Cultural considerations of the use of fear in promoting behaviour change related to HIV/AIDS risk

The use of fear arousal in preventive education and public health campaigns has demonstrated popularity as a common response to the HIV/AIDS epidemic and contributive risk behaviours such as illicit drug use and unprotected sex.  Although many health professionals believe “scare tactics” to be not just ineffective, but also immoral, the case has been made for considering fear appeals in PSAs in a cultural context (Green & Witte, 2006).

The persistent and unrelenting insistence against the use of fear in public health PSAs and mass media campaigns has been pinpointed as an American approach derived from the original study conducted in fear appeals: Janis and Feshbach’s (1953) study on dental hygiene found that the stronger the fear appeal, the less participants brushed their teeth (Janis & Feshbach, 1956).  Although its methodology was heavily criticized for exclusion of data that contributed to skewing the results, it is noted that the tradition of belief that fear-based appeals are ineffective has continued since this study (as cited in Green & Witte, 2006, p. 249; Janis & Feshbach, 1953).

Despite this, studies have shown that in African contexts, arousing fear of HIV/AIDS has the potential to contribute to a decline in prevalence rates.  A prime example of this is seen in Uganda and other African nations that made use of skull-and-crossbones-type PSAs in the mid-1980s to the early 1990s that elicited a high level of fear in audiences.  This fear, paired with strong perceptions of self-efficacy (i.e., that health was a personal responsibility and that something could be done to avoid HIV infection) encouraged change in behaviours (Green & Witte, 2006, p. 253).  Much debate has been generated in the way of both practical and ethical use of fear in public health messages, though others have also seen the value in questioning the objection to fear-based appeals and its disconnect with empirical evidence (Green & Witte, 2006; O’Grady, 2006; Kirby, 2006; Halperin, 2006).

Uganda in the mid-1980s to the early 1990s saw an approximate 66 percent decline in HIV prevalence rates.  After the mid-1990s, the softer approach favoured by Western ideals replaced the original fear-based messages and indications of a possible increase in HIV infection rates was noted (Green & Witte, 2006, p. 256).  Although it would be inaccurate to assume that the decline was the result of HIV/AIDS PSAs alone, the beneficial contributions of fear appeals in this context cannot be denied.  (For an interesting study on cultural orientations in response to fear appeals, see “Addressing cultural orientations in fear appeals: Promoting AIDS-protective behaviors among Mexican immigrant and African American adolescents and American and Taiwanese college students”.)

Interestingly, a study on the effectiveness of mass media campaigns to change health behaviour suggested that high exposure to mass media campaigns that elicit negative emotions such as fear, disgust, and sadness may promote increased cessation rates in lower socioeconomic populations.  Although addressing anti-tobacco campaigns specifically, the application of this position to campaigns related to HIV/AIDS risk behaviours provides a useful perspective (Wakefield et al., 2010, p. 1264).

Future undertakings in this stream of research should consider the potential role of knowledge sharing, rather than simple dissemination, as the perpetual and expansive growth in technology has altered the way that people access and respond to health messages.  Furthermore, in-depth study of the use of fear in different cultural contexts and with different populations within a single cultural sphere could be beneficial, as well as study of other negative emotions such as shame, disgust, and sadness.

Ultimately, agendas to push evidence-based policy over those that are consensus-based should be prioritized when health is at stake.  The use of fear as a tool to promote behaviour change must be considered in the cultural context.  Steps toward such agendas necessitate, without a doubt, a better understanding of the manipulative nature of health communication research, and by extension, ethical considerations that will certainly accompany such research (Witte, 1994).

Resources

Halperin, D. T. (2006). The controversy over fear arousal in AIDS prevention and lessons from Uganda. Journal of Health Communication, 11(3), 266-267. doi: 10.1080/10810730600630157

Kirby, D. (2006). Can fear arousal in public health campaigns contribute to the decline of HIV prevalence? Journal of Health Communication, 11(3), 262-266. doi: 10.1080/10810730600630306

O’Grady, M. (2006). Just inducing fear of HIV/AIDS is not just. Journal of Health Communication, 11(3), 261-262. doi: 10.1080/10810730600628748

Sampson, J., Witte, K., Morrison, K., Liu, W. Y., Hubbell, A. P., & Murray-Johnson, L. (2001). Addressing cultural orientations in fear appeals: Promoting AIDS-protective behaviors among Mexican immigrant and African American adolescents and American and Taiwanese college students. Journal of Health Communication, 6(4), 335-358. doi: 10.1080/108107301317140823

Witte, K. (1994). The manipulative nature of health communication research: Ethical issues and guidelines. American Behavioral Scientist, 38(2), 285-293. doi: 10.1177/0002764294038002009

References

Green, E. C. & Witte, K. (2006). Can fear arousal in public health campaigns contribute to the decline of HIV prevalence? Journal of Health Communication, 11(3), 245-259. doi: 10.1080/10810730600613807

Janis, I. L. & Feshbach, S. (1953). Effects of fear-arousing communications. The Journal of Abnormal and Social Psychology, 48(1), 78-92. doi: 10.1037/h0060732

Wakefield, M. A., Loken, B., & Hornik, R. C. (2010). Use of mass media campaigns to change health behaviour. Lancet, 376, 1261-1271. doi: 10.1016/S0140-6736(10)60809-4

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