I spent four years as the leader of the Health Communication Research Branch in the Centers for Disease Control and Prevention (CDC) during both the Clinton and Bush administrations.  My lead agency was the National Institute for Occupational Safety and Health (NIOSH).  I learned a great deal about the importance of risk communication particularly when those messages come from government leaders.  People who are good at risk communication tend to keep their jobs while those who aren’t, don’t.  And with good reason.  If you are supposed to be a health and safety expert, you should know how to talk about it.

Last night I witnessed a weak example of risk communication from a government leader.  Katie Couric of CBS News interviewed Kathleen Sebelius, Secretary for Health and Human Services.  You can follow this link to first read a transcript of the brief interview, then click on the interview image on their website to watch the video.  I’d encourage you to do so.

While Secretary Sebelius projects an approachable expertise, her responses to Couric’s questions are good examples of weak risk communication.  Couric often phrases a question that asks for a direct, clear, “yes” or “no,” while also expecting elaboration.  Yet in virtually every case, Sebelius answers the question with a long, careful, and complex response that tries to be all things to all people at all times and never clearly answers the question.  It sounds more like she is running for office and less like a health and safety expert.

The problem is particularly acute given the topic:  Vaccination for swine flu.  Vaccines are controversial health programs that generate great fear and worry in many parents.  While the overwhelming majority of most people understand the value of vaccinations in general, each particular case is cause for serious consideration.

Sebelius needs immediate coaching from risk communication trainers.  She has great presence, has an excellent voice, and shows great calmness.  She looks like a trustworthy leader who also knows what she’s talking about.

But she needs to take the next step and master the patterns of talk required for effective risk communication.  Learn and rehearse simple, direct statements.  Answer immediately with short, clear, and decisive statements, then add clarifications.  Address negative issues with sensitivity and respect, but provide correct counterarguments.  Risk communication is not like management communication.

This is not a trivial matter.  Weak risk communication can make a bad situation worse for everyone including yourself.  A painful example to consider is  Dr. Jeff Koplan who was the Director of the CDC during the anthrax attacks of 2001.  Koplan was the initial face and voice of the Federal government during those scary weeks and he was not an effective risk communicator, despite his outstanding credentials, reputation, and experience as a public health researcher and leader.  He didn’t know how to talk about the risk.  His words tended to increase fear, doubt, and worry.  Not only was he replaced as the lead spokesperson (by Dr. Anthony Fauci of the National Institutes for Health), but Koplan resigned as CDC Director just a few weeks later.

Risk communication is a difficult form of persuasion and it requires training, practice, and experience.  While it is similar to other forms of persuasion like management and leadership and to a certain extent, teaching, it has its own unique qualities that need specific study.

Good science often provides both good news and bad news in the same moment and a report by Dan O’Keefe and Jakob Jensen in the Journal of Communication illustrates this.  O’Keefe and Jensen conducted a meta-analysis of the research literature investigating the effects of message framing on health risk behavior.  The good news is that they found something.  The bad news is that the something they found is next to nothing.

At the outset we need to get on the same page with some key words.  First, a meta-analysis is a quantitative review of the literature.  Instead of doing a narrative review where you read everything on a topic, think hard about it, and draw conclusions, a meta-analysis collects all the quantitative data on a topic, analyzes the combined results, and then draws conclusions (quantitative and qualitative).  Well done metas can make a huge contribution to research by providing a large scale perspective with properly applied analysis.  So, a meta is a like a review of the lit, just with numbers instead of words.  It is a well established method that can be abused, but when done right, is a good thing.

Second, message framing is a persuasion tactic that provides information against different backgrounds.  We can say, for example, that health tests like mammograms are helpful either because:  1) the test can detect cancer early when it is easier to treat (gain frame) or 2) if you don’t test, you may not detect cancer early when it is easier to treat (loss frame).  In both message frames, the same claim is made:  Get a mammogram.  However, the gain frame focuses upon advantages while the loss frame keys on disadvantages.  Framing is usually conceptualized within Prospect Theory which is part of the Nobel-prize winning work of Dan Kahneman and Amos Tversky.  You might also know about framing, Prospect Theory, or Kahneman and Tversky through the recent book, Nudge, by Richard Thaler and Cass Sunstein.  Nudges are operationalized through “choice architecture” with message framing being a type of choice design.

Third, Nudge is the current rage for nuanced intellectuals pursuing public policy, particularly with the Federal government.  President Obama has nominated Cass Sunstein to run an important regulatory office in the Executive branch and Sunstein has made no secret of his desire to use persuasion tactics like Nudge and framing to influence citizens to make smarter choices.  While there are many elements to Nudging Public Policy, tactics like framing are part of the Standard Operating Procedure.

Fourth, according to theory, with a particular kind of behavior – disease detection – loss frames should work better than gain frames.  It’s a long argument, you need a good theory background, and it is accessible to anyone willing to die in the library for it, so go to it, otherwise you have to take this claim on its face.  Thus, when Dr. Sunstein becomes the Regulatory Czar, he might propose to write all Federal communications about women getting mammograms with loss frames to encourage more women to get the test.  He might do the same for men and tests for prostate cancer.  With anything that involves disease detection, he might require wording in the loss frame because of the theoretical advantages, plus some good experimental research.

Now, we can get to the research article from O’Keefe and Jensen.  So, what happens when you Nudge with a frame?

According to the meta-analysis, not much.

They scoured the literature and located 53 research reports that provided tests of gain versus loss frames on disease detection.  These studies involved 9,145 participants on a wide variety of topics.  The key comparison was that difference between loss framed messages versus gain framed messages.  Theory predicts that loss frames should be a lot better at motivating people to do the “right” behavior.

And, technically, this is exactly what they found.  Loss frames did produce more behavior change than gain frames and this average change was beyond the .05 level of statistical significance.  Now, the bad news:  the effect size, expressed as the correlation r, was .039.

For those of you with no stats background, a “small” effect is considered to be anything over .100.  Thus, the obtained r of .039 only one third of a small effect.  Expressed in the Windowpane format this is a 49.39% versus 50.61% difference.  Which is a quantitative way of saying, “Nothing happened” (although that is not what we say when we look at a computer screen and realize our next grant application just died).

Now, quickly to the tut-tuts and “Sir, may I interject the observation that . . .”  There is much more to the analysis.  Lots of numbers.  Lots of nuance.  Lots of potential exceptions.  I agree.  More research is needed!

Yet and still, focus on the Main Point:  All the smart money has been on a very particular bet for over 20 years and that bet is proven to be baseless with this meta-analysis.  Let me provide as unadorned a quote from the paper as I’ve ever read in a scientific research report:  “This must be counted a rather disappointing conclusion.”

Can I get a big “Hell, yeah!” from all the redneck girls and boys like me on this?

Let’s divide the remaining comment into two streams:  Science and Policy.

The science here is surprised.  Dan O’Keefe does good work and this report is yet another example of his skill, patience, and prudence.  If he has any skin in the game, I have no idea where it is.  The report is objective, balanced, and driven by science.  It provides strong evidence of a theory failure.  I would argue that the first place to pick up the pieces on the science side is through a thorough dual process analysis.  Many framing studies are done without carefully controlling or measuring the processing state of the participant (and I’d make that assertion about a lot of Prospect Theory research).  Framing can function either as a cue or an elaboration moderator and it makes a huge difference in outcomes.  Thus, frames, prospects, and Nudges still may work as claimed, but they need a large rewrite.

The policy, I fear, is probably going to be largely unaffected.  Nudgers, in particular, will probably not read this report and if they do, will find a way to isolate it from their beliefs.  Really smart Nudgers will most likely read this article, discern the master stroke missing from the meta-analysis, and adjust their thinking without testing it.  My largest worry is that people will try to Nudge within the Federal government even in the face of this empirical failure.  These results should not have occurred.  Unless you can demonstrate empirically why and how framing should still work here, you should seriously reconsider Nudging anything.

Otherwise, you are Nudging for Nothing.

When high WATT processors think about “strong” arguments, they generate positive thoughts (”elaborations”) that then lead to positive attitude change.  When high WATT processors think about “weak” arguments, they generate negative thoughts that then lead to negative attitude change.  Thus, argument quality drives direction and amount of elaboration which drives direction and amount of attitude change.  This is just basic Central Route theory from the Elaboration Likelihood Model.

Okay, class, let’s test our understanding of this simple persuasion chain with a story ripped from the headlines.  John Dvorak wrote a story providing his perspective on the recent search merger between Microsoft and Yahoo and how this will play out against Google.  Dvorak claims that Google will continue to win and that things will only get worse for Microsoft and Yahoo.  (It’s a good article and Dvorak uses a nice persuasion metaphor to argue his claim.)

One reader, “dpolara,” disagrees, claiming that Bing is a better search engine than Google.  Here’s dplora’s argument:

“Enter this equation into Bing! : x-3/x-1=x-4/x-5

(Notice that Bing solves the equation for you)

Now enter it into Google:

Now enter it into Yahoo!

Looks like Bing, once again, has differentiated itself from Google and has offered Yahoo a better product.”

Okay, literally millions of people use search engines on the Internet everyday.  How many of them will consider dplora’s argument to be strong or weak?  Now, I’ve got enough propeller in me to fancy solving for x time to time.  It’s almost up there with looking at Marilyn Monroe pictures, price shopping vodka, and checking the S&P.  But, how many other people besides me and dpolara can there be?

Yet, dpolara, wants to take the time to offer this as a refutation to John Dvorak, so it seems dpolara at least believes this is compelling information.

Remember the Rules:  It’s about the other guy, stupid!  And, All bad persuasion is sincere!

These Rules applied here would be:  How many other guys use search engines to solve for x.  And, simply because you solve for x doesn’t mean everyone else does, too.

In a prior “Good Sunday Reading” post I noted a story where the Alabama Alcoholic Beverage Control Board banned sales of a wine that used nudity on its labels.  Now, we learn that the ban is stimulating sales of the wine, Cycles Gladiator, nationally.

Where to begin?

Sex Sells! right?  Except in Alabama although even in Alabama there’s some dispute on this point.

But, why didn’t Sex Sell before the ban?  Why didn’t the lovely Art Deco-ish label attract national attention and sales before the Alabama decision?

A good persuasion theory answer is, “reactance.“  Whenever people perceive an unfair restriction on their actions, they tend to respond in a defiant, rebellious, and acquisitive way.  Simply because the restriction is “unfair,” people will tend to want the restricted thing even more.

If you work with children, you’ve seen reactance in action and probably didn’t realize it.  You just made a rule, then enforced it with the kids, and Boom! they went off like a cannon shot.  What you probably missed in these kidstorms was that perception of “unfair” restriction.  You doubtless thought your actions were just, legal, and correct, but that’s not the point.  They saw something as unfair and that’s the trigger.

And, of course, reactance and perceptions of unfairness are not restricted to children.  I hesitate to use this as a potential application, but it unfortunately seems to fit:  One might – with great respect, sensitivity, and empathy – consider that just perhaps, maybe, and possibly, that Professor Henry Gates perceived the actions of Sergeant Crowley as placing unfair restrictions and Boom, you get one defiant Harvard prof.  Thus, the GatesGate affair is not about race or class or anything else.  Just good old reactance.

Man, is persuasion science cool beans, or what?  We start with nude nymphets selling wine and end up solving a National Nightmare.

Hubba-hubba.

Tonight our long national nightmare ends with a round of beers for our President, Mr. Gates, and Mr. Crowley.  The best metaphor (a great persuasion tactic) for the event goes to Jake Tapper (or somebody else at ABC News).

The Audacity of Hops.

Brevity is the soul of headlines.