The effects of health behaviours and beliefs based on message framing among patients with chronic diseases: a systematic review

OBJECTIVE: The effectiveness of integrating message framing into educational interventions to promote the health behaviour of patients with chronic diseases is still being debated in nursing research. The objective of this study was to assess the impact of educational interventions based on gain and loss frames on the health behaviours and beliefs of patients with chronic diseases and to identify the frame that achieves better outcomes. DESIGN: The systematic review was based on PRISMA guidelines for comprehensively searching, appraising and synthesising research evidence. DATA SOURCES: We searched the PubMed, Web of Science, PsycINFO and CINAHL databases for reports published from database inception until 26 March 2021. ELIGIBILITY CRITERIA: Intervention studies, published in English, with adult patients with chronic disease conditions, and with intervention contents involved in the implementation of message framing, were considered. The outcomes were health behaviours or beliefs, such as knowledge, self-efficacy, intention or attitudes. DATA EXTRACTION AND SYNTHESIS: Data extraction and entry were performed using a predesigned data extraction form and assessed independently by two reviewers using the Cochrane Collaboration Risk of Bias I. RESULTS: A total of 11 intervention studies were included. We found that educational intervention based on both gain and loss frames could enhance the positive effects of communication, and promote healthy behaviours and beliefs in patients with chronic disease. Many of the studies we included here showed the advantage of loss framing messages. Due to the limited number of articles included and without quantitative analysis, this result should be interpreted cautiously. CONCLUSIONS: Integrating message framing into health education might be a promising strategy to motivate patients with chronic disease to improve their health behaviours and beliefs. More extensive and well-designed trials are needed to support the conclusions and discuss the effective framing, moderators and mediators of framing. PROSPERO REGISTRATION NUMBER: CRD42021250931.