The effects of message framing and healthcare provider recommendation on adult hepatitis B vaccination: A randomized controlled trial

Monica L. Kasting, Katharine J. Head, Dena Cox, Anthony D. Cox, Gregory D. Zimet

Research output: Contribution to journalArticle


Many adults in the U.S. do not receive recommended vaccines, and the research literature remains inconclusive on the best communication strategies for increasing this behavior. This study examined the association of message framing (gained-framed vs. loss-framed vs. control), and healthcare provider (HCP) recommendation (offered vs. recommended) on uptake of adult hepatitis B virus (HBV) vaccination in a high risk population using a 3 × 2 block design randomized controlled trial. Fear of shots, fear of vaccines, and perceived message framing were examined in secondary analyses. Of the 1747 participants, 47.7% (n = 833) received 0 doses of HBV vaccine, 27.8% (n = 485) received 1 dose, 10.4% received 2 doses, and 14.1% received all 3 recommended doses. There was not a significant interaction between message framing and HCP recommendation (p =.59). Mean number of doses received by the gain-framed group (m = 0.96) was not significantly different from the loss-framed group (m = 0.97, RR = 0.99, 95% CI = 0.88–1.12). However, those receiving any framing message received significantly more doses (m = 0.96) than those in the control condition (m = 0.81, RR = 1.17, 95%CI = 1.06–1.31). Participants who received a HCP recommendation received significantly more vaccine doses (m = 0.95) than those in the vaccine-offered condition (mean = 0.82, RR = 1.16, 95%CI = 1.05–1.28). These results suggest there is no difference in vaccine uptake between gain-frame and loss-frame messages, but both are better than a control message. These results also support advising HCP to provide a strong recommendation for vaccinations beyond merely offering it to patients. This study has implications for vaccine uptake beyond HBV, and can inform future research on effective vaccine communication research. Identifier: NCT00739752. Registration date: August 20, 2008.

Original languageEnglish (US)
Article number105798
JournalPreventive Medicine
StatePublished - Oct 2019


  • Framing
  • Health communication
  • Health promotion
  • Hepatitis B vaccines
  • Hepatitis B virus
  • Patient acceptance of healthcare
  • Prospect theory
  • Randomized controlled trial
  • Vaccination
  • Vaccine uptake

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health

Fingerprint Dive into the research topics of 'The effects of message framing and healthcare provider recommendation on adult hepatitis B vaccination: A randomized controlled trial'. Together they form a unique fingerprint.

  • Cite this