This blog post, provided by the IPR Behavioral Insights Research Center and written by Dr. Terry Flynn and Tim Li, is based on a research paper by Rebecca Webster, MSc, John Weinman, Ph.D., & James Rubin, Ph.D.

Key Findings

  • Positively-framed information about side effect likelihoods can reduce the experience of side effects stemming from negative expectations, not actual drug effects.
  • The use of message framing does not appear to affect ratings of medical information’s credibility or patient satisfaction with it.

Implications for Public Relations

The findings of this study provide opportunities for communicators in healthcare to consider how the information they provide can influence patient’s heath experience. If care can be improved through simple changes to how information is framed, it is worth investigating applications, such as how physicians communicate about different treatments.

Although some regulatory agencies caution against the use of framing in medication information, in case it is perceived negatively as marketing, it is important to recognize that information processing is always affected by framing to some capacity. Thinking about how message presentation influences attitudes, behaviours, and experiences can help health communicators maximize patient outcomes. The findings of this study also found that positively framed information about side effects does not reduce patient satisfaction or perceptions of credibility.

Caution does need to be taken to ensure that framing doesn’t lead to unintended consequences, like reduced reporting of legitimate and serious side effects. Messages should be designed so response aligns with what is best for all involved parties. This may involve using negative framing or combining framing with other behavioural communication strategies. In the case of reducing nocebo-induced side effects, positive framing can be combined with salient reminders to ensure serious side effects are reported or setting intentions to bolster medication adherence.

Summary
The nocebo effect is the experience of negative outcomes from a medical treatment, as the result of negative expectations. It is the opposite of the more commonly known placebo effect. When drug manufacturers and researchers conduct clinical trials on medications, participants commonly report experiencing side effects despite receiving the sham, control condition, which has no physiological effects. Outside of laboratories, people can experience nocebo-induced side effects to drugs. Previous studies have found that people can experience more side effects when they knew what drug they were taking than if they didn’t know. Not only are side effects troubling for patients, they can lead to medication non-adherence, which can have serious impacts on individual and public health.

Webster and colleagues examined if framing can reduce nocebo-induced side effects and whether the framing messaging would impact people’s perceptions of its credibility or satisfaction. Framing is the presentation of information that highlights either the positive or negative aspects to achieve a particular goal and has been shown to be successful for influencing attitudes and behaviours in health communication and other domains more broadly.

203 healthy adults read patient information leaflets about a drug they thought they were testing before consuming a tablet and reporting any side effects within an hour. The tablet was not an actual drug and had no physiological effects. Half of the participants saw a leaflet with the side effects framed as the likelihood of them occurring (i.e. 1 in 10 people will be affected). This is how it is normally presented in the UK, where this study was conducted. This framing is negative because it focuses on loss of comfort. The other half of the participants saw a leaflet with the side effects framed as the likelihood of them not occurring (i.e. 90% of people will not be affected), which is the positive framing. Percentages were used to bolster perceptions of likelihood. In previous research, percentages were shown to increase perceptions of likelihood compared to fractions or ratios.

The results showed that the participants who saw the positively framed leaflet were 34% less likely to report experiencing the side effects described in the leaflets. There was no difference between the two when it came to ratings of the leaflets’ credibility or patients’ satisfaction with the information. These findings demonstrate the potential for framing to influence the experience of drug side effects through the nocebo effect and negative expectations.

Changing the way side effects are framed in health communication may help mitigate the health and financial costs associated with nocebo-induced side effects, while still providing patients the necessary information to be fully-informed about their health care.  However, more research is needed to evaluate the potential for unintended consequences like reduced reporting of legitimate side effects and the long-term impact of framing.

Blog post compiled by Dr. Terry Flynn and TIm Li. 

Citation
Webster, R. K., Weinman, J., & Rubin, G. J. (2018). Positively framed risk information in patient information leaflets reduces side effect reporting: a double-blind randomized controlled trial. Annals of Behavioral Medicine, 52(11), 920-929. https://doi.org/10.1093/abm/kax064

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Heidy Modarelli handles Growth & Marketing for IPR. She has previously written for Entrepreneur, TechCrunch, The Next Web, and VentureBeat.
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