Use of Fear Appeals in Public Health Campaigns and in Patient/Provider Encounters

Balanced fear appeal, has both threat and efficacy with explicit conclusion.

Example of fear appeal focusing on threat alone, no efficacy. Likely to work for non-smokers and fail for smokers.

Theoretical Rationale:

The Extended Parallel Process Model (EPPM)

1. Threat motivates action, efficacy determines nature of the action.
2. When threat is low, there is NO response to the message (it's not even processed, efficacy is not considered.
3. When threat is high, and efficacy is HIGH, then people CONTROL THE DANGER and protect themselves.
4. When threat is high, and efficacy is LOW, then people CONTROL THEIR FEAR and ignore the message.
5. Critical to measure both INTENDED and UNINTENDED campaign outcomes, to see if there's NO response to your campaign versus a fear control response (can both look like SO response).

As long as percieved efficacy is stronger than perceived threat (e.g., it's a serious problem that I'm at-risk for but I know I can do something to effectively avert it), then people will control the danger by accepting your message's recommendations and make appropriate behavioral changes.

However, the critical point is when percieved threat slips above perceived efficacy, meaning that people no longer think they can do something to effectively avert the threat. The minute that perceived threat exceeds perceived efficacy, then people begin to control their fear instead of the danger and they reject the message.

Studies Testing the Model

• African-American Homeowners & Radon
• Texas Farmers & Tractor Safety
• Juvenile Delinquents & HIV/AIDS Prevention
• Michigan Residents & Railway Crossing Safety
• Homocysteine & Massachusetts Residents
• Bulimia Prevention & College Students
• Kenya Prostitutes & HIV/AIDS Prevention
• Food Pantry Workers/Customers Needs Assessment
• Beryllium Disease & Alabama Plant Workers
• Needle Sticks & Hospital Workers
• Teen Mothers & Pregnancy Prevention
• Dental Hygiene & College Students
• Hispanic Immigrant & African-American Jr. High Students and HIV/AIDS Prevention
• College Students & Genital Warts
• Skin Cancer & Texas Young Adults
• Coal Miners & Hearing Loss
• and so on...

Empirical Results

• Threat and Efficacy have been shown empirically to be the two major factors of a health risk message.
• Threat Determines Strength of Response, Efficacy Determines Nature of Response.
• Either Fear Control OR Danger Control Processes Dominate (mutually exclusive)
• Fear Appeal Campaigns may Appear to Fail, BUT Efficacy Perceptions Determine Success
• Danger Control is primarily a cognitive process, Fear Control is primarily an emotional process
• Target of threat varies culturally (individual, group).
• Definition of threat varies with target audience.
• High Threat/High Efficacy fear appeals appear to work subconsciously as well.

Applications

Risk Behaviour Diagnosis Scale

• A Rapid Assessment Tool
• Determines whether danger control or fear control processes are dominating (so you can give messages that yield behavior change)
• A Quick 12-item template scale

Rationale:

1. Sum threat score and efficacy score seperately.
2. Subtracted threat score from efficacy score, yielding a critical value.
3. If value is positive, indicates that efficacy is stronger than threat, and person is in danger control. Messages can focus on increasing perceptions of severity and sesceptibility (with appropriate efficacy messages), to increase behavior change.
4. If value is negative, indicates that threat is stronger than efficacy, and person is fear control. Messages must focus on efficacy only (because people are already too scared).

Risk Behavior Diagnosis Scale

Define Threat:____________

Define Recommended Response:____________

Efficacy - Threat = Critical Value

In this example, 15 - 19 = negative 4 (person is in fear control, needs efficacy messages, no threat).

Steps to Using the Scale

1. Clearly Define Threat
2. Clearly Define Recommended Response
3. Plug in threat and recommended response into the scale.
4. Administer to either client or audience.
5. Calculate and develop appropriate messages.

Example of Risk Behavior Diagnosis Scale.

Define Threat: HIV/AIDS

Define Recommended Response: Use Condoms

Efficacy - Threat = ____

Positive score indicates danger control processes dominating needs threat to motivate with high efficacy message.

Negative score indicates fear control processes dominating needs only efficacy messages; no threat.

Creating Appropriate Messages

A high threat message is:

• personalistic
• vivid (language and pictures)

A high efficacy message:

• explains how to do the recommended response
• addresses barriers to recommended response
• gives evidence of recommended response's effectiveness
• may role play recomended response

Low Threat Picture

High Threat Picture

Low Threat

Case study client very dissimlar to target audience, neutral language.

A 35 year-old male prostitute was referred by his private physician to the communicable disease unit of Central London Hospital on July 10, 1989. His physician had treated him one week earlier or a sore throat. On admission, the patient complained of fatigue and a rash...

Moderate Threat

Case study client a little more like Target audience, a bit more vivid language.

A 27 year-old male grocery clerk was referred by his private physician to the communicable disease unit of Chicago Regional Hospital, on July 10, 1989. His physician had treated him one week earlier for a sore throat. On admission, the patient complained of fatigue and lumps on the neck.

High Threat

Case study client identical to target audience, very vivid and descriptive language used.

A 19 year-old white male UCI college student (heterosexual) was referred by his physician to the communicable disease unit of UCI Medical Center on July 10, 1989. His physician had treated him one week earlier for a sore throat. On admission, the patient complained of fatigue and bleeding and oozing sores all over his body-including the genital area...

Click here to access a related peer-reviewed summary on the Health e Communication website, and to participate in peer review.

For more information, examples of focus group protocols and survey items, or to find articles, please see: Dr. Kim Witte's website

An abbreviated list of references provided by Dr. Witte is available: click here

Dr. Kim Witte

Center for Communication Programs

Johns Hopkins University

111 Market Place, Suite 310

Baltimore, MD 21202

wittek@msu.edu