A popular form of health message is the fear appeal to scare people into change

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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

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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

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The Deficit Model
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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

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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?

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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

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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

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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

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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

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Communication Features of Shock Tactics

• Frames Tversky and Kahneman
• Emotional Interest
• Concreteness
• Proximity
• Delivery and wording appropriate to the target
  group

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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

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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

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Shock Tactics HIV / AIDS The Grim Reaper
Campaign
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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/lipoatrop
  hy prescribed
• Lipodystrophy/lipoatrophy develops

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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

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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

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Shock Tactics Smoking Cessation QUIT
Campaign 1998
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Shock Tactics Smoking Cessation QUIT
Campaign 1998
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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.

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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

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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