Examining associations between goal and attribute framing, HIV treatment motivation, and affective responses: A mixed methods study of patient thoughts and perceptions

The use of framing in persuasive health communications considerably affects health behaviour, but our understanding of how framing influences patient motivation to take HIV treatments remains limited. This study examined how goal and attribute framing are related to the motivational and affective responses linked to HIV treatment adherence behaviours. The predominantly low-income, African American sample (n = 30) consisted of HIV patients living in Chicago and Los Angeles who reported their thoughts and perceptions regarding HIV treatment in two previous studies. We performed content analysis on data consisting of a total of 119 thoughts and perceptions, categorized the data by type of framing expressed (goal, attribute), and determined correlations between framing type, treatment-related motivation (i.e., intrinsic, extrinsic, approach, avoidance) and affective responses (i.e., positive, negative). Goal framed thoughts were classified as either gain- or loss-framed. We found that goal framed thoughts highlighting the gains associated with medication adherence were associated with higher levels of intrinsic motivation than either goal framed thoughts highlighting losses or attribute framed thoughts (p < .02). There were no significant associations between type of framing and patients' extrinsic, approach, or avoidance treatment motivations. Negative affect related more strongly to attribute framed thoughts and perceptions than to either gain- or loss-framed thoughts (p < .001). Findings suggest that gain framing may be associated with stronger and more consistent adherence and treatment engagement among HIV patients with a promotion-oriented self-regulatory focus. Future studies are needed to evaluate the relative effect of framing manipulations on actual changes in HIV treatment adherence across time.