Department of Economics, University of Haifa, Haifa, Israel.
Nursing Division, Maccabi Healthcare Services, Tel Aviv, Israel.
JMIR Public Health Surveill. 2024 Mar 6;10:e45379. doi: 10.2196/45379.
Health care authorities often use text messages to enhance compliance with medical recommendations. The effectiveness of different message framings has been studied extensively over the past 3 decades. Recently, health care providers have begun using digital media platforms to disseminate health-related messages.
This study aimed to examine the effectiveness of some of the most widely used message framings on the uptake rates of medical checkups.
This study used a large-scale digital outreach campaign conducted by Maccabi Healthcare Services (MHS) during 2020-2021, involving a total of 113,048 participants. MHS members aged 50-74 years were invited to take their recommended medical actions from the following list: human papillomavirus (HPV), mammography, abdominal aortic aneurysm, fecal occult blood test (FOBT), and pneumococcal vaccination. Each member was randomly assigned to receive 1 of 6 message framings: control (neutrally framed; n=20,959, 18.5%), gains (benefits of compliance; n=20,393, 18%), losses (negative consequences of noncompliance; n=15,165, 13.4%), recommendation (a recommendation by an authoritative figure, in this context by a physician; n=20,584, 18.2%), implementation intentions (linking potential outcomes to future reactions; n=20,701, 18.3%), and empowerment (emphasizing personal responsibility for maintaining good health; n=15,246, 13.5%). The time frames for measuring a successful intervention were 14 days for scheduling screenings (ie, HPV, mammography, or abdominal aortic aneurysm), 30 days for performing the FOBT, and 60 days for receiving pneumococcal vaccination. We also examined the effectiveness of media channels (text message or email) on uptake rates and whether the subject-line length is correlated with message-opening rates.
No significant effect of message framing on uptake rates of medical checkups was observed. The rates of appointments for screening ranged from 12.9% to 14.1% across treatments. Based on a chi-square test, there was no evidence to reject the null hypothesis that these compliance rates are independent of the treatments (P=.35). The uptake rates for the FOBT and pneumococcal vaccination ranged from 23.3% to 23.8% across treatments, and we could not reject the hypothesis that they are independent of the treatments (P=.88). We also found that emails are more effective than text messages (P<.001) and that the subject-line length is negatively correlated with message-opening rates.
No evidence was found for an effect of the 5 message framings on uptake rates of medical checkups. To enhance compliance rates, public health officials may consider alternative framings. Furthermore, media channels and the subject-line length should be given careful consideration in the planning stages of health care campaigns.
AEA RCT Registry AEARCTR-0006317; https://www.socialscienceregistry.org/trials/6317/history/201365.
医疗保健当局经常使用短信来提高对医疗建议的依从性。在过去的 30 年中，已经广泛研究了不同信息框架的有效性。最近，医疗保健提供者开始使用数字媒体平台来传播与健康相关的信息。
本研究旨在研究一些最广泛使用的信息框架对医疗检查参与率的影响。
本研究使用了 Maccabi 医疗保健服务（MHS）在 2020-2021 年期间进行的大规模数字外展活动，共有 113048 名参与者。邀请 50-74 岁的 MHS 成员从以下列表中采取他们推荐的医疗行动：人乳头瘤病毒（HPV）、乳房 X 光检查、腹主动脉瘤、粪便潜血试验（FOBT）和肺炎球菌疫苗接种。每位成员被随机分配接受以下 6 种信息框架之一：对照（中立框架；n=20959，18.5%）、收益（遵守的好处；n=20393，18%）、损失（不遵守的负面后果；n=15165，13.4%）、建议（权威人士的建议，在这种情况下是由医生提出的；n=20584，18.2%）、实施意图（将潜在结果与未来反应联系起来；n=20701，18.3%）和赋权（强调个人对保持良好健康的责任；n=15246，13.5%）。衡量干预成功的时间框架为：安排筛查（即 HPV、乳房 X 光检查或腹主动脉瘤）的 14 天、进行 FOBT 的 30 天和接受肺炎球菌疫苗接种的 60 天。我们还研究了媒体渠道（短信或电子邮件）对参与率的影响，以及主题行长度是否与邮件打开率相关。
没有发现信息框架对医疗检查参与率有显著影响。筛查预约率在治疗组之间为 12.9%-14.1%。基于卡方检验，没有证据表明这些合规率与治疗无关（P=.35）。FOBT 和肺炎球菌疫苗接种的接种率在治疗组之间为 23.3%-23.8%，我们不能拒绝它们与治疗无关的假设（P=.88）。我们还发现，电子邮件比短信更有效（P<.001），并且主题行长度与邮件打开率呈负相关。
没有证据表明这 5 种信息框架对医疗检查的参与率有影响。为了提高合规率，公共卫生官员可以考虑其他框架。此外，在医疗保健活动的规划阶段，应仔细考虑媒体渠道和主题行长度。
AEA RCT 注册表 AEARCTR-0006317；https://www.socialscienceregistry.org/trials/6317/history/201365。
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