Misinterpreting theory and ignoring evidence: fear appeals can actually work: a comment on Kok et al. (2018)

Borland, Ron

doi:10.1080/17437199.2018.1445545

Cited by 59 publications

(16 citation statements)

References 10 publications

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“…We have lifted the relevant quotes from each of the seven commentaries to illustrate this consensus. The full list is included in the supplementary part of this rejoinder, but we include the first three quotes here as an illustration: 'That motivational messages will be more effective when people believe they have the capacity to act is an outcome predicted by most health theories, including ones that would support use of threat communications […]' (Borland, 2018), '[…] we agree with Kok et al that the warnings would likely work even better with a self-efficacy message, and that self-efficacy messages should accompany fear communications whenever possible' (Brewer et al, 2018), and '[…] the higher the self-efficacy individuals have for changing a health-related behavior, the more likely they are to make the change' (Malouff, 2018).…”

Section: Consensus 2: the Relative Roles Of Threat And Efficacymentioning

confidence: 99%

Towards consensus on fear appeals: a rejoinder to the commentaries on Kok, Peters, Kessels, ten Hoor, and Ruiter (2018)

Peters

Ruiter

Hoor

et al. 2018

Health Psychology Review

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We were faced with the considerable challenge of responding to so many commentaries. Therefore, this rejoinder has two parts. In this text, we will emphasise our common ground based on a number of major points that pervade across the commentaries, while we provide more comprehensive and detailed responses to each commentary in the supplementary file. 1 We feel it is time for the debate about fear appeal effectiveness to mature into a more collaborative effort for two reasons. First, this debate does not help in achieving our mutual goal: optimally effective behaviour change interventions. Second, while this debate revealed a number of fundamental disagreements (e.g., regarding what constitutes evidence), it also revealed substantial consensus: enough to build on going forward. Although our article concerns threatening communication in general and applies to all behaviours, the ensuing debate centred around the most ubiquitous instance of threatening communication: health communications on tobacco packaging. Presently, this space is used for pictorial warning labels, aiming to promote smoking cessation among smokers and discourage smoking initiation among vulnerable non-smokers, and many of the commentary authors are researchers who have conducted research on warning labels. Therefore, we will also use warning labels as an example; but note that the processing of threatening information is a characteristic of human psychology and so applies to all threatening communications. Consensus 1: the urgency of the problem First, the debate over fear appeal effectiveness made clear how committed all involved are to promoting the health of vulnerable populations. We all agree that current smokers and vulnerable ex-smokers deserve the best possible behaviour change interventions that our discipline of health psychology can devise. That consensus exists regarding this point may seem trivial, but we feel that it is important to keep in mind that we all want the same: promoting health.

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Section: Consensus 2: the Relative Roles Of Threat And Efficacymentioning

confidence: 99%

Towards consensus on fear appeals: a rejoinder to the commentaries on Kok, Peters, Kessels, ten Hoor, and Ruiter (2018)

Peters

Ruiter

Hoor

et al. 2018

Health Psychology Review

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“…For example, syntheses of evidence have indicated that interventions targeting change in social cognitive beliefs and motivation [25][26][27][28][29][30][31], social support and norms [32,33], and planning [29] to be effective in promoting behavior change in randomized controlled trials. Similarly, interventions based on health-risk communications have been successful in promoting behavior change [34], with graphic images on tobacco products a prominent example [35][36][37][38]. Research targeting change in determinants derived from social-ecological theories, encompassing environmental, community, and policy factors, have also been shown to be effective [21,32,39,40].…”

Section: Do Interventions Based On Theory 'Work' In Changing Behavior?mentioning

confidence: 99%

Do Interventions Based on Behavioral Theory Work in the Real World?

Hagger¹,

Weed²

2019

Preprint

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BackgroundBehavioral scientists suggest that for behavior change interventions to work effectively, and deliver population-level health outcomes, they must be underpinned by behavioral theory. However, despite implementation of such interventions, population levels of both health outcomes and linked behaviors have remained relatively static. We debate the extent to which interventions based on behavioral theory work in the real world to address population health outcomes.DiscussionHagger argues there is substantive evidence supporting the efficacy and effectiveness of interventions based on behavioral theory in promoting population-level health behavior change in the ‘real world’. However, large-scale effectiveness trials within existing networks are relatively scarce, and more are needed leveraging insights from implementation science. Importantly, sustained investment in effective behavioral interventions is needed, and behavioral scientists should engage in greater advocacy to persuade gatekeepers to invest in behavioral interventions.Weed argues there is no evidence to demonstrate behavioral theory interventions are genuinely effective in real world settings in populations that are offered them: they are merely efficacious for those that receive them. Despite behavioral volatility that is a normal part of maintaining steady-state population behavior levels creating the illusion of effectiveness, interventions fail in shifting the curve of population behaviors because they focus on individuals rather than populations.Hagger responds that behavioral interventions work in the ‘real world’ in spite of, not because of, flux in health behaviors, and that the contention that behavioral theory focuses solely on individual behavior change is inaccurate.Weed responds that the focus on extending the controls of efficacy trials into implementation is impractical, uneconomic and futile, and this has squandered opportunities to conduct genuine effectiveness trials in naturalistic settings.SummaryHagger contends that interventions based on behavioral theory are effective in changing population-level behavior in ‘real world’ contexts, but more evidence on how best to implement them and how to engage policymakers and practitioners to provide sustained funding is needed. Weed argues for a paradigm shift, away from aggregative attempts to effect individual behavior change towards a focus on disrupting social practices, underpinned by understanding social and economic causation of the distribution and acceptance of behaviors in a population.

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“…noticing health warnings, self-reported cognitive responses to health warnings, and avoidance and forgoing of health warnings), making it more likely that the found effects are caused by the introduced policy because secular trends or other interventions are unlikely to influence these variables. There has been scientific debate at the national Kok, Ruiter, van den Hoek, Schaalma, & de Vries, 2007a;Kok, Ruiter, van den Hoek, Schaalma, & de Vries, 2007b;Peters, Ruiter, Kessel, & Kok, 2013;van der Kemp & Bekker, 2007;Zeeman, Willemsen, & van Gennip, 2007) and international (Biener, & Taylor, 2002;Borland, 2018;Brewer, Hall, & Noar, 2018;Brown & Whiting, 2013;de Bruin, & Peters, 2013;Hasting & MacFadyen, 2002;Kok, Bartholomew, Parcel, Gottlieb, Fernández, 2013;Malouff, 2018; level resolving around the methodological quality and outcome measures of studies claiming effectiveness of threatening communication. According to some, quasi-experimental studies (chapter 3) are the most rigorous alternative for an RCT .…”

Section: Methodological Considerationsmentioning

confidence: 99%

“…Analysis of complex mixtures -Cigarette smoke. Experimental andToxicologic Pathology, 57, 43-73. doi:10.1016/j.etp.2005.05.010 Borland, R. (2018). Misinterpreting theory and ignoring evidence: fear appeals can actually work: a comment on Kok et al (2018).…”

Section: Outline Of This Thesismentioning

confidence: 99%

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Evaluating tobacco control policies

Mourik¹,

Albert²

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Misinterpreting theory and ignoring evidence: fear appeals can actually work: a comment on Kok et al. (2018)

Cited by 59 publications

References 10 publications

Towards consensus on fear appeals: a rejoinder to the commentaries on Kok, Peters, Kessels, ten Hoor, and Ruiter (2018)

Towards consensus on fear appeals: a rejoinder to the commentaries on Kok, Peters, Kessels, ten Hoor, and Ruiter (2018)

Do Interventions Based on Behavioral Theory Work in the Real World?

Evaluating tobacco control policies

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