1. H571: WEEK 3 PERCEIVED THREATH AND FEAR APPEALS Fall 2014

2. First assignment due next week Several means 3 or 4 Follow all instructions to the letter! Read the notes in the syllabus about graduate-level writing Learn how to say a lot succinctly Also learn how to separate out what is most important If you need a figure, you can add a page. Remember to critique the studies you review Cross-sectional or longitudinal Quality of measures Appropriateness of conclusions given statistical results Please use APA format to the letter Except I want single-spaced, Calibri 11-point font).

3. DSC Chapter 5 NCI- pages 12-14 Carpenter 2000 Brewer et al 2004 Green & Witte 2006 Models Based on Perceived Threat and Fear Appeals

4. Outline Introduction to FEAR The Health Belief Model Carpenter, 2010 The Protection Motivation Theory Brewer et al., 2004 The Extended Parallel Processing Model Green & Witte, 2006

5. Fear What is FEAR? A chain reaction in the brain that starts when faced with a stressful stimulus and ends with the release of chemicals that cause your heart to race, your breathing to escalate and your muscles to energize The fight-or-flight response Can we harness the power of instinctual fear to change health risk behaviors? If people feared certain disease outcomes, they might take action to avoid them

6. Perceptions People perceive stimuli differently Public health related example? Why is this important to public health professionals? Some view themselves as invulnerable Effective response = stimulus must be perceived as scary & individual must believe they will be affected

7. Threat Perceived threat = perception of a scary stimulus (susceptibility/vulnerability) + perceived severity This construct is the inspiration for fear appeals Fear appeals - persuasive messages designed to scare people Terrible things that will happen if they do not do what the message recommends

8. Health Belief Model (HBM) Two constructs have an independent influence on health behavior: perceived threat + expected net gain of adopting a health behavior Value-expectancy model - likelihood of action determined by gains in something that a person values/desires Relies on notions of perceived severity and perceived susceptibility Perceived severity “If this negative health outcome happened to me, how bad would it be?” Perceived susceptibility “How likely am I to experience this negative health outcome?”

9. Health Belief Model

10. Clear expected net gain ≠ unlikely to adopt a health protective behavior Achieved by: increase perceived value of benefits that can be expected from the action decrease the perceived barriers to performing an action or a combination of both Likelihood of action: endpoint that is essentially a measure of behavioral intent assesses the degree of motivation a person may have to engage in a health protective behavior Health Belief Model

11. Positive net gain achieved by: A. increasing the perceived value of benefits that can be expected from the action B. decreasing the perceived barriers to performing an action C. combination of A & B Likelihood of action: a measure of behavioral intent Cues to action: events, symptoms, or reminders provided by a credible source that encourage behavior Self efficacy: added in 1988 - people will not try a new behavior unless they are confident that they can perform the behavior Individual perceives behavior as useful but does not feel capable of doing it, most likely will not try it

12. Application of HBM Work in your “Assignment 1” groups The health belief model has been described as “eloquently simple.” This simplicity, however, is also a limitation in that it fails to capture many of the constructs represented in other/newer theories. ACTIVITY: Create two lists. List 1: include at least 7 health issues that are highly predisposed to being addressed by the health belief model. List 2: include at least 7 health issues that would not work well at if they were addressed by the HBM. Trade your final lists with another group. Discuss your lists, and engage each other about the choices you made and why.

13. Protection Motivation Theory (PMT) Perceived threat + analysis of rewards and costs for engaging in either maladaptive or adaptive responses Faced with fear-arousing stimuli: adopt positive, adaptive responses to avoid the threat OR choose maladaptive, negative behaviors that ignore risk Processes : threat appraisal & coping appraisal

14. Protection Motivation Theory Threat appraisal : assessment of seriousness of a health threat by estimating probability and severity of a negative outcome if no action is taken Intrinsic and extrinsic Rewards are positive consequences for a maladaptive behavioral response Example? Considering the severity and vulnerability of negative outcomes reduces attractiveness of rewards

15. Protection Motivation Theory Coping appraisal: response efficacy of the recommended behavior, an evaluation of how effective the behavior will be in protecting the individual from harm Factors in costs of the adaptive response and perceived self-efficacy to accomplish the behavior Individual’s past experiences, environmental factors, personality variables may also affect behavior

16. Protection Motivation Theory

17. Maximize the desired effect: severity, vulnerability, response efficacy and self-efficacy should be addressed PMT is an effective predictor and model of adaptive responses to fear-based messages Use of PMT can improve efficacy of health awareness campaigns and should be taken into account when designing messages

18. Extended Parallel Process Model (EPPM) “How do individuals respond to fear-arousing communications?” Communication theory more than a behavioral theory If a fear appeal elicits a perceived threat, EPPM posits that individuals will either: accept a fear appeal message and engage in a danger control process OR reject a message and engage in a fear control process

19. Extended Parallel Process Model Danger control process means individual will engage in strategies to avert the threat This is what health messages hope to achieve Fear control process characterized by: individual’s belief that they are either unable to engage in recommended response OR believe the response to be ineffective (individual is coping by controlling the fear rather than the threat)

20. Extended Parallel Process Model Positive outcomes of protection motivation, message acceptance, and danger control - predicted by certain types of message processing Negative outcomes of defensive motivation, message rejection, and fear control - predicted by other types of message processing Message components, or the content of the message, influence the ways messages are processed Message components are theoretical building blocks

21. Extended Parallel Process Model Perceived threat (susceptibility and severity) + Perceived efficacy (self-efficacy and response efficacy) = message components in the theory Extent variables - used successfully in message design Theorized to impact individuals’ message processing If message communicates a high threat over which the person has low perceived efficacy, then what…?

22. …Person may use defensive avoidance and the message will likely fail

23. Extended Parallel Process Model Defensive avoidance - blocking further thoughts or feelings about the health threat or avoiding further exposure to information about the topic coping mechanism to deal with fear Successful fear appeal- increases sense of perceived threat AND sense of efficacy to successfully engage in recommended response

24. Brewer et al., 2004 Investigated bi-directional causation between risk perceptions and protective behavior The behavior motivation hypothesis perceptions of personal risk cause people to take protective action The risk reappraisal hypothesis when people take actions thought to be effective, they lower their risk perceptions The accuracy hypothesis risk perceptions accurately reflect risk behavior Two important methodological issues Need for careful measurement – precisely defined Need for longitudinal data (not just cross-sectional)

25. Brewer et al ’ s 3 Hypotheses

26. Brewer et al., 2004 Results

27. Avian Flu Activity Work in your “Assignment 1” groups Imagine that Avian flu becomes a virus that is now transmitted easily from person-to-person contact. In addition to getting vaccines into large numbers of people quickly, a host of other behavioral challenges are suddenly apparent (hand washing, wearing masks, etc.). ACTIVITY: Select either the PMT or the EPPM to create an intervention to prevent the flu. Explain the details of your intervention. How does your intervention use the PMT or the EPPM? Why did you choose the theory you did?

28. Effective fear messages have to include ways of avoiding the fear!

29. Examples: Effective? Ineffective?

30. http://www.youtube.com/watch?v=iRPJFuzdzkY http://www.youtube.com/watch?v=e4ZBzMOV9Js “Age of AIDS movie clip”- Uganda campaign http://www.pbs.org/wgbh/pages/frontline/video/flv/generi c.html?s=frol02s46bq90&continuous=1

31. Summary: fear messages Fear appeals appear to be effective when they: depict a significant and relevant threat (to increase perceptions of severity and susceptibility) AND outline effective responses that appear easy to accomplish (to increase perceptions of response- and self-efficacy) Low-threat fear appeals appear to produce little, if any, persuasive effects Thus, regardless of which theoretical model is advocated, the advice to message designers is: Promote high levels of threat and high levels of efficacy to promote attitude, intention, and behavior changes