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Sixty Years of Fear Appeal Research: Current State of the Evidence

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Sixty Years of Fear Appeal Research: Current State of the Evidence International Journal of Psychology, 2014 Vol. 49, No. 2, 63–70, DOI: 10.1002/ijop.12042 Sixty years of fear appeal research: Current state of the evidence Robert A. C. Ruiter1, Loes T. E. Kessels1, Gjalt-Jorn Y. Peters1,2, and Gerjo Kok1 1Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands 2Department of Statistics & Methodology, Open University, Heerlen, The Netherlands ear arousal is widely used in persuasive campaigns and behavioral change interventions. Yet, experimental evidence F argues against the use of threatening health information. The authors reviewed the current state of empirical evidence on the effectiveness of fear appeals. Following a brief overview of the use of fear arousal in health education practice and the structure of effective fear appeals according to two main theoretical frameworks—protection motivation theory and the extended parallel process model—the findings of six meta-analytic studies in the effectiveness of fear appeals are summarized. It is concluded that coping information aimed at increasing perceptions of response effectiveness and especially self-efficacy is more important in promoting protective action than presenting threatening health information aimed at increasing risk perceptions and fear arousal. Alternative behavior change methods than fear appeals should be considered. Keywords: Fear appeals; Literature review; Threat information; Persuasion; Behavior change. Threatening health messages, in the social and health of threatening health communications, but at the same psychology literature referred to as fear appeals, are time, the least persuasive component. In this article, we widely used in health communication. Members of the refer to these severity-based messages as threatening general population and health promoters who design health information or fear arousal. We then illustrate these messages tend to believe in the persuasive power the challenges involved in designing effective fear- of fear arousal. This is best illustrated in the wide-scale inducing messages by referring back to meta-analyses on use of health warnings on cigarette packages. Textual the effectiveness of fear-inducing persuasive messages, and graphic warnings on cigarette packages are typical here referred to as fear appeals. These challenges lie in examples of fear-inducing communications. Similar convincing the target audience that the health threat is examples can be found in other health domains, such as relevant to their personal lives and in inducing a strong the Australian Grim Reaper campaigns in the mid-1980s belief in the personal feasibility of the recommended to warn of the fatal effects of human immunodeficiency protective action, that is, building self-efficacy in relation virus infection/acquired immunodeficiency syndrome to the recommended health action. We conclude that the (HIV/AIDS), the US “this is your brain on drugs” choice of fear appeals is often a poor choice because campaign to prevent (excessive) substance use and of the limited and even sometimes counterproductive numerous traffic safety campaigns showing the bloody effects of fear arousal and the extensive knowledge base consequences of traffic accidents often involving young available on more effective methods of behavior change people. These campaigns are based on the assumption that (see Kok, Bartholomew, Parcel, Gottlieb, & Fernandez, by vividly demonstrating negative and life-endangering 2014, this issue). consequences of risk behaviors, people will be motivated to reduce their current risk behavior and adopt safer THREATENING HEALTH COMMUNICATIONS alternative behaviors. ARE POPULAR AND JUSTIFIED WITH WEAK Our aim in this first article of the special section on SCIENTIFIC EVIDENCE fear appeals is to discuss the use of threatening messages in health promotion campaigns. We will argue that Threatening health messages are popular in health severity information is often the most visible component education design. For example, the introduction of Correspondence should be addressed to Robert A. C. Ruiter, Department of Work and Social Psychology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. (E-mail: [email protected]). © 2014 The Authors. International Journal of Psychology published by John Wiley & Sons Ltd on behalf of International Union of Psychological Science. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. 64 RUITER ET AL. health warnings on cigarette packages in 2002 was information, neutral information could still be better accompanied by wide-scale media attention on television, remembered. radio and in newspapers throughout Europe. Soon Four experiments are left that compare threatening after the introduction of these messages, national polls health information with another behavior change method were presented that suggested that people smoked or no method. In none of these studies is behavior less because of the new health warnings. Discussion an outcome variable; outcome variables are limited to programs on radio and television featured people who soft indicators of behavior, often measures of attitude quit smoking sometime after the introduction of the health and intention. Although large to medium changes in warnings—while ignoring the fact that many of these intention have been found responsible for medium to people would relapse (e.g., Zhou et al., 2009). Also among small changes in behavior (Webb & Sheeran, 2006), those involved in intervention design there is a strong these measures are not an acceptable indicator of the belief in the persuasive efficacy of threatening health persuasiveness of threatening health messages because messages (see also Peters, Ruiter, & Kok, 2014). Risk changes in knowledge, attitude and intention might not information and information about the (positive/negative) result in changes in behavior due to defensive responses consequences of behavior are among the most widely toward the health information (e.g., Ben-Ari, Florian, & used behavior change techniques (e.g., Abraham, Krahe,´ Mikulincer, 2000). Dominic, & Fritsche, 2002; Albarrac´ın et al., 2005). It is Finally, we do acknowledge that studies into the effec- not clear, however, whether this popularity of threatening tiveness of policy changes are difficult to carry out when health information is evidence-based. Questions could implementation is at the national level, making causal be raised about how available scientific evidence for conclusions almost impossible. However, the difficulty the use of threatening health messages was interpreted, to experimentally test policy measures is not a license to for example by focusing on the scientific evidence that claim causal effects (see also Ruiter & Kok, 2005, 2006). has been used by the European Commission (EC) and World Health Organization (WHO) to argue in favor of LACK OF EVIDENCE AND SUPPORT 1 implementing graphic warnings on cigarette packages. FOR COUNTER-EVIDENCE IN HIGH QUALITY The evidence of the persuasive effects of graphic EMPIRICAL STUDIES health warnings on tobacco products has been recently summarized by Hammond (2011). Of the 94 studies In experimental social psychology, several studies have included by Hammond, 22 used an experimental design. been reported that tested the effects of frightening The other studies had no experimental setup and thus health information on persuasion. In contrast to general preclude causal conclusions: personal interviews, focus beliefs about the effectiveness of threatening information, group discussion, and cross-sectional and longitudinal these studies suggest that fear arousal may result in survey studies in which participants are asked to assess defensive reactions such as risk denial, biased information prospectively or retrospectively the effects of health processing and allocating less attention to the health warnings on personal risk behavior. The strength of the promotion messages, thus rendering threatening health non-experimental evidence is weak because the chosen information an ineffective behavior change method. study designs do not allow us to draw conclusions Typically, these defensive responses are most likely to about a causal relationship between the introduction of occur among those members of the target population who the cigarette warning labels and, for example, reported are most susceptible to the health threat (for an overview, attempts to quit. Moreover, the impact of unmeasured see Van‘t Riet & Ruiter, 2013). “third variables” (e.g., price increase, smoking ban) is Fear arousal influences the extent to and manner unknown (see also Marteau & Hall, 2001). in which people attend to health messages (see also Of the 22 experiments, 18 compared different formats Kessels, Ruiter, Wouters, & Jansma, 2014; Sussenbach,¨ of threatening health messages among each other (e.g., Niemeier, & Glock, 2013). People do attend to threatening graphic + textual warning vs. only textual warning) and health information, but in a defensive way. Threatening not against a control condition with no or neutral information motivates people to avoid it. For example, information about the risk behavior. From these studies, it Kessels, Ruiter, and Jansma (2010) recorded brain is impossible to make statements about the effectiveness activity with an electroencephalogram and showed that of threatening information.
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