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. 2022 Sep 26;3(3):577-602.
doi: 10.1007/s42761-022-00128-3. eCollection 2022 Sep.

In COVID-19 Health Messaging, Loss Framing Increases Anxiety with Little-to-No Concomitant Benefits: Experimental Evidence from 84 Countries

Charles A Dorison  1 Jennifer S Lerner  2   3 Blake H Heller  2   4 Alexander J Rothman  5 Ichiro I Kawachi  6 Ke Wang  2 Vaughan W Rees  6 Brian P Gill  7 Nancy Gibbs  2 Charles R Ebersole  8 Zahir Vally  9   10 Zuzanna Tajchman  11 Andras N Zsido  12 Mija Zrimsek  13 Zhang Chen  14 Ignazio Ziano  15 Zoi Gialitaki  16 Chris D Ceary  17 Yijun Lin  18 Yoshihiko Kunisato  19 Yuki Yamada  20 Qinyu Xiao  21 Xiaoming Jiang  22 Xinkai Du  23 Elvin Yao  24 John Paul Wilson  25 Wilson Cyrus-Lai  26 William Jimenez-Leal  27 Wilbert Law  28 W Matthew Collins  29 Karley L Richard  17 Marek Vranka  30 Vladislav Ankushev  31 Vidar Schei  32 Valerija Križanić  33 Veselina Hristova Kadreva  34 Vera Cubela Adoric  35 Ulrich S Tran  36 Siu Kit Yeung  37 Widad Hassan  38 Ralph Houston  39 Tiago J S Lima  40 Thomas Ostermann  41 Thomas Frizzo  42 Therese E Sverdrup  32 Thea House  43   44 Tripat Gill  45 Maksim Fedotov  46 Tamar Paltrow  47 Teodor Jernsäther  48 Maria Koptjevskaja-Tamm  49 Thomas J Hostler  50 Tatsunori Ishii  51 Barnabas Szaszi  52 Sylwia Adamus  53 Lilian Suter  54 Sumaiya Habib  55 Anna Studzinska  56 Dragana Stojanovska  57 Steve M J Janssen  58 Stefan Stieger  59 Stefan E Schulenberg  60 Srinivasan Tatachari  61 Soufian Azouaghe  62   63 Piotr Sorokowski  64 Agnieszka Sorokowska  64 Xin Song  11 Savannah C Lewis  65 Sladjana Sinkolova  57 Dmitry Grigoryev  66 Shira Meir Drexler  67 Shimrit Daches  68 Shawn N Geniole  69 Selena Vračar  70 Sébastien Massoni  42 Saša Zorjan  71 Eylül Sarıoğuz  72 Sara Morales Izquierdo  73 Sara G Alves  74 Sara Pöntinen  75 Sara Álvarez Solas  76 Santiago Ordoñez-Riaño  77 Sanja Batić Očovaj  78 Sandersan Onie  79   80   81 Samuel Lins  74 Sami Çoksan  82 Asli Sacakli  83 Susana Ruiz-Fernández  84 Sandra J Geiger  85 Saeideh FatahModares  86 Radoslaw B Walczak  87 Ruben Betlehem  33 Roosevelt Vilar  88 Rodrigo Cárcamo  89 Robert M Ross  90 Randy McCarthy  91 Tonia Ballantyne  17 Erin C Westgate  18 Reza Afhami  92 Dongning Ren  93 Renan P Monteiro  94 Ulf-Dietrich Reips  95 Niv Reggev  96 Robert J Calin-Jageman  97 Razieh Pourafshari  98 Raquel Oliveira  99   100 Mina Nedelcheva-Datsova  101 Rima-Maria Rahal  93 Rafael R Ribeiro  102 Theda Radtke  103 Rachel Searston  104 Redeate Habte  105 Przemysław Zdybek  87 Sau-Chin Chen  106 Princess Lovella G Maturan  107 Jennifer T Perillo  108 Peder Mortvedt Isager  109 Pavol Kačmár  110 Paulo Manuel Macapagal  111   112 Paulina Szwed  113 Paul H P Hanel  114 Paul A G Forbes  115 Patrícia Arriaga  102 Bastien Paris  63 Konstantinos Papachristopoulos  116   117 Pablo Sebastián Correa  118 Ondřej Kácha  119 Márcia Bernardo  120 Olatz Campos  121 Olalla Niño Bravo  122 Oscar J Galindo-Caballero  27   123 Chisom Esther Ogbonnaya  124 Olga Bialobrzeska  125 Natalia Kiselnikova  126 Nicolle Simonovic  127 Noga Cohen  128 Nora L Nock  129 Niklas Johannes  130 Nihan Albayrak-Aydemir  131 Nicolas Say  132 Nathan Torunsky  11 Natalia Van Doren  133 Naoyuki Sunami  134 Nikolay R Rachev  101 Nadyanna M Majeed  135 Nadya-Daniela Schmidt  136 Khaoula Nadif  137 Nadia S Corral-Frías  138 Nihal Ouherrou  139 Myrto Pantazi  130 Marc Y Lucas  140 Martin R Vasilev  141 María Victoria Ortiz  142   143 Muhammad Mussaffa Butt  144 Muhib Kabir  145 Rafał Muda  146 Maria Del Carmen Mc Tejada Rivera  147 Miroslav Sirota  148 Martin Seehuus  149   150 Michal Parzuchowski  151 Mónica Toro  152 Monika Hricova  110 Mónica Alarcón Maldonado  153 Magdalena Marszalek  125 Maria Karekla  154 Giovanna Mioni  155 Minke Jasmijn Bosma  156 Minja Westerlund  75 Milica Vdovic  157 Michal Bialek  64 Miguel A Silan  158 Michele Anne  58 Michal Misiak  159   160 Maurice Grinberg  161 Mariagrazia Capizzi  162 Mauricio F Espinoza Barría  163 Merve A Kurfali  164 Michael C Mensink  165 Mikayel Harutyunyan  166 Meetu Khosla  167 Max Korbmacher  168 Matúš Adamkovič  169   170 Matheus Fernando Felix Ribeiro  171 Maria Terskova  66 Matej Hruška  172 Marcel Martončik  169   170 Martin Voracek  36 Martin Čadek  173 Martha Frías-Armenta  138 Marta Kowal  64 Marta Topor  174 Marta Roczniewska  175   176 Marlies Oosterlinck  177 Markéta Braun Kohlová  178 Mariola Paruzel-Czachura  179   180 Marina Romanova  31 Marietta Papadatou-Pastou  181 Maria Louise Lund  182 Maria Antoniadi  154 Marc V Jones  50 Manuel S Ortiz  183 Mathi Manavalan  11 Abdumalik Muminov  184 Małgorzata Kossowska  185 Maja Friedemann  186 Magdalena Wielgus  187 Marco A C Varella  188 Melissa F Colloff  189 Maria Bradford  27 Leigh Ann Vaughn  190 Luis Eudave  191 Luc Vieira  192 Lina Maria Sanabria Pineda  27 Laura Calderón Pérez  27 Ljiljana B Lazarevic  193 Lisa M Jaremka  194 Elizaveta Kushnir  195 Lisa Anton-Boicuk  115 Gabriel Lins de Holanda Coelho  196 Lina Ahlgren  197 Carmel A Levitan  198 Leticia Micheli  199 Leonhard Volz  23 Marija Stojanovska  58 Leanne Boucher  29 Lara Samojlenko  200 Lady Grey Javela Delgado  201 Lada Kaliska  202 Lara Warmelink  203 Luis Miguel Rojas-Berscia  204 Karen Yu  205 Jakub Wachowicz  206 Kermeka Desai  17 Krystian Barzykowski  54 Luca Kozma  12 Kortnee Evans  207 Komila Kirgizova  208 Bamikole Emmanuel Agesin  209 Monica A Koehn  210 Kelly Wolfe  211 Tatiana Korobova  212 Kristoffer Klevjer  213 Kevin van Schie  214   215 Kevin Vezirian  63 Kaja Damnjanović  216 Katrine Krabbe Thommesen  217 Kathleen Schmidt  218 Katarzyna Filip  54 Karolina Grzech  219   220 Karlijn Hoyer  221 Karis Moon  222 Kafeel Rana  144 Kristina Janjić  57 Jordan W Suchow  223 Julita Kielińska  54 Julio E Cruz Vásquez  224 Julia Beitner  225 Juan Camilo Vargas-Nieto  27 Jose Carlos T Roxas  107   226 Jennifer Taber  127 Joan Urriago-Rayo  227 Jeffrey M Pavlacic  60 Jozef Bavolar  110 José A Soto  133 Jonas K Olofsson  48 Johannes K Vilsmeier  228 Johanna Messerschmidt  229 Johanna Czamanski-Cohen  230   231 Jordane Boudesseul  232 Jeong Min Lee  233 Julia Kamburidis  101 Janis Zickfeld  234 Jacob F Miranda  235 Jeroen P H Verharen  236 Evgeniya Hristova  237 Julie E Beshears  238 Jasna Milošević Đorđević  239 Jasmijn Bosch  240 Jaroslava Varella Valentova  188 Jan Antfolk  197 Jana B Berkessel  241 Jana Schrötter  242 Jan Urban  178 Jan Philipp Röer  243 James O Norton  244 Jaime R Silva  245   246   247 Jade S Pickering  248 Jáchym Vintr  249 Jim Uttley  250 Jonas R Kunst  251 Izuchukwu L G Ndukaihe  252 Aishwarya Iyer  253 Iris Vilares  11 Aleksandr Ivanov  31 Ivan Ropovik  254   255 Isabela Sula  256 Irena Sarieva  31 Irem Metin-Orta  257 Irina Prusova  66 Isabel Pinto  74 Andreea Ioana Bozdoc  258 Inês A T Almeida  259 Ilse L Pit  260   261 Ilker Dalgar  262 Ilya Zakharov  263 Azuka Ikechukwu Arinze  124 Keiko Ihaya  264 Ian D Stephen  90 Biljana Gjoneska  265 Hilmar Brohmer  266 Heather Flowe  267 Hendrik Godbersen  84 Halil Emre Kocalar  268 Mattie V Hedgebeth  269 Hu Chuan-Peng  270 MohammadHasan Sharifian  271 Harry Manley  272 Handan Akkas  273 Nandor Hajdu  52 Habiba Azab  274 Gwenael Kaminski  275 Gustav Nilsonne  48   276 Gulnaz Anjum  251 Giovanni A Travaglino  277 Gilad Feldman  278 Gerit Pfuhl  279 Gabriela Czarnek  53 Gabriela Mariana Marcu  258   280 Gabriela Hofer  266 Gabriel Banik  281 Gabriel Agboola Adetula  282 Gijsbert Bijlstra  283 Frederick Verbruggen  14 Franki Y H Kung  284 Francesco Foroni  285 Gage Singer  108 Fany Muchembled  286 Flavio Azevedo  287 Farnaz Mosannenzadeh  288 Evelina Marinov  101 Eva Štrukelj  289 Zahra Etebari  290 Ernest Baskin  291 Elkin Oswaldo Luis Garcia  292 Erica Musser  293 I M M van Steenkiste  294 El Rim Ahn  18 Ekaterina Pronizius  36 Emily A Jackson  17 Efisio Manunta  274 Elena Agadullina  31 Dušana Šakan  78 Pinar Dursun  295 Olivier Dujols  296 Dmitrii Dubrov  31 Megan Willis  297 Murat Tümer  298 Jennifer L Beaudry  299 Dora Popović  300 Daniel Dunleavy  301 Ikhlas Djamai  302 Dino Krupić  303 Diego Vega  304 Hongfei Du  305 Débora Mola  306 William E Davis  307 Dawn Liu Holford  114 David M G Lewis  207   308 David C Vaidis  192 Daphna Hausman Ozery  309 Danilo Zambrano Ricaurte  310 Daniel Storage  311 Daniela Sousa  312 Daniela Serrato Alvarez  313 Anna Dalla Rosa  314 Dajana Krupić  315 Dafne Marko  316 David Moreau  317 Crystal Reeck  318 Rita C Correia  74 Cassie M Whitt  319 Claus Lamm  36 Claudio Singh Solorzano  320 Claudia C von Bastian  321 Clare Am Sutherland  322   323 Clara Overkott  324 Christopher L Aberson  325 Chunhui Wang  326 Christiana Karashiali  327 Chris Noone  328 Faith Chiu  329 Chiara Picciocchi  330 Cemre Karaarslan  72 Nicola Cellini  331 Celia Esteban-Serna  332 Cecilia Reyna  333 Carlota Batres  334 Ranran Li  335 Caterina Grano  320 Joelle Carpentier  336 Christian K Tamnes  251 Cynthia H Y Fu  337   338 Byurakn Ishkhanyan  339   340 Lisa Bylinina  341 Bastian Jaeger  93   335 Carsten Bundt  251 Tara Bulut Allred  342 Ahmed Bokkour  301 Natalia Bogatyreva  66 William J Chopik  343 Benedict Antazo  344 Behzad Behzadnia  345 Maja Becker  346 Beatrice Cocco  347 Wei-Lun Chou  348 Barbora Hubena  349 Barbara Žuro  350   351 Balazs Aczel  52 Ekaterina Baklanova  352 Hui Bai  353 Busra Bahar Balci  354   355 Peter Babinčák  356 Barnaby James Wyld Dixson  357 Aviv Mokady  358 Heather Barry Kappes  359 Mohammad Atari  360 Anna Szala  361 Anna Szabelska  362 John Jamir Benzon Aruta  363 Artur Domurat  179 Nwadiogo Chisom Arinze  364 Arianna Modena  365 Arca Adiguzel  269 Arash Monajem  366 Kanza Ait El Arabi  367 Asil Ali Özdoğru  368 Adriana Julieth Olaya Torres  369 Andriana Theodoropoulou  370 Anita Penić Jurković  371 Angelos P Kassianos  372   373 Andrej Findor  374 Andree Hartanto  135 Anais Thibault Landry  375 Ana Ferreira  260 Anabela Caetano Santos  278   376   377 Anabel De la Rosa-Gomez  378 Amélie Gourdon-Kanhukamwe  379   380   381 Anna Louise Todsen  382 Alper Karababa  383 Allison Janak  384 Alexandre Bran  192 Alexa M Tullett  385 Anna O Kuzminska  386 Anthony J Krafnick  97 Anum Urooj  285 Ahmed Khaoudi  302 Afroja Ahmed  387 Agata Groyecka-Bernard  64 Adrian Dahl Askelund  388 Adeyemi Adetula  63   252 Anabel Belaus  118 Abdelilah Ca Charyate  389 Aaron L Wichman  390 Alina Stoyanova  101 Anna Greenburgh  391 Andrew G Thomas  392 Alexios Arvanitis  393 Patrick S Forscher  63   394 Peter R Mallik  395 Maximilian A Primbs  283 Jeremy K Miller  396 Hannah Moshontz  397 Heather L Urry  398 Hans IJzerman  63   399 Dana M Basnight-Brown  400 Christopher R Chartier  395 Erin M Buchanan #  401 Nicholas A Coles #  2   402
Affiliations

In COVID-19 Health Messaging, Loss Framing Increases Anxiety with Little-to-No Concomitant Benefits: Experimental Evidence from 84 Countries

Charles A Dorison et al. Affect Sci. .

Abstract

The COVID-19 pandemic (and its aftermath) highlights a critical need to communicate health information effectively to the global public. Given that subtle differences in information framing can have meaningful effects on behavior, behavioral science research highlights a pressing question: Is it more effective to frame COVID-19 health messages in terms of potential losses (e.g., "If you do not practice these steps, you can endanger yourself and others") or potential gains (e.g., "If you practice these steps, you can protect yourself and others")? Collecting data in 48 languages from 15,929 participants in 84 countries, we experimentally tested the effects of message framing on COVID-19-related judgments, intentions, and feelings. Loss- (vs. gain-) framed messages increased self-reported anxiety among participants cross-nationally with little-to-no impact on policy attitudes, behavioral intentions, or information seeking relevant to pandemic risks. These results were consistent across 84 countries, three variations of the message framing wording, and 560 data processing and analytic choices. Thus, results provide an empirical answer to a global communication question and highlight the emotional toll of loss-framed messages. Critically, this work demonstrates the importance of considering unintended affective consequences when evaluating nudge-style interventions.

Keywords: Anxiety; COVID-19; Message framing; Nudges.

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Conflict of interest statement

Conflict of InterestThe authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
An example of a public service announcement from the CDC. This public service announcement used gain-framed messages to encourage mask-wearing (image from May, 2021)
Fig. 2
Fig. 2
Loss-framed vs. gain-framed messages regarding COVID-19 influenced anxiety but not behavioral intentions, policy support, or information seeking. Cohen’s d was used as the effect size, with positive values indicating higher levels of the outcome variable in the loss-framed vs. gain-framed condition. Dots and bars represent the effect size estimates and 95% confidence intervals respectively. Country-level effect size estimates are denoted in black and overall effect size estimates are denoted in yellow. Country names are denoted by their International Organization for Standardization codes. To improve the viewability of the x-axis, 40 countries with fewer than 30 participants per group (i.e., relatively wide error bars) are removed from the plot. Nevertheless, these countries are still included in the overall effect size estimates

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