Critical reflection in midwifery practice: the protection motivation theory

Background: The aim of this paper is to shed light on the notion of fear and inter-personal working relationships, and to promote safe midwifery practice, by critically reflecting on our practice and being aware of fear appeals and the protection motivation theory (PMT).

Theory: PMT provides a general account of the impact of persuasive communication, emphasising the cognitive processes that mediate behaviour change and questions whether ‘fear appeals’ could influence behaviour. Discussion: It is possible that when a midwife decides on a particular care pathway, she determines the degree and perception of the four elements of the PMT; severity, vulnerability, response-efficacy and self-efficacy. If the midwife decides that both the degree of severity and her perception of vulnerability are high, whereas response and self-efficacy perceptions are low, she will probably decide against her original care pathway. For the PMT to be used safely, an appropriate judgement call is required and is based on full understanding of the situation, effective communication with the multidisciplinary team, full knowledge of the proposed care, and competence and confidence in the proposed care. Conclusion: By critically reflecting on their practice and using the PMT, the author believes that midwives will be able to work in partnership with obstetricians to provide safe and effective care within their sphere of practice and in the absence of fear.     

Sixty years of fear appeal research: Current state of the evidence

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.     

Scary warnings and rational precautions: A review of the psychology of fear appeals

Abstract

Research into the effects of fear-arousal on precautionary motivation and action is reviewed. Current models do not adequately distinguish between emotional (i.e., fear arousal) and cognitive (i.e., threat perception) responses to fear appeals and, in general, are not well supported. Evidence suggesting that (i) coping appraisals are more powerful predictors of precautionary action than threat perception and that (ii) fear control processes may interfere with precautionary motivation, recommends cautious and limited use of fear appeals in health promotion. It seems likely that fear arousal is less important in motivating precautionary action than perceptions of action effectiveness and self-efficacy. Moreover, perceived personal relevance may be critical to the emotional and cognitive impact of threat information. Available findings are summarised in the form of a process model that highlights the potential complexity of fear arousal effects. Sequential measurement of fear arousal, other than by self-report, is recommended in studies seeking to clarify these effects.     

Effect of Persuasive Appeals in AIDS PSAs and Condom Commercials on Intentions to Use Condoms1

The study compared the effect of five persuasive appeals used in AIDS PSAs and condom commercials (fear arousal-no sex/condom theme; fear arousal-sex/condom theme; erotic; humorous; factual) on 122 male and 114 female college students' i]ntentions to use and taking of condoms. Results showed that the two fear appeals were more effective than other appeals in increasing intentions to use condoms with a new partner. The fear appeal–no sex/condom theme was more effective than other appeals for increasing intentions to use condoms with a steady partner. Compared to men, women rated commercials as more effective for increasing intentions to use condoms with a new partner. Persuasive appeals had no effect on the taking of free condoms. The best predictor of commercial effectiveness was the degree to which a commercial evoked a high fear of AIDS. Other significant predictors were subjects' a]ttitude toward condom use and commercial qualities of being humorous, romantic, credible, and factual. Implications are that all five types of appeals are potentially effective for use in AIDS PSAs. Recommendations include combining appeals (e.g. fear with erotic) and emphasizing the positive features of condom use.     

Sex differences in dealing with bureaucracy

The present study set out to test the popular stereotype of male communicative dominance in the context of dealing with bureaucracy. The study examined the responses of male and female officials of various bureaucratic organizations to different persuasive appeals activated by male and female clients. Log-linear analysis was used to reveal the relationships between sex composition of client-official dyads and outcome across types of organizations and types of persuasive appeal. Findings indicate that the sex of the client and the official significantly affected the outcome only when the type of appeal was taken into account. Although male and female clients did not differ in rates of successful outcome, males were more persuasive when using stronger (i.e., normative) appeals, and females were more effective when applying weaker (i.e., altruistic) appeals. The results demonstrate that no simple answer can be found to the old issue of sex-bound persuasiveness. The answer is highly dependent on a combination of contextual aspects, communicative tactics, and measures of response.This research was supported by the Research Authority of the University of Haifa. The author wishes to thank the late Joseph Shepher, Marilyn Safir, Maya Weinberg, and Brenda Danet and an anonymous reviewer for their helpful comments on an earlier version of this article, and to acknowledge the contribution of Henry Lever in providing the MULTC program.     

The Persuasive Effects of Emotive Visual Imagery: Superficial Manipulation or the Product of Passionate Reason?

This study reevaluates the persuasive impact of emotional visual appeals within politics and examines two different explanations for their effects. One possibility is that the effects of emotive visual images are essentially superficial in nature, consistent with the view that feelings aroused by an affective image are transferred somewhat mechanically to a political candidate or cause with which it is paired. This transfer-of-affect explanation suggests that emotional appeals may work best among the least informed voters or those paying the least attention to a persuasive political message. The second possibility is that emotional appeals work via passionate reason, in which affective responses to an emotive image are integrated with, and potentially bias, reasoned thought about the accompanying message. This integrated approach leads to the counterintuitive prediction that individuals who are most highly involved in an issue (and who know the most about it) are most influenced by emotional imagery. This prediction arises from growing evidence that people highly involved in value-laden social issues generate the strongest emotional responses to issue-related persuasive appeals. These two models were tested in a study in which undergraduate students were presented with a picture of a cute or an ugly animal and a flyer from an organization advocating a pro- or anti-environment stance with respect to preserving the animal's habitat. The responses showed that emotive imagery was most persuasive among the most involved environment supporters, providing clear evidence of passionate reasoning.     

A comparison of the roles of exemplar,action, coordinate,and superordinate relations in the semantic processing of 4- and 5-year-old children

Four types of semantic relation, assumed by different researchers to be implicated in the organization of semantic information, were investigated by means of false recognition and word association tasks presented to independent samples of 4- and 5-year-old children. The same set of basic object stimulus words was used for each task as a means of validating the findings. Twenty-four girls and twenty-four boys at each age level were divided into four experimental groups for the false recognition task. One of four categories of experimental foil words, representing the four types of semantic relation, namely, exemplar, action, coordinate, and superordinate, was presented to one of the four groups. It was found that 4-year olds produced false alarms to exemplar and action relations significantly more frequently that to coordinate and superordinate relations. Five-year olds, in contrast, produced false alarms to exemplar and coordinate relations significantly more frequently that to action and superordinate relations. An independent group of 12 girls and 12 boys at each age level took part in the word association task. Among the 4-year olds, action relations were produced significantly more frequently than either particularization (exemplar and contextual) or coordinate relations. Among the 5-year olds, action relations were produced significantly more frequently than particularizations but the difference between action and coordinate relations was no longer significant. Coordinate groupings, following Riegel [in G. B. Flores d'Arcais & W. J. M. Levelt (eds.), Advances in psycholinguistics. New York: American Elsevier, 1970], were interpreted as implicit classifications derived from the intersect of stored relations. There was little evidence to support the hypothesis that young children comprehend word meanings in terms of logical class inclusion structures.     

The effects of source likeability and need for cognition on advertising effectiveness under explicit persuasion

• While there is evidence that an endorser's likeability plays a determining role in the advertising effectiveness of explicit persuasive appeals, this paper examines the impact of the need for cognition (NFC) as a moderator of this relationship. We find that this effect holds, as predicted, for individuals with lower NFC, but not for those with higher NFC. Furthermore, the effects of explicit persuasion and the endorser's likeability on evaluations of products or services by lower‐NFC consumers were found to be mediated by the attribution of self‐interest. In contrast, advertising effectiveness for higher‐NFC consumers was predictable only by the valence of their cognitive responses to the product.

Copyright © 2009 John Wiley & Sons, Ltd.     

It's My Campaign I'll Cry if I Want to: How and When Campaigns Use Emotional Appeals

Recent research in the area of campaign advertising suggests that emotional appeals can influence political attitudes, electoral choices and decision‐making processes. Yet is there any evidence that candidates use emotional appeals strategically during campaigns? Is there a pattern to their use? For instance, are fear appeals used primarily late in the campaign by trailing candidates in order to get voters to rethink their choices? And are enthusiasm appeals used more commonly early on in order to shore up a candidate's base? We use affective intelligence theory—and supplement it with the idea of a voter backlash—to generate expectations about when candidates use certain emotional appeals (namely, anger, fear, enthusiasm, and pride) and which types of candidates are most likely to do so. We then test these ideas using campaign advertising data from several U.S. Senate races from 2004. Our research thus provides a link between research on campaign decision making—here the decision to “go emotional”—and research focusing on the effects of emotional appeals on voters.     

Fear inhibition and species specific defense reaction termination may contribute independently to avoidance learning

A series of three experiments was conducted to test the proposal of Cicala and Owen (Learning and Motivation, 1976, 7, 356–367) that warning signal termination reinforces avoidance learning by permitting fear to dissipate and that a feedback signal reinforces avoidance learning through conditioned inhibition of fear. A CER procedure with a second-by-second analysis was used to measure fear elicitation and fear reduction following classical conditioning or avoidance training. The results show that a feedback signal produces rapid and marked fear reduction, suggesting an inhibitory process. Although warning signal termination produced fear reduction, the slowness of this process suggests fear dissipation and not an inhibitory process. The combination of both events reduced fear no more effectively than a feedback signal alone. It is suggested that warning signal termination is effective in some avoidance learning situations not because it reduces fear, but possibly because it helps terminate an avoidance response that closely resembles a species specific defense reaction.     

The Influence of Regulatory Fit on Persuasion Under Different Military Operations: The Moderating Effects of Need for Cognition

On the basis of regulatory focus theory (Higgins, 1997 Higgins, E. T. 1997. Beyond pleasure and pain. American Psychologist, 52: 1280–1300. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]), two experiments were conducted to explore the effects of regulatory fit on persuasion under different military operations. It is proposed that appeals presented in promotion focus frames are more persuasive in promotion focus military operations (e.g., offensive), while prevention focus–framed appeals are more persuasive in prevention focus military operations (e.g., defensive). In study one, 99 military personnel were randomly assigned to either of 2 (messages: promotion vs. promotion focus frame) × 2 (operations: offensive vs. defensive) conditions. No significant results were found. In study two, 53 military cadets were randomly assigned to either of 2 (messages: promotion vs. promotion focus frame) × 2 (operations: offensive with superior forces vs. defensive with inferior forces) conditions. The results indicate that need for cognition (NFC) moderates the effects of regulatory fit on persuasiveness. For high-NFC subjects, promotion focus–framed appeals are more persuasive in numerical superiority attacking operations, whereas prevention ones are more persuasive in numerical inferiority defending operations. This interaction effect was not found for low-NFC subjects.     

Cognitive differentiation as a function of information type and its relation to career choice

Although providing occupational information is a common vocational counseling practice, recent research has raised questions about the utility of such information. Cognitive differentiation (the ability to differentiate among job titles on 12 constructs) has been shown to be positively related to an “appropriate” career choice. Differentiation, however, appears to decrease as a function of traditional types of occupational information (e.g., Occupational Outlook Handbook, U.S. Department of Labor, Washington, D.C., 1980). The present study investigated the hypothesis that information related to Holland personality characteristics of persons in various occupations would increase subjects' ability to differentiate among those job titles. One hundred fifty undeclared-major freshman undergraduate students were randomly assigned to one of three condition groups: objective information, personality information, no information. All subjects were administered the Career Decision Scale and Cognitive Differentiation Grid. Results indicated that subjects receiving personality information exhibited a significantly greater degree of differentiation among careers than subjects receiving objective information. These results confirm the major hypothesis of the study and suggest that the provision of personality information may be more useful in promoting career choice than the types of information traditionally provided.     

Congruency,consistency, and differentiation of vocational interests as predictors of vocational satisfaction and preference stability

The Ramak interest inventory (Meir, E. I. Manual for the Ramak and Courses interest inventories, 1975; Barak, A. & Meir, E. I. Journal of Vocational Behavior, 1974, 4, 377–387), together with an occupational choice satisfaction (OCS) inventory, was administered to 158 males and 202 females who had responded to the Ramak 7 years before. The results of the study show: (a) congruence (Holland, J. L. Making vocational choices, 1973) correlated positively with males' and females' OCS (p < .01), while consistency and differentiation correlated with males' OCS when vocational interests were congruent with occupational field; (b) congruency, consistency, and differentiation all had a positive effect on OCS of males (p < .05); (c) when there was incongruency, no negative correlations between consistency and differentiation on the one hand and OCS on the other were found; (d) for males and females, positive correlations (p < .05) were found between congruency, consistency, differentiation, and stability of occupational interests; and (e) differentiation measured in percentages was found valid twice. Theoretical and practical implications of the findings are discussed.     

Discrete emotions and persuasion: the role of emotion-induced expectancies

The authors argue that specific emotions can alter the persuasive impact of messages as a function of the emotional framing of persuasive appeals. Because specific emotions inflate expectancies for events possessing matching emotional overtones (D. DeSteno, R. E. Petty, D. T. Wegener, & D. D. Rucker, 2000), the authors predicted that attempts at persuasion would be more successful when messages were framed with emotional overtones matching the emotional state of the receiver and that these changes would be mediated by emotion-induced biases involving expectancies attached to arguments contained in the messages. Two studies manipulating discrete negative emotional states and message frames (i.e., sadness and anger) confirmed these predictions. The functioning of this emotion-matching bias in parallel with emotion-induced processing differences and the limitations of a valence-based approach to the study of attitude change are also considered.     

Protection motivation and self-efficacy: A revised theory of fear appeals and attitude change

The effects of fear appeals on persuasion were investigated in a factorial experiment that was designed to test a combined model of protection motivation theory and self-efficacy theory. As predicted, the probability of a threat's occurrence and the effectiveness of a coping response both had positive main effects on intentions to adopt a recommended preventive health behavior. More importantly, the findings provided support for self-efficacy expectancy as a fourth component of protection motivation theory: Self-efficacy had a direct influence on intentions and interacted with two other variables of protection motivation theory. The interaction effect was interpreted in terms of two new decision-making strategies that people use when confronted with a fear appeal: a precaution strategy and a hyperdefensiveness strategy. In addition, the results replicated previous findings on the relationship between self-efficacy expectancy and outcome expectancy. A model incorporating protection motivation theory and self-efficacy theory is presented as a possible general model of attitude change.     

The role of esteem and coping in response to a threat communication

Two experiments examined the relations among self-esteem, perceived competency to cope, and actual coping behaviors following a threat communication. Leventhal's “parallel response model” (in Advances in experimental social psychology, L. Berkowitz (Ed.), New York: Academic Press, 1970, Vol. 5) predicts that low-esteem subjects will show deficits in both competency and coping behaviors. Experiment 1 manipulated threat level of a tetanus communication. Low-esteem subjects showed coping deficits on measures of free associations, free recall, fatalism, and coping. Threat groups differed only on fear and danger measures. Experiment 2 manipulated the fear level of an antismoking film and used false feedback to alter perceived competency. Positive feedback increased perceived competency to quit smoking among low-esteem subjects only. Without feedback, low-esteem subjects reduced smoking less than high-esteem subjects; positive feedback reversed the pattern. The discussion argued that, consistent with Leventhal's model, the low-esteem coping deficit has two independent causes: (1) excessive concern with fear, and (2) inadequate perceived competency.     

Task-dependent evaluative processing of moral and emotional content during comprehension: An ERP study

Recently, we showed that when participants passively read about moral transgressions (e.g., adultery), they implicitly engage in the evaluative (good–bad) categorization of incoming information, as indicated by a larger event-related brain potential (ERP) positivity to immoral than to moral scenarios (Leuthold, Kunkel, Mackenzie, & Filik in Social, Cognitive, and Affective Neuroscience, 10, 1021–1029, 2015). Behavioral and neuroimaging studies indicated that explicit moral tasks prioritize the semantic-cognitive analysis of incoming information but that implicit tasks, as used in Leuthold et al. (Social, Cognitive, and Affective Neuroscience, 10, 1021–1029, 2015), favor their affective processing. Therefore, it is unclear whether an affective categorization process is also involved when participants perform explicit moral judgments. Thus, in two experiments, we used similarly constructed morality and emotion materials for which their moral and emotional content had to be inferred from the context. Target sentences from negative vs. neutral emotional scenarios and from moral vs. immoral scenarios were presented using rapid serial visual presentation. In Experiment 1, participants made moral judgments for moral materials and emotional judgments for emotion materials. Negative compared to neutral emotional scenarios elicited a larger posterior ERP positivity (LPP) about 200 ms after critical word onset, whereas immoral compared to moral scenarios elicited a larger anterior negativity (500–700 ms). In Experiment 2, where the same emotional judgment to both types of materials was required, a larger LPP was triggered for both types of materials. These results accord with the view that morality scenarios trigger a semantic-cognitive analysis when participants explicitly judge the moral content of incoming linguistic information but an affective evaluation when judging their emotional content.     

Survival of the Fittest: Rhetoric During the Course of an Election Campaign

Despite the tradition of studying campaign effects, we know little about the rhetorical strategies of candidates. This study speculates about the types of appeals that incumbents and challengers find most effective and that are, as a result, most likely to dominate an election campaign. Candidates have an incentive to use arguments that evoke emotions such as fear, anxiety, and anger. Emotional appeals allow candidates to emphasize consensual values, which makes it easier to mobilize their party's base while simultaneously attracting the support of the uncommitted. The use of emotional appeals is also consistent with the media's preference for drama and excitement in news reporting. Thus, emotional appeals will be more enduring than other types of appeals, and hence more likely to dominate the rhetorical landscape. A content analysis of newspaper coverage of the 1988 Canadian federal election campaign provides suggestive evidence in favor of this view.