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Background. Health messages are more effective when framed to be congruent with recipient characteristics, and health practitioners can strategically decide on message features to promote adherence to recommended behaviors. We present exposure to United States (U.S.) culture as a moderator of the impact of gain- vs. loss-frame messages. Since U.S. culture emphasizes individualism and approach orientation, greater cultural exposure was expected to predict improved patient choices and memory for gain- framed messages, whereas individuals with less exposure to U.S. culture would show these advantages for loss-framed messages.
Methods. 223 participants viewed a written oral health message in one of three randomized conditions: gain-frame, loss-frame, or no-message control, and were given ten flosses. Cultural exposure was measured with the proportions of life spent and parents born in the U.S. At baseline and one week later, participants completed recall tests and reported recent flossing behavior.
Results. Improved patient decisions (increased flossing) and memory maintenance during the week were each predicted by congruent cultural exposure and message frame (e.g., low cultural exposure and loss frame). Incongruent messages led to the same flossing as no message. Memory retention did not explain the flossing effect.
Limitations. Flossing behavior was self-reported. Cultural exposure may only have practical application in either highly individualistic or collectivistic countries.
Conclusions. In healthcare settings where patients are urged to follow a behavior, asking basic demographic questions could allow medical practitioners to intentionally communicate in terms of gains or losses to improve patient decision making and adherence.
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