1. This presentation will probably involve audience discussion, which will create action items. Use PowerPoint to keep track of these action items during your presentation In Slide Show, click on the right mouse button Select “Meeting Minder” Select the “Action Items” tab Type in action items as they come up Click OK to dismiss this box This will automatically create an Action Item slide at the end of your presentation with your points entered. The Use of “Fear Appeals” in Public Health Campaigns and in Patient/Provider Encounters Dr. Kim Witte, wittek@msu.eduwittek@msu.edu - Center for Communication Programs, Johns Hopkins University - Department of Communication, Michigan State University Based on the Book: Effective Health Risk Messages: A Step-by-Step Guide, Sage Publications, http://www.sagepub.com/Shopping/Detail.asp?id=4193

2. Introduction n Definitions, What is a Health Risk Message? n Theoretical Rationale for Effective Health Risk Messages n Applications to Real-Life Settings: The Risk Behavior Diagnosis Scale

3. Health Risk Messages (aka “Fear Appeals” or “Scare Tactics”) n Imply some sort of risk n Inherently fear-arousing (because of the implied risk) n Formally known as “Fear Appeals”

4. Health Risk Messages have 2 components n A Threat Component –Severity of Threat - is it serious or severe? (magnitude of threat) –Susceptibility to Threat - can it happen to me? ( possibility of experiencing threat) n A Recommended Response (address efficacy issues) –Response Efficacy - does response work? –Self-Efficacy - can I do response? –Barriers to Self-Efficacy - what blocks me from doing response?

5. Example of fear appeal focusing on threat alone, no efficacy, implicit conclusion.

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

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

8. 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 NO response).

9. As long as perceived 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 perceived 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. Danger Control Responses Fear Control Responses

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

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

13. Applications: Risk Behavior Diagnosis Scale n A Rapid Assessment Tool n Determines whether danger control or fear control processes are dominating (so you can give messages that yield behavior change) n A Quick 12-item template scale Rationale: 1. Sum threat score and efficacy score separately. 2. Subtract 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 susceptibility (with appropriate efficacy messages), to increase behavior change. 4. If value is negative, indicates that threat is stronger than efficacy, and person is in fear control. Messages must focus on efficacy only (because people are already too scared).

14. Risk Behavior Diagnosis Scale Define Threat=________________; Define Recommended Response:______________________________________ Strongly Strongly Disagree Agree RE 1. [Recommended response] is effective in preventing [health threat]: 1 2 3 4 5 RE 2. [Recommended response] work in preventing [health threat]:1 2 3 4 5 RE 3. If I [do recommended response], I am less likely to get [health threat]:1 2 3 4 5 SE 4. I am able to [do recommended response] to prevent getting [health threat]:1 2 3 4 5 SE 5. I have the [skills/time/money] to [do recommended response] to prevent [health threat]:1 2 3 4 5 SE 6. I can easily [do recommended response] to prevent [health threat]:1 2 3 4 5  Eff____ ******************************************************************************************************************* Strongly Strongly Disagree Agree SEV 7. I believe that [health threat] is severe:1 2 3 4 5 SEV 8. I believe that [health threat] has serious negative consequences:1 2 3 4 5 SEV 9. I believe that [health threat] is extremely harmful:1 2 3 4 5 SUSC 10. It is likely that I will get [health threat]:1 2 3 4 5 SUSC 11. I am at risk for getting [health threat]:1 2 3 4 5 SUSC 12. It is possible that I will get [health threat]:1 2 3 4 5  Thr_____ 15 19 Efficacy - Threat = Critical Value In this example, 15 - 19 = - 4 ( person is in fear control, needs efficacy messages, no threat).

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

16. Example of Risk Behavior Diagnosis Scale. Define Threat= HIV/AIDS Define Recommended Response: Use Condoms Strongly Strongly Disagree Agree RE 1. Condoms are effective in preventing HIV/AIDS infection: 1 2 3 4 5 RE 2. Condoms work in preventing HIV/AIDS infection:1 2 3 4 5 RE 3. If I use condoms, I am less likely to get infected with HIV/AIDS:1 2 3 4 5 SE 4. I am able to use condoms to prevent getting infected with HIV/AIDS :1 2 3 4 5 SE 5. I am capable of using condoms to prevent HIV/AIDS infection:1 2 3 4 5 SE 6. I can easily use condoms to prevent HIV/AIDS infection:1 2 3 4 5  Eff___ ******************************************************************************************************************* Strongly Strongly Disagree Agree SEV 7. I believe that HIV/AIDS infection is severe:1 2 3 4 5 SEV 8. I believe that getting HIV/AIDS has serious negative consequences:1 2 3 4 5 SEV 9. I believe that getting HIV/AIDS is extremely harmful:1 2 3 4 5 SUSC 10. It is possible that I will get HIV/AIDS:1 2 3 4 5 SUSC 11. I am at risk for getting HIV/AIDS:1 2 3 4 5 SUSC 12. It is likely that I will get HIV/AIDS:1 2 3 4 5  Thr_____ 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).

17. Examples of each condition according to threat/efficacy beliefs.

18. Creating Appropriate Messages n A high threat message is: –personalistic –vivid (language and pictures) n 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 recommended response

19. Low Threat PictureHigh Threat Picture

20. Low Threat Moderate Threat High Threat Case study client very dissimilar Case study client a little more like Case study client identical to target to target audience, neutral language. Target audience, a bit more vivid audience, very vivid and descriptive language. language used.

21. For more information, examples of focus group protocols and survey items, or to find articles, please see: www.msu.edu/~wittek/index.htm The End...