Advancing the Extended Parallel Process Model Through the Inclusion of Response Cost Measures

Authors and Affiliations

Lance S. Rintamaki
Department of Communication and Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, New York, USA
Z. Janet Yang
Department of Communication, University at Buffalo, The State University of New York, Buffalo, New York, USA

Study Overview

Purpose: This study aims to advance the Extended Parallel Process Model (EPPM) by incorporating measures of response costs related to health behaviors, particularly in the context of sexually transmitted infections (STIs) and condom use.
Methodology: A questionnaire gauging perceptions regarding STIs and condom use was completed by a sample of 502 college students. They read CDC information about the health risks of STIs and the efficacy of latex condoms.
Key Findings: Results from hierarchical ordinary least squares regression indicated that including response cost measures enhanced the predictive power of the EPPM.
Historical Context: The EPPM has been a significant model in health communication since its introduction by Witte (1992, 1994) and explains how individuals process fear appeals aimed at promoting health behaviors.

Importance of the EPPM

The EPPM combines elements from several preceding theories:
- Fear-As-Acquired Drive Model (Hovland, Janis, & Kelly, 1953; Janis, 1967)
- Parallel Process Model (Leventhal, 1970, 1971; Leventhal, Safer, & Panagis, 1983)
- Protection Motivation Theory (Maddux & Rogers, 1983; Rogers, 1975)
The model posits that fear appeals result in two types of appraisal:
1. Threat Appraisal
- Assess susceptibility: e.g., likelihood of contracting STIs.
- Assess severity: e.g., potential harm from STIs.
1. Efficacy Appraisal
- Response efficacy: Effectiveness of the recommended protective behavior (condom use).
- Self-efficacy: Belief in one's ability to perform the protective behavior (e.g., using condoms).
Responses: High threat and efficacy lead to danger-control responses (e.g., starting to use condoms), while high threat and low efficacy lead to fear-control responses (e.g., avoidance or denial).

Current Study Context

Background on STIs: In the U.S., over 19 million new infections each year, with young adults (ages 15-24) disproportionately affected, representing around 50% of new cases while being only 25% of sexually active individuals.
CDC Recommendations: Advocates for using male latex condoms as a primary strategy to prevent STI transmission.
Research Gap: Previous studies indicate that response costs (drawbacks associated with condom use) should be considered, as they were not part of the original EPPM framework.

Definitions of Key Concepts

Response Costs: Drawbacks associated with a proposed health behavior (e.g., condom use), including both tangible and intangible elements.
- Examples of response costs relating to condom use:
- Diminished sexual sensation
- Mood disruption (emotional state and social context)
- Relational costs (partner’s preferences)
- Value conflicts (ideological or moral concerns regarding condom use)
Self-efficacy: Belief regarding one’s access and capability to execute a specific behavior (e.g., obtaining and using condoms).
Response Efficacy: Individual judgments about the effectiveness of the recommended behavior (e.g., belief that condoms prevent STIs).
Fear Appraisal: Includes perceived susceptibility and perceived severity; these influence how individuals respond to stimuli that provoke fear, such as health threats.

Methodology

Survey Development Process: Conducted in two steps:
1. Preliminary Survey: Gathered initial qualitative feedback from 54 participants regarding their perceived drawbacks to condom use. Responses were categorized through coding, creating an inventory of response costs.
2. Final Survey: A larger quantitative survey was conducted with 502 college students, including measures for EPPM constructs and newly operationalized response cost measures.
Data Collection: A self-administered survey assessed behavioral intentions, measures of fear, EPPM constructs, and response costs using a 6-point Likert scale.

Results

Hierarchical Ordinary Least Squares Regression: Analysis showed enhancement in predictive power upon introducing response costs. Key findings:
- Fear was positively related to perceived severity of STIs and mood-related response costs.
- Current condom use correlated with higher fear levels, though initially, self-efficacy was inversely related to fear.
- Danger-control intentions for condom use were positively influenced by self-efficacy, perceived severity, and diminished sexual sensation.
- Response costs significantly impacted behavioral intentions; those perceiving condoms as reducing sensation were less likely to plan on using them.

Discussion and Implications

Findings support integrating response costs into the EPPM, enhancing its explanatory power concerning health behavior predictions related to condom use.
Health communication strategies should focus on messaging that emphasizes mitigating perceived drawbacks of condoms, thus alleviating fears associated with STIs while promoting safer sexual practices.
Communicators need to balance messages about protection with practical advice to address misconceptions about condom use (e.g., effects on sexual pleasure).

Conclusion

The study confirms the utility of adding response cost measures to the EPPM framework, allowing for improved health intervention strategies aimed at increasing condom use among college students.
Future research should further explore the role of response costs in health behavior models, ensuring interventions remain grounded in accurate theoretical frameworks without compromising the model's parsimony.

References

Detailed referencing from the study, illustrating the breadth of theoretical underpinnings and supporting research across various health communication contexts.

Based on the provided notes on the study by Rintamaki and Yang, here are the answers to your questions:

Research Questions: The authors are attempting to answer whether the inclusion of "response cost" measures (the perceived drawbacks of a health behavior) enhances the predictive power of the Extended Parallel Process Model ( $EPPM$ ) regarding sexually transmitted infection ( $STI$ ) prevention and condom use.
Theory: They use the Extended Parallel Process Model ( $EPPM$ ). This theory explains how individuals process fear appeals through two appraisals:
- Threat Appraisal: Assessing the severity of a threat and one's susceptibility to it.
- Efficacy Appraisal: Assessing response efficacy (effectiveness of the solution) and self-efficacy (one's ability to perform the solution).
- These appraisals result in either danger-control (taking protective action) or fear-control (denial or avoidance).
Research Type: The research is primarily quantitative, as it relies on regression analysis of survey data, though it included a preliminary qualitative step to identify response cost categories.
Participants: The study involved a sample of $502$ college students for the primary survey and $54$ participants for the preliminary qualitative survey.
Instruments: Data was collected using a self-administered questionnaire that included scales to measure $EPPM$ constructs, behavioral intentions, and response costs.
Form of Data: The primary form of data was numerical, utilizing a $6$ -point Likert scale to gauge perceptions and intentions.
Methods of Analysis: The authors employed hierarchical ordinary least squares ( $OLS$ ) regression to analyze the quantitative survey data and used coding for the preliminary qualitative responses.
Results: The study found that including response cost measures significantly enhanced the predictive power of the $EPPM$ . Key findings showed that fear was related to severity and mood costs, while danger-control intentions were influenced by self-efficacy, perceived severity, and sensations of diminished pleasure.
Conclusions: The authors concluded that adding response cost measures to the $EPPM$ framework allows for better prediction and understanding of health behaviors, specifically condom use among young adults.
Limitations: While not explicitly listed in a single section, the text notes the need for future research to avoid compromising the model's parsimony (simplicity) and suggests that the specific focus on college students and condom use may require further exploration in other contexts.
Practical Utility: This research can be used to improve health communication strategies. Instead of only focusing on the fear of $STIs$ , communicators should also address and mitigate the perceived drawbacks (costs) of condom use, such as misconceptions about reduced sensation or mood disruption.