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Health communication summary week 1-7 with articles

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Universiteit Van Amsterdam (UvA)

This summary consists of week 1-7 from the health communication course. They also contain a summary for every article that needed to be studied for the exam. My grade was a 7,9. Good luck!!

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Health communication summary
Week 1 - Affective appeals
Seminar PowerPoint slides
Why is it so important to look at the role of affect (beinvloeding) in persuasion?
• First of all: you need to know that affect is an encompassing (omvattende) term for emotions (short-lived
immediate and specific) and moods (less intense, longer and either positive or negative)
• Most of the models we have discussed emphasize cognition and rationality when predicting behaviour.
• But emotions and moods are largely ignored.

Emotions are viewed as internal mental states representing evaluative reactions to events, agents, or objects, that
vary in intensity. They are generally short-lived and intense and directed at some external stimuli. Consist of five
components: 1. cognitive appraisal or evaluation of a situation, 2. the physiological component of arousal, 3. motor
expression, 4. motivational component, 5. subjective feeling of state.

What are the principles of functional emotion theories as also mentioned by Darwin?
Darwin: Behaviours in response to emotional feelings serve adaptive functions developed through evolutionary
processes.
1. Emotions have inherent adaptive functions: For example, the adaptive functions of anger and sadness are self-
assertion and social support seeking, respectively. Adaptive behaviour is a behaviour, which contributes
directly or indirectly to an individual's survival or reproductive success and is thus subject to the forces of
natural selection. They make sure we survive.
2. Emotions are based on events that are personally relevant: they signal when something happens that is
important to our goals.
3. Each emotion has a goal or motivation that is represented in a tendency to action so that people become
aroused, sustain, and direct cognitive or physical activity. So for instance anger signals that our important
goals are blocked, whereas fear signals our goal of being safe is in danger.
4. Emotions organize and motivate behaviour: For instance, with anger: it motivates us to remove the goal
blockage. So if other people do something that is blocking your goals you might want to punch them… this
does not mean you immediately punch but your action tendency is to make your body ready for aggression. It
organizes behaviour because it makes sure we pay attention to our emotion before we can continue our
regular course of action.

When can affect influence persuasion?
Several ideas when affect can arise and influence persuasion effects:
• Within the receiver, prior to message reception
o (e.g., you just heard you passed the exam, and are happy right before processing a persuasive
message)
• Through prior contextual information
o (e.g., funny TV-show, sad movie etc.)
• Through a persuasive message itself (focus of this week!)
o (e.g., Fear-appeal, humour-appeal, guilt-appeal etc.)

Emotional appeals examples
Guilt: Chickens saying we are not nuggets
Disgust: Schimpie, the toenail infector
Sadness: Lonely dog
• On the right you see an induction of sadness, but this ad also moves from sadness to hope, because it gives
hope that one can turn around this sad situation for this animal.
• Emotional flow is the idea that not one emotion is experienced but there is a flow from one emotion to the
next, fear-then-relief, or you see the sad dog, become sad but known you can help and thus experience hope
Hope: Hope to save a child
Pride: NYC Girls project -> I am a girl
Calmness: Breastfeeding

,Witte, K., & Allen, M. (2000). A meta-analysis of fear appeals: Implications for effective public health campaigns.
Feelings in health promotion messages: Fear
Fear appeal: A message that has the goal to arouse fear in order to motivate attitude and behaviour change

General fear appeal process
Message Fear appeal
Perceived susceptibility/severity Cognition
(fear emotion)
Behaviour change Conation
(Fear) is between brackets because not all models of fear appeals have given fear that much attention

The purpose of this article is to provide a comprehensive review and update of the fear appeal research, because
health researchers and practitioners continue to contend that fear appeals backfire.

Fear (= emotion) and threat (= cognition) are conceptually distinct, but they are intricately and reciprocally related
➔ the higher the perceived threat, the greater the fear experienced.

Three key independent variables:
1) Fear: a negatively valanced emotion, accompanied by a high level of arousal.
2) Perceived threat:
• Perceived susceptibility to the threat: the degree to which one feels at risk for experiencing the threat.
• Perceived severity of the threat: the magnitude of harm expected from the threat.
3) Perceived efficacy:
• Perceived self-efficacy: one’s beliefs about his or her ability to perform the recommended response.
• Perceived response efficacy: one’s beliefs about whether the recommended response works in averting the
threat.

The outcomes studied in fear appeals appear to fall into two general classes:
1) Outcomes related to acceptance of the message’s recommendations.
• I.e., attitudes, intentions, behaviours in line with the recommendations.
2) Outcomes related to rejection of the message.
• I.e., defensive avoidance, reactance, denial.

Models that predict behaviour change through fear appeal
1. Fear-as-acquired drive: Janis
Drive = motivator to change attitudes and behaviours
Fear functions as a motivator
Drive theories: the level of fear works as a drive to motivate actions but can have facilitating (desired response) and
inhibiting effects (undesired response: avoidance).
Facilitating effect of fear”
• Fear ->Negative ‘’condition’’ ->So: Fear can lead as a motivational drive to change the condition in the right
direction
• First there can be a facilitating effect if fear: because it is negative it motivates people to change
something to not feel negative anymore.
But also an interfering effect of fear:
• Too much fear -> Too negative ‘’condition’’ -> Avoidance effects of the content that they are exposed to
Fear: effects according to the drive approach
• The level of fear arousal produced by a fear appeal acts as a drive to
motivate actions.
• Low and high levels of fear will have no effect.
• Fear has the highest effect when it is in the middle
• Rejected, because the model’s central hypothesis, that acceptance of
the message occurs when fear is reduced, was not supported

,Attention then turned to explaining emotional versus cognitive responses to fear appeals.
2. Parallel Response Models: Leventhal
Fear can lead to two parallel processes and responses:
1. Danger control: Cognitive response
• How to avoid the threat/ control the danger?
2. Fear control: emotional/affective response
• How to reduce feelings of fear about the danger
Difference PRM – EPPM:
• PRM has no role for efficacy (the extent to which people think they can accelerate the behaviour)
• PRM does not include a stepwise appraisal (1. threat appraisal 2. efficacy appraisal)
The higher the level of fear, the higher the effect on behaviour and behavioural determinants will be

Rejected, because Leventhal failed to explicitly state when danger control and fear control processes would be
initiated or occur and the model was subsequently criticized as lacking specificity and being untestable.

The model did change current thinking about fear appeals and separated emotional from cognitive processes.
3. Protection Motivation Theory: Rogers
• Protection motivation theory uses logical formulas, based on subjective expected utility models. Very cognitive
and emotion had a limited role. (Emotion came into play in the severity concept a bit).
• Based on (cognitive) subjective expected utility
• What (utility) will I (subjective) get when (not) performing (expected)
• So mainly focus on danger control (which is cognitive)
o Maladaptive response is avoidance or withdrawal of a threat.
o Adaptive response is how people can cope with a threat.
o Response efficacy: The appraisal of how effective a certain behaviour is to prevent or avert a threat
o Self-efficacy: The extend to which people feel that they can perform a certain behaviour.
o Protection motivation: The motivation to protect yourself from a risk.
o Intrinsic/ extrinsic rewards: I will feel good when I perform the behaviour, Others will like me more if I perform
the behaviour etc.

• If I only see rewards and experience no risks (threats), the chance of a maladaptive response is high. If I
experience no rewards from my behaviour and perceive the threat as great, the chance that I will continue to
exhibit negative behaviour is lower.
• The chance of an adaptive response is calculated by subtracting the costs related to the positive behaviour
from the extent to which I feel that my own response effectiveness is high. If the efficacy is higher than the
costs, this results in a strong coping appraisal, which in turn results in a high protection motivation (or
intention) to perform the healthy behaviour.

Important: The PMT model does not focus on the role of emotion, but only on the danger parts of the mechanisms of
fear appeals, but efficacy was introduced here into the fear appeal theory

PMT appears to do a good job of explaining when and why fear appeals work (i.e., perceptions of high threat and high
efficacy appear to produce the most message acceptance). However, PMT fails to explain when and how fear appeals
fail.

Leventhal’s model forms the basis of the theory, PMT explains the danger control side of the model (i.e., when and
why fear appeals work), and portions of Janis and McGuire’s explanations can be accounted for under the fear
control side of the model (i.e., when and why fear appeals fail).

, 4. Health belief model

Kind of like Protection Motivation Theory, but self-efficacy is included as a variable + key interventions.
• HBM is an old model but was adapted in 1988 to include self-efficacy. Self-efficacy can influence the benefits
and barriers to behaviour change.
• Barriers and benefits are direct determinants of behaviour.
• Susceptibility and severity motivate behaviour via threat.
• Cues are things in the environment that can make the threat more salient.
• But again: where is the emotion?

Shortcomings of these (earlier) models
• Each of the prior models only explains a part of how fear-appeals work. E.g. they don’t include the emotion
fear
• Unclear when/ why / under which conditions fear appeals work or don’t work
• Witte integrated (most of) these older models:
o Extended Parallel Process Model

5. Extended Parallel Process Model: Witte

The evaluation of a fear appeal initiates two appraisals of the message, which result in one of three outcomes.
Message
Contains elements of threat and efficacy
Threat appraisal
Perceived threat is composed of two dimensions:
• Perceived susceptibility to the threat (i.e., the degree to which one feels at risk for experiencing the threat)
• Perceived severity of the threat (i.e., the magnitude of harm expected from the threat, how serious/severe is the
consequence of displaying the undesired behaviour).
o Low susceptibility or a low severity -> no fear and disregard the message
o High susceptibility and severity to the threat -> fear -> continue to the next appraisal
• The more individuals believe they are susceptible to a serious threat, the more motivated they are to begin the
second appraisal.
Efficacy appraisal
Perceived efficacy also is composed of two dimensions: Whether people will become motivated to control the danger
of the threat or control their fear about the threat.

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