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 The meta-analysis included 127 papers (9% unpublished) yielding 248 independent samples (NTotal = 27,372) collected from diverse populations.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 trued¯ = 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.

Resistiveness to care (RTC) is common in older adults with dementia. RTC disrupts nursing care, increasing costs of care by 30%. Elderspeak (infantilizing communication used by nursing staff) may trigger RTC in individuals with dementia. Videotaped care episodes (N=80) of nursing home residents with dementia (N=20) were coded for type of staff communication (normal talk and elderspeak) and subsequent resident behavior (cooperative or RTC). Bayesian statistical analysis tested relationships between staff communication and subsequent resident RTC. The probability of RTC varied significantly with communication (Bayes p = .0082). An increased probability of RTC occurred with elderspeak (.55, CrI = .44 -.66), compared to normal talk (.26, CrI = .12-.44). Communication training has been shown to reduce elderspeak and may reduce RTC in future research.

A meta-analysis of 150 research reports summarizing the results of multiple behavior domain interventions examined theoretical predictions about the effects of the included number of recommendations on behavioral and clinical change in the domains of smoking, diet, and physical activity. The meta-analysis yielded three main conclusions. First, there is a curvilinear relation between the number of behavioral recommendations and improvements in behavioral and clinical measures, with a moderate number of recommendations producing the highest level of change. A moderate number of recommendations is likely to be associated with stronger effects because the intervention ensures the necessary level of motivation to implement the recommended changes, thereby increasing compliance with the goals set by the intervention, without making the intervention excessively demanding. Second, this curve was more pronounced when samples were likely to have low motivation to change, such as when interventions were delivered to non-patient (vs. patient) populations, were implemented in non-clinic (vs. clinic) settings, used lay community (vs. expert) facilitators, and involved group (vs. individual) delivery formats. Finally, change in behavioral outcomes mediated the effects of number of recommended behaviors on clinical change. These findings provide important insights that can help guide the design of effective multiple behavior domain interventions.

After reading the manuscript, readers will be able to: (1) Describe previous attempts at group intervention to improve voice for individuals with Parkinson's disease. (2) List three ways that the group intervention tried in this study differed from LSVT(®). (3) Identify three limitations to this study that must be addressed before advocating implementation of the group approach in clinical situations.

Physical activity is an integral component of overall health. Once activities and activity levels are known, current practices can be augmented or changed to accommodate improved understanding of physical activity. Because an active lifestyle is important in preventing obesity and other chronic conditions and for general health, nurse practitioners (NPs) should ask adolescents about their common activities and encourage them to continue the more vigorous activities and reduce time spent in sedentary pursuits. Prescriptive physical activity can be included for primary, secondary, or even tertiary prevention, thus crossing all levels of NP practice.