Fear arousal is widely used in persuasive campaigns and behavioral change interventions. Yet, experimental evidence argues against the use of threatening health information. The authors reviewed the current state of empirical evidence on the effectiveness of fear appeals. Following a brief overview of the use of fear arousal in health education practice and the structure of effective fear appeals according to two main theoretical frameworks-protection motivation theory and the extended parallel process model-the findings of six meta-analytic studies in the effectiveness of fear appeals are summarized. It is concluded that coping information aimed at increasing perceptions of response effectiveness and especially self-efficacy is more important in promoting protective action than presenting threatening health information aimed at increasing risk perceptions and fear arousal. Alternative behavior change methods than fear appeals should be considered.

The findings provide the first neuroscientific support for the hypothesis that threatening health information causes more efficient disengagement among those for whom the health threat is self-relevant.

Use of fear appeals assumes that when people are emotionally confronted with the negative effects of their behaviour they will change that behaviour. That reasoning is simple and intuitive, but only true under specific, rare circumstances. Risk perception theories predict that if people will experience a threat, they want to counter that threat. However, how they do so is determined by their coping efficacy level: if efficacy is high, they may change their behaviour in the suggested direction; if efficacy is low, they react defensively. Research on fear appeals should be methodologically sound, comparing a threatening to a non-threatening intervention under high and low efficacy levels, random assignment and measuring behaviour as outcome. We critically review extant empirical evidence and conclude that it does not support positive effects of fear appeals. Nonetheless, their use persists and is even promoted by health psychology researchers, causing scientific insights to be ignored or misinterpreted.

The authors tested whether individually tailored health communications receive more attention from the reader than nontailored health communications in a randomized, controlled trial among student volunteers (N = 24). They used objective measures of attention allocation during the message exposure. In a between-subjects design, participants had to read tailored or nontailored nutrition education messages and at the same time had to pay attention to specific odd auditory stimuli in a sequence of frequent auditory stimuli (odd ball paradigm). The amount of attention allocation was measured by recording event-related potentials (ERPs; i.e., N100 and P300 ERPs) and reaction times. For the tailored as opposed to the nontailored group, results revealed larger amplitudes for the N100 effect, smaller amplitudes for the P300 effect, and slower reaction times. Resource allocation theory and these results suggest that those in the tailored group allocated more attention resources to the nutrition message than those in the nontailored group.

Risk communications are an integral aspect of health education and promotion. However, the commonly used textual risk information is relatively difficult to understand for the average recipient. Consequently, researchers and health promoters have started to focus on so-called decision aids, such as tables and graphs. Although tabular and graphical risk information more effectively communicate risks than textual risk information, the cognitive mechanisms responsible for this enhancement are unclear. This study aimed to examine two possible mechanisms (i.e., cognitive workload and attention). Cognitive workload (mean pupil size and peak pupil dilation) and attention directed to the risk information (viewing time, number of eye fixations, and eye fixation durations) were both measured in a between-subjects experimental design. The results suggest that graphical risk information facilitates comprehension of that information because it attracts and holds attention for a longer period of time than textual risk information. Graphs are thus a valuable asset to risk communication practice for two reasons: first, they tend to attract attention and, second, when attended to, they elicit information extraction with relatively little cognitive effort, and finally result in better comprehension.