Communicating STD Rates to Vulnerable Populations: Results of a National Message Framing Study with Sexually Active African Americans

Theoretical Background and research questions/hypothesis: African Americans (AAs) bear a heavier burden of reported STDs than any other racial group in the United States. Experts have advocated for raising awareness of health disparities as “a necessary first step” to mobilize communities and prompt behavior change. Yet little is known about the effects of racially comparative STD data on AA audiences’ affect and behavioral intent, or whether these outcomes are influenced by differential message framing. This research assessed the relative effectiveness of STD rates framed in absolute, progress (positive), and disparities (negative) frames; and measured the impact on audiences’ affect, STD-related knowledge, motivations and behavioral intent.

Methods: AA respondents, ages 18-30 years, were recruited through a survey research firm using a nonprobability-based quota sample. Through an online survey (N=551), we tested respondent reactions to a mock news article about gonorrhea, framed one of three ways: Impact (described the impact and consequences of gonorrhea in the AA community in absolute terms); Progress (emphasized improvements in gonorrhea rates among AAs over time); and Disparity (highlighted the disproportionate impact of gonorrhea among AAs compared to whites). Participants were randomly assigned to view one of the article versions and asked to respond to questions assessing knowledge, trust, emotions, behavioral intent, and offensiveness of the article. All but the latter question were closed-ended, using a 5-point Likert scale to assess level of agreement with 10 statements (1=strongly disagree; 5=strongly agree). We calculated and compared mean scores across frame types for each statement.

Results:  A total of 170 respondents read the progress version; 184 respondents read the impact version; and 197 read the disparity version. Statistically significant differences (noted below, p<0.05) were found for all but three of the constructs (motivated condom use, knowledge that gonorrhea can be life-threatening, and perceived offensiveness). Trust in the article’s information was higher among those who read the impact version (3.99) compared with the disparity version (3.79). The impact version (4.03), compared with the progress version (3.82), was more likely to make someone want to learn more. The progress version was both less upsetting (2.64) and more encouraging (3.96) than either the impact (3.36 and 3.57) or disparity version (3.36 and 3.38). Respondents who read the impact version were more likely than those who read the progress or disparity versions to report wanting to get tested (3.93 vs. 3.70 and 3.66) and planning to talk to friends about the article (3.71 vs. 3.37 and 3.47), respectively. Agreement with gonorrhea rates being high among AAs was strongest among those who read the impact version (3.80) compared to the disparity (3.71) and progress (3.26) versions.

Conclusions: Overall, the impact frame performed significantly better than the disparity frame, though not significantly better than the progress frame.

Implications for research and/or practice: Findings generally suggest using either an impact or progress frame—and avoiding a disparities frame-- to communicate about STD burden with vulnerable populations. Implications from this and other framing studies, as well as recommendations for health communication efforts, will be discussed.