health psych fear appeals and intervention lectures

Protection Motivation Theory (PMT) is what type of model

• Social cognition model. (same category as HBM, TPB)

• Protection Motivation Theory (PMT)

• Extended HBM by including fear (an emotional component)

• Fear can drive our behaviors

Components of PMT

severity

susceptibility

self efficacy

response efficacy

fear

Fear appeals

Threatening health messages that aim to elicit emotional response (scared, anxiety, worried)

Two components of fear appeals based on PMT

1. Fear arousal 

2. Safety conditions

fear arousal parts PMT

• There is a threat

• You are at risk 

• The threat is serious

Safety conditions parts PMT

• Recommended action

• Action is effective and easy

• Both target self/response efficacy 

response efficacy

• how effective health behavior is

• ex: (how effective is wearing sunscreen in terms of preventing skin cancer?)

Brown and Smith (2007) question

• How do people respond to potentially distressing anti-smoking messages? Does including imagery that induce fear make messages more effective?

Brown and Smith (2007) set up

• Daily young smokers 

• So they were yet to experience smoking related disease

• Randomly assigned to one of two brochures anti-smoking messages

• Low distress condition 

• 4 facts paired with 4 images as well

• Ex: an average two pack per day smoker faces a reduced life expectancy of 8 years

• Smoking causes 30% of cancer deaths 

• Smoking kills more people than any other drug

• One half of smokers will eventually be killed by their habit

• High stress condition 

• Same facts and wording but gross and scary pictures accompanied with them.

Brown and Smith (2007) measuring outcomes

• Message evaluation 

-Makes me want to quit/does not make me want to quit

-persuasive/not persuasive 

• Perceived risk 

-“If you continue to smoke the way that you do…”

• Time spent reading message 

Brown and Smith (2007)outcomes for personal risk, time spent reading, persuasion levels

• Low distress condition rated their personal risk higher than high distress group

• Low distress condition spent more time reading the brochure than high distress group (makes it seem more persuasive therefore)

• Low distress conditions rated their evaluation of persuasion higher than the high distress.

Do fear appeals work?

• Fear appeals may be threatening:

-Threat to freedom (feeling manipulated) (hurts sense of autonomy)

-Threat to self as competent 

• Fear appeals that stress severity→ defensive responses 

• Useless at best, harmful at worst? 

• Fear appeals that stress severity do what?

• defensive responses 

• Denial of risk

• Biased processing of information (one might be more critical during high stress fear appeals)  

• Avoidance 

Cigarette graphic warnings

• A pack a day smoker could see a cigarette pack around 7300 times per year (so large outreach since regularly interacted with)

• Many countries implemented graphic warning labels 

• Canada 25-19% 

• Australia higher quit calls

• Few experiment studies to test if these images are effective or not 

• Other things may have impacted these statistics (like eas a surge of prize on cigs at the same time)

Malouff et al. (2012) Australian smokers setup

• Randomly assigned to two conditions 

• Written warnings (ex: smoking causes gangrene)

• Written +graphic warning

• Followed participants for 8 week

• 4 exposure weeks

focused on stage of change

Malouff et al. (2012) Australian smokers outcomes for stage of change and cigarette consumption

• Stage of change

-Baseline: no difference between two conditions (between prep and contemplation)

-4 weeks later: graphic group is more towards preparation while baseline did not change. Significant difference*

-8 weeks later: no significant difference (4 week difference diminished) 

• Only short term change in stage of change 

• Cigarettes smoked day before 

-Baseline/4weeks/8 weeks: no significant difference between groups 

-Motivation did not translate into action*

• Good intentions but no actual impact

• Compared to text only warnings: graphic images on cigs are:

• More noticed

• Rated as more affective 

• Elicit more negative feelings about smoking 

• Increase intentions to quit 

Tannenbaum (2015)] question

• Does the amount of fear matter? Do they not work because they do not scare you enough? (blue line)

• Moderate amount of fear best? Optimal level (red line)

• More scary means more likely to reject messaging 

Tannenbaum (2015)] outcome

Yes, does the amount of fear matter?

• Moderate and high fear messages were more effective than low ones. 

Does including efficacy info matter in fear appeals? 

Does including efficacy info matter? 

• PMT

• Yes! Just scaring people alone does not work. Must tell them why they are confident that they can do it.

• One of the most popular methods for behavior change, but argued to be among the least effective 

• If they work may depend on content and outcome

Fear appeals are most effective when message is paired with

• coping/self-efficacy/response efficacy

• Why do we continue to use fear appeals given the mixed support?

• Intuitive appeal

• Lack awareness of research and theory

PMT parts

threat appraisal:

• severity

• vulnerability

• intrinsic rewards

• extrinsic reward

coping appraisal

• response efficacy

• self-efficacy

• response cost

both go into behavior intention

why  is there often a gap between theory and practice.

• Why?: come from a good place→ but fear appeals do not address the skills and social contexts that lead people to be at risk for drugs. It actually sends a different message → “ I used to do drugs but look at me now!” might make people think it gives an image of power and prestige instead.

•  It does not address people’s confidence to refuse drugs or people’s social determinants of drug use or people’s decision making skills on drugs. 

• Ex: people who formally use drugs warning students of danger

• Studies found that this strategy may lead to significant increase in drug use (1987)

Overview of 4 steps of designing an intervention

• Identify target behavior and population

• Identify most salient beliefs (within a certain population) 

• Identify predictors of target behavior 

• Develop intervention (format/content) 

Identify target behavior and population strategies

Target behavior should be as specific as possible (action, time, context) 

• Eat more healthy (vague goal) 

• Eat a piece of fruit at lunchtime everyday 

the more vague the behavior,  

• The harder to measure success of intervention 

• The harder to identify key beliefs about behavior 

Who are we targeting? Important to focus on! 

Identify most salient beliefs 

• Beliefs about target behavior in the target population. Barriers of people vary in populations (ex: getting those to exercise in senior living facility is different than high schoolers) 

Qualitative work/open ended questions to identify modal (salient) beliefs examples

• What are the beliefs of eating more vegetables?/common

• What negative health outcomes related to not eating vegetables concern you?

• What are the barriers to eating more vegetables?

By the end of step two of intervention planning we should know:

• what specific beliefs should our intervention target 

• Overall: Population matters here! Populations are very dif from each other

predictors of target behavior 

Drawing on modal beliefs, what theoretical constructs predict behavior?

• Cost as perceived barrier = lower vegetable consumption? 

• Longevity as health benefit= higher vegetable consumption?

• Beliefs are here but they are predicting behavior. Most find what actually predicts behaviors. 

By the end of stage 3 of intervention planning we should know:

• do all modal beliefs predict behavior? 

• Are all the theoretical constructs needed?

Develop interventions

• Target beliefs identified in steps 2 & 3. Now we want to change beliefs

• Format: decide how to target beliefs and method (Leaflets, videos, lectures, discussions, etc. )

• content : theories describe what beliefs to change, but not how…

What were Montanaro and Bryan (2014) studying?

Using the Theory of Planned Behavior (TPB) to develop a condom-use intervention.

. Population: college students.
Why did researchers target college students? Only 20–30% used condoms every time they had sex, and they faced higher risks of HIV and other STIs.

• Montanaro and Bryan (2014) 

• Step 1: identify target behavior and population 

• behavior= condom use 

• Population = college students

• Rationale for picking this group:

-20-30% of college aged adults use condoms every time they have sex

-They are higher risk groups for HIV and other STIs 

• Montanaro and Bryan (2014) step 2: modal beliefs (attitudes, norms, perceived)

• Attitudes: 

• Physical benefits: condoms are effective in preventing pregnancy 

• Hedonistic attitudes: condoms can help make sex more enjoyable 

• emotional attitudes: condom use shows I respect and care about my partner.

This study did not ask the population group, instead the researchers made up these modal beliefs =MISTAKE IN RESEARCH!!!

• Norms:

• Peers condom use (used reference group for peers who do well academically) 

• They should have used reference groups as maybe people within social groups as who to give info on to college aged students…maybe more meaningful. 

• Perceived control:

• Overcome barriers to condom use (carrying + correctly using them) 

• Prob not actually barriers for college aged students…MISTAKE, they should have asked population group

• Montanaro and Bryan (2014) Step 3: predictors of target behavior

• Previous research suggests that all TPB variables predict intentions to use condoms 

• What about the specific modal beliefs they selected?

• Montanaro and Bryan (2014) step 4 changing attitudes

• format : computer based information 

• Content: present facts about condoms that target modal beliefs 

-” when used properly, condoms are 98% effective in preventing pregnancy.” → ex of a persuasive message 

• Montanaro and Bryan (2014) Step 4 changing norms

• Content:

• 80% of Lehigh students use a condom every time they have sex

• Do you use condoms less often, about the same, or more often than the most lehigh students?

• Lehigh students with higher GPAs tend to use condoms more often. 

• Montanaro and Bryan (2014) perceived control

• format : video 

• content:

• Friend being taught how to correctly put on a condom on (using a banana) 

• Proper ways to carry/store condoms 

Do not address most common barriers 

This bad study shows how not getting modal information can impact study 

Take away from condom study (Montanaro and Bryan )

• Interventions do not always follow four steps to intervention development. +can still be effective 

• Not all TPB components necessary for changing condom preparation behaviors 

• Dropping components does not allow us to test theories, but could lead to more effective interventions especially if they are not working 

• More than one study needed to test for certain theories then if we drop components if we want to build up evidence for them. 

• most important factor in if someone does a behavior or not

• self-efficacy →

• How can we increase people’s confidence in their ability to perform healthy behavior?

self-efficacy could be increased by:

mastery experiences

vicarious experience

verbal persuasion (someone just saying “you can do it”)

mastery experience

1. during session/ after session/ multiple grades.

   • Past experience 

•  A person actually does behavior in all these categories. Practice behavior to understand that behavior is easy to do. 

**Multiple graded→ start small to build up on behavior to help build up confidence 

past experience

think about successful changes you have done before to increase self-efficacy. 

vicarious experience

• learn about other peoples’ experiences 

• Coping or mastery models (mastery: I have mastered this and now you can do it. Coping: It was difficult at first but I started small and then I could do it→shows they are challenges but you can overcome them.

• Live or virtual 

Most effective changes to self-efficacy:

mastery experience > vicarious experience > verbal persuasion 

• Olsen and McAuley 2015 exercise intervention setup

• 8 week interventions or control (education)

• Older adults with type 2 diabetes 

• 6 month follow up: outcomes exercise and self-efficacy 

Mastery experiences; recognizing past exercise successes, gradually increasing independent exercise 

Vicarious experiences: identifying exercise heroes, exercising with peers (because you are exercising but doing it with others proves that others can do it too)

Verbal persuasion: exercise leader encouragement, peer encouragement 

• Olsen and McAuley 2015 exercise intervention result

Results: increase in walking self efficacy and exercise in minutes per day

• Exercise increases a lot right after 2 months but decreases slightly after 6 months
  
  

• Olsen and McAuley 2015 exercise intervention take away

Take away:

• Theory provides a useful tool for developing interventions 

• Lots of potential ways to apply theories (research needed to test whether theory driven techniques work)

• Intervention work can inform theory