The fear appeal literature is diverse and inconsistent Existing fear appeal theories explain the positive linear results occurring in many studies, but are unable to explain the boomerang or curvilinear results occurring in other studies The present work advances a theory integrating previous theoretical perspectives (ie, Janis, 1967; Leventhal, 1970; Rogers, 1975, 1983) that is based on Leventhal's (1970) danger control/fear control framework The proposed fear appeal theory, called the Extended Parallel Process Model (EPPM), expands on previous approaches in three ways: (a) by explaining why fear appeals fail; (b) by re‐incorporating fear as a central variable; and (c) by specifying the relationship between threat and efficacy in propositional forms Specific propositions are given to guide future research

Putting the fear back into fear appeals: The extended parallel process model

The fear appeal literature is examined in a comprehensive synthesis using meta-analytical techniques. The meta-analysis suggests that strong fear appeals produce high levels of perceived severity and susceptibility, and are more persuasive than low or weak fear appeals. The results also indicate that fear appeals motivate adaptive danger control actions such as message acceptance and maladaptive fear control actions such as defensive avoidance or reactance. It appears that strong fear appeals and high-efficacy messages produce the greatest behavior change, whereas strong fear appeals with low-efficacy messages produce the greatest levels of defensive responses. Future directions and practical implications are provided.

A Meta-Analysis of Fear Appeals: Implications for Effective Public Health Campaigns

This article reports the first meta-analysis of the literature on protection motivation theory (Rogers, 1975, 1983; Rogers & Prentice-Dunn, 1997), a model of disease prevention and health promotion that has generated research for over two decades. The literature review included 65 relevant studies (N= approximately 30,000) that represented over 20 health issues. The mean overall effect size (d+= 0.52) was of moderate magnitude. In general, increases in threat severity, threat vulnerability, response efficacy, and self-efficacy facilitated adaptive intentions or behaviors. Conversely, decreases in maladaptive response rewards and adaptive response costs increased adaptive intentions or behaviors. This held true whether the measures were based on intentions or behaviors, and suggests that PMT components may be useful for individual and community interventions.

A meta-analysis of research on protection motivation theory.

Several theories construe risk appraisals as key determinants of decisions and actions, and this idea has been supported in correlational studies. However, correlational data cannot answer the question, “Does heightening risk appraisals change people’s intentions and behavior?” The present review meta-analyzed experimental evidence in order to address this issue. We identified 4 elements of risk appraisal—risk perception, anticipatory emotion, anticipated emotion, and perceived severity—and located experiments that (a) engendered a statistically significant increase in risk appraisal among treatment compared to control participants and (b) measured subsequent intention or behavior. Heightening risk appraisals had effects of d+ = .31 (k = 217) and d+ = .23 (k = 93) on intention and behavior, respectively. There was evidence that the elements of risk appraisal combined to influence outcomes. For instance, heightening risk perceptions had larger effects on outcomes when anticipatory emotions or perceived severity was also increased. Crucially, risk appraisal effects were augmented by coping appraisals: Risk appraisals had larger effects on outcomes when response efficacy and self-efficacy were enhanced or when response
costs were reduced. The largest effect sizes were observed when risk appraisals, response efficacy, and self-efficacy were simultaneously heightened (d+ = .98 and .45, for intention and behavior, respectively). These findings indicate that heightening risk appraisals changes intentions and behavior. However, the direct effects of risk appraisals were generally small. Exploiting synergies among the elements of risk appraisal, and between risk appraisals and coping appraisals, should make for more effective behavior change interventions.

Does heightening risk appraisals change people's intentions and behavior? A meta-analysis of experimental studies.

Fear appeals are a polarizing issue, with proponents confident in their efficacy and opponents confident that they backfire. We present the results of a comprehensive meta-analysis investigating fear appeals' effectiveness for influencing attitudes, intentions, and behaviors. We tested predictions from a large number of theories, the majority of which have never been tested meta-analytically until now. Studies were included if they contained a treatment group exposed to a fear appeal, a valid comparison group, a manipulation of depicted fear, a measure of attitudes, intentions, or behaviors concerning the targeted risk or recommended solution, and adequate statistics to calculate effect sizes. The meta-analysis included 127 articles (9% unpublished) yielding 248 independent samples (NTotal = 27,372) collected from diverse populations. Results showed a positive effect of fear appeals on attitudes, intentions, and behaviors, with the average effect on a composite index being random-effects d = 0.29. Moderation analyses based on prominent fear appeal theories showed that the effectiveness of fear appeals increased when the message included efficacy statements, depicted high susceptibility and severity, recommended one-time only (vs. repeated) behaviors, and targeted audiences that included a larger percentage of female message recipients. Overall, we conclude that (a) fear appeals are effective at positively influencing attitude, intentions, and behaviors; (b) there are very few circumstances under which they are not effective; and (c) there are no identified circumstances under which they backfire and lead to undesirable outcomes.

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Appealing to fear: A meta-analysis of fear appeal effectiveness and theories.

Despite the importance of alcohol abuse prevention programs, the effectiveness of many components of these programs has not been demonstrated empirically. An experiment tested the efficacy of three components of many prevention programs: fear appeals, one- versus two-sided message style, and the expertise of the source. The persuasive impact of this information was examined on 113 ninth-grade students' intentions to abstain from drinking alcohol while they are teenagers. The results reveal that fear appeals are successful in strengthening students' intentions to refrain from drinking. Implications are discussed for implementing these principles and for designing future investigations of alcohol abuse prevention programs.

Robert D. Stainback

Papers

Identifying Effective Components of Alcohol Abuse Prevention Programs: Effects of Fear Appeals, Message Style, and Source Expertise