title: The effectiveness of gain-versus loss-framed health messages in improving oral health in Iranian secondary schools: a cluster-randomized controlled trial.
abstract: BACKGROUND
  Adherence to oral self-care behaviors is low among adolescents.
  
  
  OBJECTIVE
  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.).
authors.affiliation: Qazvin Research Center for Social Determinants of Health, Qazvin University of Medical Sciences, Qazvin, Iran, pakpour_amir@yahoo.com.
authors.forename: Amir H
authors.initials: AH
authors.lastname: Pakpour
authors.forename: Mir Saeed
authors.initials: MS
authors.lastname: Yekaninejad
authors.forename: Falko F
authors.initials: FF
authors.lastname: Sniehotta
authors.forename: John A
authors.initials: JA
authors.lastname: Updegraff
authors.forename: Stephan U
authors.initials: SU
authors.lastname: Dombrowski
mesh_terms: D000293:Adolescent; D005260:Female; D006267:Health Education, Dental / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007492:Iran; D008297:Male; D009909:Oral Health; D011788:Quality of Life; D012572:School Health Services; D012574:Schools; D012648:Self Care / Q000523:psychology*