- Title
- Fear factors – why do Australians still expose ourselves to the sun and what makes us adopt or reject a health message? – a study into fear appeals and an exploration of sun related health behaviour
- Creator
- Wheatley, Jane
- Resource Type
- thesis
- Date
- 2013
- Description
- Professional Doctorate - Doctor of Clinical and Health Psychology
- Description
- Scope: Given Australia’s high rate of skin cancer, continued sun exposure, and disturbingly high rate of skin cancer rate in Australia, despite the prevalence of health promotion campaigns, there is a need for further research into the factors affecting behaviour change. Health promotion campaigns have utilised fear in their efforts to affect behaviour change. It is assumed that the presentation of graphic images or frightening messages will allow for greater information processing and information recall which will then lead to behaviour change. To date there has been little research which attempts to not only examine the impact of the emerging dominant type of health campaigns, fear appeals, on health information recall and behaviour change, but to combine this with an attempt to explain the impact and interaction of individual differences and in message acceptance and behaviour change in terms of the Australian cultural context. Purpose: This thesis work was undertaken to determine both the efficacy of fear appeals in relation to both information recall, and affecting behaviour change, and to identify other factors affecting Australians’ motivation to make healthier sun behaviour choice. Utilising method triangulation, this research adds to our knowledge of which moderating factors affecting health information recall, and the interaction with attitudes, beliefs and behaviours in relation to sun exposure and skin cancer in Australia. The research was comprised of three studies; two quantitative and one qualitative. Study 1 was a quantitative pilot study that investigated the level of health knowledge reported by individuals, and predictors of recalled health information following the presentation of a fear appeal. The study investigated the role of anxiety, susceptibility, vulnerability, age, or sex as predictors of recall and whether graphic imagery affected recall, anxiety, perceived susceptibility or perceived vulnerability. The aim of this research was to determine if graphic, mild or no imagery, alter information recall and what other factors predicted this recall. Study 2 extended on the pilot study and investigated general & skin cancer health information recall and predictors of recall, as well as one-month post intervention behaviour change. The additional factor of coping was also added to study 2 to investigate whether defensive coping mechanisms are a factor in behaviour change. Finally, study 3 was a qualitative study to explore discourses about sun protection and sun cancer beliefs, attitudes and behaviour in the context of the Australian culture, using Interpretative Phenomenological Analysis (IPA) in order to gain a depth of information through a detailed interpretative account of the cases. Methodology: Three studies were carried out – two qualitative and one quantitative. In study 1, 133 participants were asked to report on their own health behaviours and presented with health information, both related and unrelated, to skin cancer. They were then exposed to mild or graphic imagery relating to skin cancer or asked to sit silently for 50 seconds (control group). Participants then completed the Beck Anxiety Inventory and measures of skin cancer perceived vulnerability and susceptibility. Their recall of health information was then tested. In study 2, 88 participants were asked to report on their own health behaviours and then shown health information related to both skin cancer and general health. They were then exposed to mild or graphic imagery relating to skin cancer or benign imagery (landscapes). Participants then completed the Beck Anxiety Inventory, the Coping Response Inventory and measures of vulnerability and susceptibility. Their health knowledge was then tested and they were invited to participate in a one month follow up test. Sixty-three participants agreed to participate in one month follow up testing and of these, 32 returned the follow up questionnaires. These questionnaires were information about their current health behaviours, the Beck Anxiety Inventory, the Coping Response Inventory and measures of vulnerability and susceptibility. Study 3 was a qualitative study in which 12 participants who were Australian citizens and over the age of 18, participated in a one-to-one semi-structured interview comprising of questions pertaining to attitudes, beliefs and behaviours about sun and skin care. These interviews were then transcribed and analysed using IPA. Results: It was found in study 1, exposure to no intervention imagery (control condition) had an effect on overall information recall, with those who were exposed to imagery (mild or graphic) recalling less information. However, there was no significant difference in relation to recall of skin cancer information specifically. Information recall was found to be predicted by perceived skin cancer vulnerability and age which both had a negative linear relationship with recall. Skin cancer information recall was predicted by skin cancer susceptibility (positive relationship) and skin cancer vulnerability (negative relationship). Finally, results showed a difference in anxiety between conditions, with those exposed to graphic imagery reporting significantly higher anxiety than those in the control condition. In contrast, study 2 found that there was no significant difference between imagery conditions for skin cancer recall and general information recall. General health information recall, was predicted by behaviours - ‘Holiday Sunscreen Use’ (positive relationship) and ‘Cancer Council Visits’ (negative relationship). Skin cancer information recall was predicted by age, in a negative linear relationship. Several behaviours were found to have predictive models. Everyday sunscreen use was found to be predicted by perceived skin cancer vulnerability and initial everyday sunscreen usage in a negative linear relationship. Holiday sunscreen usage was predicted by initial holiday sunscreen usage in a linear relationship. Active sunscreen use was predicted by cognitive avoidance in a negative linear relationship. From the interviews in study 3, seven superordinate themes and 42 subordinate themes were extracted from the interview transcripts using IPA. The superordinate themes revealed that sun exposure attitudes and behaviours were strongly related to positive associations of tanning with the Australian culture. These associations related to perceptions of health, attractiveness and social acceptance. Conclusions and Implications: The results of the current studies show the mixed impact of fear appeals and provide support for the overriding influence of individual and cultural factors on behaviour change. As past research in relation to sun exposure and protection has not investigated a comprehensive range of differing individual and cultural influence factors, the current research also adds to the literature by demonstrating that individuals’ behaviour choices are influenced by various normative factors. Fear appeals and health campaigns in general should consider the vital importance of these cultural and individual factors in predicting behaviour change and barriers to change. In the case of fear appeals, behaviour change was not predicted by graphic imagery, or information recall, and was instead predicted predominantly by prior behaviours, calling into question the need for fear at all. Responses to interviews further added to evidence that individual and other factors (such as culture) come into play when individuals make their health choices.
- Subject
- fear appeals; behaviour change; anxiety; health knowledge; skin cancer; sun exposure; coping
- Identifier
- http://hdl.handle.net/1959.13/938914
- Identifier
- uon:12697
- Rights
- Copyright 2013 Jane Wheatley
- Language
- eng
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