every week	86 (39.6)
Almost there, but not quite	54 (24.9)
Around half of recommended	33 (15.2)
A long way off recommended	41 (18.9)
Did not state	3 (1.4)
Typical month, how often do you drink alcohol?
Never	29 (13.4)
Once a month or less	43 (19.8)
2 to 4 times a month	66 (30.4)
2 to 3 times a week	49 (22.6)
4 or more times a week	28 (12.9)
Did not state	2 (.9)
Units of alcohol on a typical day
1–2	49 (22.6)
3–4	66 (30.4)
5–6	32 (14.7)
7–8	20 (9.2)
9+	21 (9.7)
Did not state	29 (13.4)
6 or more units on one occasion
Never	66 (30.4)
Less than monthly	73 (33.6)
Monthly	25 (11.5)
Weekly	38 (17.5)
Daily or almost daily	9 (4.1)
Did not state	6 (2.8)

¹ Gender UK psoriasis population characteristics (males 47.7%) according to Springate et al. (2017).

² Age Psoriasis UK population characteristics (0–19 years [12.1%), 20–39 years [29.6%], 40–59 years [31.4%], 60–79 years [22.8%], 80 > years [4%]) according to Springate et al. (2017).

³ The Department of Health recommends adults are moderately active for 2 and a half hours or vigorously active for 75 min each week. For example 30 min on at least 5 days a week.

Pso = Psoriasis; PsoA = Psoriatic Arthritis; DOH = Department of Health.

Table 2. Descriptive statistics for all primary and secondary outcome variables.

Variable	M (SD)
	Gain-frame			Loss-frame
	Psoriasis symptom reduction (n = 56)	CVD risk reduction (n = 56)	Overall	Psoriasis symptom reduction (n = 52)	CVD risk reduction (n = 48)	Overall
Behavioural intentions (Alcohol)	10.56 (6.30)	9.60 (5.33)	10.00 (5.74)	7.24 (4.56)	10.35 (5.15)	9.15 (5.13)
Behavioural intentions (Diet)	13.21 (5.37)	13.23 (5.55)	13.22 (5.45)	12.63 (6.04)	14.22 (5.78)	13.53 (5.91)
Behavioural intentions (Physical activity)	13.87 (5.27)	13.62 (5.71)	13.73 (5.50)	12.97 (5.19)	14.43 (4.89)	13.80 (5.04)
Emotional response to information	8.13 (4.46)	8.47 (5.34)	8.32 (4.95)	7.00 (5.10)	10.16 (4.91)	8.76 (5.21)

Table 3. Results of ANOVA examining effects of message framing and message focus on behavioural intentions and emotional responses to health messages.

Effect	df	F	P	Partial n^2
Alcohol intention
Message frame	1	2.081	.151	.013
Message focus	1	1.453	.230	.009
Message frame X message focus interaction	1	5.241	.023*	.032
Total	163
Diet intention
Message frame	1	.062	.804	.000
Message focus	1	.966	.327	.005
Message frame X message focus interaction	1	.903	.343	.005
Total	197
Physical activity intention
Message frame	1	.003	.956	.000
Message focus	1	.619	.432	.003
Message frame X message focus interaction	1	1.232	.268	.006
Total	201
Emotional response
Message frame	1	.145	.704	.001
Message focus	1	5.743	.018*	.029
Message frame X message focus interaction	1	3.752	.054	.019
Total	197

* Significant at the p < .05 level.

Table 4. Regression model for continuous (age and self-efficacy) and categorical variables on alcohol behavioural intentions (n = 165).

Model		R^2	ΔR^2	β	95%CI	p-value
1		.008	−.014
	Age			.049	−.055 to .080	.572
	Sex			.054	−1.395 to 2.593	.536
	Self-efficacy			.051	−.160 to .289	.554
2		.046	.004
	Age			.056	−.055 to .079	.514
	Sex			.035	−1.533 to 2.490	.692
	Self-efficacy			.047	−.162 to .284	.581
	Message frame			−.636	−13.506 to −1.072	.027*
	Message focus			−.441	−11.042 to .202	.085
	Frame X focus interaction			.784	.333 to 7.923	.040*
3		.121	.076
	Age			.098	−.042 to .088	.246
	Sex			−.014	−2.094 to 1.875	.870
	Self-efficacy			.119	−.077 to .369	.164
	Message frame			−.608	−12.874 to −.811	.028*
	Message focus			−.403	−10.478 to .430	.101
	Frame X focus interaction			.722	.079 to 7.448	.049*
	Risk category			.290	1.167 to 5.152	.001*

* Significant at the < .05 level.

Table 5. Regression model for continuous (age and self-efficacy) and categorical variables on diet behavioural intentions (n = 197).

Model		R^2	ΔR^2	β	95% CI	p-value
1		.144	.130
	Age			−.261	−.247 to .040	.157
	Sex			.046	−3.670 to 4.736	.801
	Self-efficacy			.266	−.114 to .808	.142
2		.153	.124
	Age			−.258	−.254 to .049	.185
	Sex			.050	−3.950 to 5.109	.799
	Self-efficacy			.269	−.137 to .839	.160
	Message frame			−.195	−16.303 to 11.831	.751
	Message focus			−.146	−14.369 to 11.061	.795
	Frame X focus interaction			.313	−6.949 to 10.211	.705
3		.228	.035
	Age			−.291	−.268 to .031	.131
	Sex			−.024	−4.918 to 4.261	.902
	Self-efficacy			.341	−.044 to .947	.080
	Message frame			−.303	−17.661 to 10.126	.617
	Message focus			−.263	−15.863 to 9.347	.636
	Frame X focus interaction			.376	−6.297 to 10.514	.641
	Risk category*			.314	−.831 to 5.692	.139

* model based on n = 36 with BMI data.

Table 6. Regression model for continuous (age and self-efficacy) and categorical variables on physical activity behavioural intentions (n = 201).

Model		R^2	ΔR^2	β	95% CI	p-value
1		.397	.387
	Age			−.177	−.113 to −.025	.004*
	Sex			.041	−1.092 to 1.465	.49
	Self-efficacy			.587	.540 to .796	<.001*
2		.402	.381
	Age			−.175	−.113 to −.024	.004*
	Sex			.037	−1.128 to 1.495	.55
	Self-efficacy			.586	.536 to .795	<.001*
	Message frame			−.127	−5.631 to 2.530	.51
	Message focus			−.054	−4.695 to 2.681	.760
	Frame X focus interaction			.170	−1.476 to 3.501	.513
3		.454	.432
	Age			−.188	−.117 to −.032	.001*
	Sex			.055	−.834 to 1.712	.35
	Self-efficacy			.613	.565 to .816	<.001*
	Message frame			−.137	−5.799 to 2.084	.46
	Message focus			−.075	−5.014 to 2.121	.66
	Frame X focus interaction			.195	−1.119 to 3.694	.43
	Risk category			−.231	−3.495 to −1.080	<.001*

* Significant at the < .05 level.

Springate, D. A., Parisi, R., Kontopantelis, E., Reeves, D., Griffiths, C. E., & Ashcroft, D. M. (2017). Incidence, prevalence and mortality of patients with psoriasis: A U.K. population-based cohort study. British Journal of Dermatology, 176(3), 650–658. doi:10.1111/bjd.15021

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