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Summary Health communication week 1 till 4 (77643SP05Y)
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Covers all micro lectures from week 1 till 4. Course started in February 2022.
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Summary Health CommunicationWeek 1
Micro lecture 1: Extended Parallel Process Model (EPPM)
Feelings in health promotion messages: fear
Fear appeal = a fear appeal is a message that has the goal to arouse fear to motivate
attitude and behavior change.
The general process explanation of how for appeals work (EPPM):
It starts with a message à fear appeal (elements of threat for example), which leads to
cognition in the receiver (perceived susceptibility/severity).
Perceived susceptibility refers to the extent to which one feels themselves susceptible to
the risk (for example, contracting a disease), while the perceived severity refers to how
severe this specific disease, for example, is perceived to be. These cognitions subsequently
lead to the emotion: fear. These cognitions, possibly emotions, subsequently lead to
behavior change (conation).
There are 5 theories that explain fear:
1. Fear-as-acquired drive (Hovland, Janis has a similar model)
- Drive (to change attitudes and behaviors) = motivator
- Facilitating effect of fear:
o Fear à
o Negative “condition”
o Motivational drive to change the condition
- But also, an interfering effect of fear:
o Too much fear
o Too negative “condition”
o Avoidance effects
1
, - Basically, what they proposed is a u-shape model. High levels of fear will also
have negative effects. Events like avoidance will appear. However, there is not
much evidence founded for this curvilinear relationship and other models took
place of these ‘drive models.’
One of the most well-known models is the Parallel Response Models (PRM) (Leventhal).
- Fear can leas to two parallel processes and responses:
1. Danger control: cognitive response
§ How to avoid the threat?
2. Fear control: affective response (works independently)
§ How to reduce feelings of fear?
Difference PRM – EPPM:
- PRM has no role for efficacy yet.
- PRM does not include a stepwise appraisal.
- PRM doesn’t explain the sequence of the processes and responses.
According to the PRM, there is no curvilinear relationship between the level of fear and the
effects of attitude and behavior. So how higher the level fear, the bigger the effect on
behavior and behavioral determinants will be.
Further, a big cognitive revolution in social sciences took place. One of the well-known
theories, is the Protection Motivation Theory (PMT) (Rogers).
- Based on (cognitive) subjective expected utility
o What (utility) will I (subjective) get when (not) performing (expected)
- So, mainly focus on ‘danger control’ (which is cognitive)
2
,In the upper box it’s observable how the likelihood of maladaptive response is based on
intrinsic/extrinsic rewards of onsite behavior, minus the perceived severity and perceived
vulnerability. That leads to how much threat appraisal there is. How higher the rewards and
the lower the severity and vulnerability, how lower the threat appraisal will be.
In the lower box the likelihood of adaptive response is observable (coping appraisal). This is
based on the response efficacy and self-efficacy, minus response costs. The response
efficacy is the appraisal of how much behavior is effective in averting a threat (for example,
how effective is condom use for not getting and STD). Self-efficacy is the extent to which
people can perform a certain behavior.
Both threat and coping appraisal leads to protection motivation, which is the motivation to
protect yourself from a risk. At the end it leads to action or inaction. (PMT has only a small
role for emotion).
Another subjective utility model is the Health Belief Model (HBM) (Rosenstock, Becker). In
the basis, this is about the same model as the Protection Motivation Theory. There are some
key differences as well, which is that self-efficacy is included as variable as modifying factor,
that leads to perceived susceptibility and severity. Another variable that has been included
is, is the ‘cues to action’ (an external stimulus in the environment, that can lead to a
perceived threat).
3
, This leads us to shortcomings of these (earlier) models:
- Each of the prior models only explains a part of how fear-appeals work
- Unclear when/why appeals don’t work (boomerang effect).
- Witte integrates (most of) these older models:
o Extended Parallel Process Model (EPPM)
Within the Extended Parallel Process Model (EPPM) you’re exposed to a message (fear
appeal). In this message there’s ideally a threat component and efficacy component. The
threat component is showing the severity of a certain condition. The efficacy element.
shows how you can cope with the threat.
Based on how effective this message is, there will be either high or low susceptibility and
severity in the first appraisal of this model (threat appraisal). So, people see a message and
appraise their own threat level, this can be high or low! When either susceptibility or
severity is low, people will experience no fear and disregard the message. It could also be
people who experience high susceptibility and severity, which leads to fear. When that’s the
case, according to the model, people will go to the second appraisal (efficacy appraisal).
The efficacy appraisal consists of the self and response efficacy. Again, either of these
appraisals can be high or low. Is self or response efficacy low? People will then start the
process of fear control, which leads to defensive motivation and message rejection. The
reason why people end up in the fear control is because they cannot cope with the fear.
Only when there’s a high self and response efficacy, people will follow the danger control
route and accept the message.
4
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