Combining gain-loss frame and background color to increase the effectiveness of online oral health messages: Differences among decision stages

Background: Gain-loss framing is one of the most popular verbal techniques for increasing message persuasiveness. Color is believed to be a compelling visual cue for persuasion purposes. The verbal and visual elements of online health messages are often studied and applied independently of each other, although they may be mutually supportive in a communication process. Objective: Drawing on the protection motivation theory, this study aims to examine the effects of the gain-loss frame and background color of online messages as well as their combination on users’ threat appraisal and coping appraisal in the context of oral health. The health action process approach, a theoretical model of behavior change, is further introduced to test whether the decision stage moderates the effects of message design on readers’ protection motivation. Methods: An online experiment involving 258 participants, including 119 non-intenders, 47 intenders, and 92 actors, was conducted based on a 2 × 2 between-subject design. Each participant was instructed to read an online oral health message that was communicated with either gain- or loss-framing and displayed on a either red or blue background. The change in one's protection motivation was elicited with the reading task and measured with the differences between the ratings in the pretest and posttest. Results: While there was no significant main effect of gain-loss frame on the participants’ oral health protection motivation, the red background was more effective in increasing the participants’ coping appraisal than the blue background. In particular, displaying the loss-framed message on a red background was effective in increasing the non-intenders’ coping appraisal, but not effective for intenders or actors. Conclusions: Humans’ automous and rapid responses to visual elements (e.g., background color) of messages can be enhanced with the combination of verbal elements and harnessed to achieve message effectiveness. It is also necessary to tailor message visual/verbal design to suit individual decision stage.