The data support the assumption that there is an important association between threat and coping appraisals facilitating behaviour change. Moreover, the widely held notion that people have to be scared or threatened to encourage attitude and behaviour changes should be treated with caution. Communication should instead focus on efficacy to foster adaptive responses. Statement of contribution What is already known on this subject? There is mixed support for the effectiveness of fear appeals in persuasive health communication, especially regarding the interaction of threat perceptions and coping appraisals for fear and danger control processes. The Extended Parallel Process Model - being a current and often applied model to investigate the effects of fear appeals - suggests a multiplicative relationship between threat perceptions and coping perceptions Most studies applying conventional analysis strategies (e.g., [M] ANOVAs) indicate that perceptions and appraisals of threat and efficacy are not directly related to each other. What does this study add? It demonstrates the parallelism and interaction between threat appraisal and coping appraisal processes and demonstrates the usefulness of SEM in testing associations within the EPPM. It confirms the assumption of an important multiplicative association between threat and coping appraisals within the EPPM, while related cognitive processes still seem to operate independently. Adaptive responses to persuasive messages are mainly triggered using efficacy cues, not threat, which could also be triggered by promoting positive emotional experiences (e.g., gain-framing or entertainment education).

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Patients’ participation in healthcare requires comprehensive health knowledge and can benefit from online health information seeking behaviours (O-HISB). The internet is a particularly vital source for seeking health-related information in many regions of the world. Therefore, we take a European cross-country comparative perspective on O-HISB. We aim to compare the importance of personal, health(care)-related, and cognitive determinants of using the internet for health-related purposes in four European countries. We conducted online surveys among the German, Swiss, Dutch, and Austrian public and described patterns of health information seeking online. The internet seemed to be a widely used source of health information in the four selected European countries. The explanation patterns of personal, health(care)-related, and cognitive factors differ by country and between selecting the internet as a source of health information and the frequency of online use. Using online media appeared to be more common for women and for current health problems. Respondents’ willingness and competencies are essential for online health information seeking. To prevent the increase of social and health-related disparities, there is an urgent need to support underprivileged population groups and increase motivations and eHealth literacy to use the internet for health-related purposes.

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