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Purpose: Successful treatment of osteoarthritis (OA), the most prevalent cause of disability of posture and movement in older adults worldwide, is strongly dependent on timely usage of conservative care involving health behaviors such as physical activity and pain management. However, recent findings show intentions to adhere to these conservative treatments are negatively influenced by false beliefs, and rely strongly on testimonies of other patients. In order to achieve behavioral change, it is important that patients receive appropriate and reliable information about effective treatment options in a format that not only appeals to them, but also effectively targets false beliefs. In the current experiment, we compared the effectiveness of a variety of persuasive communication techniques on increasing intentions to adhere to OA health behaviors by changing these beliefs for the better.
Methods: The experiment consisted of a 2 (exemplar vs informative message) x 2 (gain-frame vs loss-frame) between subject factorial design. Members of a research panel (n=639) with a self-reported diagnosis of knee osteoarthritis were recruited between February and April 2021 via email. Participants were stratified by gender and randomized into one of four conditions with a video messages applying framing and exemplification (the use of an exemplary figure) as techniques of persuasive communication. The messages (M= 1073 words, SD=129) were audiotaped by the same female speaker (maximum duration of 10 minutes), subtitled, and complemented with images in a slideshow format. After this video, participants filled out a questionnaire on socio-demographic and disease characteristics, beliefs about and intentions to adhere to physical activity and pain medication as OA health behaviors (7-point Likert-scales based on the 'Theory of Planned Behaviour' and the 'Treatment beliefs in hip and knee OsteoArthritis' questionnaires), and several items to check whether the manipulation was perceived as intended. At the end of the questionnaire, participants were thanked for their time and debriefed.
Results: A total of 154 respondents had completed the questionnaire. Sociodemographic and disease related characteristics corresponded well to the general population of Dutch primary care, and were distributed evenly across conditions. Main results show loss framing combined with an exemplar could lead to more positive beliefs than gain framing in either the exemplar or informational condition. These beliefs seem to be moderated by certain sociodemographic and disease characteristics, and in turn, several of these characteristics moderated the mediation of beliefs on intentions to adhere to OA health behaviors.
Conclusions: Results show that a message of under 10 minutes, when stated in a certain manner, could already make a significant difference in a patients’ intentions to adhere to OA health behaviors. While the use of an exemplar alone had little effect, framing a message when informing the patient may be a useful tool to promote conservative treatment. Our results suggest, however, that framed communication should be used with care as the effect direction seems to depend on symptom severity. Messages should thus preferably be targeted to specific sub-groups, as opposed to the OA population as a whole.
Table 1Characteristics of participants (n=154)
Female, n (%)
110 (71)
Age (in years), mean (SD)
62.3 (7.9)
BMI, mean [kg/m2], (SD)
27.3 (4.4)
Daily functioning (KOOSa; 0-100), mean (SD)
64.5 (18.0)
Pain VAS (0-10) , mean (SD)
4.6 (2.2)
Experiencing symptoms for more than five years, n (%)
Table 3Interaction effects of framing and exemplification on beliefs about and intentions to adhere to OA health behaviors
Exemplification x Gain frame Mean (SD) (n=39)
Exemplification x Loss frame Mean (SD) (n=37)
Informational x Gain frame Mean (SD) (n=39)
Informational x Loss frame Mean (SD) (n=37)
Physical activity
Beliefs
6.4 (1.0)
6.8 (0.5)
6.3 (1.5)
6.5 (1.0)
Intentions
6.5 (1.1)
6.6 (1.0)
6.8 (0.4)
6.7 (0.7)
Pain medication
Beliefs
4.5 (1.9)A
6.0 (1.1)B
5.3 (1.9)AB
5.0 (1.7)A
Intentions
4.0 (2.4)
4.9 (2.4)
4.4 (2.5)
3.9 (2.6)
Note: Mean (SD) beliefs and intentions on a 7-point Likert scale; Margins sharing a letter in the group label are not significantly different at the 5% level.
Figure 1Interaction plot of framing and exemplification on beliefs about pain medication. Note: Mean of pain medication beliefs on a 7-point Likert scale “If I use pain medication when pain prevents me from being physically active, that is… good/pleasant/wise” (1=completely disagree, 7=completely agree).
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