My first love, before public health law, was health
communications. A health communication in its simplest form is a PSA - think - Slip,
Slap, Slop; Buckle Up Saves Lives; 1% or Less is Best. Health communications become trickier to pull
off when the goal is to change a complicated behavior, such as eating less
fried food, getting more physical activity or quitting smoking. To move people towards change in these areas
some health advocates will use fear appeals embedded in a health communication. I love a well-done fear appeal! By well-done I mean that the fear message is
constructed using a theory/model that has been tested and found effective, for
example the Extended Parallel Process Model (see e.g., (Witte, 1992; Witte & Allen, 2000).
The most important components of the Extended Parallel
Process Model are the constructs that, when taken into consideration, move the
target audience towards danger control (e.g., quitting smoking to prevent lung
disease (the feared outcome)) instead of fear control (e.g., smoking
more). There are four constructs that,
though not unique to the EPPM, are especially important because without careful
attention to these four constructs, a fear appraisal can backfire.
The important constructs are relevancy of the threat, severity
of the threat, efficacy of the response, and self-efficacy in regards to the
response (action to be taken by the population). Relevancy and severity work
together. Staying with the smoking
example, the message that smoking causes lung disease is relevant if the person
hearing the message is a smoker and believes that lung disease is a serious
condition - one that will affect them negatively. The person has to believe that
the condition could happen to them and that it is worse than the discomfort of
quitting the old behavior or adopting a new one, here the behavior to adopt is
quitting smoking.
The response/action is whatever the health communication encourages
the person to do in order not to “get” the disease or condition they should be
‘afraid’ of getting. Some examples
include, wearing sunscreen, exercising every day, quitting smoking, using
condoms. The efficacy of response refers
to whether or not a person believes: sunscreen stops aging or sunburn, quitting
smoking reduces lung disease risks, exercise prolongs life or condoms prevent
sexually transmitted infections. I think
you can probably guess what self-efficacy in regards to the response is and why
it is vital. If a person does not believe that they have
the ability to do the action, AND they have been sufficiently frightened of the
outcome if they do not, they could engage in what Witte refers to as fear
control - and in the case of lung disease and smoking, that could mean smoking
more. (I am scared that I will get a lung disease and die, but I do not think I
can quit smoking; this is very stressful, in order to handle my stress, I need
to smoke.)
Though it is not explicit in the model, there is an
association among the constructs of relevancy, severity and efficacy and the source of the message itself. When there is time and money, health
educators/advocates create the best fear appeals from formative work with the
target audience. The formative work
involves asking people to rate certain sources for their veracity and
impact. A question might be - Where do
you go for information about health? *
friend, *partner, *doctor, *coworker etc.
I have a personal anecdote to offer as an example of the
source concept in action. I live in near
the coast in SW Florida and I visit the
beaches as often as I can. When I first
arrived here in 2007, my running friends and I would end our runs near the
water. My friends said that the cold water would reduce the inflammation caused
by our long runs and help us to remain injury free. I believed my running friends because they
were a reliable source. Who would know
more about keeping the body in running condition than people who run marathons
every month?! But these same friends,
and plenty of other people, told me that I should shuffle my feet in the water to
avoid getting stung by a sting ray.
Really? To me that was just
asking for trouble, if the sting rays were even there. (i.e., I did not believe in the threat itself
(though I did think a sting ray was VERY scary) and I didn’t think shuffling my
feet made any sense.) So…. 7 years later (yesterday)…I was walking the shore at
Lido Beach and at each life guard stand there was a sign (see image below) that
said “Watch out for Sting Rays, Shuffle your feet!” That did it - to me, the source was to be
trusted and now I believe 1) there are sting rays in these waters and 2)
shuffling is the recommended response. But
- and here is where it falls apart. I am
very fearful of the sting rays but not very confident in the response or my
ability to do the response correctly. I
am, for the most part, going to engage in fear control. I will stay out of the water. This response keeps me from fully enjoying my
day at the beach, but it doesn’t increase my risk of the outcome (getting
stung), like smoking more would increase the risk of lung disease. My reaction to the sting ray sign may not be
that uncommon. If I were to create a
health communication for sting ray awareness I would build in a component that
explains what shuffling the feet accomplishes and show images (via TV) of
someone successfully carrying this action out. 
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