Fear Appeals A popular form of health message is the fear appeal – to scare people into change Fear appeals can be effective – only if: properly designed do more than just frighten Fear is multidimensional Pushing somebody to change their behaviour when they are not ready, invariably leads to resistance

Fear Appeals Fear appeals create an impression of message effectiveness Unfortunately audience judgments of perceived effectiveness of an advertisement has been shown NOT to be a reliable predictor of behaviour To be effective, media campaign should be integrated with supportive activities TAC Media Campaigns provides public education support to enforcement activities, legislative change and raises community awareness

The Deficit Model

Young People Pre-existing beliefs, attitudes and prior behaviour acts as a screen for messages from the media and society Prior knowledge and experiences determine the extent to which threat communications are accepted/discounted and subsequent strategies they engage in Young people are in a critical stage of development – when they shift their key point of reference from family to peer group

Young People Young people more likely to assess risks for opportunity for gains, compared to adults who tend to focus on opportunity for loss Opportunity for gain – include peer approval, self-image, self-esteem Need to understand What belief do young people hold? Who are their relevant referents? What are the barriers to desired behaviour change?

Shock Tactics and Fear Shock tactics are designed to lead to fear response and subsequent behaviour change Shock tactics can evoke a range of affective responses including fear, anger, puzzlement, guilt, shame It cannot be assumed that a threat appeal will evoke a fear response Fear is multidimensional and complex Inhibitory Fear – where the audience makes an effort to reduce the anxiety caused by the stimulus Anticipatory Fear – related to the perceived likelihood of experience the threat, where the aim is the deal with the threat rather than avoid the anxiety

Shock Tactics Fear can evoke a range of cognitive responses: Third Person Effect Optimistic Bias Maladaptive Coping Responses Fatalism Avoidance Religious faith reliance Inaccurate information beliefs Denial

Protection Motivation Theory – Rogers (1983) People motivated to take action to protect themselves from a health threat, according to: Severity - Perceived severity of threat Vulnerability - Perceived probability of its occurrence Response Efficacy - Perceived efficacy of advocated response Self Efficacy - Perceived self-efficacy to perform the response

Shock tactics – what works Vulnerability – predictive of intention and behaviour Response Efficacy – predictive of intention Tay & Watson 2002: Low/Moderate Fear & High Response Efficacy High Fear & High Response Efficacy High Fear & Low Response Efficacy

Communication Features of Shock Tactics Frames – Tversky and Kahneman Emotional Interest Concreteness Proximity Delivery and wording appropriate to the target group

Shock Tactics and Young People The health message must penetrate several levels of passive and active defenses Threat based advertising while relevant and influential for some segments, may not be relevant and influential for the entire audience Fear more effective with adults and with children or young people Fear arousing messages more effective for the converted

Why Shock Tactics fail Fail to increase perception of vulnerability Fail to promote high response efficacy – instead maladaptive actions occur As fear appeals increase in strength, so do defensive responses

Shock Tactics – HIV / AIDS The Grim Reaper Campaign

Why not Grim Reaper II ? Given the 2 distinct (heterogeneous) target groups – focus on the toxic side effects of antiviral treatments To increase sense of vulnerability: Risk of HIV transmission HIV Transmission Disease Progression Increased viral load – antiviral therapy recommended Antivirals associated with lipodystrophy/lipoatrophy prescribed Lipodystrophy/lipoatrophy develops

Why not Grim Reaper II ? Confuses the debate about HIV transmission Significant possibility of detrimental effects Reduce QoL for people living with HIV HIV positive individuals deferring, rejecting or poorly adhering to antiviral therapy Increased disease progression among HIV positive Increased communal viral pool Increases in HIV transmission

Shock Tactics – Smoking Cessation QUIT Campaign 1998 Quit Victoria has conducted graphic smoking cessation campaigns for many years Negative health effects of smoking well known and undisputable Tools Taxes on cigarettes Regulations at point of sale Advertising ban on cigarette promotion Quit programs, Quitline, pharmacological quitting aids Anti-smoking mass media campaigns

Shock Tactics – Smoking Cessation QUIT Campaign 1998

Shock Tactics – Smoking Cessation QUIT Campaign 1998

Effective Shock Tactic Campaigns NOT stand alone media campaigns! Effective Shock Tactic Campaigns integrated into evidence-based behavioural programs in the community. Drive Drive – Random breath testing, increase penalties and enforcement Grim Reaper – Safe Sex Education, Free Needle Exchange programs QUIT – Quitline, Quit programs in workplaces, advertising bans at point of sale, smoking restrictions Stand-alone/One-off events or campaigns – do not work.

Things to Remember When Working with Young People Whilst fear appeals may have a motivational role, prevention programs are more like to be effective if they focus on: Building Decision Making Skills General Coping Skills Assertive Skills / Resist Peer Pressure Self-Esteem/Self-efficacy Encourage Conversations/Discussions Similar Communicator & Credible

Things to Remember When Working with Young People Provides New Facts Disablement Rather Than Death / Short Term and Social (Peer) Effects Personal Relevance Avoid A Paternalistic Approach Avoid A Didactic Approach Avoid Single, One-off “Events” Low-Moderate Fear & High Response Efficacy