Will You Win or Lose? Getting People Tested for Diabetes

Reading time: 4 – 7 minutes

Do you respond better to scary messages or those telling you what you’ll gain? This question has concerned health promoters and researchers for many years. A recent study in the UK has shown that the response is related to gender [1]. Men responded better to messages that focus on the negatives or “losses”.

Diabetes is increasingly common, particularly type 2 diabetes which is often caused by lifestyle factors such as unhealthy diet, lack of exercise, alcohol use and smoking. What is less well known is that early detection and control of type 2 diabetes is associated with better outcomes. Diabetes can cause damage to the retinas and kidneys, in addition to heart and circulation problems. However, when diagnosed, treatment can reduce these risks and earlier diagnosis allows earlier treatment and leads to better health [2]. Within health promotion, we consider several types of “prevention” [3]. The most obvious is “primary prevention”, which aims to stop people getting ill in the first place. “Secondary prevention” refers to early detection and treatment, which helps prevent serious illness by catching disease early. Finally, “tertiary prevention” prevents an existing illness from getting worse and reduces complications. People engage in behaviours and have lifestyles that put them at risk for illness, so we need to address primary prevention, by attempting to reduce these behaviours. That said, people’s lifestyles will never be ideal and genetics also play a role in many disorders, including type 2 diabetes. As such, secondary prevention is vital to get people tested.

To encourage people to attend testing and screening, two broad approaches have been used. Crudely put, the choice is between scaring people into coming in (loss framed) or coaxing people in (gain framed). It is this distinction that Park et al [1] explored. In loss framed messages, they emphasised the down sides of not testing — “your diabetes may led to more complications.” In the gain framed messages, they show the positive elements of having a test — “you can receive early and more effective treatment.” They randomly allocated patients, with a risk of diabetes, from General Practices to receive either the loss or gain framed message. 59 people were invited with the loss framed and 57 with the gain framed message. 82% of patients attended the surgery for screening. All were then sent a questionnaire to exam anxiety levels and perceptions about diabetes.

Going against findings in the area, overall there was no difference in attendance at screening based on whether loss or gain framed messages were received. Also going against received wisdom, there was no difference in the emotions of the participants after receiving the messages. It seems logical that those receiving the loss frame message would be more anxious as they may be afraid of what might happen to them. In this case, this was not seen. The emotional impact and levels of anxiety were the same. The way in which people thought about diabetes as an illness was also the same, irrespective of gain or loss message. So far, no significant results in terms of differences between groups being significant, but important contributions to the literature. Finally, the authors report an interesting difference relating to gender. Attendance for testing was higher in men invited using the loss frame. Attendance was higher in women invited using the gain frame. This exciting finding is novel and has clear practical implications: emphasis to men what they will lose if they do not attend testing and emphasise to women what they will gain when they attend testing.

Clearly, further research is required to substantiate these results: as they are novel it is important to replicate them. The study used messages which maybe are not that extreme — both are carefully and moderately worded messages. Nevertheless, the differences by gender are interesting. Do men need to be afraid before they will get a test? Do women need to be reassured before they are ready to risk a negative result? The research literature in psychology and public health on this topic is enormous. How you respond? We all receive lots of health messages every day, whether it is from a health care professional directly or the less noticeable drip-drip of media and advertising, or reading a fabulous website. Do we need to take the time to think of both sides of the coin: the loss and gains. I wonder what would happen had the study used loss, gain and also a combined message.

References

1. Park et al. A randomized evaluation of loss and gain frames in an invitation to screening for type 2 diabetes: effects on attendance, anxiety and self-rated health. J Health Psychol. 2010 Mar;15(2):196-204.
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2. Holman et al. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008 Oct 9;359(15):1577-89. Epub 2008 Sep 10.
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3. Fletcher, R.W. & Fletcher, S.W. Clinical Epidemiology: The Essentials. Baltimore: Lippincott Williams & Wilkins. 2005.