Frames and counter-frames giving meaning to palliative care and euthanasia in the Netherlands.

BACKGROUND: Based on the case of palliative care and euthanasia in the Netherlands, this paper presents an analysis of frames and counter-frames used in the ongoing public debate about these two intertwined topics. Each (counter)frame presents a cultural theme that can act as a prism to give meaning to palliative care and/or euthanasia. Each frame comprehends a different problem definition, consequences and policy options. Typical word choices and metaphors are identified that can evoke these frames and the underlying reasoning. The frames do not belong to a specific stakeholder but a pattern can be seen in their use that is related to interests and ideology. METHODS: An inductive framing analysis was conducted of 2,700 text fragments taken from various Dutch newspapers, websites of stakeholders and policy documents in the period 2016-2018. After an extensive process of thematic coding, axial coding, selective coding and peer review seven frames and seven counter-frames about palliative care and euthanasia were constructed. Fifteen experts in the field of palliative and/or end-of-life care commented on the overview during a member check. RESULTS: Two frames about palliative care were constructed: the Fear of death frame, which stresses the hopeless 'terminality' of palliative care and the Heavy burden frame, in which palliative care is too big a responsibility for the relatives of the patient. In addition, two counter-frames were constructed: palliative care as a contributor to Quality of life and Completion. With regard to euthanasia, five frames were identified that lead to a problematising definition: Thou shalt not kill, Slippery slope, Lack of willpower, I am not God, and Medical progress. Five counter-frames offer a non-problematising definition of euthanasia in the debate: Mercy, Prevention, Triumph of reason, Absolute autonomy, and Economic utility thinking. CONCLUSIONS: The debate in the Netherlands on euthanasia and palliative care is characterized by a plurality of angles that goes beyond the bipolar distinction between the pros and cons of euthanasia and palliative care. Only with an overview of all potential frames in mind can an audience truly make informed decisions. The frame matrix is not only useful for policy makers to know all perspectives when joining public debate, but also to health care workers to get into meaningful conversations with their patients and families.

Using counterframing strategies to enhance anti-stigma campaigns related to mental illness.

RATIONALE AND METHODS: Despite the prevalence of media-based anti-stigma campaigns, there is little empirical evidence of their effectiveness and little guidance regarding which communicative strategies can bolster their message. Using a Belgian sample (N = 737) recruited in March-April 2019, the current experimental study manipulated a campaign message using counterframing strategies. Hierarchical linear regression analyses were used to investigate the effectiveness of the resulting nine variants. RESULTS: Campaign effectiveness was most increased by stating that people with a mental illness are "not free-riders or poseurs", or by redefining them as "go-getters" who are "certainly not abnormal or crazy". These variants decreased desired social distance, and significantly reduced stereotype endorsement for people with a high need for cognitive closure. Whereas several campaigns decreased attitudinal stigma for people with a high need for cognitive closure, they inadvertently increased it for people with a low need for cognitive closure. CONCLUSION: This study indicates that small changes in the body copy can impact a campaign's destigmatizing potential. As such, empirical testing is essential to avoid ineffective or counter-productive anti-stigma interventions. Moreover, this study demonstrates that refuting stigmatizing statements can be a valid strategy in anti-stigma interventions, even though previous literature has argued against it.

Negotiating climate change: A frame analysis of COP21 in British, American, and Chinese news media.

Climate negotiations have increasingly resonated with global governance and world power relations. However, media studies of climate change have paid relatively less attention to media frames of the problem solving. This study addresses this issue by examining the media coverage of COP21 from three countries that have considerable influence on climate politics: the United Kingdom, the United States, and China. By applying an inductive frame analysis, the study identified 10 media frames embedded in the discussions on climate negotiations. A deductive analysis further assessed the prevalence of these frames. The findings suggest that the frames were significantly influenced by the values of the established and emerging powers in the international policy area. The British and American media upheld the underlying norms that have long underpinned the existing Western-led order, while Chinese media coverage manifested a rising power in need of world recognition.

An Experimental Examination of the Effectiveness of Framing Strategies to Reduce Mental Health Stigma.

The media are often blamed for perpetuating the stigma surrounding mental illnesses, but they can also be used to counter stigmatizing narratives. Drawing on framing theory, this study tested the potency of two framing strategies (deframing and reframing) to reduce mental health stigma, using an online between-subject posttest-only survey experiment (N = 400), conducted in Belgium in November 2017. For people without a personal history of mental illness, deframing (i.e. refuting the stigmatizing narrative) was able to significantly reduce public stigma, while reframing (i.e. introducing a new frame) significantly lowered perceived stigma. For people with a personal history of mental illness, however, the framed texts failed to significantly reduce public stigma, perceived stigma, or internalized stigma. In some cases, these texts even increased their public and perceived stigma. In summary, this study demonstrates that framing can serve as a tool in creating anti-stigma messages, although frames may have different effects on people with and without a stigmatized condition. Finally, it is important to keep the frame's persuasiveness into account, as unpersuasive frames can increase support for the opposing position.

Information Sources as Explanatory Variables for the Belgian Health-Related Risk Perception of the Fukushima Nuclear Accident.

The media play an important role in risk communication, providing information about accidents, both nearby and far away. Each media source has its own presentation style, which could influence how the audience perceives the presented risk. This study investigates the explanatory power of 12 information sources (traditional media, new media, social media, and interpersonal communication) for the perceived risk posed by radiation released from the damaged Fukushima nuclear power plant on respondents' own health and that of the population in general. The analysis controlled for attitude toward nuclear energy, gender, education, satisfaction with the media coverage, and duration of attention paid to the coverage. The study uses a large empirical data set from a public opinion survey, which is representative for the Belgian population with respect to six sociodemographic variables. Results show that three information sources are significant regressors of perceived health-related risk of the nuclear accident: television, interpersonal communication, and the category of miscellaneous online sources. More favorable attitudes toward nuclear power, longer attention to the coverage, and higher satisfaction with the provided information lead to lower risk perception. Taken together, the results suggest that the media can indeed have a modest influence on how the audience perceives a risk.

From the wizard to the doubter: prototypes of scientists and engineers in fiction and non-fiction media aimed at Dutch children and teenagers.

The aim of this paper is to gain insight into the prototypical scientists as they appear in fiction and non-fiction media consumed by children and teenagers in The Netherlands. A qualitative-interpretive content analysis is used to identify seven prototypes and the associated characteristics in a systematic way. The results show that the element of risk is given more attention in fiction than in non-fiction. Also, eccentric scientists appear more often in fiction. In non-fiction, the dimension useful/useless is more important. Furthermore, fictional scientists are loners, although in practice scientists more often work in a team. In both fiction and non-fiction, the final product of the scientific process gets more attention than the process itself. The prototype of the doubter is introduced as an alternative to the dominant representations because it represents scientists and engineers in a more nuanced way.

Communication in nuclear emergency preparedness: a closer look at information reception.

Preparedness of the general population plays a key role in the effective implementation of protective actions in case of a nuclear emergency (e.g., evacuation or intake of iodine tablets). In this context, a good communication of emergency management actors with the public along the entire cycle of preparedness-response-recovery is of paramount importance. This article aims at providing a better understanding of the way people process communicated messages and the factors that may influence how they do this. In particular, it investigates information reception as part of the information processing in precrisis communication. As a case study, the precrisis communication context was chosen, as it has been tackled to a lesser extent in the literature. The empirical data used for this study originated from a large-scale opinion survey in Belgium. One topic in this survey addressed the information campaign for the distribution of iodine tablets, in the context of preparedness for nuclear emergencies. The findings of this study demonstrate that systematic predictors have a stronger influence on information reception, as compared to heuristic predictors. The latter are only to a minor extent involved in the reception of emergency preparedness information. The hypothesized pattern--that more specific knowledge about the field relates to a higher reception of information--was confirmed for precrisis communication. Contrary to expectations, results showed that people with a high perception of radiation risks were less attentive to information about protective actions. People with little confidence in authorities were also more likely to have a low reception of information.

Toward a more nuanced perception of Alzheimer's disease: designing and testing a campaign advertisement.

Starting point of this study was the assumption that Alzheimer's disease is made worse for the person who has the disease by the negative regard in which the illness is held by society. The aim was to test by means of a campaign advertisement whether more nuanced counterframes could have an impact while remaining credible and comprehensible to the public. A sample of thousand people living in Belgium evaluated the campaign in an experimental design. This revealed that all the versions tested achieved a high average evaluation. The ad in which the heading referred to the fear of death and degeneration was judged to be most attention-grabbing, easier to understand, and more credible than the alternative heading with the idea that someone with Alzheimer's could still enjoy playing cards. Together, these findings provided a basis for the use of counterframes to generating a more nuanced image of Alzheimer's disease.

Frames and counter-frames giving meaning to dementia: a framing analysis of media content.

Media tend to reinforce the stigmatization of dementia as one of the most dreaded diseases in western society, which may have repercussions on the quality of life of those with the illness. The persons with dementia, but also those around them become imbued with the idea that life comes to an end as soon as the diagnosis is pronounced. The aim of this paper is to understand the dominant images related to dementia by means of an inductive framing analysis. The sample is composed of newspaper articles from six Belgian newspapers (2008-2010) and a convenience sample of popular images of the condition in movies, documentaries, literature and health care communications. The results demonstrate that the most dominant frame postulates that a human being is composed of two distinct parts: a material body and an immaterial mind. If this frame is used, the person with dementia ends up with no identity, which is in opposition to the Western ideals of personal self-fulfilment and individualism. For each dominant frame an alternative counter-frame is defined. It is concluded that the relative absence of counter-frames confirms the negative image of dementia. The inventory might be a help for caregivers and other professionals who want to evaluate their communication strategy. It is discussed that a more resolute use of counter-frames in communication about dementia might mitigate the stigma that surrounds dementia.