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Should we scare people for their own good?

Many people think it is a good behaviour change strategy to make people fear a health consequence to make them change their behaviour. For example, the reasoning behind the warning on cigarettes packs is to scare smokers away from smoking.

Should this strategy be used more widely, for example to encourage the adoption of protective actions against COVID-19?

The researchers in the field of health communication have been debating this question for a long time, and still are. Some data show that fear-appeals are associated with changes in behavior, while others point that it can trigger defensive reactions which leads to resistance to change.

What is consistent in the literature however is that, if used, fear-appeal should always be accompanied by messages that state what can be done to prevent the threat AND give people confidence that they can indeed change their behaviour to prevent the threatening thing from happening. Like if the cigarette packs were accompanied by how to keep from getting diseased, blackened lungs and guidance to seek support and start a smoking cessation programme.

In a recent study, we explored those mechanisms and measured three types of defensive reactions:

1. suppression (i.e. not wanting to think about the threat);

2. reappraisal (i.e. agreeing with beliefs such as “I know people who had unhealthy habits and lived long lives”); and,

3. denial (i.e. thinking that the information about the threat has been exaggerated).

We showed that things might be even more complex than previously considered: efficacy was associated with less suppression and less reappraisal (as expected), while associated with MORE denial. This result is surprising but similar effects have been found in a few others papers too. Thus, there might be a real effect here, which is worth investing more before concluding under which conditions fear-appeal is effective.

It is worth remembering that fear-appeal can be expected to have an effect only when a determinant of the behaviour is a lack of susceptibility or vulnerability. This means that when people do not know about the danger of the behaviour, it might be useful to inform them about it, and when people do not consider themselves at risk while they are, it might again be important to make them realize that they are.

Thus, it is important to choose the communication strategy or tone relying on a diagnostic of the reasons why people do, or do not do, the behavior. Scientific knowledge about behavior change is a field in constant progression, and new data might give new insights. Until then, we can keep building interventions that build on evidence like this to help change behaviour.

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