Framing preventive care messaging and cervical cancer screening in a health-insured population in South Africa: implications for population-based communication?

The impact of health message framing on cervical cancer screening uptake is poorly understood. We undertook a prospective randomized control study between August 2013 and February 2014 within a health-insuered population. The study consisted of 748 females, aged 21–65?years who had not had a Pap smear in the previous 3?years and were randomly selected to receive either a loss-framed, gain-framed, or neutral health message (control) regarding cervical cancer screening via email. Pap smear uptake was determined from medical claims data. The median age was 43?years (interquartile range: 26–60?years). Overall Pap smear screening rate was found to be 8.36?percent (confidence interval: 8.08%-8.64%). Screening rate in the control group was 9.58?percent (confidence interval: 9.29%-9.87%), 5.71?percent (confidence interval: 5.48%-6.98%) in the gain-framed group, and 8.53?percent (confidence interval: 8.24%-8.81%) in the loss-framed group. Statistically there was no difference between the screening rates of the groups (p?=?0.75). Females were 43?percent (odds ratio?=?0.57) less likely to have a Pap smear if exposed to a gain-framed message, compared to a neutral-framed message; however, this finding was non-significant (p?=?0.13). When receiving a loss-framed message, females were only 23?percent (odds ratio?=?0.87) less likely to have a Pap smear compared to a neutral-framed message, also not significant (p?=?0.69). In addition, further age stratification revealed no differences in Pap smear uptake between different age groups. These findings indicate that Pap smear uptake in this health-insured population is low, with no difference in exposure to differently framed health messages when emailed. Framing of health messages may not be a significant consideration when constructing population-based communication through emails.