5c. Fear Appeals in Health Communication Campaigns

Edvard Munch. (1893). The Scream. Retrieved from http://samling.nasjonalmuseet.no/en/object/NG.M.00939

Given that this module focuses on health communication theories and concepts, I thought I’d devote some time to addressing a polarizing issue that continues to divide public health practitioners: the use of fear appeals to encourage changes in health-related knowledge, attitudes, and behaviours. A fear appeal is a persuasive message that attempts to arouse fear in order to direct behaviour by emphasizing impending danger or harm.¹ Generally, health communication messages based on fear appeals present a risk, emphasize vulnerability to the risk, and sometimes (but not always) suggest protective actions to reduce or eliminate the risk.^2-3

The Origins of Fear Appeals

Fear appeals have long-established roots in the fields of marketing and political science. One of the most infamous fear appeal ads ran during the 1964 U.S. Presidential election, the first election held after the Cuban missile crisis and the assassination of John F. Kennedy. At the time, there was a high level of public anxiety over the threat of nuclear war with the Soviet Union. The Republican nominee, Barry Goldwater, indicated that he was open to the limited use of nuclear weapons. President Lyndon Johnson, the Democratic party nominee, quickly seized on his opponent’s misstep with the “Daisy” ad shown below. It still has a powerful impact, over 50 years later.

Types of Fear Appeals: Individual Danger vs Collective Danger

Fear appeals in public health generally adhere to one of two formats: danger to the individual or danger to the collective (although some employ combinations of both).

Danger to the Individual 

Fear appeals focused on danger to the individual emphasize the diseases and negative impacts resulting from persistent, unhealthy behaviours. From the 1970s to the early 2000s, this was the standard formula followed by smoking cessation public service announcements (PSAs). The ad below certainly checks all the boxes.

Danger to the Collective

In contrast, fear appeals focused on danger to the collective depict how the irresponsible actions of an individual (e.g., driving while impaired) can put the health and well-being of others at risk. To illustrate this example, I’m sharing a link to one of the more controversial fear appeal PSAs in recent years. It was developed by the government of Northern Ireland in 2014 to discourage speeding. I don’t know if the ad correlated with greater adherence to speed limits, but it certainly generated attention!

The Ethics of Inducing Fear through Communication Campaigns

Fear appeals remain a controversial choice in the “toolbox” of population health strategies due to the plethora of ethical and efficacy issues associated with their use.

Ethical and Efficacy Issues Associated with Fear Appeals:⁴

• exposing large numbers of people to potentially disturbing messages without their consent,
• the possibility of maladaptive, defensive responses arising from repeated portrayals of high-risk behaviours practised by individuals (evidence indicates that fear appeals have less impact among those with low self efficacy),
• desensitization and habituation that causes individuals to “tune out” over time, and
• the stigmatization of individuals who are already suffering the consequences of unhealthy behaviours, many of whom may also face social, economic, and environmental barriers to behaviour change.⁴
  

With respect to the last point, however, it should be noted that fear appeal PSAs can be designed in a way that avoids ‘blaming the victim’ by emphasizing the need for structural change. For example, the following ad by Covenant House, a Toronto-based shelter for homeless youth, uses disturbing imagery of young people without shelter in cold weather to emphasize the need for greater access to housing and support services for young people who have resorted to living on their own to escape abusive situations.

Assessing the Effectiveness of Fear Appeals

So, do fear appeals “work”? To date, the evidence is mixed. A 2013 meta-analysis of six studies found that threat (i.e., the “fear” generated by the fear appeal) only had a limited effect when audience efficacy (to make changes) was high, and efficacy only had an effect when threat was high.⁵ These findings stand in sharp contrast with those obtained by a more recent meta-analysis of 127 studies, which concluded that fear appeals are effective in positively influencing attitudes, intentions, and behaviours, especially when they include efficacy statements and depict high susceptibility and severity.⁶

Research suggests that several factors increase the persuasiveness of fear appeals.^{3, 6}

They Arouse Fear

First, an effective fear appeal should arouse the emotion of fear. To do this, it must include a description of what physical or social harms will result if the recipient does not comply with the appeal’s recommendations. In general, the more fear-arousing the content, the more fear will be produced. The threat contained in the message must truly entail a negative consequence. For example, most tobacco-related fear appeals include the threat of premature morbidity and mortality.

 

Health Canada. (2011, December 12). Warning for Cigarettes - Dying of Lung Cancer. Retrieved from https://www.canada.ca/content/dam/canada/health-canada/migration/healthy-canadians/publications/healthy-living-vie-saine/health-labels-cigarettes-etiquettes-sante/alt/cigarette-jpg/cigarettes-11-eng.jpg

 

They Personalize the Risk

Second, an effective fear campaign personalizes the risk to the priority audience.^{3, 6} The audience must feel personally vulnerable or susceptible to the negative consequences depicted in the message. Many fear appeals fail because the priority audience does not feel vulnerable.

They Tell How the Risk Can be Reduced

In addition to arousing fear, an effective message should also specify what the priority audience can do to constructively reduce their risk of harm.^{3, 6} This part of the message should attempt to do two things: increase personal efficacy and response efficacy.

Personal efficacy concerns the target’s perception that he or she has the ability to follow message recommendations. Successful health communication campaigns, for example, have emphasized the ease of using a condom, putting on sunblock, or performing a breast self-examination.

Response efficacy is the ability of the message recommendation to eliminate or reduce the threat depicted in the message. When response efficacy is high (i.e., the recommended action is depicted as effective), willingness to comply is increased. Therefore, the creator of a fear-arousing campaign should ensure that the effectiveness of the recommended responses is clearly demonstrated within the message.

 

Cooch Creative. (2011, July 12). SunSmart Cut Out. Retrieved from http://www.adsoftheworld.com/media/outdoor/sunsmart_cut_out

 

They Take into Account the Resources and Skills of the Audience

Lastly, before a priority audience will comply with preventive recommendations, they must have the necessary resources and skills to do so.^{3, 6} Therefore, in constructing fear appeals, the producer should consider the skills needed to avert the threat compared to the skills of the intended audience.

I’ll leave you to determine if communication campaigns utilizing fear appeals would be an appropriate component of the intervention mix for your iterative assignment. But regardless of what the evidence tells us, I don’t expect that the public health sector will reach consensus on the use of fear appeals any time soon.