Gains Versus Losses: Communicating about Cytomegalovirus (CMV) Preventive Behaviors

Theoretical Background and research questions/hypothesis:  Congenital cytomegalovirus (CMV) infection is the leading cause of hearing loss and one of the most common causes of birth defects and developmental delays in infants. Transmission occurs when a pregnant woman has contact with the saliva or urine of an infected person. Young children are the primary carriers. The focus of this study is how to effectively communicate with women about CMV prevention behaviors. The theoretical framework of this study was based in economic prospect theory, which suggests that presenting alternatives in terms of what is gained versus lost will change the outcome of the decision made. Hypotheses for this study were 1) gain framed messages will result in greater overall behavioral intention, 2) for the group of women who perceive they are at risk for CMV infection, the loss frame will result in greater behavioral intention, and 3) messages framed as “CMV is the most common cause of birth defects” will be associated with greater behavioral intention.

Methods:  This was a 2x2 factorial design with four message conditions. Gain and loss frame messages focused on, respectively, the benefits or costs of practicing or not practicing preventive behaviors. Wording of “small chance” or “most common” was used to manipulate perceived risk of being infected with CMV. Data were collected from an online panel of women currently pregnant or planning pregnancy in the next year who had a child less than 5 years at home. Measures included past behavior, awareness of CMV, perceived susceptibility, perceived behavioral control, behavioral intention, response efficacy and several manipulation checks.

Results:  A total of 840 women completed the survey. CMV risk behaviors were common among the sample. Although most women indicated they would change their behaviors in the desired direction, neither gain-loss framing nor “small chance,” “most common” framing had a significant effect on behavioral intention. Regardless of frame, perceived behavioral control and response efficacy did increase behavioral intention. Among the subset of women that perceived themselves to be at risk, describing CMV as one of the “most common” things that could affect a baby significantly increased perceived susceptibility and perceived risk.

Conclusions:  Although women indicated intention to change behavior, intention did not vary in response to gain-loss message framing. This indicates that economic prospect theory is not the most effective method of communicating CMV prevention behaviors to expectant mothers. Findings that perceived risk and susceptibility as well as perceived behavioral control and response efficacy appear to have more influence over maternal behavioral intention suggest that the Health Belief Model may be a more important framework for communication about CMV prevention behaviors. 

Implications for research and/or practice:  Further research is needed to explore the suitability of the Health Belief Model in explaining and influencing behavior change to prevent CMV, specifically, to explore the perceived benefits and barriers associated with each CMV preventive behavior. Practitioners should continue to counsel women regarding CMV prevention and public health campaigns are needed to increase awareness of CMV. Both may emphasize the relative prevalence of CMV to increase perceived susceptibility and risk among pregnant women.