I've been FRAMED...visually

Eliciting and maintaining positive health behaviour change is a tough challenge; it's a cornerstone of public health policy and vital to reducing healthcare costs and improving quality of life. Getting the right health behaviour message across in the right way to the right people at the right time, persistently enough to garner health behaviour change is essential.

It had been thought that the proliferation of apps and content across technology distribution channels could provide a powerful resource for behaviorists. However, there is growing evidence of an atrocious level of abandonment of health and well-being apps as shown below:

There are many reasons app usage and persistence are low. I'm not about to explore all of these but let's be clear, there is a problem. We believe there can be an issue with framing in many apps and web sites. [2] described framing best,

The key idea is that people’s decisions, in part, depend on the way problems are stated (e.g., positively or negatively). A classic example is how a doctor describes the odds of a grueling operation: many would prefer to choose an operation of which an outcome is “90 out of 100 are alive after five years” than “10 out of 100 are dead after five years”. Even if these two phrases contain the same information, people even experts (i.e., doctors) are systematically subject
to framing effects. In addition, framing effects occur without people knowing that they are being affected by it. People are susceptible to the framing as long as they understand the valence of an option—whether something is good or bad—without necessarily understanding what makes the option appealing

Digital health, based as it is on data collection and coalition from personal sensors such as activity trackers, offers users performance feedback as a key feature. This feedback, in conjunction with goal-setting functions, may improved the tendency toward positive behaviour change among users. Along with self-monitoring and goal setting, digital health apps and services look to make use of framing. Framing on its own has struggled to generate discernible benefits for physical activity interventions,

Given that, in the domain of PA, some studies (including the present study) show a small advantage of gain-framed information and no study to our knowledge reported an advantage of loss-framed information, we suggest that information promoting PA is best framed in terms of gains. It seems, however, that the effects of framing are likely to be small,[9].

Within a quasi-digital health context (use of pedometers), [1] looked at the effect of framing on an individual's self-efficacy. Their findings were valuable and interesting to us:

  1. An achieved framing led to a high self-efficacy than a remaining framing. In other words, showing you what you have done as opposed to how much you have left to do.
  2. A text-only framing led to higher self-efficacy than text and visual (in the form of a progress bar).
  3. Performance feedback shown in a raw data format such as "nn,nnn" steps completed" was perceived as a greater accomplishment than the same data represented in a percentage complete format such as "30% achieved."

[3B] in a meta analysis of health behavior message framing found that

Gain-framed messages appear to be more effective than loss-framed messages in promoting illness prevention behaviors on the whole

[2] conducted a fascinating exploration of the influence of visual framing for privacy coverage attributes on user preferences for apps. The investigators created visuals for a privacy critics’ rating of an app, conveying how privacy-preserving or privacy-invasive the app is. They found among their study participants that when a privacy rating of a given app is disclosed visually, people are influenced by the privacy rating.

As an app designer being mindful of the role of positive and negative valency when incorporating progress and feedback data by graphic and or text is crucial to an affirmative contribution toward fulfillment of the target behavior by the user.

You can see for yourself how we try to engage thoughtfully with framing in our client portfolio


[1].Choe EK, e. (2016). Persuasive performance feedback: the effect of framing on self-efficacy. - PubMed - NCBI. [online] Ncbi.nlm.nih.gov. Available at:http://www.ncbi.nlm.nih.gov/pubmed/24551378 [Accessed 2 Feb. 2016].

[2].Choe, E., Jung, J., Lee, B. and Fisher, K. (2016). Nudging People Away from Privacy-Invasive Mobile Apps through Visual Framing. Capetown South Africa: Springer, pp.pp74-91.

[3].Detweiler, J., Bedell, B., Salovey, P., Pronin, E. and Rothman, A. (1999). Message framing and sunscreen use: Gain-framed messages motivate beach-goers. Health Psychology, 18(2), pp.189-196.

[3B] Gallagher, K. and Updegraff, J. (2011). Health Message Framing Effects on Attitudes, Intentions, and Behavior: A Meta-analytic Review. Annals of Behavioral Medicine, 43(1), pp.101-116.

[4].http://www.apa.org, (2016). To Motivate Healthy Behavior, It's Often Not What You Say, But How You Say It. [online] Available at:http://www.apa.org/research/action/motivate.aspx [Accessed 1 Feb. 2016].

[5].Locke, E. and Latham, G. (2002). Building a practically useful theory of goal setting and task motivation: A 35-year odyssey. American Psychologist, 57(9), pp.705-717.

[6].Nelson, R. and Hayes, S. (1981). Theoretical Explanations for Reactivity in Self-Monitoring. Behavior Modification, 5(1), pp.3-14.

[7].Nietfeld, J., Cao, L. and Osborne, J. (2006). The effect of distributed monitoring exercises and feedback on performance, monitoring accuracy, and self-efficacy. Metacognition and Learning, 1(2), pp.159-179.

[8].Rothman, A. and Salovey, P. (1997). Shaping perceptions to motivate healthy behavior: The role of message framing. Psychological Bulletin, 121(1), pp.3-19.

[9].Salovey, P. and Williams-Piehota, P. (2004). Field Experiments in Social Psychology: Message Framing and the Promotion of Health Protective Behaviors. am behav sci, 47(5), pp.488-505.

[10].van 't Riet, J., Ruiter, R., Werrij, M. and de Vries, H. (2009). Investigating message-framing effects in the context of a tailored intervention promoting physical activity. Health Education Research, 25(2), pp.343-354.


Dr Daryl Foy

Dr Daryl Foy is a Behavioural Scientist who specialises in the design of effective health behaviour change apps based on evidence including his own validated models for optimising persistent use. He consults to industry on how-to integrate persuasive design into LEAN product development as well as conversational UI. He can be contacted at dlfoy@mortonlawson.com