Motivation and emotion/Book/2013/Protection motivation and health
Protection motivation and health: What is protection motivation and how does it affect health?
What it is?
There are a variety of health related behaviours that increase our risk of illness, disability and death. It has become and will continue to be, a national priority to reduce these behaviours and encourage healthier behaviours which result in longevity and general well-being (Keller, 1999). These attempts to reduce those behaviours range from print on tobacco packaging depicting the negative consequences of smoking, adverts in daily papers of the consequences of excessive drinking to stories relayed on the news containing the latest developments of STD’s. Unfortunately seeing these health messages is not as entirely effective as receiving advice over the telephone, face to face therapy and seeking medical advice in person (Keller, 1999). This is a major problem health communication faces, and to overcome this the media and health experts tend to focus on fear arousal and how this can effectively affect persuasion (Keller, 1999). A fear appeal usually contains three parts, first it will focus on a particular health risk, it will then focus on consequences and vulnerabilities to that health risk, and thirdly it outlines a protective action that can be taken up to prevent this health risk (Keller, 1999). The persuasion to take up this protective action stems from the feeling and arousal of fear, the unpleasant emotional state brought upon by being exposed to the fear appeals presented to those who would be at risk of negative health behaviours (Keller, 1999). There are a variety of fear-persuasion theories and models which examine and explain fear appeals, and these are:
This chapter will be focusing on specifically Protection Motivation Theory (PMT), a theory put forth by R.W Rogers in 1975 in an attempt to better understand fear appeals, and how it affects a person's health. According to PMT, an individual exposed to a fear appeal results in that person assessing the severity and importance of a behaviour, the probability of the behaviour's occurrence, and the belief in the effectiveness of the recommendations provided in the fear appeal. Perceptions about these three factors arouse protection motivation and adaptive or maladaptive changes in behaviour, which in turn provides the incentive to seek a healthier behavior and to reduce the probability of that health risk (Keller, 1999). Two cognitive process upon exposure to a health threat message or a fear appeal are initiated, and these are threat appraisal and coping appraisal (Sturges & Rogers, 1996). Essentially PMT show the difference and distinguishes between adaptive and maladaptive coping behaviours when faced with a health threat (Ireland, 2011). PMT suggests that a risk to health is appraised by considering the following factors:
- How severe the threatened health behaviour is considered to be, which is the threat appraisal of it's severity
- How susceptible or how vulnerable a person believes themselves to be, which is the threat appraisal towards vulnerability
- How successful a preventative behavior actually is, which is the coping appraisal of success
- How confident the person feels in preventing and reducing the health risk, which is the coping appraisal of that person's self-efficacy (Ireland, 2011)
Fear arousal is expected to enhance protection motivation by heightening threat appraisal and creating an adaptive response (Ireland, 2011). If coping appraisal is unsuccessful a maladaptive response may occur, for example a person who smokes feels that smoking is just too addictive, and that if they make the decision to quit by themselves they are unlikely to complete this adaptive change of behaviour (Ireland, 2011). The threat-appraisal process takes into account the factors associated with the response that creates the danger, such as the severity of the danger and a person's susceptibility towards it (Sturges & Rogers, 1996). The coping-appraisal process evaluates a persons' ability to cope with and avoid the health risk (Sturges & Rogers, 1996). Previous research has discovered that usually these threat and coping processes interact with each other (Sturges & Rogers, 1996). For example if response efficacy or self-efficacy was high, higher levels of the severity of the threat and one's vulnerability to it culminated in stronger intentions to adopt the recommended behavioural change (Sturges & Rogers, 1996). On the other hand if response efficacy or self-efficacy was lower, increases in severity and vulnerability weakened behavioural intentions (Sturges & Rogers, 1996). This has been discovered in studies exploring people's intentions towards moderate drinking, intentions to stop smoking, intentions to protect oneself against sexually transmitted diseases, and self-reported condom use (Sturges & Rogers, 1996). Two of the core variables in this theory are the effectiveness of the response and a persons' ability to act upon it successfully (Sturges & Rogers, 1996).
Other theories with fear appeals
Protection motivation and health
These five theories all share the core belief that a person's motivation protection resides from a perceived threat and the desire to avoid any negative consequences from said threat (Floyd, Prentice-Dunn, & Rogers, 2006). The theories also share a cost-benefit component in which the person weighs the costs of taking the precautionary action up against the expected positives of undertaking that action (Floyd et al., 2006). PMT has been shown to be a viable model on which to base individual and community health interventions, and these will be discussed in further detail soon (Floyd et al., 2006). A major reason this is so is because the PMT model provides an understanding of why attitudes and behaviour can change when people are confronted with threats, it is after all an attitude-based model (Floyd et al., 2006). For example the decision an individual makes to take protective action is a positive result of severity because a person must believe that there is some harm from this health behaviour, such as lung cancer for smokers, and that they are susceptible to this threat (Floyd et al., 2006).
There are rewards though for this behaviour, both intrinsic and extrinsic which must both be overcome; an example of an intrinsic reward would be the pleasure of inhaling tobacco smoke, and an example of an extrinsic reward would be friends approval of that individual smoking with them (Floyd et al., 2006). PMT is similar to other forms of motivation as it arouses, directs and sustains activity (Floyd et al., 2006). This appraisal of threat contains the motivation for an individual to start the coping process and behavioural change (Floyd et al., 2006). To decide to adopt the recommended coping response, a person has to believe that fulfilling the coping response will avoid the threat and that they have the ability and will power to perform the response (Floyd et al., 2006). Of course these considerations also have to outweigh the costs of performing the coping response and behavioural change, and continuing with the smoking example one such cost would be withdrawal symptoms (Floyd et al., 2006).
A recent meta-analytic review was conducted by Milne, Sheeran, and Orbell (2006) which sought to investigate the success PMT had in predicting health behaviours and health intentions. They sought to discover how effective threat and coping appraisal were in predicting attention, how well the PMT variables were associated with intention, how effective variables of PMT were at predicting current and subsequent health behaviours, and finally how successful had manipulations of those variables been in creating changes in beliefs (Milne et al., 2006). The data examined in this research followed strict selection criteria, the studies analysed measured behavioural intentions, contained applications of PMT, and the behaviour studies had to relate to a health behaviour (Milne et al., 2006). Specifically there were two types of studies collected in this research, and these were detection which are conducted to enable a person to discover if they had a behaviour which could result in a health risk, and preventive behaviours which as it sounds enabled a person to continue or stop a certain behaviour that will reduce the risk of a health threat (Milne et al., 2006). They found that PMT variables were significantly associated with current behaviour, that threat and coping appraisals were associated with intention, though coping appraisals were more strongly correlated with intention than threat appraisals (Milne et al., 2006).
As they had predicted, health related intentions were significantly associated with subsequent behaviour, and this supports the model of PMT as the model itself predicts that intention is the one of the strongest and immediate predictors of behavioural change (Milne et al., 2006). This supported previous research, and another finding also supported previous research; this finding was that as mentioned above both appraisals affect intention (with coping affecting it more), but even with threat appraisal affecting intention, it is still a lacklustre predictor of behaviour and intention (Milne et al., 2006). This could be because once a person feels vulnerable towards a health threat they can then create a protective behaviour and thus a positive relationship between perceived personal risk and perceived behaviour; whereas once the protective behaviour is adopted, that person may no longer feel susceptible towards that risk, thus it will result in a negative relationship between perceived personal risk and perceived behaviour (Milne et al., 2006). Finally self-efficacy was found to be strongly associated with intention and current behaviour as it is a major factor in the coping appraisal of PMT (Milne et al., 2006).
Everyday protection motivation
Nearly everybody enjoys going to the beach, kicking back and enjoying passing a ball around or laying in the sun, despite the fact the beach is fun and getting a tan is attractive, skin cancer is a serious health risk. For example Ch’ng and Glendon (2013) examined in their research how effective PMT could be in predicting sun protection behaviours. In this study they measured typical reported behaviours, previous reported behaviours, current sunscreen use and current observed behaviours (Ch’ng & Glendon, 2013). When looking at the variables of PMT in relation to predictors of sun protection behaviours, they found that:
- People who reported high perceived vulnerability to skin cancer were more likely to account for their chances of developing the disease in the future, which leads them to engage in sun protection behaviours (Ch’ng & Glendon, 2013)
- There were extrinsic and intrinsic perceived rewards associated with the maladaptive behaviour, for example people felt that for their social life they preferred to show off a tan, and that bathing in the sunlight was a relaxing thing to do (Ch’ng & Glendon, 2013)
- People had perceived barriers and costs to using sunscreen, for example those who were aiming for a tan, sunscreen reduced the overall effect of tanning (Ch’ng & Glendon, 2013)
- They discovered other coping appraisals which acted as barriers to sun protection as well, such as image issues and forgetfulness (Ch’ng & Glendon, 2013)
- Finally they looked how self-efficacy supported a better health behaviour, that when an individual believed that using sunscreen reduced the risk of melanoma, they were more likely to engage in a protective behaviour (Ch’ng & Glendon, 2013)
The research showed that perceived vulnerability, response costs and response efficacy were strongly associated with protection motivation, though perceived severity was less associated with sun protection (Ch’ng & Glendon, 2013). This could be because perceived severity of skin cancer was of low importance for this sample which would result in little to no motivation to engage in protective behaviour; the sample being a convenience sample taken from Queensland beaches who had stayed within the sun for 30 minutes for the duration of the interview (Ch’ng & Glendon, 2013). The researchers suggest that unlike perceived vulnerability which emphasises a definite health risk, perceived severity does not exhibit those individual's awareness of that health risk (Ch’ng & Glendon, 2013). For example participants might have been unaware of the different varieties of skin cancer, or they were unable to ascertain the risk of skin cancer compared with unspecified other threats to their health, such as major sun burn or heat stroke (Ch’ng & Glendon, 2013).
What this means is that while those individuals might have been aware of the seriousness of skin cancer and the negative consequences it presents, they might not necessarily have associated that perception with their own personal health (Ch’ng & Glendon, 2013). This study did have limitations though which need to be taken into account, for example this was a convenience sampling and may not of represented the target population, which reduces the generalisability of Ch’ng and Glendons (2013) findings. From this information, if you find yourself a regular beach goer, you may wish to focus on the vulnerability you place on yourself by not enacting sun protective behaviours, focus on reducing barriers and response costs such as forgetting to apply sunscreen, and focus on response efficacy, such as learning about how sunscreen protects you from risk of skin cancer.
Now looking at another health behaviour, this research is taking a different spin on PMT by applying it to anti-speeding messages and how they affect a young persons' intention to speed and place themselves and others at risk. Anti-speeding fear appeals usually focus on the negative consequences of taking up the behaviour of speeding, and these message attempt to motivate drivers, particularly young drivers, to adopt the desired behaviours seen in these messages (Glendon & Walker, 2013). Glendon and Walker (2013) examined the various models PMT presents with threat and coping appraisals in relation to exceeding posted speed limits, and these are:
- For perceived severity a person may believe that having a car accident would be much worse whilst speeding than while driving at the posted speed limit (Glendon & Walker, 2013)
- For perceived vulnerability a person would believe they are more likely to have an accident whilst speeding (Glendon & Walker, 2013)
- For perceptions about rewards an individual may simply find enjoyment from speeding (Glendon & Walker, 2013)
- With self-efficacy a person may believe they have the ability and constraint to drive within the speed limit (Glendon & Walker, 2013)
- With response efficacy that person may believe that driving within the posted speed limit will reduce their risk of a car crash (Glendon & Walker, 2013)
- And finally the potential costs associated with carrying out the maladaptive behaviour, for example a person my be running late and speeding would be a solution to this problem (Glendon & Walker, 2013)
A major hurtle in their research was that male drivers were prone to adopting speeding behaviours over female drivers, luckily it was found that PMT based anti-speeding messages were consistent for both genders in their effectiveness at creating the intention to drive within the speed limit over jurisdictional anti-speeding messages (Glendon & Walker, 2013). The table provides some examples of PMT and jurisdiction messages (Glendon & Walker, 2013):
Table 1. PMT Message Examples
|PMT Variable||PMT Message||Jurisdictional Message|
|Severity||Kill your speed, not yourself||Every K over is a killer|
|Vulnerability||Speeding? You are not safe from a speed camera||You speed you pay!|
|Rewards||Speed! The thrill that kills||Slow down stupid|
|Self-efficacy||You can save a life. You can drive the speed limit||Focus on speed - slow down|
|Response efficacy||Don't speed and you won't get a fine||10kph less will save lives|
|Response Cost||Running late? Speeding is never worth the risk||Drive safe - what's your rush?|
Another finding in the research was that PMT messages that focused on threat appraisals, specifically severity and vulnerability, rather than coping appraisals resulted in stronger associations with intent to drive within the speed limit; where as there were no differences in threat and coping appraisals in jurisdictional messages (Glendon & Walker, 2013). Unlike preventive action that focused on coping appraisals, such as educational essays and short media advertisements and speeding in previous research, the mediums for this study were basic messages which comprised of a small amount of text with no accompanying image or sound (Glendon & Walker, 2013). This resulted in these messages producing poignant anti-speeding behaviours which focused more on vulnerability and severity of the risks of speeding, while also reducing the impact coping appraisals may of had on predicting intentions to speed (Glendon & Walker, 2013).
What this can mean for the general public and the individual is that perhaps big campaigns which focus on bombarding demographics with information, statistics and images in an attempt to change speeding behaviours can be not as effective as short, acute messages focused on vulnerability and severity of speeding. This has started to be seen on roads, there are signs with basic text which focus on the use of phones whilst driving, not taking adequate breaks while driving and drinking and then driving. What speeding messages based around PMT can offer though is important insight on crucial areas that should be targeted during the training and education of young drivers, as well as being a factor in other driving related media messages (Glendon & Walker, 2013).
How it can help you
So we've now had a look at fear appeals, how they affect behavioural changes in the face of a health risk, some theories which also postulate behavioural changes, in particular protection motivation theory. In summary it is the ability of the PMT to highlight and evaluate the intention behind the behavioural change that makes it such a successful model of providing positive protective health behaviours and for also effectively understanding fear appeals. So perhaps if you become faced with a health risk dilemma, to overcome becoming stuck with the negative consequences, you could always look at the threat and coping appraisals the PMT puts forth and apply them to your own situation, look at how effective each of those variables are in predicting your behaviour and begin the journey of a healthier and happier lifestyle.
- Extrinsic Motivation
- Intrinsic Motivation
- Health Behaviours
- PMT with Healthy Eating
- PMT with Sexual Motivation
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