Abstract: In response to calls for greater integration of research on the effects of visual images in the emotional and cognitive processing of health-related posts on Facebook, this study examined the questions of how gain-and-loss framed images, the valence of emoticon responses, and level of personal relevance of health topics contribute toward intentional engagement (e.g., sharing the posts) on Facebook. This study conducted a 2 (visual framing: gain vs. loss) × 2 (personal relevance of health topic: high vs. low) × 2 (emoticon valence: positive vs. negative) mixed-factorial experiment. A total of 187 college students were recruited to assess the impact of visual framing, personal relevance, and emoticon valence on sharing intention. Results showed that negative emoticons led to a higher intention to share health news posts than positive emoticons. Moreover, two parallel mediation models showed that (a) gain-framed images with high-relevance topics positively predicted perceived susceptibility but negatively predicted perceived severity that both positively impacted sharing intention; (b) loss-framed images with low-relevance topics positively predicted perceived severity but negatively predicted perceived susceptibility that both positively impacted the sharing intention. The implications regarding the contribution to the literature of visual framing and emotion on social media engagement and health communication are discussed.