framing of prenatal screening test results and women's health-illness orientations as determinants of perceptions of fetal health and approval of amniocentesis

Abstract Framing effects of medical test results and interactions of these effects with personal perspectives were investigated in the context of prenatal screening. Hundred and Thirty-three pregnant women undergoing the ‘triple-test’ were assessed as having health or illness orientations, and were randomly presented with reassuring/moderate/severe diagnoses framed in normal/abnormal terms, forming a 2 × 3 × 2 between subjects design. Evaluations of fetus' health and recommendations to perform amniocentesis were assessed. Findings showed healthier evaluations of the fetus and weaker recommendations to perform amniocentesis in normal versus abnormal framings. An interaction was found between framing, diagnosis, and personal orientations: women with health orientations receiving a moderate diagnosis framed in abnormal terms were significantly more inclined to recommend amniocentesis than illness-oriented women given the same diagnosis; the normal/abnormal framing of severe diagnoses yielded opposite effects on health-oriented versus illness-oriented women. The influences of framing effects and health/ illness orientations on health perceptions and behavioral intentions were discussed.

[1]  K. Lemm,et al.  Sensitivity to varying gains and losses: the role of self-discrepancies and event framing. , 1995, Journal of personality and social psychology.

[2]  Peter Salovey,et al.  The Influence of Message Framing on Intentions to Perform Health Behaviors , 1993 .

[3]  R. Gonzalez,et al.  Personality and Judgment Heuristics: Contextual and Individual Difference Interactions in Social Judgment , 1997 .

[4]  E. Higgins,et al.  Emotional responses to goal attainment: strength of regulatory focus as moderator. , 1997, Journal of personality and social psychology.

[5]  Jens Förster,et al.  Approach and avoidance strength during goal attainment : Regulatory focus and the goal looms larger effect , 1998 .

[6]  J. Green,et al.  Serum screening for Down's syndrome: some women's experiences. , 1993, BMJ.

[7]  D. Lauver,et al.  Message framing, dispositional optimism, and follow-up for abnormal Papanicolaou tests. , 1990, Research in nursing & health.

[8]  F. Fraser,et al.  Genetic counseling: parents' responses to uncertainty. , 1979, Birth defects original article series.

[9]  Arie W. Kruglanski,et al.  Classic and current social comparison research: Expanding the perspective. , 1990 .

[10]  Alexander J. Rothman,et al.  The effects of message framing on mammography utilization. , 1995, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[11]  R. Croyle,et al.  Psychological Reactions to Risk Factor Testing , 1991 .

[12]  M. Shohat,et al.  Down Syndrome Prevention Program in a Population With an Older Maternal Age , 1995, Obstetrics and gynecology.

[13]  A. Tversky,et al.  Prospect theory: analysis of decision under risk , 1979 .

[14]  Joan Meyers-Levy,et al.  The Influence of Message Framing and Issue Involvement , 1990 .

[15]  J. Wardle,et al.  The psychological costs of screening for cancer. , 1992, Journal of psychosomatic research.

[16]  J. Bloom,et al.  Hypertension labeling and sense of well-being. , 1981, American journal of public health.

[17]  H. Cuckle.  Improved parameters for risk estimation in Down's syndrome screening , 1995, Prenatal diagnosis.

[18]  D. Cioffi.  When good news is bad news: medical wellness as a nonevent in undergraduates. , 1994, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[19]  F. Meaney,et al.  Providers and consumers of prenatal genetic testing services: what do the national data tell us? , 1993, Fetal diagnosis and therapy.

[20]  J. Rybash,et al.  The framing heuristic influences judgements about younger and older adults' decision to refuse medical treatment. , 1989, Applied cognitive psychology.

[21]  A. Tversky,et al.  Prospect Theory : An Analysis of Decision under Risk Author ( s ) : , 2007 .

[22]  T. Marteau,et al.  Obstetricians presenting amniocentesis to pregnant women: Practice observed , 1993 .

[23]  J. Opitz,et al.  Psychological aspects of genetic counseling. IV. The subjective assessment of probability. , 1987, American journal of medical genetics.

[24]  Lauren G. Block,et al.  When to Accentuate the Negative: The Effects of Perceived Efficacy and Message Framing on Intentions to Perform a Health-Related Behavior , 1995 .

[25]  Howard Leventhal,et al.  Vulnerability Beliefs, Symptom Experiences, and the Processing of Health Threat Information: A Self‐Regulatory Perspective , 1995 .

[26]  Lola L. Lopes,et al.  [Advances in Experimental Social Psychology] Advances in Experimental Social Psychology Volume 20 Volume 20 || Between Hope and Fear: The Psychology of Risk , 1987 .

[27]  Parental history of hypertension and screening attendance: effects of wellness appeal versus threat appeal. , 1987, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[28]  Performance incentives and means: How regulatory focus influences goal attainment. , 1998 .

[29]  S. Kalichman,et al.  Context framing to enhance HIV-antibody-testing messages targeted to African American women. , 1995, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[30]  J. Klayman,et al.  Confirmation, Disconfirmation, and Informa-tion in Hypothesis Testing , 1987 .

[31]  Theresa M. Matteau.  Psychology and screening: narrowing the gap between efficacy and effectiveness. , 1994 .

[32]  T. Marteau,et al.  Is routine AFP screening in pregnancy reassuring , 1993 .

[33]  O. J. Dunn.  Multiple Comparisons among Means , 1961 .

[34]  Irwin P. Levin,et al.  Need for Cognition and Choice Framing Effects , 1996 .

[35]  S. Michie,et al.  The psychological effects of false‐positive results in prenatal screening for fetal abnormality: A prospective study , 1992, Prenatal diagnosis.

[36]  Haim Mano,et al.  Risk-Taking, Framing Effects, and Affect , 1994 .

[37]  A. Tversky,et al.  The framing of decisions and the psychology of choice. , 1981, Science.

[38]  Fraser Fc.  On being a medical geneticist. , 1963 .

[39]  J. Pligt,et al.  Problem representation, frame preference and risky choice , 1990 .

[40]  E. Higgins.  Promotion and Prevention: Regulatory Focus as A Motivational Principle , 1998 .

[41]  K. Quaid.  Psychological and ethical considerations in screening for disease. , 1993, The American journal of cardiology.

[42]  E. Higgins,et al.  Expectancy × Value Effects: Regulatory Focus as Determinant of Magnitude and Direction , 1997 .

[43]  S. Shiloh,et al.  Effect of framing on the perception of genetic recurrence risks. , 1989, American journal of medical genetics.

[44]  E. Higgins.  Beyond pleasure and pain. , 1997, The American psychologist.

[45]  M. Enkin.  Risk in pregnancy: the reality, the perception, and the concept. , 1994, Birth.

[46]  Helmut Jungermann,et al.  Rarely occurring headaches and rarely occurring blindness: Is rarely=rarely? The meaning of verbal frequentistic labels in specific medical contexts. , 1996 .

[47]  R. Salonen,et al.  Experiences of Mothers Participating in Maternal Serum Screening for Down’s Syndrome , 1996, European journal of human genetics : EJHG.

[48]  F. J. Zuuren.  The standard of neutrality during genetic counselling: An empirical investigation , 1997 .

[49]  R B Haynes,et al.  Increased absenteeism from work after detection and labeling of hypertensive patients. , 1978, The New England journal of medicine.

[50]  T. Marteau.  Psychological Aspects of Prenatal Testing for Fetal Abnormalities , 1991 .

[51]  Elke U. Weber,et al.  Contextual Effects in the Interpretations of Probability Words: Perceived Base Rate and Severity of Events , 1990 .

[52]  D. Cioffi.  Asymmetry of doubt in medical self-diagnosis: the ambiguity of "uncertain wellness". , 1991, Journal of personality and social psychology.

[53]  T. Marteau,et al.  Framing of information: its influence upon decisions of doctors and patients. , 1989, The British journal of social psychology.

[54]  A. Tversky,et al.  On the elicitation of preferences for alternative therapies. , 1982, The New England journal of medicine.

[55]  G. d'Ydewalle,et al.  Framing Biases in Genetic Risk Perception , 1990 .

[56]  Alexander J. Rothman,et al.  Shaping perceptions to motivate healthy behavior: the role of message framing. , 1997, Psychological bulletin.

[57]  A. Tversky,et al.  Choices, Values, and Frames , 2000 .

[58]  J. Canick,et al.  Maternal serum screening for Down's syndrome in early pregnancy. , 1988, BMJ.

[59]  S. Shiloh,et al.  Perception of risk in genetic counseling , 1989 .

[60]  Shelly Chaiken,et al.  The effect of message framing on breast self-examination attitudes, intentions, and behavior. , 1987, Journal of Personality and Social Psychology.

[61]  B. Trock,et al.  Psychological side effects of breast cancer screening. , 1991, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[62]  C. Carver,et al.  Optimism, coping, and health: assessment and implications of generalized outcome expectancies. , 2009, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[63]  S. Shiloh,et al.  Correlates of health screening utilization: The roles of health beliefs and self-regulation motivation , 1997 .

[64]  S. Michie,et al.  Understanding responses to predictive genetic testing: A grounded theory approach , 1996 .

[65]  M. Feijóo,et al.  Counselling following Diagnosis of Fetal Abnormality: A Comparison between German, Portuguese and UK Geneticists , 1994, European journal of human genetics : EJHG.