Effects of message framing and health literacy on intention to perform diabetes self-care: A randomized controlled trial

Aims: To evaluate the effect of positive and negative message framing in diabetes education on attitudes, perceived control, and behavioral intentions toward diabetes self-care, and to identify potential moderating effects of health literacy on message framing. Methods: A total of 52 patients with type 2 diabetes that visited an ambulatory endocrinology wing at a university hospital in Korea were randomized into positive or negative message framing groups. Each group watched a 10-minute video that was either positively or negatively framed, accentuating desirable outcomes from good diabetes self-care in the former and undesirable outcomes from inadequate diabetes self-care in the latter. Two-way ANCOVA controlling for HbA1C was conducted to evaluate outcomes. Results: Patients who watched the negatively framed message showed significantly more favorable attitudes and perceived control toward diabetes self-care than those who viewed the positively framed message. Message framing had significant indirect effects on behavioral intentions for diabetes self-care that were mediated by attitudes and perceived control. Conversely, no significant interaction effects were observed between health literacy level and message framing of these same markers. Conclusion: The use of negative message framing in diabetes education is a promising strategy for shaping favorable attitudes, beliefs, and intentions toward diabetes self-care behavior.