Healthy Choices
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Marketing Policy Dec 1, 2007

Healthy Choices

Do people prefer the carrot or the stick?

Based on the research of

Angela Y. Lee

Jennifer L. Aaker

Which tactic would motivate you to obey instructions for taking a prescribed medicine: fear of harmful health consequences of not taking the drug or confidence in the eventual health benefits bestowed by the drug?

According to a study by Angela Lee, professor of marketing at the Kellogg School of Management, and Jennifer Aaker (the University of California at Berkeley), the persuasiveness of healthcare-related advertisements depends on whether the ad’s wording—or framing—induced fear or confidence. “Framing, especially in the healthcare domain, has been studied in terms of how effective it is,” Lee said. “How do we get people to get tested for certain illnesses or comply with certain procedures?”

Conflicting results among studies using positive and negative messages to motivate people to follow healthcare recommendations provoked Lee and Aaker to investigate when positive frames or negative frames may be differentially effective. They published their findings in the February 2004 issue of the Journal of Personality and Social Psychology.

Lee and Aaker argued that the mixed results in whether positive or negative messages encourage compliance were due to differences in the desirability of the outcome advocated in the message. A positive frame that promotes something desirable is more effective than a negative frame that laments the absence of something desirable. At the same time, a negative frame that threatens the onset of something undesirable is more effective than a positive frame that promises the absence of something undesirable—a concept known as “regulatory fit” (Lee discusses this aspect more fully in the Q&A below). The researchers noted the most effective ways to prompt healthy behaviors: by touting the benefits or emphasizing the dangers. “To survive, we need to approach food and avoid being food,” Lee explained, “and the signal of ‘food’ or ‘danger’ is much stronger than the signal of ‘no food’ or ‘no danger.’”

To assess the effectiveness of positive and negative framing in a health promotion scenario, Lee—who received the Kellogg School’s Stanley Reiter Best Paper Award in March 2007 for this work—manipulated the wording of mock Web sites and ads advocating the health benefits of grape juice. Subjects read either a positively framed ad that touted the energy-boosting effects of grape juice (“Get energized!”) or a negatively framed ad that warned that not drinking the juice would keep them from being energized (“Don’t Miss Out on Getting Energized!”). The results showed that the subjects preferred the positively framed ad, which promoted a desirable outcome.

However, in a disease prevention scenario, in which ads attributed heart disease avoidance with drinking juice in either a positive (“Prevent Clogged Arteries!”) or negative (“Don’t Miss Out on Preventing Clogged Arteries!”) frame, subjects were more motivated by the negatively worded ad.

“The difference between the two scenarios is how people think about something desirable versus something undesirable,” Lee said. “A positive frame fits with a desirable outcome and a negative frame fits with an undesirable outcome.” Missing out on something desirable is perceived as more detrimental in the case of the more severe consequence of heart disease as opposed to the health-promoting consequence of increased energy.

The researchers found the same pattern of positive and negative framing when ads for a sunscreen product and for a mononucleosis drug were used.

Lee and Aaker, who are consumer psychologists, wondered why their subjects were more persuaded by positively framed health promotion messages and negatively framed disease prevention messages. “Linguistically, it would make sense that whichever ad is simplest would be most persuasive,” Lee said. Typically subjects are more swayed by short, crisply worded ads. What, then, explains the advantage of the lengthier ad in the undesirable disease prevention scenarios?

The researchers decided to explore how easy it was for people to process the persuasive messages. “If something is easy to understand, they think it is more believable and true,” Lee said. To evaluate this possibility, Lee and Aaker surveyed their subjects’ ability to comprehend each message and their interest in the ad. People thought the more persuasive messages were easier to understand, which supports the theory of processing fluency.

Processing fluency was also measured by flashing words from ads on a computer screen and asking subjects if they could identify the words. Subjects recognized the words more quickly when the words came from the more persuasive ad. These findings present further evidence that an ad that is easier to process is more persuasive.

“The results have important social implications,” said Lee, citing cancer prevention, smoking, exercise, and weight loss among examples of health concerns in which framing could be used to encourage a particular behavior.

Faculty Q&A: Professor Angela Lee talks about the origins of her research on frame theory

Nearly ten years ago, Professor Angela Lee happened upon a research subject that has resulted in her work on regulatory focus theory gaining tremendous recognition, most recently in the form of the Stanley Reiter Best Paper Award, given annually to a member of the Kellogg School faculty. While attending a lecture by her colleague and coauthor Wendi Gardner, a social psychologist at Northwestern, Lee became fascinated by Gardner’s discussion of “turning Americans into Chinese.” In particular, Gardner had designed an experiment in which a group of Americans, who are more likely to think of themselves individually because they are part of an individualistic nation, adopted a collectivistic mindset more common to Asian culture.

Lee was intrigued by how the findings moved beyond the cultural literature’s traditional boundaries, in which “researchers were stating that culture A is different from culture B, but without an underlying reasoning as to why this was the case,” she says. “Wendi was saying that these differences are the product of the different ways in which people can look at themselves—as either an independent person or as part of a larger group.”

Bridging the focus between the cultural literature and how people process information, Lee, Gardner, and another researcher named Jennifer Aaker extended the ‘self-view’ concept. They examined the implications of Japanese and Koreans tending toward self-criticism and Americans focusing on self-enhancement. Says Lee: “When these two groups try to attribute meaning to outcomes, Asians are more likely to attribute failures to the self whereas Americans are much more likely to attribute successes to the self.” This raised the question of whether the two groups process negative and positive information differently. To help determine the answer, Lee collected five studies to address that question. With Gardner and Aaker she discovered that regulatory focus theory had great explanatory power in terms of how people from differing cultures think and what motivates them.

Q: Talk more about regulatory focus theory. What is the idea of motivation that’s involved?

Professor Lee: This framework is called self-regulatory focus theory because it basically says there are two motivational drivers in human nature. One is the need to be nurtured: when driven by this need, we strive toward growth and accomplishment. On the other hand, we also have a fundamental need to feel secure. These both have evolutionary roots —we want to have food so we can grow and multiply, but we also want to avoid being food so we can survive. It turns out this duality dictates how we regulate our behaviors and attitudes in all sorts of contexts, since we are constantly seeking to service these needs.

Q: So is there always a constant balance between these two motivators? Or does one win out over the other based on the type of person you are?

Professor Lee: Even though we all have both needs, because we have limited resources we tend to focus on one over the other. How you allot your energy or resources has implications for your behavior. So what regulatory theory focus does is to identify the two needs initially and then break them down further into why people act a certain way in accordance with these needs.

It turns out that there are two different foci: promotion and prevention. People who are promotion focused have stronger nurturance needs, which in turn means they are more tuned in to striving toward growth and accomplishment. They also have an avoidance system, which is another story altogether. Promotion-focused individuals try to approach gains and avoid non-gains (or the absence of good things). For them, not having good things is really bad, so that’s what they try to avoid. On the other hand, people who are prevention focused have dominant security needs. They approach the absence of negative things. They don’t really care about good things, they are mainly happy if bad things don’t happen. So they avoid bad things.

Q: So is there always a constant balance between these two motivators? Or does one win out over the other based on the type of person you are?

Professor Lee: Instead of just simple approach and avoidance behaviors, individuals look at either approaching good things or approaching the absence of bad things. Or avoiding the absence of good things or avoiding bad things. That’s how the system works. To bring this back to the beginning, when I actually looked at cultural differences I found that people with an independent self-view (like Americans) are more promotion focused. In contrast, people with an interdependent self-view (Southeast Asians) are prevention focused.

Q: What is the connection between persuasive messaging and regulatory focus theory?

Professor Lee: Well, in the healthcare field right now, for example, there is a discussion about how to prompt people to follow the advocacy in the various messages. Given that messaging is very expensive—think of all the health-related flyers and brochures that exist—there is a lot of discussion about the best way to get people to comply. A number of experts think about this issue in terms of framing: is it more effective to use a gain frame that focuses on the positive or a loss frame that focuses on the negative effects? The findings have been very inconsistent, as different people come up with different explanations as to why one frame is better than the other, but much of this depends on the situation.

If we want people to come in and get tested for hepatitis, it turns out there are at least two ways to frame a message in order to get them to comply. Typically we say “do this and you will receive this benefit” which in this case would be identifying the disease earlier enough to start treatment. Or we try to scare them and say “if you don’t do this you won’t get the benefit or you will suffer these consequences,” which would mean it could potentially be fatal.

Q: And this is where you began applying your regulatory focus theory?

Professor Lee: My co-author and I thought regulatory focus theory, with our four main frames—gains, non-gains, losses, and non-losses—could have a much better handle on what constitutes persuasive messaging. We started to apply regulatory focus theory to sort out the messiness in the literature. We argued that if the appeal is emotional, a gain frame works better than a non-gain. In prevention appeals about safety and security, the loss frame works better. This is true in the case of healthcare mentioned earlier. It sounds strange, but saying ‘miss out on clogged arteries’ works better than simply saying ‘prevent clogged arteries.’

It is quite counter-intuitive, but it works! Across all the studies we presented, using the loss frame in connection with the prevention appeal actually worked better and this is really where regulatory focus theory comes in and reveals that things can actually be a lot clearer if you apply this framework. It clearly maps out what motivates us and what we find persuasive, given the message at hand. We find it persuasive because it resonates with how we think about things in a more natural way; there’s fluency between how we process particular information and how the message is delivered.

Featured Faculty

Mechthild Esser Nemmers Professor of Marketing; Faculty Director, Golub Capital Social Impact Lab

About the Writer
Article written by Molly W. McElroy, a freelance writer based in Somerville, Massachusetts.

Interview by Chris van Nostrand, Assistant Director of Communications, Kellogg School of Management. Featured originally in the Dean’s Student Update newsletter, March/April 2007.
About the Research

Lee, Angela Y. and Jennifer L. Aaker (2004), “Bringing the Frame into Focus: The Influence of Regulatory Fit on Processing Fluency and Persuasion,” Journal of Personality and Social Psychology, 86(2): 205-218

This article received the Kellogg School’s "Stanley Reiter Best Paper Award" in 2006.

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