Why? Because! with Physicians

Attributional Frame

I’ve demonstrated before the large, practical persuasive impact of minor word choices.  The easiest word game is with the Why? Because! persuasion play.  You can force people to make either internal or external attributions for their behavior, producing very different outcomes.  You might recall from my Primer page on Attribution the health study that used a letter to motivate women to get a mammogram.  Some women got a letter that used the word You to produce an internal attribution for getting tests while others got the same letter but with The Physician to produce an external attribution for the testing.  For example:

“Your doctor will look at the mammogram for very small masses that aren’t detectable by a self exam.”

“You will ask if the mammogram revealed very small masses that aren’t detectable by self exam.”

When women received the You letter, they were more likely to get a mammogram (66%) versus women who got the Your Doctor letter (57%).  All with just that little word difference.

Now comes along a new study that tries the same persuasion play, but with physicians rather than patients.  Tony Roberto and colleagues designed letters that varied with the word choice and also the frame (more on that in a second) creating four different types of letters, plus a control condition.  The letters encouraged physicians to perform a particular test regarding kidney function that is well within their training, experience, and skill.  A large group of doctors were randomly assigned to get one of the five letters (control or the four combinations of attribution and framing).  The docs were then surveyed for their intention and behavioral likelihood to perform the recommended test.

The attributional manipulation was quite simple.  For example:

Your failure to detect the disease early may lead to its progression, increasing the likelihood that your patients will need dialysis.

A physician’s failure to detect the disease early may lead to its progression, increasing the likelihood that a person will need dialysis.

Notice both sentences argue the same claim about prevention and progression and only vary on that minor wording difference of Your Failure or A Physician’s Failure.  Additionally Roberts et al. included a framing manipulation that actually worked!  (Please read why this is surprising here.)

The Big News in this is not that Why? Because! worked or that for once a framing manipulation worked as predicted, but because these two persuasion variables interacted to create the same positive outcome (stronger intention and behavior likelihood to do the new test), but under different conditions.

See, when physicians got a letter that had You words with a Gain frame (Your success in detecting the disease early may prevent its progression . . .), they reported stronger intentions and greater behavior likelihood of performing the new test compared to the letter with The Physician in the Gain frame at a small Windowpane effect.  Thus, connecting a Gain with You is better than a Gain with The Physician.

Now, with a Loss frame, the effect reversed.  Thus, when physicians got a letter that had The Physician Words with a Loss frame (A physician’s failure to detect the disease early may lead to its progression . . . ), they reported stronger intention and greater behavior likelihood compared to the letter with Loss and You; this was a moderate Windowpane effect.  Thus, connecting a Loss with The Physician is better than Connecting a Loss with You.

Simply put, You will Gain works better than Physicians will Gain and Physicians will Lose works better than You will Lose.

More simply still:  people will take personal responsibility for Gains, not Losses; people will take “corporate” responsibility for Losses, not Gains.

The practical persuasion here is that you need to consider both the attribution and the frame.  People want to see themselves as accountable for Gains, but they want a group responsibility for Losses.  Either approach works, but you need to keep them separate.  If you are pitching Gains, make sure you make tight, personal attributions – this is Yours, only You can do it, You make it happen.  If you are pitching Losses, make sure you make them diffuse, group attributions – this is Ours, only We can do it, We make it happen.

It also appears that group attributions with Loss frames works the strongest.  People tend to be punishment averse.  They don’t like losses, pain, or suffering compared to the “same” amount of reward.  But, as we’ve noted before, this Gain versus Loss frame is considerably trickier than the early theory predicted.