Objective To explore the framing effect of health promotion information on processes of change and decision balance among community residents in the context of primary prevention of hypertension. Methods A randomized controlled trial was conducted, enrolling 314 volunteers from Jiangchuan Community Health Service Center, Minhang District, Shanghai. Participants were randomly assigned to either a gain-framed group (positive framing, n=159; information emphasized the benefits of ceasing unhealthy behaviors) or a loss-framed group (negative framing, n=155; information emphasized the harms of engaging in unhealthy behaviors) using a random number table. Participants’ cognitive level (depth of information processing and problem-solving) and future orientation (attention to future outcomes when making decisions) were assessed. Processes of change and decisional balance were evaluated before and after the intervention, and stratified analyses were performed by sex, age, cognitive level, and future orientation.

Results Both gain-framed and loss-framed interventions led to significant improvements in scores for processes of change (all P＜0.05). Regarding subdimensions, 8 dimensions improved in the gain-framed group, whereas 6 dimensions improved in the loss-framed group. Before the intervention, no significant difference was observed in decisional balance scores between the two groups (96.0 88.0, 104.0 vs 98.0 90.0, 106.0, Z = 1.459, P = 0.144). After the intervention, decisional balance score was significant improved in both groups (all P＜0.05), and which was higher in the loss-framed group than that in the gain-framed group (102.0 94.0, 110.0 vs 99.0 91.0, 108.0, Z = 2.157, P = 0.031). Stratified analyses by gender showed that both male and female participants exhibited significant improvements in scores for processes of change and decisional balance after intervention. Among different age groups, for people under 39 years old, both indicators (scores for processes of change and decisional balance) increased after intervention in gain-framed group, while only decision balance score improved after intervention in loss-framed group (both P＜0.05); for people aged 39 to 55 years, only score for processes of change improved after intervention in both groups (both P＜0.05); for people over 55 years old, both indicators increased after intervention in loss-framed group, while only score for processes of change increased after intervention in gain-framed group (both P＜0.05). Stratified analyses by cognitive levels showed that in subjects with low-cognition, only score for processes of change increased after intervention in both groups (both P＜0.05); in subjects with medium-cognition, only decisional balance score increased after intervention in loss-framed group, while both indicators increased after intervention in gain-framed group (both P＜0.05); in subjects with high-cognition, only score for processes of change increased after intervention in gain-framed group (P＜0.05), while there were no statistically significant changes in both indicators after intervention in loss-framed group (both P＞0.05). Stratified analyses by future orientation showed that in reality-oriented participants, both indicators increased after the intervention in both groups (both P＜0.05); in balance-oriented participants, there were no statistically significant changes in both indicators after intervention in loss-framed group (both P＞0.05), while both indicators increased after intervention in gain-framed group (both P＜0.05); in future-oriented participants, both indicators increased after intervention in loss-framed group (P＜0.05), while the change in the two indicators was not statistically significance in the gain-framed group (both P＞0.05).

Conclusions The framing effect of health promotion information plays a significant role in primary prevention of hypertension. Both gain-framed and loss-framed information can improve processes of change and decisional balance scores, but their effects are different: gain-framed information has a broader impact on processes of change across more dimensions, whereas loss-framed information has a more pronounced effect on decisional balance. The effectiveness of framing interventions varies by sex, age, cognitive level, and future orientation, suggesting that tailoring information framing according to target population characteristics may optimize health behavior promotion.