The Effectiveness of Gain- Versus Loss-Framed Health Messages in Improving Oral Health in Iranian Secondary Schools: A Cluster-Randomized Controlled Trial

BACKGROUND: Adherence to oral self-care behaviors is low among adolescents. PURPOSE: This study aims to examine effects of two message framing interventions on oral self-care behaviors and health among Iranian adolescents. METHODS: Cluster-randomized controlled trial, with four schools randomly assigned to receive gain-framed, loss-framed, or no messages. Brushing/flossing, attitudes, intentions, oral health related quality of life (OHRQOL), and clinical examinations were measured at baseline, two and twenty-four weeks. Data were analyzed using multilevel modeling. RESULTS: At 2 weeks, loss-frame participants reported higher brushing and flossing rates, and more favorable attitudes and intentions to brush, compared to the other groups. At 24 weeks, loss-frame participants showed better OHRQOL, gingival health and less dental plaque compared to the other groups. Attitudes and intentions mediated intervention effects for the loss-framed group. CONCLUSIONS: Loss-framed messages were more effective than gain-framed messages in encouraging oral self-care behaviors among Iranian adolescents. These effects were mediated through attitudes and intentions. (clinicaltrials.gov number NCT01421108.).