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Abstract
Guided by prospect theory (Kahneman & Tversky, 1979), a large body of research has investigated relative effectiveness of gain- and loss-framed message appeals in various health communication contexts. Several meta-analytic reviews (e.g., O'Keefe & Jensen, 2007, 2009), however, suggest that the anticipated relative advantage of each type of frame under certain conditions (e.g., prevention versus detection behavior) was not found in the existing literature. In an effort to explore why such a robust theory in economics and behavioral psychology fails to receive consistent empirical support in health communication research, this dissertation critically reviews empirical research on gain- and loss-framed message effects, with a comparison to the original prospect theory. This process identified four mismatches between the original theory and application in health communication research: Existing studies and the original theory differed in terms of (1) conceptualization of riskiness, (2) subjectivity of perceived riskiness, (3) absence/presence of required efforts in adopting a behavioral option, and (4) argument framing. Identifying the four mismatches leads to an integration of prospect theory and major constructs in health behavior theories (i.e., response efficacy and perceived susceptibility). Based on the theoretical integration, hypotheses and research questions were proposed and tested in two online experiments, with the first experiment portraying a fictitious disease and the second one focusing on a real health issue. Both experiments employed 2 (cognitive belief: high versus low) x 2 (message frame: gain versus loss) x 2 (perceived barriers: high versus low) factorial between-subjects designs. Results showed that hypotheses addressing Mismatch 1 did not receive consistent support: The effects of valence frame on behavioral change when communicating cognitive beliefs with different levels of riskiness (i.e., uncertainty) were largely not significant. However, hypotheses and research questions exploring issued identified in Mismatch 2 and Mismatch 3 offered a nuanced understanding of the use of prospect theory in health communication research: The percentage gap between the percentage communicated in health messages and the one reported by the participants about their own perceptions of response efficacy and susceptibility can be theorized as an indicator of persuasive effects. In addition, when communicating a familiar health topic, compared with an unfamiliar health issue, perceived barriers did not increase the perceived levels of riskiness (i.e., uncertainty) after message exposure. Implications, limitations, and direction for future research are discussed.