Loes T. E. Kessels

Sixty years of fear appeal research: current state of the evidence.

Fear arousal is widely used in persuasive campaigns and behavioral change interventions. Yet, experimental evidence 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.

Increased attention but more efficient disengagement: neuroscientific evidence for defensive processing of threatening health information.

OBJECTIVE Previous studies indicate that people respond defensively to threatening health information, especially when the information challenges self-relevant goals. The authors investigated whether reduced acceptance of self-relevant health risk information is already visible in early attention processes, that is, attention disengagement processes. DESIGN In a randomized, controlled trial with 29 smoking and nonsmoking students, a variant of Posners cueing task was used in combination with the high-temporal resolution method of event-related brain potentials (ERPs). MAIN OUTCOME MEASURES Reaction times and P300 ERP. RESULTS Smokers showed lower P300 amplitudes in response to high- as opposed to low-threat invalid trials when moving their attention to a target in the opposite visual field, indicating more efficient attention disengagement processes. Furthermore, both smokers and nonsmokers showed increased P300 amplitudes in response to the presentation of high- as opposed to low-threat valid trials, indicating threat-induced attention-capturing processes. Reaction time measures did not support the ERP data, indicating that the ERP measure can be extremely informative to measure low-level attention biases in health communication. CONCLUSION The findings provide the first neuroscientific support for the hypothesis that threatening health information causes more efficient disengagement among those for whom the health threat is self-relevant.

Increased attention for computer-tailored health communications: an event-related potential study

The authors tested whether individually tailored health communications receive more attention from the reader than nontailored health communications in a randomized, controlled trial among student volunteers (N = 24). They used objective measures of attention allocation during the message exposure. In a between-subjects design, participants had to read tailored or nontailored nutrition education messages and at the same time had to pay attention to specific odd auditory stimuli in a sequence of frequent auditory stimuli (odd ball paradigm). The amount of attention allocation was measured by recording event-related potentials (ERPs; i.e., N100 and P300 ERPs) and reaction times. For the tailored as opposed to the nontailored group, results revealed larger amplitudes for the N100 effect, smaller amplitudes for the P300 effect, and slower reaction times. Resource allocation theory and these results suggest that those in the tailored group allocated more attention resources to the nutrition message than those in the nontailored group.

Understanding the positive effects of graphical risk information on comprehension: measuring attention directed to written, tabular, and graphical risk information.

Risk communications are an integral aspect of health education and promotion. However, the commonly used textual risk information is relatively difficult to understand for the average recipient. Consequently, researchers and health promoters have started to focus on so-called decision aids, such as tables and graphs. Although tabular and graphical risk information more effectively communicate risks than textual risk information, the cognitive mechanisms responsible for this enhancement are unclear. This study aimed to examine two possible mechanisms (i.e., cognitive workload and attention). Cognitive workload (mean pupil size and peak pupil dilation) and attention directed to the risk information (viewing time, number of eye fixations, and eye fixation durations) were both measured in a between-subjects experimental design. The results suggest that graphical risk information facilitates comprehension of that information because it attracts and holds attention for a longer period of time than textual risk information. Graphs are thus a valuable asset to risk communication practice for two reasons: first, they tend to attract attention and, second, when attended to, they elicit information extraction with relatively little cognitive effort, and finally result in better comprehension.

Neuroscientific evidence for defensive avoidance of fear appeals

Previous studies indicate that people respond defensively to threatening health information, especially when the information challenges self-relevant goals. The authors investigated whether reduced acceptance of self-relevant health risk information is already visible in early attention allocation processes. In two experimental studies, participants were watching high- and low-threat health commercials, and at the same time had to pay attention to specific odd auditory stimuli in a sequence of frequent auditory stimuli (odd ball paradigm). The amount of attention allocation was measured by recording event-related brain potentials (i.e., P300 ERPs) and reaction times. Smokers showed larger P300 amplitudes in response to the auditory targets while watching high-threat instead of low-threat anti-smoking commercials. In contrast, non-smokers showed smaller P300 amplitudes during watching high as opposed to low threat anti-smoking commercials. In conclusion, the findings provide further neuroscientific support for the hypothesis that threatening health information causes more avoidance responses among those for whom the health threat is self-relevant.

The effects of tailored and threatening nutrition information on message attention : evidence from an event-related potential study

Recent evidence indicates that attention is higher for individually tailored as compared to non-tailored health communications. The present study examined whether the predicted increased attention for the tailored as opposed to general nutrition education messages is moderated by presenting high vs. low threat information about the negative consequences of an unhealthy diet. In a mixed subject experimental design, undergraduate students (N=34) were reading tailored and non-tailored nutrition education messages with either high or low threat information about the negative consequences of an unhealthy diet. At the same time, they had to pay attention to specific odd auditory stimuli in a sequence of frequent auditory stimuli (oddball paradigm). The amount of attention allocation was measured by recording event-related potentials (ERPs; i.e., N100, MMN, P300) and reaction times. Result revealed main effects of tailoring and threat, indicating that more attention resources were allocated to tailored vs. non-tailored messages and to low threat vs. high threat messages. The findings confirm that tailoring is an effective means to draw attention to health messages, whereas threat information seems to result in a loss in message attention.

Eye movement responses to health messages on cigarette packages

BackgroundWhile the majority of the health messages on cigarette packages contain threatening health information, previous studies indicate that risk information can trigger defensive reactions, especially when the information is self-relevant (i.e., smokers). Providing coping information, information that provides help for quitting smoking, might increase attention to health messages instead of triggering defensive reactions.MethodsEye-movement registration can detect attention preferences for different health education messages over a longer period of time during message exposure. In a randomized, experimental study with 23 smoking and 41 non-smoking student volunteers, eye-movements were recorded for sixteen self-created cigarette packages containing health texts that presented either high risk or coping information combined with a high threat or a low threat smoking-related photo.ResultsResults of the eye movement data showed that smokers tend to spend more time looking (i.e., more unique fixations and longer dwell time) at the coping information than at the high risk information irrespective of the content of the smoking-related photo. Non-smokers tend to spend more time looking at the high risk information than at the coping information when the information was presented in combination with a high threat smoking photo. When a low threat photo was presented, non-smokers paid more attention to the coping information than to the high risk information. Results for the smoking photos showed more attention allocation for low threat photos that were presented in combination with high risk information than for low threat photos in combination with coping information. No attention differences were found for the high threat photos.ConclusionsNon-smokers demonstrated an attention preference for high risk information as opposed to coping information, but only when text information was presented in combination with a high threat photo. For smokers, however, our findings suggest more attention allocation for coping information than for health risk information. This preference for coping information is not reflected in current health messages to motivate smokers to quit smoking. Coping information should be more frequently implemented in health message design to increase attention for these messages and thus contribute to effective persuasion.BACKGROUND While the majority of the health messages on cigarette packages contain threatening health information, previous studies indicate that risk information can trigger defensive reactions, especially when the information is self-relevant (i.e., smokers). Providing coping information, information that provides help for quitting smoking, might increase attention to health messages instead of triggering defensive reactions. METHODS Eye-movement registration can detect attention preferences for different health education messages over a longer period of time during message exposure. In a randomized, experimental study with 23 smoking and 41 non-smoking student volunteers, eye-movements were recorded for sixteen self-created cigarette packages containing health texts that presented either high risk or coping information combined with a high threat or a low threat smoking-related photo. RESULTS Results of the eye movement data showed that smokers tend to spend more time looking (i.e., more unique fixations and longer dwell time) at the coping information than at the high risk information irrespective of the content of the smoking-related photo. Non-smokers tend to spend more time looking at the high risk information than at the coping information when the information was presented in combination with a high threat smoking photo. When a low threat photo was presented, non-smokers paid more attention to the coping information than to the high risk information. Results for the smoking photos showed more attention allocation for low threat photos that were presented in combination with high risk information than for low threat photos in combination with coping information. No attention differences were found for the high threat photos. CONCLUSIONS Non-smokers demonstrated an attention preference for high risk information as opposed to coping information, but only when text information was presented in combination with a high threat photo. For smokers, however, our findings suggest more attention allocation for coping information than for health risk information. This preference for coping information is not reflected in current health messages to motivate smokers to quit smoking. Coping information should be more frequently implemented in health message design to increase attention for these messages and thus contribute to effective persuasion.

Short and Sweet: The Persuasive Effects of Message Framing and Temporal Context in Antismoking Warning Labels

Current warning labels on cigarette packages are generally focused on long-term losses that can be incurred if one continues smoking. This study compares the effects of these labels against warning labels that stress short-term losses of smoking as well as labels that stress short- and long-term benefits that can be obtained when one quits smoking. A 2 (message frame: gain vs. loss) × 2 (temporal context: short vs. long term) between-subjects experiment was conducted among 132 smokers, with attitude toward quitting smoking and intention to quit smoking, as well as information-seeking behavior and message recall, as the dependent variables. Findings were in line with theory regarding message framing and temporal discounting, showing enhanced effects of gain over loss frames and short-term over long-term consequences on warning labels for attitudes and intentions. In addition, an interaction between message frame and temporal context was found. Especially, gain-framed messages showed stronger effects on intentions to quit smoking than loss-framed messages when warning labels concerned short-term outcomes. Findings suggest that current warning labels, with an emphasis on long-term negative health outcomes, should be reconsidered.

Ignoring theory and misinterpreting evidence : the false belief in fear appeals

ABSTRACT Use of fear appeals assumes that when people are emotionally confronted with the negative effects of their behaviour they will change that behaviour. That reasoning is simple and intuitive, but only true under specific, rare circumstances. Risk perception theories predict that if people will experience a threat, they want to counter that threat. However, how they do so is determined by their coping efficacy level: if efficacy is high, they may change their behaviour in the suggested direction; if efficacy is low, they react defensively. Research on fear appeals should be methodologically sound, comparing a threatening to a non-threatening intervention under high and low efficacy levels, random assignment and measuring behaviour as outcome. We critically review extant empirical evidence and conclude that it does not support positive effects of fear appeals. Nonetheless, their use persists and is even promoted by health psychology researchers, causing scientific insights to be ignored or misinterpreted.

Attentional effects of self-affirmation in response to graphic antismoking images

OBJECTIVE Self-affirmation has been shown to reduce defensive responding to threatening information. However, little is known about the cognitive and attentional processes underlying these effects. In the current eye-movement study, the authors explored whether self-affirmation affects attention allocation (i.e., number of fixations) among those for whom a threatening health message is self-relevant. METHODS After a self-affirmation manipulation, 47 smokers and 52 nonsmokers viewed a series of cigarette packs displaying high or low threat smoking-related images accompanied by a brief smoking message containing risk, coping or neutral textual information. RESULTS Self-affirmed smokers made more fixations to the cigarette packs than did nonaffirmed smokers (across both high and low threat images), whereas self-affirmed nonsmokers made fewer fixations to the cigarette packs than did nonaffirmed nonsmokers (again across both image types). The textual information did not moderate responses. CONCLUSIONS Findings indicate attention-increasing effects of self-affirmation among those for whom the information is self-relevant (smokers) and attention-decreasing effects of self-affirmation among those for whom the information is not self-relevant (nonsmokers). Such findings are consistent with the calibration model of self-affirmation (Griffin & Harris, 2011) in which self-affirmation increases sensitivity to the self-relevance of health-risk information. The use of an implicit measure of visual orienting informs our understanding of the working mechanisms of self-affirmation when encoding health information, and may also hold practical implications for the design and delivery of graphic warning labels. (PsycINFO Database Record