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WHEN THE FEAR CONTENT OF A FEAR APPEAL MIGHT BE
IRRELEVANT: CAN YOU SCARE THE ALREADY SCARED?

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Nithya Muthuswamy

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WHEN THE FEAR CONTENT OF A FEAR APPEAL MIGHT BE IRRELEVANT:
CAN YOU SCARE THE ALREADY SCARED?

By

Nithya Muthuswamy

A DISSERTATION

Submitted to
Michigan State University
in partial fulﬁllment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY
Department of Communication

2006

ABSTRACT

WHEN THE FEAR CONTENT OF A FEAR APPEAL MIGHT BE IRRELEVANT:
CAN YOU SCARE THE ALREADY SCARED?

By

Nithya Muthuswamy
Fear appeals have long been used to persuade audiences to adopt protective and healthy
behaviors. The fear appeal literature, however, is equivocal about the implications of fear
inducing message content in a context in which high fear preexists. Yet, fear inducing
messages are frequently used in such contexts. Based on the extended parallel processing
model framework (Witte, 1991), this dissertation assesses the impact of fear arousing
messages and efﬁcacy in a high fear situation, speciﬁcally HIV/AIDS in Namibia, Africa.
Research questions and propositions concerning the impact of fear inducing content on
perceived threat and outcome variables are presented. A 2 (high fear, low fear) x 2 (high
efﬁcacy, no efﬁcacy) experiment with a no message offset control and efﬁcacy only
conditions is presented to test the propositions and research questions on 374
undergraduate participants from the University of Namibia. The data revealed that
participants held pre-existing high fear with regard of HIV/AIDS. Further, results
suggested that threat levels of a message had little impact on perceptions of fear, or the
outcome measures including attitudes, intentions, or behaviors. Also, the efﬁcacy content
of the message had little impact on attitude, and intentions, and an ambiguous impact on
behaviors related to condom use. The limitations of this study as well as its implications
to fear appeal theory and practice are detailed in the discussion section. It is concluded
that the use of fear appeals to persuade audience with high levels of pre-existing fear is

ill-advised and ineffective.

Copyright by
Nithya Muthuswamy
2006

To all the scholar practitioners around the world who are working tirelessly
' to stem the tide of HIV/AIDS.

iv

ACKNOWLEDGEMENTS

I would like to thank Dr. Timothy Levine, the chair of my committee for steering
me through the entire dissertation process. I appreciate his immense contribution to my
all round professional development as a scholar. His enthusiasm for research, and his
uncompromising emphasis on the quality of work has been a major driving force through
my education at Michigan State. I also thank my committee members, Dr. Mary
Bresnahan, Dr. Kami Silk and Dr. Jeanne Gaze] for their valuable time and feedback on
my manuscript. I was truly lucky to work with such wonderful scholars

I am also thankful to Dr. Kim Witte who made it possible for me to go to Namibia
and work in the area of HIV /AIDS. The topic of my dissertation grew out of my
experiences in Namibia. I am very grateful to Ms. Cathrine Nengomasha, professor at the
university of Namibia, for volunteering to help collect data. She executed this arduous
task meticulously and thoroughly. I thank all the faculty members and the students in the
university for their time and input on this study.

Lastly, I thank my parents. Their unconditional support, and their unwavering
faith in my abilities to excel has been the strongest motivating force in my life. They have
‘been there’ for me in the true sense of the term. For my dissertation, they came all the
way from India to take care of my son, so I could ﬁnish up. I owe them so much! I thank
my husband, Krishna for all his help and support. And I would like to thank my son
Prem, the love of my life, for being so understanding and patient while I worked on my

dissertation.

TABLE OF CONTENTS

LIST OF TABLES .................................................................................. vii
LIST OF FIGURES ................................................................................ viii
LIST OF MESSAGES .............................................................................. ix
LIST OF QUESTIONNAIRES ..................................................................... x
Chapter 1: Introduction .............................................................................. 1
The Extended Parallel Processing Model ........................................................ 3
Fear appeals in a high fear context: The literature ..................................... 8
HIV/AIDS in Namibia — an overview ................................................... 1 1
Chapter 2: Method .................................................................................. 19
Participants ................................................................................. 19
Design ....................................................................................... 21
Message Design ............................................................................ 21
Pre-study .................................................................................... 22
Instrumentation ............................................................................. 24
Pre-study results ............................................................................ 25
The experimental study .................................................................... 28
Phase I .............................................................................. 28
Phase II .............................................................................. 29
Chapter 3: Results ................................................................................... 32
Substantive ﬁndings ........................................................................ 32
Supplemental Analyses .................................................................... 36
Chapter 4: Discussion .............................................................................. 39
APPENDICES
Appendix A: Tables ................................................................................. 52
Appendix B: Figures ................................................................................ 56
Appendix C: Messages ............................................................................ 61
Appendix D: Questionnaires ...................................................................... 65
REFERENCES ...................................... , ............................................... 76

vi

LIST OF TABLES

Table 1. Means, Standard Deviation and Reliabilities of Constructs ........................ 53
Table 2. Group Means on Dependent Outcomes ................................................. 54
Table 3. Correlation Matrix of Variables of Interest ........................................... 55

vii

LIST OF FIGURES

Figure 1. Fear Among
Control Group Respondents ............................................................... 57

Figure 2. Defensive Avoidance
for Respondents in Fear and Danger Control Groups ................................. 58

Figure 3._Message Derogation
for Respondents in Fear and Danger Control Groups ................................. 59

Figure 4. Perceived Manipulation
for Respondents in Fear and Danger Control Groups .............................. ,,,,60

viii

LIST OF MESSAGES

Message 1. High fear message .................................................................. 62
Message 2. Low fear message ................................................................... 64
Message 3. High efﬁcacy message .............................................................. 66

ix

LIST OF QUESTIONNAIRES

Questionnaire 1. Phase I ........................................................................... 66

Questionnaire 2. Phase II ........................................................................... 75

Chapter 1
Introduction

Scaring people into changing their behaviors has been a frequently used
persuasive strategy (Witte, 1994). This strategy, labeled as a fear appeal, has been
studied and used for decades across diverse locations and populations. It is particularly
common in the context of health communication as a tool to persuade focal audiences to
adopt protective and healthy behaviors (Hale & Dillard, 1995; Witte & Allen, 2000).
Health scholars and practitioners have been deeply interested in understanding exactly
what types of messages motivate health protective behaviors and what types of messages
minimize the probability of inadvertent and counterproductive reactions in target
audiences (Witte, Cameron, Mc Keon & Berkowitz, 1996).

The extended parallel processing model (Witte, 1991 , 1992b) represents the state
of art in thinking about the effectiveness of fear appeals by specifying with precision the
conditions under which fear appeals work or boomerang. Speciﬁcally, the model suggests
that when perceived threat is lower than perceived efﬁcacy, cognitive processes are
triggered resulting in the acceptance of message recommendations and positive changes
in attitudes, behavior, and intentions. On the other hand, when levels of threat exceed
perceptions of efﬁcacy, emotional reactions to the message are triggered resulting in
maladaptive responses and rejection of message recommendations.

As one strategy to prevent the potential negative outcomes that can result from the
use of fear inducing messages, Witte recommends that researchers and practitioners
survey the focal audience to ascertain preexisting levels of severity and susceptibility

toward the threat object prior to planning a fear appeal campaign. The results of this

diagnosis are intended to inform the implementation of a fear appeal campaign. Whereas
an audience analysis is an important step toward averting the potential negative impact of
a scare tactic, in certain circumstances the fear appeal literature is equivocal about exactly
how the audience analysis might be used to inform and direct the strategic planning of a
campaign. In particular, given a context in which audiences’ levels of fear are high to
begin with, the speciﬁc guidelines that the model suggests will be the most effective in
motivating the audience to adopting pro-healthy behaviors, while at the same time
reducing possibilities of defensive avoidant behavior resulting in message rejection, are
unclear. Under such circumstances, ﬁndings in the fear appeal literature do not lend
themselves to unequivocal interpretations. That is, if high levels of fear pre-exists, there
is considerable lack of theoretical and empirical clarity concerning whether it is useful to
reinforce/validate the existing high perceptions of fear, to present messages with low
levels of fear, or to do away with fear completely so as to minimize the probability of
defensive reaction.

This paper seeks to investigate the role of fear inducing content in a high fear
context, as applied to the case of the HIV/AIDS pandemic in Namibia. HIV/AIDS is a

serious challenge facing Namibia (www.cdcorg). AIDS has become the single most

 

serious threat to life, education, social, and economic progress in the country

(mchdccrg) and is the primary cause of death and hospitalization (U SAID, 2002).

 

Further, more than one in ﬁve individuals (22.5%) in the adult population (14-49 years)
are infected with the virus (Ministry for Health and Social Services, 2002). The serious
impact of the illness on the lives of Namibians, and the extent to which it has spread in

Namibia puts this country in a unique situation. It is likely that Namibians are

experiencing high pre-existing fear toward HIV /AIDS. This study will investigate the
role of fear content in this high pre-existing fear context.

Toward this end, the EPPM is detailed, and the contribution of this theory to the
fear appeal literature is presented. Next, the ambiguity in literature with regard to the role
of fear in the context of a high fear message will be highlighted. Third, a brief description
of the HIV/AIDS pandemic in Namibia will be presented. Fourth, the propositions
regarding the role of fear in a high fear context (HIV/AIDS issue in Namibia) will be
advanced. Lastly an experiment testing these propositions is detailed, and the ﬁndings of
this experiment are reported, and discussed.

The Extended Parallel Processing Model

The extended parallel processing model (EPPM) was developed by Witte (1991,
1992) as a model to assist scholars and practitioners in the development of effective risk
communication messages and offer insight into how to channel an individual’s fear into
motivation for effective action, rather than an inhibitor of self- protective behavior. The
EPPM is a synthesis of three major theoretical approaches, the fear as acquired drive
model (Hovland, Janis & Kelly 1953; Janis 1967), the parallel process model (Levanthal,
1970) and protection motivation approach (Rogers, 1975, 1983).

According to the EPPM, upon perceiving a threat in the environment, individuals
cognitively appraise the extent of the threat by engaging in a primary appraisal process
(Witte, 1994). Threat is deﬁned as an external stimulus variable in the environment that
exists with or without a person’s knowing (Witte, 1992). The cognitive appraisal of a
threat is contingent upon two underlying dimensions — perceived severity and perceived

susceptibility. Perceived severity refers to an individual’s perceptions about the

magnitude of a threat (e. g., “AIDS leads to death,” Witte, 1992). Perceived susceptibility
refers to individual’s belief about his or her chances of experiencing the threat (e. g., I am
at risk of contracting HIV/AIDS, Witte, 1992).

If individuals assess that the signiﬁcance or magnitude of the threat is low, and
their risks of experiencing the threat are low, then further processing of the message is
stalled and no response is elicited (Witte, 1991; Witte, 1992b). On the other hand, as
individuals’ perception of severity of the threat and their perceived susceptibility toward
experiencing the threat increases, they experience fear. According to EPPM, fear is
deﬁned as an internal emotional reaction comprising of psychological and physiological
dimensions that may be aroused when a serious and personally relevant threat is
perceived (Easterling & Leventhal, 1989; Lang 1984; Ortony & Turner, 1990). The
heightened perceptions of fear motivate individuals to engage in a secondary appraisal
process in which they evaluate efﬁcacy (Witte, 1992). Fear is the motor that is the
propelling force that drives individuals to action, and thus is a central variable in this
model.

Efﬁcacy is deﬁned as the effectiveness, feasibility and ease with which a
recommended response impedes or averts a threat (W itte, 1994). Speciﬁcally, perceived
efﬁcacy refers to thoughts or cognitions about the effectiveness and ease of two
underlying dimensions, response efﬁcacy and self-efﬁcacy. Self efﬁcacy refers to the
individuals beliefs about their ability to perform the recommended response (W itte,
1994). Response efﬁcacy is the assessment of the ability of the response to avert the

threat (Witte, 1994).

According to the model, when individuals’ perceptions or beliefs about their
ability to perform the recommended response and their faith in the ability of the response
to avert the threat are lower than levels of perceived threat (susceptibility and severity of
threat), individuals engage in a process called fear control (W itte, 1994). Fear control is
an involuntary and automatic (Bargh, 1989; Lazarus, 1991) emotional coping process that
occurs when people are faced with a signiﬁcant and relevant threat, but believe that they
are unable to perform a recommended response and/or that the response is ineffective
(Witte, 1992). Coping responses that diminish fear, such as defensive avoidance
(Hovland, Janis & Kelly, 1953; Janis & Mann, 1977), denial, and reactance G3rehm,
1966) including issue/message derogation and perceived manipulative intent are classic
manifestations of fear control responses (W itte, 1994). When individuals engage in fear
control, they psychologically reduce fear rather than the danger causing the fear.
Consequently, messages invoking fear control are counter productive.

In contrast, when individuals perceive that their self efﬁcacy and response
efﬁcacy is higher relative to their perceptions of fear, then danger control processes are
triggered. Danger control is a cognitive process eliciting protection motivation that occurs
when a person believes he or she is able to effectively avert a signiﬁcant and relevant
threat through self-protective changes (Witte, 1994). When in danger control, people are
motivated to reduce the threat. Danger control responses are beliefs, attitude, intention
and behavior changes in accordance with message’s recommendations. Thus, messages
leading to danger control are by deﬁnition effective, and achieve the desired effects.

In summary, cognitions (and not emotions) about threat and efﬁcacy cause

attitude, intention or behavior changes. When levels of efﬁcacy exceed levels of threat

then adaptive responses are elicited. Maladaptive responses result when perceptions of
threat exceed levels of efﬁcacy. Thus according to EPPM, the higher the threat, the more
likely that message recommendations will be accepted, so long as threat levels do not
exceed levels of efﬁcacy. The point where threat and efficacy are equal, that is where any
greater threat or any less efﬁcacy would result in a shiﬁ from danger control to fear
control might be called the critical point (Witte, 1994).

One of the crucial contributions of EPPM to the fear appeal literature is the
emphasis that the model places on the role of efﬁcacy, and its relationship to threat.
Efﬁcacy is viewed as an important moderator variable that explains the relationship
between perceived threat and response outcomes. The model speciﬁes that while some
fear may be aroused from the initial appraisal of threat, it is the heightened and
intensiﬁed fear resulting from the perception of low efﬁcacy/high threat together that
activate defensive motivation and result in maladaptive outcomes (W itte, 1992b). A lack
of efﬁcacy explains why people sometimes do the opposite of what was advocated in the
message (Rippetoe & Rogers, 1987; Witte, 1992b).

A second critical contribution to fear appeal literature is Witte’s (1992b) subtle
and yet critical distinction between fear and threat. According to Witte, threat is an
external stimulus variable (i.e., a property of the message) that exists with or without a
person’s knowing, whereas fear is a negatively valenced emotion elicited by a threat.
O'Keefe (1990) echoes this important difference by distinguishing message content
versus audience reactions as two deﬁnitions of fear appeal. He notes that messages with
gruesome contents might not arouse fear, and fear might be aroused without gruesome

contents. These two deﬁnitions of fear appeals have nonetheless been conceptually and

operationally confounded in most fear appeal studies. Overall, it has been observed that
the higher the message threat (message content) the greater is the fear experienced
(audience reaction) (Witte, 1992).

Thus, EPPM synthesizes and integrates the vast, diverse, and seemingly
inconsistent fear appeal literature. In the fear appeal literature, some studies substantiated
the effectiveness of fear appeals (e. g., Beck, 1984; Stainback & Rogers, 1983) others
demonstrated their ineffectiveness (e.g., Janis & Feshback 1953; Kohn, Goodstadt,
Cook, Sheppard, & Chang, 1982).) and still others documented mixed results (Hill &
Gardner, 1980; Rogers & Mewbom 1976). Overall, the empirical ﬁndings were
“disappointingly inconsistent, if not contradictory” (Witte, 1992, p. 331). In addition, the
fear appeal theories were only able to account for the positive linear association between
fear and message acceptances observed in many studies, but were not able to explain the
curvilinear results occurring in other studies (W itte, 1992b).

The EPPM expanded on previous approaches and explained why fear appeals
failed by reincorporating fear as a central variable in the model, and by specifying the
relationship between threat and efﬁcacy. Witte’s model explained that the reason why
health risk messages sometimes backﬁre was because the message induced fear control
processes (high fear/low self efﬁcacy combination) instead of the cognitive danger
control process (W itte, 1994). This model has been tested in nearly 50 studies across a
wide variety of topics including skin cancer (Stephenson & Witte 1997), HIV/AIDS
prevention (Casey, 1995; Murray-Johnson, Witte, Liu, & Hubbel, 2001 ;Witte, 19923;
Witte, 1994, Witte, Cameron, Lapinski, & Nzyuko, 1998; Witte & Morrison, 1995;

Witte, Sampson, Liu, & Morrison, 1995), teen pregnancy (Witte, 1997), genital warts

(Witte, Berkowitz, Cameron, & McKeon, 1998; Witte, Cameron, McKeon, & Berkowitz,
1996), breast cancer (Kline, 1995), radon awareness (Witte et al., 1998), and tractor
safety (W itte et al., 1993). In addition, EPPM has focused on many different populations,
including high school students (Witte, et al., 1995), juvenile delinquents (Witte &
Morrison, 1995), college students (Witte, 1992; Witte, 1994; Witte et al., 1998), African-
Americans (Witte et al., 1996), farmers (Witte et al., 1993), and Kenyan prostitutes
(W itte, et al., 1998), and claims good empirical support (see Witte & Allen, 2000; Witte,
Meyer & Martel], 2001). The predictions of the theory in a high fear context will now be
considered.
Fear appeals in a high fear context: The literature

To the knowledge of the author, the EPPM predictions have not been empirically
tested in a high pre-existing fear context. That is, experiments that allow for a
considerable degree of conﬁdence in drawing causal inferences concerning EPPM
predictions have not been conducted in a high fear context. For example, in Witte’s
(1994) experimental test of the EPPM, only those who had not taken a course on AIDS or
human sexuality were eligible to participate in the study. Likewise, subjects were
prescreened for eligibility in Witte’s (1992) study testing the model. Only 8% of the
sample screened was found eligible to take part for the study. Participants who had taken
a course of AIDS or human sexuality were excluded providing a set of participants who
were relatively uninformed about AIDS'. In contrast, in conducting an EPPM study on

perceptions toward skin cancer, Stephenson and Witte (1998) did not pre-screen

 

l Witte explains that this decision was made because the persuasive messages targeted only this population.
One might question then if fear appeals only work for the relatively uninformed and unfamiliar segments of
the population.

participants. The authors however argue that their sample was relatively uninformed
about skin cancer. To substantiate this claim, they report that“... A recent national
survey showed that only one third of the Americans knew that Melanoma was skin cancer
and only 50% knew that it was cancer at all” (p. 147).

Whereas the reasons for prescreening, and testing a relatively ignorant sample are
not clear, one plausible explanation might have to do with the role of fear appeals in the
context of pre-existing high levels of fear. Individuals who are relatively unfamiliar with
AIDS (or any other object in the environment) lack prior knowledge and/or personal
experience with the illness. It is therefore likely that they are uncertain about its causes,
consequences (severity of the impact), and the likelihood that they might be susceptible
to the disease. When average individuals are not cognizant about an object, it is difﬁcult
to image that they feel threatened by it when the object has not even entered their
cognitive radar. It is only upon primary cognitive appraisal of the threat that an
assessment of fear is made (Witte, 1991). The uncertainly emanating from the lack of
prior knowledge and/or experience might however translate into fear when a high fear
message is provided. The severity and susceptibility of the threat is explicitly made
known to participants in the message induction.

If this were the case, then at least two interrelated implications follow. First, high
levels of fear did not pre-exist in the participants tested in previous experimental studies.
Thus, existing data is uninformative about the effects of fear messages on already scared
participants. Second, inducing fear with a message may require an audience with
relatively low levels of pre-existing fear and it may not be possible to induce fear in the

already scared. If the entire sample is already experiencing high levels of fear toward

HIV/AIDS, then inducing higher levels of fear might not be possible because of a ceiling
effect. Even the most graphic message content may pale in comparison to the impact of
previous, ﬁrst hand experience.

In the absence of unequivocal empirical evidence that clariﬁes the role of fear in a
high fear context, it might be useful to turn to other co—relational studies and documents
that provide guidelines for fear appeals scholars and practitioners on this issue.
Researchers typically caution that one needs to be careful in using fear appeals in a high
fear context (see Witte, 1998). However, there seems to be little clarity on what this
means. For example, in a theoretical formative evaluation of pre- existing risk levels
among Kenyans toward HIV and AIDS, Cameron, Witte, Lapinski, and Nzyuko (1999)
found that the focal audience perceived that HIV/AIDS was highly severe in magnitude,
and that they were highly susceptible to this killer disease. Based on this information, the
researchers recommend that it is important to develop message interventions focusing on
the efﬁcacy of the recommended response, with a moderate emphasis on susceptibility
and severity of beliefs. Thus Cameroon et a1. advocate a moderate fear/high efficacy
strategy to promote message acceptance for a high pre-existing fear audience.

However, in documents examining the role of fear appeals in tobacco control
(Thesenvitz, 2000) and the Witte, Girma and Girgre (2002) assessment of the EPPM
variables among Ethiopians toward HIV/AIDS, the authors speculate that even a
moderate level of fear might be too much under conditions of high severity and
susceptibility. These authors argue that messages that increase perceptions of efﬁcacy are
most important for people in fear control, and that people “should not be frightened

further.” In other words, some authors advocate a no fear, high self-efﬁcacy strategy in

10

order to avoid reinforcing fear control processes among focal audiences. They reason that
fear appeals work only when perceptions of efﬁcacy exceed level of perceived threat.
In summary, the question remains; in the unique context of high pre-existing
perceptions of severity and susceptibility, what type of message is most effective? Does
one induce low levels of fear in messages, or do way with fear inducing messages all
together? These questions, however, rest on the premise that it is possible to affect fear
in a preexisting high fear context. This assumption has not been experimentally tested.
Thus it is important to investigate whether fear content in a message makes any
difference in a pre existing high fear context.
HIV/AIDS in Namibia — an overview
The HIV /AIDS epidemic is the most serious challenge facing Namibia today

(tumucdcorg). More than one in ﬁve individuals (22.5%) between the ages of 14 and 49

 

years are infected with the virus in Namibia, with infection rates ranging from 44% in
Katima Mulilo to 9% in Opuwo (Ministry for Health and Social Services, 2002). This
makes Namibia the ﬁfth highest HIV/AIDS affected nation in the world. A total of
230,000 adults and children are estimated to be living with HIV/AIDS in Namibia
(UNAIDS, 2002). AIDS is the primary cause of death and hospitalization in Namibia
today (USAID, 2002). Thus, AIDS has become the single most serious threat to life,
education, social, and economic progress in Namibia today (www.cdcorg).

HIV infection in Namibia occurs primarily via sexual intercourse and mother to
child transmission (U SAID, 2002). With an estimated 70,000 births a year, a 23%
seroprevelance rate among mothers, and a 40% mother to child transmission rate,

approximately six thousand infants are likely to be infected each year (U SAID, 2002).

11

What makes this situation worse is that the rate of infection seems to be rising

(U SAID,2002). The Biannual serosurveillance report conducted by the Ministry of
Health and Social Services, Namibia (2002) shows a continued increase in HIV
prevalence among pregnant women. The report indicates that although the tests target
only pregnant women, the results give an indication that the HIV prevalence is also
increasing among the general population. It is estimated that more and more infants will

die of AIDS than from all other causes (\nuvusaidgov). The UNAIDS agency (2002)

 

indicated that there are already more than 120 000 orphans and vulnerable children with a
projected rate of 250, 000 children to be orphaned by 2020.
(http://allafrica.com/stories/200408130432.html).

Given this state of affairs, most Namibians have heard about AIDS, and know
about its causes and consequences. The population has high levels of literacy (83.3 %,
UNDP, 2002). Also, local (non proﬁts, church based initiatives), national (Ministry of
Health and Social Services, 2002), and international programs (e.g., President’s
Emergency plan initiative to combat HIV /AIDS) aimed at spreading awareness about the
HIV/AIDS illness are in place (U SAID, 2002). Further, research conducted by the Center
for Communication Programs, and the Health Communication Partnership ( a USAID
initiative based at Johns Hopkins University) reveals that Namibians on the whole have
high knowledge about the causes (primarily sexual transmission) and fatal consequences
of illnesses (Murray-Johnson, Keulder, & Witte, 2004a, 2004b). In the words of
Grotinger, Mainga and Pietersen (2000), “Every Namibian is surely aware of AIDS, the
risk and patterns of transmission and the effects of HIV and AIDS on individuals in the

community” (p. 83). Thus, Namibians know that the illness entails severe consequences.

12

Given the rate of prevalence (over one in ﬁve individuals among the adult
population), and the fact that HIV infection is generalized and spread across Namibia
(Ministry of Health, 2002; USAID, 2002), AIDS is not just an illness that affects ‘others.’
For many if not most Namibians, this illness hits close to home. People have had close
personal experiences with this illness (Murray-Johnson, et al., 2004a). They have either
known a family member who has died of this illness or they have had to take care of
orphans themselves. It is also likely that a few of them have been child victims of parents
who have died of AIDS.

In addition, given that it is common knowledge among Namibians that the cause
of the infection in Namibia is unprotected sexual intercourse (I-Iaoses, 2000) combined
with the normative pressures of having unprotected sex and multiple sexual partners in
the African culture (see Katjire, Langa, Siwa, Mbuche & Tjongarero, 2000; Grobler,
2000), it is likely that people in Namibia also perceive themselves to be susceptible to the
illness (Murray-Johnson et al., 2004; http://chora.virtualave). Thus, Namibians are likely
aware of the possibility that they could be having sex with an infected person. The
annual research conducted by the health communication partnership has also found this to
be the case (Murray-Johnson et al., 2004). In short, because the prevalence rate is high
(one in every ﬁve adults on an average is HIV positive or has contracted AIDS), the
illness is generalized through out the adult population in Namibia, and is proximal to the
lives of so many Namibians, it is likely that individuals perceive that they themselves
may be susceptible to the illness. The resultant consequence of these heightened
perceptions of threat is high fear (per EPPM rationale). It is therefore likely that in

Namibia, the population experiences preexisting high levels fear towards HIV/AIDS

13

Proposition 1: In Namibia, the population has pre-existing high levels of fear
with regard to HIV/AIDS.

If proposition 1 is true, then for a sample drawn from this population, threat
inductions are unlikely to substantially increase fear, because of a ceiling effect. In other
words, if participants already think of HIV/AIDS as being highly severe and that they are
susceptible, being exposed to a high fear message will not result in a further heightening
of fear levels. When pre-existing levels of fear are already high, there is little room leﬁ to
make participants more frightened. At best, a high fear message is only conﬁrming their
worst fears (fears that they know, and those that correspond to the reality they live in).

Proposition 2: Threat inductions in messages are unlikely to increase fear when
preexisting levels of fear are highz.

If people with high pre-existing fear levels are exposed to a low fear message, it is
possible that the low fear message may be read as contrary to their experience and
knowledge of HIV /AIDS. Therefore, regardless of accuracy, low fear messages are likely
to be perceived as inaccurate and inconsistent with the reality that participants experience
and know. As a consequence, participants might also perceive a low fear message as less
credible, and consequently will be less likely to be persuaded by the contents of the
message. Therefore, participants might dismiss or discount the message. This line of
reasoning predicts that a low fear message is unlikely to lower fear among participants
and consequently will be ineffective.

Alternatively, in the case of a low fear induction, theoretically there is room for

fear reduction, and it is possible that in fact a low fear message might reduce perceptions

 

2 This proposition and many subsequent propositions predict no-difference ﬁndings. The author is aware of
the inferential difﬁculties involved in accepting the null hypotheses. This issue is addressed in detail in the
discussion section.

14

of threat. According to Boster and Mongeau’s (1984) meta analysis of fear appeal
literature, low fear messages are likely to be more persuasive that a high fear message for
individuals who are more anxious. This is because people who are highly fearful and
anxious tend to ‘check out’ (i.e., engage in fear control) in the face of a high fear appeal
message, and do not engage in cognitive processes necessary for danger control.
Therefore conditional on proposition 1 being true, it is plausible that a low fear message
might reduce fear and be processed more rationally. In the absence of evidence that
demonstrate the role of a low fear induction under conditions of pre-existing levels high
levels of threat, two rival propositions are advanced.

Proposition 3a: Low threat messages will have little impact on perceptions of fear
when levels of pre-existing threat is high.

Proposition 3b: Low threat messages will reduce the pre-existing perceptions of
fear.

If propositions 1, 2 and 3a are true then the fear content of the message and the
perceived threat will have little impact on the adaptive outcome measures. According to
EPPM, the primary appraisal of a threat is a prerequisite to further processing of the
message. Because high fear pre-exists, this condition cannot have been induced by a
message, and therefore cognitive appraisal of the threat severity and susceptibility occurs

independent of the message. Because perceived threat is not impacted, further processing

 

3 If it is possible to lower fears through a message induction, it will be interesting to observe the extent to
which fear is lowered. Speciﬁcally, will fear be lowered to an extent that efﬁcacy will be higher than levels
of perceived fear? If this were the case, then contrary to EPPM predictions, lowering levels of fear and not
enhancing it might yield more beneﬁcial results. This is because, consistent with EPPM, threat levels will
be lower than efﬁcacy levels — and this combination will put individuals in danger control processes that
result in adaptive outcomes.

15

of the message is stalled and no response is elicited. Therefore message threat content is
irrelevant.

Further, according to the model, fear mediates the relationship between threat
(message content) and the dependent measures. Because fear (the mediator) is invariant
and will not be impacted by the message content, the model predicts that there can be no
impact of the message on the dependent outcomes (attitudes, intentions and behavior
change). Therefore, if P1, P2, P3a, then

Proposition 4: Threat levels of a message have little impact on attitudes,
intentions and behavior.

The EPPM speciﬁes that once individuals appraise levels of threat, they engage in
secondary appraisal processes. At this stage, the outcomes of perceived threat depend on
how individuals evaluate their own ability to adopt the recommended response as well as
the ability of the recommended response to avert the threat. These perceptions of ability
are labeled self and response efﬁcacy respectively. With regard to the role of efficacy in a
high fear condition, at least two possibilities exist.

First, EPPM speciﬁes that in order for a message to produce positive attitudinal
and behavioral effects, efficacy must exceed threat. It is possible that pre-existing threat
levels are so high that no amount of efficacy content can overcome the high levels of
threat. If this is the case, then EPPM logic predicts that individuals will engage in fear
reduction regardless of message content. Thus if proposition 1 and 2 and 3a and 4 are

true, then it is possible that perceived efficacy might not exceed perceived threat because

16

perceived threat is already extremely high“. Consequently, participants might be engaging
in fear control regardless of efﬁcacy conditions (high efficacy or no efﬁcacy).

Proposition 5a: Under conditions of high pre-existing threat, the efficacy content
of the message will have little impact on attitude, intentions and behaviors.

Alternatively, it is plausible that participants exposed to a sufficiently high
efﬁcacy message (regardless of fear content) will have their self efficacy and response
efﬁcacy enhanced by the message, while participants who do not read the self efﬁcacy
message feel less afﬁrmed. If levels of efﬁcacy can be raised to the critical point where
they meet or exceed preexisting threat levels, then high efﬁcacy measures may provoke
danger control processes, and high efficacy messages may be effective regardless of high
or low fear content. A no efﬁcacy message, however, will be ineffective due to fear
control process.

Proposition 5b: Under conditions of high pre-existing fear, the efﬁcacy content of
the message will have a positive impact on attitude, intentions and behaviors.

If, however, proposition 1 and 3b are true, then only the participants exposed to
the low fear/high efﬁcacy conditions will exhibit a positive inﬂuence on the dependent
outcomes. If message inductions lower levels of threat to an extent that perceived threat
is lower than levels of perceived efﬁcacy, then according to EPPM logic, dependent

outcomes will be inﬂuenced positivelys. Therefore if proposition 1 and 3b, then:

 

‘ Also, if efﬁcacy levels exceeded threat levels (and if the predictions of the model were true) then the HIV
infection rates in Namibia should be seeing a downward trend and not the reverse. Since data are not
consistent with this, it is possible that in fact participants are already engaging in fear control processes

5 This is a prediction contrary to EPPM in which lowering fear levels is predicted to result in positive
impacts on outcomes.

17

Proposition 6: Under conditions of high pre-existing threat, the efﬁcacy content
of the message will have a positive impact on attitude, intentions and behaviors when
used in combination with a low fear message.

Lastly, given the possibility that efﬁcacy and threat might or might not combine
to have an impact on the dependent outcomes in the context of high preexisting fear, it is
interesting and informative to assess how efﬁcacy impacts dependent outcomes in the
absence of a fear induction. Given a pre-existing high fear situation, participants might
not be in a position to cognitively process the high efﬁcacy component of the message
when they are presented with a fear content that precedes the efﬁcacy component of
message. In other words, even before getting to the efﬁcacy content of the message,
participants might have already ‘checked out’ (i.e., engage in fear control) while reading
the fear content of the message. That is reading the message may activate and conﬁrm
their worst fears, producing defensive processing. Therefore it becomes important to
investigate the impact of an efficacy only message on participants’ attitude, intentions
and behaviors in the absence of a fear induction.

RQ 1: Under conditions of high preexisting fear, what is the impact of a high
efﬁcacy only message on attitude, intentions and behaviors relative to the control

condition?

These propositions and research question were tested in the manner described

below.

18

Chapter 2
Method
Participants

Four hundred and thirty-four undergraduate male and female students enrolled in
various departments at the University of Namibia (UNAM) participated in this study.
UNAM is a public university, and the only university in Namibia. Therefore, it attracts
students from all ethnic, economic and geographical cross sections from around the
country. Of the 434 students in this study, 60 students took part in the pre-study, and 374
students participated in the main experiment. Students were randomly assigned to one of
six experimental conditions, with varying levels of the independent variables. This
sample size, in the main experiment, allowed for approximately 60 respondents per cell
with a statistical power of .77 for a medium effect (i.e., d = .5, r = .24).

In the main experiment, 69% of the respondents (n = 254) were female, and the
rest ( n=114, 31%) were male. Their ages ranged from 18 to 45 years, with an average of
22.67 years. The majority of participants (n=159, 43.8%) were between 18 to 20 years
old. Half the sample in this study (n= 175, 50.7%) was freshmen, while a little over one
ﬁﬁh of the sample (n= 79, 22.9%) was in their ﬁnal year of undergraduate education.
Sixty- one respondents (17.7%) reported that they were in their second year of university
education, and only a small proportion of the respondents (n=30, 8.7%) were third year
students. A vast majority of the respondents (n=312, 85.5%) were Namibians, and
represented regions from all around the country. The remaining ﬁfty-three participants

(14.5%) belonged to other African countries such as Angola, Botswana, Nigeria, South

19

Africa, Zimbabwe and Uganda. Prior to this study, these respondents had lived in
Namibia between 1 1/2 years to 15 years, with an average of 2.95 years.

The vast majority of the respondents in this study were single (n=330, 91.2%).
Only thirty respondents (8.3%) were married and an even smaller proportion among them
(n=2, 0.6%) were divorced. More than half of the sample (n =199, 55.1%) mentioned that
they were involved in a long-term relationship (lasting three or more months) at the time
of this study. In contrast, 44.9% of the respondents (n=l62) reported that they were not
romantically involved on a long- term basis with any one, at the time of this study. When
asked about their behaviors with regard to HIV/AIDS, almost all respondents (n= 364,
98.4%) denied using needles to use drugs. A vast majority of them also denied having
sexual relationships with people who use needles and drugs (n= 333, 90.5%). Over half
the sample (n= 187, 54.7%) reported not having sex with any one over the last three
months. The remaining students (45.3%) stated that they engaged in sexual relationships
with one to as many as eleven different partners over the course of the last three months.
Slightly over one-third of the respondents (n=142, 38.6%) indicated that they had been
tested for HIV /AIDS. The rest (n= 226, 61.4%) had not undergone screening.

This sample was well aware of the HIV /AIDS pandemic. The majority of the
respondents (n=288, 79.3%) had a family member or a friend who had died of AIDS.
More than two- thirds of the respondents (n= 238, 66.3%) mentioned that they knew a
family member or a friend living with HIV /AIDS. Almost all the respondents (n =355,
97.3%) had come across HIV/AIDS advertisements on TV, Radio and Posters.

Participants were asked if these advertisements scared them. A little over half the

20

respondent sample (n = 194, 53.4%) replied in the negative, while the rest (n = 169,
46.6%) said that these advertisements intimidated them.
Design

Threat and efﬁcacy was systematically varied in a 2 (high fear, low fear) x 2 (high
efﬁcacy, no efficacy) independent groups factorial design, with a no message offset
control group and an offset high self-efﬁcacy only condition. Participants were randomly
assigned to one of the six experimental conditions to test the propositions of the study.
The cell sizes were as follows: Sixty-six participants read a high fear message combined
with high efﬁcacy (Condition 1), 61 students read high fear message without any efﬁcacy
content (Condition 2), 59 students were exposed to a low fear message with high efﬁcacy
(Condition 3), 65 participants read a low fear message without any efﬁcacy content
(Condition 4), 60 students read an efficacy only message (Condition 5), and 63 of them
did not read any message (Condition 6). The control group served as a baseline
comparison of pre-existing levels of fear, and attitudes, intentions and behaviors toward
AIDS and condom use. The efﬁcacy only condition assessed the impact of self-efﬁcacy
on the dependent measures independent of a fear induction. The dependent variables in
the study were attitude toward using condoms, intentions to use condoms, self-reported
safe sex behaviors, defensive avoidance, message derogation, and perceived manipulation
in message content.
Message Design

The messages (Appendix A) and questionnaire items were adapted from Witte
(1994). The high fear and low fear messages consisted of a core message informing

respondents about what HIV/AIDS was, and a case study of a ﬁctitious AIDS patient.

21

Threat was varied in these two sections. In the low threat message, severity and
susceptibility was minimized by showing innocuous photographs of clinical laboratory
tests, and by focusing on the impact of AIDS on non-college aged risk group and by
using neutral language. In contrast, in the high threat message, severity was emphasized
by showing graphic photographs of late stage AIDS victims and by using extremely vivid
language. Further, HIV infection among college students was highlighted in the message
and their personal risk of contracting the AIDS virus was emphasized in personalistic
language to maximize perceived susceptibility to AIDS. Each message was equated for
order of arguments, and number of pictures. Similar inductions have successfully induced
threat in previous research (Witte, 1992; Witte, 1994). A message about the effectiveness
of condoms was added to the fear messages in the efficacy condition. Response efﬁcacy
was maximized by emphasizing that condoms substantially reduced the risk of HIV
transmission if used correctly. Self-efﬁcacy was increased by discussing the beneﬁts and
ease of using condoms as well as providing refutations of typical excuses partners gave
for not wanting to use condoms.
Pre-study

Pre-testing UNAM students posed a conceptual problem. Conducting a pre-study
with a student sample in the University of Namibia would result in testing the
propositions of the study. That is, this study predicts that there will be no effects for
threat in message content, due to high preexisting levels. If pre-test results are consistent
with this, then this could be just because of a weak induction, or because in fact the
predictions are accurate or both. There will be no way to assess which of these reasons

account for the results. But pre-testing instruments on a sample drawn from a different

22

population would not be substantively informative. A pre-test should be conducted on a
sample that is to be surveyed (Hoyle, Harris & Jude, 2002).

To overcome these problems, a pre-study was conducted on a sample of
Namibian University students with the following modiﬁcations. Participants were asked
to read a high and low threat inducing message and ﬁll out a survey about their thoughts
and perceptions on how other people like them (people other than themselves) reading
this message were likely to react to the message in terms of threat and efﬁcacy. This
indirect approach in assessing the potency of the message had a number of advantages.
When participants evaluated the messages based on other people’s reactions rather than
their own, it was likely that they might rate the messages more objectively. That is, given
a high threat message, participants may not be likely to view a message as high fear
producing when asked about their own reactions to the message content. Instead they
might be more objective and would therefore be more likely to assess the contents of the
message as being high in fear content when asked to give their opinion on ‘other
people’s’ reaction to the message.

Further, in order to ascertain if the message inductions (threat and efﬁcacy) were
in fact effective, the messages were pre-tested on 30 students in the University of
Namibia in a repeated measures design so that subjects served as their own control. Each
participant read all three kernel messages, i.e., high fear messages, low fear messages,
and high efﬁcacy messages (related to condom use) and then gave feedback on how other
people (students other than themselves) would react on fear, threat and efﬁcacy based on
the messages they read. The high and low threat messages and the high efﬁcacy message

were counterbalanced so as to avoid order effects. Further, a no-message control group

23

(N = 30) was also included in the pre-study to assess efﬁcacy items only, in the absence
of any message. Unlike the threat variable (high and low threat), there was no low -
efﬁcacy group that would allow for comparison of scores between high and low efﬁcacy
conditions. Therefore, a no-message group was included in the pre-study to capture
baseline efﬁcacy and serve as a comparison group for the efficacy scores obtained after
reading the high efﬁcacy message.

In short, the pre-study assessed whether the instructions, messages and the items
were understood by the sample, and whether the inductions were in fact perceived as
intended.

Instrumentation

The response formats for all the scales used in the pre-study were Likert- type,
ranging ﬁ'om l (Strongly Disagree) to 5 (Strongly Agree). Fear was assessed by using a
ﬁve-point scale (e.g., “Reading this message will make people ﬁightened”). The
reliability of the fear scale that elicited participants’ responses after they read the high
threat message was a= .73. The reliability of the fear scale after respondents read the
low threat message was a = .89. Perceived severity was assessed from responses to a
four-point scale with items such as, “ Reading this message will make people think that
HIV/AIDS is extremely harmful.” Perceived susceptibility was also measured using a
similar format. Items such as “Reading this message will make people think that they are
likely to get HIV/AIDS,” were included in the perceived susceptibility scale. The
perceived threat scale computed by adding the severity and susceptibility scores was also

analyzed for reliability. The threat scale that participants responded to after reading the

24

high fear message yielded a reliability of a: .71. This scale yielded a reliability of a=
.85 for the low fear message.

Response efﬁcacy was measured on a 4 point scale comprising of items such as,
‘This message is likely to make people feel that condoms are effective in preventing
HIV/AIDS.” Students also responded to a 5- point self efﬁcacy scale that included items
such as, “This message will make people think that using condoms is easy.” When the
condom and self-efﬁcacy items were averaged to create an efﬁcacy index, with a
reliability of 0F. 80. The reliability of this scale for the no message condition was a=
.83
Pre-study results

Participants strongly agreed (M = 4.21) that reading a highly threatening message
would make people frightened about HIV /AIDS. In contrast, students thought that
reading the low threat message would only somewhat cause people to fear about this
illness (M = 3.09). A paired sample t-test was conducted to assess if this observed
differences was statistically signiﬁcant. Tests revealed that indeed participants thought
that others like them would be signiﬁcantly more frightened after reading the high fear
message ( N= 29, M=4.21, SD = 0.57), than the low fear message (N = 29, M: 3.09, SD
=0.57), t (28)=5.20, p<.01. In addition, respondents felt that the high fear message (N=
29. M = 4.17, SD = 0.57) would read as signiﬁcantly more threatening to people than the
low fear message (N= 29. M = 3.37, SD = 0.96), t (28)=4.22, p<.01

Scores obtained after students read the efficacy message were compared to those
in the no message condition. When condom efﬁcacy and self efﬁcacy scores were

combined, tests revealed that those who read the message (N=29, M=3.97, SD =. 70)

25

scored signiﬁcantly higher on perceived efﬁcacy than those who did not (N = 30, M =
3.60, SD = .65), t (57)=2.06, p=. 04.

The pre-study also included a qualitative component that asked respondents what
they felt like when they read the message. Their reactions to the high threat message
corroborated with the quantitative ﬁndings. “The message was too scary and at some
stages I did not even want to continue. But I did,” said one participant. Another student
expressed, “ I turned around and counted 5 people around me and knew that 1 of them is
HIV positive. . .this was scary.” The severity of the high threat message was highlighted
in the reactions of one participant who said, “I thought that all of us people on earth will
just die of HIV/AIDS.” The extent to which participants felt that other people like them
would be susceptible to the illness was captured well by the reactions of one respondent.
The respondent said, “ I feel like its me who is infected, because the way I’m feeling
when I see the picture sounds like it happened to me. ”

The same set of students had contrasting reactions upon reading the low fear
message. In the words of one respondent, “Knowing that having the virus does not mean
your life is over was reassuring.” Another respondent felt that the low threat message
made him/her feel that, “Getting AIDS is not the end of the world.” Anther participant
noted that the message “did not stimulate my fears. ” Interestingly, many participants
expressed that the low threat messages were in fact lacking in fear. This was made known
in their recommendations elicited to make the message more effective. One responded
suggested that, “The message could emphasize more on the deadly consequences of
getting HIV /AIDS.” Another student reasoned that “because of the statements in the text

in bold, “there is less to fear now!” and “ no point in worrying,” the message will not be

26

effective for everyone who reads it.” Similarly, another participant suggested that “there
needs be a lot of examples of people who are infected so that we people can see that. At
least then we are going to be afraid when we see symptoms of this disease.” The
message is okay, I just want to tell the people to take it seriously not as a joke,” cautioned
one respondent.

Qualitative feedback was also elicited for the efficacy message. Overall
respondents felt that the message made them feel like condoms were easy to use, and that
they were the best protection against HIV/AIDS for sexually active people. For example,
one participant stated, Condoms are the best protection against HIV/AIDS pandemic.
Another respondent felt that the message “made me feel protected when I am using
condoms. I think it is very easy to save your life by using condoms as a protection when
having sex. Yet another student felt that reading the message would make “all people can
carry condoms everywhere they go and use it when necessary. This respondent felt that
reading the efﬁcacy message would inspire people to “stop being selﬁsh and start
protecting one another from contracting the virus.”

Several respondents commented on the usefulness of the statements designed to
counteract potential arguments made by sexual partners to avoid using condoms. For
example, one participant stated, “I like the sentence which they wrote about excuses to
your partner. The response which are given are excellent for the young people.”
Similarly, another responded noted “If (the message) gives good points on how partners
would help themselves when faced with a lots of excuses made by the other partner who
is not willing to make use of a condom. This (the message) encourages me not allow my

partner to discourage me from using condoms.”

27

In addition, the pre-study elicited responses on whether the messages were easy to
understand, and if there were any word or sentence that were difﬁcult to comprehend.
Overall, students did not report much difficulty in message comprehension, language or
structure of sentences.

The experimental study

Phase I

UNAM students (N= 374) who did not take part in the pre-study were solicited to
participate in a study evaluating AIDS educational materials. A faculty member in the
Department of Communication at UNAM collected data from the students with the help
of a research assistant. Students were solicited during class hours. They were told that the
materials that they were to review were at the early stages of development and that their
reactions to the messages were needed in order to reﬁne them. Anonymity of responses
was emphasized. Participants were directed to read the messages carefully and to
underline important passages to ensure close attention. Next, they were asked to complete
a posttest questionnaire assessing their own reactions to the message, and their
perceptions on the various dependent outcomes. The phase 1 questionnaire measured
participants reactions to the message on fear, severity, susceptibility, response efﬁcacy,
self efficacy, attitude and intentions related to condom use, and fear control outcomes
such as defensive avoidance, message derogation, perceived and manipulation. This
questionnaire also elicited demographic information from the respondents (See Appendix

B).

28

Phase 11

Two weeks after the completion of phase 1 of the study, the research assistants
approached the students once again to ﬁll out a post-study questionnaire (See Appendix
C). The post-study questionnaire elicited responses on participants’ behavior related to
condom use since they participated in the ﬁrst phase of the study. This survey was
matched with the phase 1 survey that they had turned in. After the questionnaires were
completed, participants were debriefed about the purpose of the study and given
information about the AIDS cell on campus.

The messages (Appendix A) and questionnaire items were adapted from Witte
(I994). All response format for all scales used in this study were Likert-type, ranging
from 1 (Strongly Disagree) to 5 (Strongly Agree). All instruments measuring the .
constructs of interest (See Table 1) included items identical to those tested in the pre-
study, with one exception. The stem of the items used in the pre study was modiﬁed to
reﬂect self-assessment of the message rather than ‘other people’s opinion. That is, instead
of the stem “Reading this message will make people feel ...... ,” the items in the
experimental study simply read “ I feel ..... .‘ Thus, the fear scale comprised of ﬁve items,
such as “I feel frightened of HIV/AIDS. Also, all items used to measure constructs of
interest in this study were screened for unidimensionality and reliability.

One item was deleted from the fear scale as it failed to contribute toward scale
validity. The fear scale was unidimensional and had reliability for the fear scale was a=
.91. The severity scale included four items such as, “ I believe that HIV/AIDS is a brutal
disease.” One item was deleted as it failed to contribute to scale reliability. This scale was

unidimensional and had a reliability of a= .81. The susceptibility scale consisted of ﬁve

29

items such as “ It is likely that I might be at risk of getting HIV/AIDS.” Reliability for
this scale was a: .85. The threat index that was obtained by averaging the severity and
susceptibility scores had a reliability of a: .79.

Response efﬁcacy (condom efﬁcacy) was measured in terms of responses to
items such as “Condoms can be trusted to prevent the spread of HIV/AIDS.” Reliability
of this four point scale was a: .86. This scale was also assessed for unidimensionality.
Five items were designed to create the self efficacy scale (e. g., “I feel that condoms are
easy for me/my partner to use.”) The reliability of this scale was a=.87. When
combined, the nine condom and self efﬁcacy items yielded an efﬁcacy index with a
reliability of a=.88

Danger control and fear control outcomes were also measured in the ﬁrst phase of
the experiment. All the items were assessed for unidimensionality. Intentions toward
condom use were assessed by using a 5- item scale that asked respondents if they planned
to talk to their partner’s about using condoms, advantages of using condoms, and whether
they hoped to buy and use condoms in the next couple of weeks. Scale reliability was a
= .92. Attitude towards condom use was measured by items such as, “When having sex,
using condoms is the right thing to do.” The reliability of the attitude scale was a= .91.
Behavior was assessed in the second phase of the study. Responses were elicited on the
behavior scale which was scored as ‘Yes’ ‘No’ responses to ﬁve items (e.g., After I
participated in this study, I/my partner bought condoms) Reliability of this scale was a:
.91.

Fear control outcomes measured in this study were defensive avoidance, message

derogation and perceived manipulation. Defensive avoidance assessed whether the

30

messages that respondents read, made them feel like they wanted to ‘switch off’ and stop
thinking about HIV/AIDS. Items in this scale included, “The minute I realized that this
message is about HIV, my ﬁrst thoughts were "oh please, not another HIV/AIDS
message!" This scale comprised of four items and had a reliability of a: .87. Fear
control was also assessed by investigating whether respondents tended to derogate the
message content after reading it. The generic message derogation scale comprised of two
items that asked participants to respond to statements such as, “This message blows
HIV/AIDS out of proportion” This scale had a reliability of a= .70. A three-item scale
which assessed message derogation with speciﬁc reference to AIDS, was also constructed
(e. g., According to me, this message does not give correct information about how
HIV/AIDS spreads). This scale yielded a reliability of CF .77. Third, this study also
assessed if respondents tended to derogate the message with speciﬁc reference to
condoms. A 3-item scale (e. g., This message gives a lot of wrong information on how
useful a condom is in preventing HIV/AIDS) constructed to capture this construct yielded
a reliability of a=. 81. Lastly, the perceived manipulation scale assessed if respondents
felt that the message was trying to exploit them and deceive them in any way. This scale
consisted of four items. One item was deleted because it failed to contribute to scale
reliability. The perceived manipulation scale had a reliability of a= .80 Means, standard

deviations and reliabilities of all the scales used in this study are presented in Table 1.

31

Chapter 3
Results
Substantive ﬁndings

Proposition 1 stated that in Namibia, the population has pre-existing high levels of
fear with regard to HIV /AIDS. Data from the control group were examined in order to
test this proposition. Independent of any message induction, respondents in the control
group indicated that they were very scared of the HIV/AIDS illness (N= 63, M=4.31, SD
= .91). The majority of the respondents strongly agreed (n=24 38.1%) or agreed (n= 26,
41.27%) that they were terriﬁed by HIV/AIDS. Only 7 respondents (11.2%) in this group
expressed that they were not afraid or were neutral towards the illness (See Figure 1).
Further, the mean obtained in the control group was contrasted against the mid-point of
the scale. A one sample t-test revealed that the control group mean on fear was
signiﬁcantly greater than the scale mid point, t (3 73)=l9.02, p<. 01.

Proposition 2 stated that threat inductions in messages are unlikely to increase
fear when preexisting levels of fear are high. A two-way analysis of variance with threat
and efficacy as ﬁxed factors and fear as the dependent variable was conducted to test this
proposition. No main effect for threat was detected on fear F (1,127)=1.42, p=. 24, 772 =
.01. Respondents in both the high threat groups (N=l27, M= 412, SD = 1.11)
experienced more or less equal levels of fear when compared to those in the low threat
conditions (N= 124, M=3.96, SD=1.00). Thus the data were consistent with Proposition 2.
Regardless of the threat induction, respondents reported high levels of fear towards

HIV/AIDS.

32

Two rival propositions were proposed to examine the role of low threat messages
on fear levels. Proposition 3a stated that low threat messages will have little impact on
perceptions of fear when levels of pre-existing fear are high. Proposition 3b stated that
low threat messages will reduce the pre-existing perceptions of fear. The Dunnett’s t-test
that compares all conditions to the control group was conducted to investigate these rival
propositions. Respondents in both, the low threat, high efﬁcacy condition (N= 59,
M=3.99, SD=.95, p=.3) and the low threat, no- efficacy condition (N= 65, M=3.92, SD
=1 .05, p= .13) were not signiﬁcantly different on fear from the no-message control group
(N=63, M=4.31, SD = .91).

However, a one-way analysis of variance that was conducted with fear as a
dependent variable revealed signiﬁcant between group differences, F (5, 368) =3.15,
p=.01, If = .04. In particular, respondents in the low fear, no efﬁcacy condition (N = 61,
M: 3.92, SD = 1.05) reported signiﬁcantly less fear toward HIV /AIDS than those in the
high fear, high efﬁcacy group (N= 65, M= 4.32, SD= .97), p=.03. All other between-
group comparisons were non-signiﬁcant. Thus, results revealed that while the low threat
messages did not have much impact on perceptions of fear when the message conditions
were compared to the control group, this was not the case when the four experimental
groups were compared with each other. Fear in the low fear, no efﬁcacy group was
signiﬁcantly lower in comparison to the high fear, high efﬁcacy group.

Proposition 4 posited that threat levels of a message will have little impact on
attitudes, intentions and behavior. A two-way analysis of variance test revealed that threat
levels in message content had no impact on intentions to use condoms, F (1, 124) = .04,

p= .84, I72 = .02, attitude toward condom use F (1, 126) =-— .04, p=.85, I72 = .01, and

33

behavior, F (1, 78)=0.78, p=.38, 272 = .01. Respondents in the high threat conditions (N
= 124, M = 4.07, SD = 1.24) held more or less similar intentions to use condoms when
compared to participants in the low threat conditions (N =119, M = 4.09, SD = 1.11).
Likewise, respondents in the high threat groups (N=126, M=4.42 SD=0.75) held similar
attitudes towards condom use as those in the low threat condition (N=122 ML—'4.44,
SD=0.83). Lastly, no signiﬁcant differences were observed between the high threat
conditions (N=78 M=0.41, SD =0.51) and the low threat conditions (N = 71, M= 0.34,
SD = 0.41) on behavior. Thus, data were consistent with proposition 4.

Two rival propositions were advanced for Proposition 5: Proposition 5a predicted
that under conditions of high pre-existing fear, the efﬁcacy content of the message will
have little impact on attitude, intentions and behaviors. In contrast Proposition 5b
proposed that under the same conditions, the efficacy content of the message will have a
positive impact on attitude, intentions and behaviors. A two-way analysis of variance
revealed that responses in the high efﬁcacy message (N = 122, M= 4.16, SD = 1.12) were
not signiﬁcantly different from the no- efficacy message condition (N= 121, M= 4.00, SD
= 1.13) on intentions to use condoms, F (1, 122) = 1.05, p=. 30, 172 =. 00. Similarly, in
both the threat conditions, participants who read the high efﬁcacy message (N= 125,
M=4.42, SD =.82) responded no differently than those in the low efficacy condition (N=
123, M: 4.46 SD = .76) in their attitude toward condom use, F (1, 125) = .05, p= .83,

n2 = .02. A two-way analysis of variance revealed that the efficacy levels in the message

had a marginal impact on behavior, F (1, 74) = 4.07 p =.054, 112 =.03. Regardless of
threat levels, students who read the high efficacy message (N = 74, M= 0.46, SD = .51)

were somewhat likely to adopt safe sex behaviors than those who did not read the

34

message (N=75, M= .30, SD=. 40). In conclusion, proposition 5a was mostly supported.
The efﬁcacy content of a message did not have a substantial impact on intentions and
attitude towards condom use, and had an ambiguous effect on behavior.

Proposition 6 stated that under conditions of high pre-existing fear, the efﬁcacy
content of the message will have a positive impact on attitude, intentions and behaviors
when used in combination with a low fear message. In order to test this proposition, ﬁrst
the threat x efﬁcacy interaction was assessed. Tests did not yield any signiﬁcant
interaction effects for intentions, F (l , 242) = 0.93, p= .41 , I72 = .00, attitudes, F (1 ,
247)=. 14, p=. 64, 7,2 = 00, and behaviors, F(1, 148)= 2.06, p=. 15 772 =. 01. Post Hoe
tests conﬁrmed that regardless of whether respondents were in the high fear, high
efﬁcacy group (N= 65, M= 4.08, SD=1.22), the high fear low efﬁcacy group (N=59, M
=4.05, SD=1.27), the low fear high efﬁcacy group (N=57, M=4.23, SD=1.01), or the low
fear no efﬁcacy group (N=62, M=3.96, SD=1.17), their intentions to use condoms were
more or less similar. F (3, 242) = 0.57, p=. 64, n2 =. 01. Post hoc analyses revealed that
respondents in the high fear, high efﬁcacy group (N = 66, M = 4.39, SD =0.80) held
somewhat similar attitudes toward condom use when compared to participants in the high
fear, no efficacy group (N= 60, M= 4.46, SD = 0.69), the low fear, high efﬁcacy condition
(N=59, M =4.49, SD=0.85) and the low fear no efﬁcacy condition (N=63, Ark-4.43,
SD=0.82), F (3, 247) = 0.10, p = .96 772 =. 00. A one-way ANOVA found ambiguous
effects for behavior, F (3, 148) = 2.44, p=. 067, 77.: .05. Although no signiﬁcant
difference was observed on behavior between participants in the high efficacy, high fear
condition (N=40, W. 54, SD=. 58) and those in the low fear, high efﬁcacy conditions

(N=34, M=. 36, SD = .41, p = .12), respondents in the high fear, high efficacy condition

35

expressed signiﬁcantly more positive behaviors than participants in the high fear, no
efficacy condition (N= 38, M= .29, SD = .41, p=. 01) and the low fear, no efﬁcacy
condition (N= 37, M = .32, SD = 41). Thus overall, proposition 6 failed to receive
complete support and message efﬁcacy had limited impact on most dependent outcomes.

Lastly, a research question asked under conditions of high preexisting fear, what
is the impact of a high efﬁcacy only message on attitude, intentions and behaviors
relative to control condition? An independent sample t-test was employed to examine the
potential differences in attitudes, intentions and behaviors toward condom use between
the efﬁcacy only condition, and the control group. Respondents in the efﬁcacy only
group (N=59, M: 4.07, SD=] .20), and the control group (N=63, M=4.26, SD =1.15) did
not differ signiﬁcantly on intentions toward condom use, t (128) = -0.879, p =. 38.
Likewise students in the efﬁcacy only condition (N= 58, M= 4.38, SD = 0.78) did not
differ from the no- efficacy condition (N= 63, W454, SD = 0.62) on attitude toward
condom use, t (119) = 1.23, p=.22. Lastly, students who read only the efﬁcacy message
(N = 31, M= .43, SD =.43 did not exhibit signiﬁcantly different behaviors from those in
the control condition (N=38, M=.40, SD = .39), t (67)= 0.29, p=.77. See Table 2 for a
detailed description of mean values on all the dependent outcomes for all 6 experimental
groups.
Supplemental Analyses

It can be argued that even though threat levels in message content did not increase
fear in this context of pre-existing fear, perhaps message threat levels might impact levels
of perceived threat, which in turn could inﬂuence dependent outcomes positively.

Because literature has used perceived threat and fear interchangeably, the impact of threat

36

messages on perceived threat is also explored. Interestingly, a main effect for message
threat was found on perceived threat, F (1,127) = 6.07, p=. 01. Respondents who read the
highly threatening messages perceived these messages as more threatening (N = 127, M =
3.76, SD = 0.73) than those in the low threat condition (N= 124, M= 3.53, SD = 0.70).
Nonetheless the effect size for message threat on perceived threat was very small, ( 172 =.
02).

The role of low threat messages on perceived threat was further analyzed to
examine proposition 3. The Dunnett’s t-test revealed no signiﬁcant differences in
perceived threat between the low fear high efﬁcacy group (N=59, M=— 3.51, SD=.73) and
the control (N=63, M= 3.60 SD=0.79). A comparison between the low fear no efficacy
group (N=65, M = 3.54, SD =0.68) and the control group also did not yield any
signiﬁcance, p =.10.

In addition to testing the propositions in this study, an examination into the
predictions of EPPM with regard to the role of fear, threat and efﬁcacy in predicting fear
and danger control outcomes (independent of message inductions) particularly in the
context of pre-existing fear is worthwhile. Simple bivariate correlations revealed that fear
was not correlated with intentions to use condoms r (365) =. 001 , p= .99, attitude towards
condom use, r (365) = .07, p=.21, or behavior, r (218) =.06, p=.37. In contrast, threat was
correlated with attitude toward condom use r (361) =.48, p <.01, but not intentions, r
(365)=.06, p=.28.and behaviors, r(218)=.11, p=.10. Efﬁcacy was the only variable that
was positively correlated with all the dependent outcomes, intentions r (365)=.32, p<.01,
attitudes, r (369) =.49, p<.01, and behavior toward condom use, r (218)=.002, p<.01. See

Table 3 for correlations matrix for all the variables of interest.

37

Further, EPPM predicts that low levels of efﬁcacy in comparison to threat levels
result in fear control processes. That is, only respondents in this low efficacy/high threat
situation are likely derogate the message, perceive that the message is trying to
manipulate them and defensively avoid the message recommendation. To test this,
respondents whose efficacy scored exceeded their threat scores were compared to those
whose threat scores were higher than their efﬁcacy measures (See Figures 2, 3 and 4). All
three fear control outcomes were plotted on a scatter plot separately for both the groups.
A negative relationship between the fear control outcomes (defensive avoidance,
message derogation6 and perceived manipulation) for both the groups was found.
Consistent with EPPM, an increase in the difference between the efficacy- minus- threat
scores yielded lower levels of fear control outcomes. Yet, data showed that the higher the
difference between the threat- minus -efﬁcacy scores, the lower the likelihood to
defensively avoid, derogate or perceive manipulation in the message. Further, no
difference was observed between the high efﬁcacy/low threat respondents and the high
threat/low efﬁcacy respondents on message derogation, t (367)= 0.21 , p=.81, defensive
avoidance, t (367)=1.93, p=.06, and perceived manipulation, t (368)=0.81, p=.42. In

short, data revealed that the tenets of EPPM model did not hold.

 

6 Interestingly, a positive relationship between message derogation and the efﬁcacy 4hreat scores were
found. That is, respondents who scored higher on efﬁcacy than on threat, also tended to derogate the
message more. This ﬁnding is squarely contradictory to the EPPM predictions.

38

Chapter 4
Discussion

Fear appeals have long been used in numerous and diverse contexts in order to
motivate people to adopt protective behaviors. Yet, the implications of using fear- based
messages in contexts in which fear toward a target object pre-exists has not been
empirically investigated. Nonetheless, fear based campaigns have presumed that
communicating fear content can in fact inﬂuence people’s fear levels even in these
contexts. These vital assumptions remain to be tested.

For theoretical guidelines, the extended parallel processing model was chosen
because this model represents the state of art thinking in fear appeal literature. Fear is
central to EPPM and this model describes with great clarity and precision, the conditions
under which fear appeals work or fail. This model has also been used in multitude of
contexts and populations.

The HIV/AIDS illness in Namibia was chosen as a context to study the impact of
fear based messages using the EPPM framework because of the severity of the onslaught
of the disease in this country, and the rampant extent to which the pandemic has impacted
the lives of people living there. More than one in ﬁve individuals in their prime (14 to 49
years) of age fall victim to this illness. AIDS is not just an illness that affects ‘others.’ For
many Namibians, HIV/AIDS hits close to home. Indeed, HIV/AIDS is the single largest
cause of death in Namibia, and given that a downward trend in the prevalence rate of
HIV/AIDS is not being observed, it continues to threaten life, and socio-economic
development in the country. In short, HIV/AIDS in Namibia provides an ideal context to

test the impact of fear messages under pre-existing high fear.

39

Towards this end, the EPPM was outlined, and the ambiguity with regard to the
role of fear in the context of a high fear message was highlighted in both co- relational
and experimental studies. Next, an overview of the HIV/AIDS pandemic in Namibia was
presented. In light of the Namibian context, propositions and research questions
regarding the role of fear and efﬁcacy in predicting attitudes, intentions and behaviors
related to condom use was put forth based on the EPPM framework. A 2 (high/low
threat) x 2 (high, no efficacy) factorial design with 2 offset controls, i.e., no message
condition and an efﬁcacy only condition was proposed to test these propositions. The
messages and the instrument used in this study were modiﬁed from Witte’s (1994) study.

First, a pre-study was conducted. This study aimed to assess if the messages
constructed for the main study were easy to follow, and whether the instruments to be
used in the ﬁnal study were conceptually equivalent, particularly in a cross- cultural
context. Most importantly, the pre-study was conducted to ensure that the messages were
perceived as intended (that is, the high threat messages were in fact seen as highly
threatening, and vice versa) by the target audience. However, conducting a pre-study
posed a conceptual dilemma. This main proposition in this paper was that highly
threatening messages would fail to scare people. In other words, one of the main
pr0positions in the study was that the manipulation check would fail. This made it
difficult to test whether in fact the messages designed were high and low in threat levels.

Two implications followed: First, it became imperative that a manipulation check
be conducted in the pre-study. If the messages that the students were presented with, were
not high and low on fear, then the entire study, its rationale and propositions, would

remain untested. Second, unlike other studies, testing whether the messages had the

40

desired effect in the main study would be synonymous with testing its proposition,
therefore making it impossible to conduct a meaningful manipulation check. Thus it was
imperative that a manipulation check be conducted at the pre-study stage. However, even
if pre-study data revealed that in fact the messages were perceived as intended, it would
be unclear whether this was the case because the propositions in the study were being
supported, or if in fact the message content had the desired effect, or both.

Two decisions were made to work around this conceptual problem. First, a
within-subjects design was implemented. All participants were asked to read both the
high and low fear messages. It was thought that if the same set of students were presented
with both types of messages, they would be able to perceive the difference in the message
if any. Second, subjects were asked to rate the message based on their opinion of how
scary these messages might seem to peeple like them. Having participants withhold their
own opinion and evaluate the message based on their perception of other people’s
reaction, was thought to increase their objectivity in evaluating the message, a criteria
needed to be able to ‘see’ the message for what it is. Thus it was decided to avoid
conducting a pre-study on a sample outside that of the student population in Namibia
(e. g., expert rating of the messages, student sample in the United States). Conducting a
manipulation check on the target population became possible.

The results of the pre-study suggested that the inductions were effective.
Qualitative and quantitative data revealed that participants felt that the high threat
message would be signiﬁcantly more frightening than the low fear message. In addition,
respondents felt that the high fear message would read as more threatening to people than

the low fear message. Interestingly, after reading the low fear message, many participants

41

perceived a lack of emphasis on fear, and predicted that only a message high in threat
would yield desirable outcomes. The efﬁcacy message was also pre-tested. In comparison
to participants who did not read any message on condoms, participants who read the high
efﬁcacy message were much more likely to feel that condoms could be trusted to prevent
HIV/AIDS, and that using condoms was easy. Thus the results of the pre-study suggested
that the message inductions were effective. .
Proposition 1 posited that in Namibia, the population has pre-existing high levels
of fear. The data were consistent with this proposition. Independent of any threat, the
vast majority of students expressed that they were terriﬁed by HIV/AIDS. Understanding
why this is the case becomes clearer when data are viewed in the unique context of
HIV/AIDS in Namibia. The degree and extent of HIV/AIDS in Namibia, and its deadly
consequences to the lives of people have made most Namibians very familiar with this
illness. Many Namibians have had close personal experiences with this illness, and have
lived the deadly consequences that this disease entails. They have witnessed that
HIV /AIDS has been the single most serious threat to their life, social and economic
progress. AIDS has been the primary cause of death of their loved ones. For example,
when they were asked how many people they know who are infected by the virus, many
students replied, ‘ Hundreds. We cannot even count.’ The majority of the respondents
reported having a family member or a friend who had died of AIDS. More than two-
thirds of the respondents mentioned that they knew a family member or a friend living
with HIV/AIDS. Indeed, all Namibians have high knowledge about the causes and fatal
consequences of this illness (Murray-Johnson, Keulder & Witte, 2004a). Given this, it is

only natural that HIV/AIDS scares them.

42

The question that becomes relevant given this high pre-existing fear towards
HIV /AIDS is whether people’s perceptions of fear can be altered (can be increased or
decreased) so that fear can be channelized to persuade people to engage in protective
behaviors. Proposition 2 stated that threat inductions in messages would not increase
perceptions of fear. Data supported this proposition. The groups that read the high fear
message did not experience higher levels of fear than the groups that read the low fear
message. Because people had lived to witness the harsh realities of HIV /AIDS, a
message, however potent in threat appeared too weak to make any meaningful difference
to people’s pre-existing fear levels. Interestingly, even though the pre-study elicited
strong emotional reactions of fear, and the respondents strongly believed that other
people would be terriﬁed about HIV /AIDS after reading the message, this was not the
case when respondents were asked to rate their own fears. This strongly suggests that
Namibians have lived and experienced far worse situations, and reading a mere
description of the consequences of the illness (however gruesome and deadly) was pale in
light of their personal encounters with the illness.

If fear levels cannot be meaningfully increased by message inductions, the
question remains whether they can be lowered. This is an important question (particularly
in the context of high pre-existing fear), because if fear levels can be lowered to a point
where efficacy levels were greater than fear levels, then people can be motivated to adopt
healthy and protective behaviors (EPPM). To test if fear levels can be lowered by
message inductions in a high pre-existing fear context, the data obtained in the no
message control group served as a baseline against which the scores of the two low fear

conditions were compared. Results revealed that participants who read the low fear, high

43

efﬁcacy message, and the low fear no efﬁcacy message were more or less equally fearful
of HIV/AIDS as those who had not read any message at all. In other words, the low fear
message failed to alleviate pre-existing fear levels. As argued previously, perhaps
respondents found that the low fear content in message (howsoever realistic in content),
was not consistent with their own real life experiences with the illness. It appears that
they were not able to bring themselves to fear less about this illness.

Therefore, if the threat content of a message did not increase or reduce fear levels,
this study posited that threat levels of a message would have little impact on attitudes,
intentions and behaviors related to condom use. Based on EPPM, it was reasoned that
because fear, the intervening variable (between message threat and dependent outcomes)
is invariant, there will be no relationship between threat and the dependent outcomes.
Results were consistent with this proposition. Regardless of whether respondents were in
the high fear high efficacy, the high fear, no efﬁcacy group, the low fear, high efﬁcacy
condition, or the low fear no efﬁcacy condition, their intentions, attitudes and behaviors
with regard to condom use were more or less similar. Thus, message threat made little
difference to these dependent outcomes.

The role of efﬁcacy in predicting the dependent outcomes was also examined.
Two rival propositions regarding the impact of efficacy on attitudes, intentions and
behaviors related to condom use were proposed. If the efﬁcacy content in the message
exceeded threat levels, then positive impact on dependent outcomes can result (per
EPPM). In addition to the two rival propositions, a research question regarding the role of
efﬁcacy only messages (in the absence of any threat message) in impacting these

outcomes was also posed. Because fear already pre-exists, it was thought that perhaps an

44

efﬁcacy only messages could yield a desirable outcome. The data suggested that the
efficacy content of a message had little impact on attitudes, and intentions related to
condom use, and a marginal impact on behavior. Even though respondents in all four
conditions exhibited similar attitudes and intentions toward condom use, students who
read the high efﬁcacy message (regardless of threat levels) were somewhat likely to
adopt safe sex behaviors than those who did not read the message.

Proposition 6 posited that participants in the low threat, high efﬁcacy condition
would be more positive in their attitude, intentions and behaviors related to condom use
than respondents in the other three conditions. Based on the EPPM, it was thought that if
fear could be reduced to a level where efﬁcacy was higher than threat, then positive
impact on the dependent outcomes might result. However, when the threat x efficacy
interaction was assessed, a signiﬁcant interaction effect was not found on intentions,
attitudes, or behaviors. Further, post hoc tests revealed that the four experimental groups
did not differ in their intentions to use condoms, and that they held somewhat similar
attitudes toward condom use. For behavior, although no signiﬁcant difference was
observed on behavior between participants in the high efﬁcacy, high fear condition and
those in the low fear, high efficacy conditions, respondents in the high fear, high efﬁcacy
condition expressed signiﬁcantly more positive behaviors than participants in the high
fear, no efﬁcacy condition and the low fear, no efﬁcacy condition.

To test whether the efﬁcacy only message was effective in inﬂuencing dependent
outcomes positively, the responses of the efﬁcacy only condition were compared to the
no message control. The data revealed that the respondents in the efﬁcacy only condition

fared no better than the no message control condition on attitudes, intentions and

45

behaviors with regard to condom use. Thus, the efﬁcacy- only message did not yield a
substantial impact on the dependent outcomes.

In short, data suggested that varying message threat levels in the message did not
increase or lower perceptions of fear among participants. And because fear is the motor
in the EPPM model that drives individuals to embrace protective or maladaptive
outcomes, increasing or reducing threat levels in message did not impact dependent
outcomes. This, combined with the lack of interaction between threat and efﬁcacy, as
well as evidence presented in the supplemental analyses that assessed patterns in
participants’ fear control respondents, showed that the tenets of EPPM did not hold. But
it can be argued that perhaps message threat levels impacted levels of perceived threat
(and not fear), which in turn inﬂuenced dependent variables positively. If this were the
case, then respondents in the high threat message conditions would perceive higher threat
than those in the low threat conditions. Data yielded support for this although the effect
size for message threat on perceived threat was very small. Even though respondents in
all four experimental conditions were equally scared of HIV/AIDS, participants in the
high threat conditions felt more threatened with regard to HIV/AIDS than those in the
low threat conditions.

Thus the data revealed the subtle and yet important distinction between fear and
threat. Even though the relationship between fear and threat is substantial, r (3 74) =.3 8,
p<.01, participants did not respond to these two constructs in the same way. While the
difference between fear and threat is an important one, a discussion on the implications of
this distinction is worthwhile. First, it is important to keep in mind that the high threat

condition respondents felt as threatened by HIV/AIDS as those in the no message control

46

condition. Just like fear, levels of threat in the experimental conditions were not different
from the no message control.

Second, even if one looked within the four experimental groups and concluded
that perceived threat can be impacted (unlike fear) in the context of high pre-existing
fear, the effect of perceived threat on the dependent outcomes was minimal. As presented
earlier, data supported the claim that threat levels in messages have little impact on the
dependent outcomes. Further more, supplemental analyses revealed that the relationship
between perceived threat and behaviors is modest, and its relationship with attitudes,
intentions is weak. Thus it appears that even though perceived threat can be manipulated,
there is not much yield in doing so under conditions of pre-existing fear, given that threat
perceptions have little impact on the dependent outcomes.

Third, given that data suggests that a) fear cannot be impacted in the context of
preexisting fear, b) threat levels in messages only have minimal impact on people’s
perceptions of threat and c) fear and threat are not substantially associated with most
dependent outcomes, it becomes evident that the role of fear and threat in a context of
pre-existing fear is minimal. These ﬁndings are interesting because they contradict a
rather intuitive notion that fear and threat inductions are required to elicit pro-healthy
behaviors. “If only they knew how deadly HIV /AIDS is”, “if only we could scare them
enough,” is an intuitive approach, but not one that is supported by empirical evidence in
this study. Practitioners, and campaign designers are strong believers that this approach
will work. Millions of dollars are being spent on fear campaigns in Namibia and
elsewhere in Africa. Not only practitioners, but even Namibians themselves strongly

recommend frightening others like them so that positive action can be elicited. Despite

47

seeing and living the consequences of HIV/AIDS, they still believe that threatening
people with a message on AIDS can impact their intentions, attitudes and behaviors
positively. And often the debate about the use of fear is simply an ethical one, “Should
we or should we not use fear to change people’s behaviors and attitude when people are
already scared of a target object?” In reality the question is much deeper, and pertains to
that of potential, “Can we, or can we not use fear to change their attitudes and behaviors
in a high pre-existing fear context? The response to these questions based on data
obtained in this study is in the negative. Thus the assumption of campaign designers that
they can modify fear levels and thereby inﬂuence people’s attitudes, intentions and
behaviors positively is not supported by empirical data. Also, it appears that efﬁcacy
messages used in conjunction with fear messages do little to inﬂuence attitudes, and
intentions positively. Given these ﬁndings, it appears that there is little value in using
fear appeals in such contexts.

That fear appeals do not work in a pre-existing fear context, might throw light on
when fear appeal messages might operate effectively. Perhaps when the extent and
magnitude of a target object (HIV/AIDS, in this example) is so high that it crosses a
threshold, fear messages might not be effective in creating additional fear, in lowering
fear, or in achieving desirable outcomes. Similarly if the magnitude of the target object
and its prevalence is very low or non-existent, fear is less likely to impact people’s
minds. If people are unaware of a target object, it is less likely that they can be made to
fear about it. Above and below these two high and low threshold points, the contents of
fear appeal might be irrelevant. Between these two threshold points, it is likely that fear

can be induced (increased or lowered), and can elicit desirable outcomes.

48

For example in the context of HIV/AIDS, instilling fear towards the illness by
way of a message may not be an effective approach in Namibia, and similar results may
be found in other Afiican countries as well where the HIV/AIDS prevalence rate and the
consequences it entails has crossed an upper limit. Likewise, in contexts where the
prevalence rate and the impact of the illness has still not reached a minimum point,
scaring people into believing that HIV /AIDS is an illness that one should beware of,
might not be effective. Only in contexts where the HIV /AIDS infection has just begun to
spread rapidly and has started to create a substantial but not overwhelming impact (e. g.,
India, China), fear messages might prove timely and effective. Thus between the high and
low threshold points of fear, there is room for molding fear so that it yields beneﬁcial
results. Future research in this area will be extremely beneﬁcial in guiding scholars and
practitioners by specifying exactly when the threshold points (both high and low) are
crossed for a particular target object, and when the time is right to introduce fear-based
messages so that it’s impact will be most effective. This information can be incorporated
as part of any audience analysis and can prove pivotal in executing a meaningful
campaign.

Lastly, the lack of effectiveness of fear- based messages found in this study also
highlights the complexity of the target object chosen in this study, HIV /AIDS. This
disease cannot be viewed outside the social context within which it is harbored. In
Namibia, unprotected sexual intercourse, the primary reason for HIV/AIDS transmission
is intrinsically linked to issues of gender relations, alcohol and drug abuse, poverty and
unemployment. There is a strong belief that the responsibility to stem the surging tides of

HIV/AIDS infections lies with the woman alone. Alcoholism is seen as the root cause

49

that leads to unprotected sex and HIV /AIDS. Many Namibians feel that it is meaningless
for them to think about using protection when unprotected sex provides them with some
money to buy food. Given this wider social context, it is no surprise that an effort
focusing on scaring people and promoting condom use alone does not yield desirable
outcomes. These interwoven social issues are deeper and warrant a multi-pronged
approach, and any campaign that fails to acknowledge the interrelationship between these
issues is likely to be less effective.

Many campaigns, and AIDS education efforts continue to treat HIV/AIDS as a
medical condition, and not a social condition. For example, in Namibia, messages on
AIDS rarely allude to alcohol abuse, even though alcoholism has been identiﬁed as the
primary cause that promotes unprotected sex. Similarly, HIV /AIDS campaigns do not
discuss gender issues, even though safe sex negotiations are housed within the context of
gender relations. Instead, messages isolate HIV/AIDS from these vital issues, and such a
‘stand alone’ approach does not resonate with people who live within the myriad of social
context. What is also needed to enhance effectiveness in addressing attitudinal and
behavioral change is an attempt to build local capacity. Local capacity can be mobilized
to evolve indigenous methods that address the illness ‘from within.’ This approach might
result in the creation of communication message content, channel and medium that might
be very different from mainstream approaches, and yet be very effective in achieving
desired outcomes.

Lastly, it must be acknowledged that this study is not without limitations. One of
the most important limitations in this study is the method in which the propositions have

been tested. Many of the propositions in the study predict no effect, or the null. However,

50

in null hypothesis signiﬁcance testing, when data reveal ‘no effect,’ the null is not
accepted. Rather, one fails to reject it. In order to minimize the risk of failing to reject
the null when it is false, a sample size large enough to provide modest power was
included. However, a much larger sample size would have provided further conﬁdence in
retaining the null. Future research can employ other statistical techniques that are better
suited to test propositions predicting the null. In addition, there was some attrition
between phase 1 and phase 2 of the study. Although 60% of the phase 1 respondents
completed the phase 2 survey, a higher proportion of participants would have provided
greater conﬁdence in interpreting the behavioral results.

In conclusion, the results of the study strongly suggest that there is little
substantive yield in scaring the already scared. From a practice point of view, it appears
that the consequences associated with fear-based messages are not substantial enough to
justify the investment of time and money required to design and disseminate such
HIV /AIDS messages. This ﬁnding is particularly important in the context of HIV/AIDS
intervention. Further testing can be undertaken using different target audiences in varied
settings to see if these ﬁndings are replicated. Perhaps then we can be more conﬁdence in
making any conclusive claim about the utility of fear messages in a context of pre-

existing fear.

51

Appendix A

Tables

52

Table 1
Means, Standard Deviation and Reliabilities of Constructs

 

 

Variable Mean Standard Deviation Alpha
Severity 4.23 0.86 .81
Susceptibility 3.20 0.96 .85
Perceived threat 3.60 0.73 .79
Fear 4.04 1.06 .91
Response Efficacy 3.46 0.10 .86
Self efﬁcacy 3.79 0.86 .87
Perceived Efficacy 3.64 0.80 .88
Attitudes 4.44 .076 .91
Intentions 4.1 1 l .17 .92
Behaviors 0.39 0.45 0.91
Defensive Avoidance 2.31 1.03 .87
Message Derogation-General 1.87 0.92 .70
Message Derogation —AIDS 2.05 0.94 .77
Message Derogation — Condoms 2.53 1.07 .81
Perceived Manipulation 1.73 0.77 .80

 

53

Table 2

Group Means on Dependent Outcomes

 

 

Variable Condition 1 Condition 2 Condition 3 Condition 4 Condition 5 Condition 6
High F ear, High F ear, Low Fear, Low fear, no Eﬁicacy No message
High Low High efficacy Only control
Eﬂicacy Eﬂicaey Eﬂlcacy
M SD M SD M SD M SD M SD M SD
Intentions 4.08 (1.22) 4.05 (1.27) 4.24 (1.01) 3.96 (1.18) 4.07 (1.20) 4.26 (1.12)
Attitudes 4.39 (0.80) 4.46 (0.69) 4.45 (0.85) 4.43 (0.82) 4.38 (0.78) 4.54 (0.62)
Behaviors 0.54 (0.58) 0.28 (0.41) 0.36 (0.41) 0.32 (0.41) 0.43 (0.44) 0.40 (0.39)
Defensive
2.29 (0.96) 2.25 (0.10) 2.20 (1.01) 2.31 (1.02) 2.51 (1.09) 2.32 (1.15)
Avoidance
Message
1.67 (0.79) 1.85 (1.08) 1.72 (0.81) 2.11 (0.99) 1.90 (0.83) 1.96 (0.93)
Derogation
Perceived
1.61 (0.69) 1.71 (0.81) 1.64 (0.68) 1.72 (0.82) 1.86 (0.75) 1.86 (0.82)

Manipulation

 

54

Table 3

Correlation Matrix of Variables of Interest

 

 

Fear Perceived Perceived Attitudes Intentions Behaviors
Threat Efficacy
Fear
Perceived .36M
Threat
Efﬁcacy .03 .06
Attitudes .07 .l 1* .49"
Intentions .001 .06 .33** .48**
Behaviors .06 .11 .21 ** .23" .24"

 

** Correlation is signiﬁcant at the 0.01 level.
* Correlation is signiﬁcant at the 0.05 level.

55

 

Appendix B

Figures

56

Frequency

Figure 1

Fear Among Control Group Respondents

 

 

 

1.00 1.50 2.00 2.50 3.00 3.50

Fear

57

Std. Dev = .91
Mean - 4.31
N = 63.00

4.00 4.50 5.00

Defensive Avoidance for Respondents in Fear and Danger Control Groups

Defensive Avoidance

Defensive Avoidance

Figure 2

Threat > Efﬁcacy

 

 

 

 

 

 

 

 

 

6
51 :3 :1 DD :1
c1
1: c1 c1 0 (:1 1:10
41 a 1:) D an [3
c1 0 :1 0121003 0 cm
a :1 13 can am 13033:)
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~\_*‘Nl\00 c1 c1 c1 111:1:
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2-4 0c: 1111 EDD [30 01mm: minimum:
:1 1:1 0 o on m
or: U m 0 cm
‘1« D D Dun mo [3 Doc: nmmumrmcnu
0
t u 1 t t r t
-3.5 -3.0 -2.5 -2.0 -1.5 —1.0 -.5 0.0 .5
Efﬁcacy-Threat
Efﬁcacy > Threat
6
54 t3 a a
:1
DD 0 a
41 on [DD D u
c1 :10 13 n
111 am a cram r1
3-4 0:13 1: a on 03001:] D D
D um DD true a a
ﬂinging-3111300110011] o
2- a mum arer uiﬁfg‘tiwgw U r: m M
turn :30 c1 Gavan on c1 0
c: a DC o c1 a 0 arms 0 c1
1« LIIIIZDII] urmnmcrcnmuu 0 ma (:1 no D D
0
t ﬂ 1 t t t
-.5 0.0 .5 1.0 1.5 2.0 2.5 3.0

Efﬁcacy - Threat

58

Figure 3
Message Derogation for Respondents in Fear and Danger Control Groups

Threat > Efﬁcacy

 

 

 

 

 

 

 

 

 

6
5 1 D D
o 13 c1
4 4 D D D 13 C1 D a
D a D D
3 - D c1 c1 D an a: co D D D 1:1 :1
C
.3 ”"\\ C] (13 Cl DEIDD cm
‘9 X
8’2- mo Dmxhgantmumnam
h T‘“‘“"-~\
8 D a o 0 :1 U mam u can: murmur N
0)
031- c1 0 DOD our] Dmmutru DummHmtmmlmn
0
2 0
W I T U 1' U I
-3 5 -3 0 —2 5 -2.0 -1 5 -1 0 - 5 0 0 5
Efﬁcacy - Threat
6
5 a D D
4 - 1:1 C DU 1:) r3 0
c1 0 :1 c1 0 13
3 . o 111:} 0 m D :1 1:1 :3 a u
C
3 c1 :1 a m :3 m acn- a o D
to “M"...
89 2 .1 tr. [111313 0 {It} TI'IIS' r: HTPJp’_mD___D~v—E}Bwtr'w' U a
‘— ____,__aa._—.~———--—--'"‘ "grﬂa-
8 a 11: an) m :13 run {If mm sun :3 a D D
9’ .. . .
a) ‘l - mmmrlr mmnummrmm; m u m D :1 c1
0
2 0
I I I 7 U V
-.5 0.0 .5 1.0 1.5 2.0 2.5 3.0

Efﬁcacy - Threat

59

Figure 4
Perceived Manipulation for Respondents in Fear and Danger Control Groups

Threat > Efﬁcacy

 

 

 

 

 

 

 

 

 

 

6
5 -« :1 D
u
4 « U 13
U c1
c1 0 Cl :1 O
S 34 c' a D O D on a
'ﬁ 0 C C; an
a .. :1 r3 :1 0 cm
.5 2 . NWT—*Lwaléf5 um: ummmmnn
2 Cl 13 121:1 '01: ‘m—ammx
'U m :1 D :D 0 D
g I a 0 CD0 mm: 1mm :1: D cmuttjuzzxzxmmmaru
g
0. 0
-3 5 -3 0 -2 5 -2.0 -1 5 -1 0 - 5 0 0 5
Efﬁcacy - Threat
Efﬁcacy > Threat
4.5
4.0 1 U
D D
3.5 <
{3 D a Cl 0
3.0-‘ mm as D '3 :1 Cl
C c1 D so a 1::
o 2.5‘
g D n a :n: B ﬂat) D t]
a 201 marrm am") man n can: :1 c1 c1 c: o
.E _ ““5“ ‘
g 07:1 t “ff—mt”! mm—m-~ﬁ&a—~Qﬁ-~_“hﬂ_w ___j
1.5 .
‘8 [D '3 u] cant) a :3 13 O
>
'g 1.04 minus narcrnnxmrrzn DIIU'IJLI‘. in CD I: D :1; :1 C] D D
a
Q .5
-.5 0.0 .5 1.0 1.5 2.0 2.5 3.0

Efﬁcacy - Threat

60

Appendix C

Messages

61

Message 1
High Fear Message

 

Please read the message below carefully and underline sentences and paragraphs that you
think are important.

 

AIDS is a deadly disease. AIDS @ by damaging the brain and destroying the body's
ability to ﬁght illnesses. Having sex and sharing needles with infected persons can lead to AIDS.
There is Q known cure for AIDS. Therefore, a person who gets AIDS die_s. Saying "no" to sex,
no to sharing needles, and using condoms reduces chances of getting HIV/AIDS. The problem
with AIDS is that you cannot tell by simply looking at your partner if he/she is infected. Xﬂ
cannot even know by asking him/her, because they cannot be trusted. What if your partner slept
with some one in the past who was HIV+ and did not tell you about it? Also, your partner may be
HIV+ and not even know it. Thousands of people are HIV+ and don‘t know it. So, think negative:
If something can go wrong. it will.

AIDS is not ‘out there.’ but very near us. right here in Namibia. HIV/AIDS is the leading cause of
death in Namibia. Namibia has the highest infection rate in Sub Saharan Africa, and is th_ird in the
world. You may think that AIDS doesn't affect you personally, but it does. Don’t we all know a
friend or a family member who has suffered or died from AIDS? Evegone is at risk for AIDS.
Research shows that university students just like you are at a high risk for getting HIV /AIDS.
According to a UNAM report, 7 increased sexual activity in campus, sugar-daddy practices,
sexual experimentation, prostitution, unprotected sex, multiple partners, and other hi gh-risk
activities exist in UNAM. This study concludes that the UNAM culture afﬁrms pis_k more than
safety, and death more than life. Remember, 22.5% of people between the ages of 15- 49 are
infected in Namibia. Look around your classroom—this means about Qerson out of thQS
students around you could have the AIDS virus. THE REASONS TO FEAR ARE HERE,
RIGHT NOW, AMONGST US.

Here is a case study from Medical Journal: A doctor who had just treated a 19 year old student
for sore throat referred him to a hospital in Windhoek. There, the student complained of tiredness,
and bleeding wounds all over his body, including his private (genital) area. He tested HIV +. The
student’s mouth, throat, and private areas were badly affected by diseases named ‘Kaposi
Sarcoma’ and ‘Perianal Herpes’. Because of AIDS, his whole body was an open wound with
dozens of red-blue pus-infected sores (See picture in next page). He was in unbearable and
agonizing pain even when he had to eat or go to the bathroom. His skin was eroded, and he had
constant diarrhea, causing acute burning in the anal area. He had several tumors on the penis. To
prevent more infection, the open pus-infested wounds in his body had to be cleaned daily. This
was extremely painful. Because he had difficulty in breathing, tubes were inserted into him. But
then thick, choking liquid ﬁlled the wounds causing bubbling in his throat and windpipe. The
patient was too ill to beneﬁt from any treatment. He got more infections and died within 32 hours.
The worst part was that nothing could be done to prevent his terrible suffering and death.

 

7 The name of the report is: “ The impact of HIV/AIDS on the University of Namibia and the University
Response”

62

Message 2
Low Fear Message

 

Please read the message below carefully and underline sentences and paragraphs that you
think are important.

 

Very simply, AIDS is caused by a virus that prevents the body’s ability to ﬁght other diseases.
AIDS is not spread by casual contact in parties, by hugging, or shaking hands with anyone. You
cannot get AIDS by being near an infected person, drinking from the same cup, or sharing a toilet
seat. People cannot get AIDS by witchcraft. So not everyone is at risk of AIDS. Having sex and
sharing needles with infected persons may lead to AIDS. And this can be easily prevented by
saying "no" to sex and drugs, or by using condoms. Remember that even if a person is HIV+,
he/she need not have m symptoms of AIDS. Also, getting AIDS is mp the end of the world.
AIDS by itself does not lead to death. So don’t think that your life is over. Do not panic!

At present, hundreds of people around the world are working on vaccines and cures for
AIDS. Treatments have also improved greatly. As a result, some HIV + people may__ live up to_____ 25
years and ev_e___n more without getting AIDS! Recently, Australian scientists reported that they
found a simple, yet highly effective way to help ﬁght HIV infections. So there rs much to hope
m THERE IS LESS TO FEAR NOW! With the help of HIV tests people can get early
treatments that will help protect them from other diseases, and live longer. In short, there is no
point in worrying about HIV/AIDS! You need to think positive!

When the AIDS epidemic ﬁrst started, new cases were found pn_lyin ‘special’ risk
groups, especially among gay men. In the 19905 in the United Statespnearly 70% of AIDS
patients were gay _mgn. So not everyone is at risk of getting HIV/AIDS. Also, AIDS seems to
have originated far away from Namibia, in Central Africa. If you are wondering about the extent
of AIDS around you in UNAM, be assured! UNAM seems to be well protected from AIDS.
There 9have been veg few HIV/AIDS related deaths on campus to date. According to a UMAM
report, o_nly 3 staff and 7 students died of HIV/AIDS between 1994 and 2000”. So don’ t be
afraid!

Here is a case study from a medical journal: A 45 year-old male prostitute was referred by
his doctor to Central London Hospital in London. There, when he complained of tiredness and
rash, tests revealed that he was HIV +. But he did not have AIDS. The results of the Western Bolt
test and the RIPA test (see pictures in next page) showed that nothing was physically wrong with
him. He had no signs of AIDS or AIDS-related illnesses. He recovered quickly within a week
from the rashes. He became healthy again and returned to his home. His family had no problems
adjusting to the knowledge of his HIV status. He also began an experimental treatment. In the
future, he may beneﬁt from other promising treatments. In this patient, there are absolutely no
signs of AIDS or AIDS-related illnesses. His diagnosis appears to be excellent and he still
remains healthy.

 

8 www2ncsu.edu
9 The name of the report is: The impact of HIV/AIDS on the University of Namibia and the University

response.

63

Message 3
High Efﬁcacy Message
HOW CAN I PREVENT AIDS?

 

Please read the message below carefully and underline sentences and paragraphs that you
think are important.

 

One of the main reasons for AIDS in Namibia is sexual intercourse. Therefore the gnly
way to protect oneself is to abstain, or use condoms. The facts about condoms are clear: If you
cannot abstain, then using condoms is the M protection against AIDS at this moment. Using
condoms can dramatically reduce your chances of getting HIV/AIDS. People who do not use
condoms are 10 times more likely to get AIDS than those who do. Other birth control methods d_o
po_t protect against HIV. So if you are sexually active, use a condom. It will keep you safe!
Condoms have other beneﬁts too. They are super em to use! They do not cost much. Nw will
ask you questions when you buy them! You M even need a medical prescription. You can ﬁnd
condoms in many places, in shops and bars too! It’s so easy to carry a condom! (Turn the page to
see pictures.) Also, condoms can be pulled out in the "heat of the moment." Putting on a condom
takes no time! Buy a pack and try them! Use a condom eveg time you have sex. Never use the
same condom twice. Put on the condom before the penis makes any contact.

It may be difﬁcult for you to talk about sex, and condoms. Here are some sentences that might
make starting a conversation a little easier without even mentioning AIDS!

a) "I care about you a lot, but I don't want to do anything that we may regret later. If we decide
to go further, how do you feel about using condoms?"

b) "If you're thinking what I'm thinking...then we'd better get condoms before we go any further. "
c) "It is not that I don’t trust you, but I will relax and enjoy more if we use condoms."

(I) “Don’t think that I am immoral or promiscuous. I simply don’t want to regret anything later.”

 

 

Talk to your partner and see what he or she thinks. If he/she comes up with excuses, here are
some responses you could use!

 

 

 

 

 

 

 

 

 

If your partner says: Your response could be :

“Putting it on interrupts everything” “Not ifl help gt it on!”

“It does not feel as good with condoms” “I’ll be more relaxed. Then I can make it feel better
for you”

“Not this time, please just this once” “Once is all it takes!”

“But don’t you love me?” “Yes I do and if you love me too you will help
protect ourselves”

“Men don’t use condoms” “But responsible men do”

“Oops I don’t have one. We can use it “I have one”

next time”

“I don’t sleep around, I’m not gay, and I “That’s not the point. No one is safe. So let’s protect

don’t do ourselves”

drugs”

“Condoms are too expensive” “Protecting our lives makes the expense worth it for
me”

 

 

 

 

So don’t be shy to talk about using condoms. IT IS SO SIMPLE TO USE CONDOMS. YOU
CAN DO IT!! The battle against HIV/ AIDS will be won only if YOU protect yourself. Be
determined and committed to protecting yourself! Your life is in YOUR HANDS ALONE!
CONDOMS CAN SAVE YOUR LIFE!

Appendix D

Questionnaires

65

 

Questionnaire 1
Phase I

Now, please respond to all the statements below. Remember that there are no rights or wrong answers. We
only seek your honest opinion Please answer all questions truthﬁylﬂ and completely. No one will ever be
able to connect your questionnaire with you.

You may notice that some questions may sound similar: Please just answer them honestly and accept our
apology if we seem to be asking the same thing more than once.

Using a pen or pencil, please circle the number that by reﬂects your feelings and opinion. Circle o_n£y m

number per sentence.

 

l. I feel frightened of HIV/AIDS.

l 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree
2. HIV/AIDS scares me.

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree
3. HIV/AIDS teniﬁes me.

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree
4. 1 am worried about HIV/AIDS.

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree
5. I am afraid of HIV/AIDS.

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree
6. I believe that HIV/AIDS is a serious disease.

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree
7. I think that HIV/AIDS is extremely harmful.

l 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree
8. I believe that HIV/AIDS is a brutal disease.

66

l 2 3
Strongly Disagree Neutral
Disagree
9. I consider HIV/AIDS to be a harsh disease.

1 2 3
Strongly Disagree Neutral
Disagree

10. Sometimes I worry that I might get HIV/AIDS.

l 2 3
Strongly Disagree Neutral
Disagree

1 1. It is possible that I might get HIV/AIDS.

1 2 3
Strongly Disagree Neutral
Disagree

Agree

Agree

Agree

Agree

12. It is likely that I may be at risk of getting HIV/AIDS.

1 2 3
Strongly Disagree Neutral
Disagree

13. I feel that I may get HIV/AIDS.

1 2 3
Strongly Disagree Neutral
Disagree

14. I might be likely to get HIV/AIDS.

1 2 3
Strongly Disagree Neutral
Disagree

Agree

Agree

4
Agree

Strongly
Agree

Strongly
Agree

Strongly
Agree

Strongly
Agree

Strongly
Agree

Strongly
Agree

5
Strongly
Agree

15. Condoms are quite effective in helping reduce the spread of HIV/AIDS.

l 2 3
Strongly Disagree Neutral
Disagree

l6. Condoms can be trusted to prevent the spread of HIV/AIDS.

1 2 3
Strongly Disagree Neutral
Disagree

67

4
Agree

4
Agree

5
Strongly
Agree

Strongly
Agree

l7. Condoms can help protect oneself ﬁom HIV /AIDS.

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree

18. If l/my partner (sexual partner) use condoms, then I will feel better protected against HIV /AIDS.

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree
19. I feel that condoms are easy for me/my partner to use.

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree
20. Condoms are simple for me/ my partner to use.

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree
21. I feel that l/my partner can use condoms.

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree
22. Condoms are quite clear-cut for me/my partner to use.

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree
23. According to me, condoms are quite straightforward for me/my partner to use.

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree

Regardless of your intentions to have sexual intercourse, please respond to the following statements as
though you will have sex during the next two weeks or so. Again, your response will remain completely

anonymous.

24. I intend to have sexual intercourse during the next two week or so. (Circle one number)
1. Yes 2. No
25. In the next two weeks or so, I hope to talk to my partner about using condoms.
1 2 3 4 5
Deﬁnitely Not sure Deﬁnitely
No Yes

68

26. 1 plan to talk to my partner about the advantages of using condoms, in the next couple of weeks.

1 2 3 4 5
Defrnitely Not sure Deﬁnitely
No Yes
27. In the next two weeks or so, I intend to talk to my partners about how easy it is to use condoms.
1 2 3 4 5
Deﬁnitely Not sure Deﬁnitely
No Yes
28. In the next couple of weeks, I intend to convince my partner that we must use condoms.
l 2 3 4 5
Deﬁnitely Not sure Deﬁnitely
No Yes
29. I intend to buy condoms or tell my partner to buy condoms in the next couple of weeks.
1 2 3 4 5
Deﬁnitely Not sure Deﬁnitely
No Yes
30. In the next two weeks or so, I intend to use condoms or have my partner use condoms to protect
myself.
1 2 3 4 5
Deﬁnitely Not sure Deﬁnitely
No Yes

Please circle the number that M reﬂects your feelings and opinion. Circle M gn_e number per sentence.

31. When having sex, condoms should be used.

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree
32. When having sex, using condoms is the right thing to do.

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree
33. Condoms should be used to protect oneself.

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree
34. Me or my partner using condoms when having sex is a good thing.

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree

69

35. When having sex, using condoms is a safe thing to do for me and my partner.

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree
36. If I decide to have sex, then it is beneﬁcial for me/ my partner to use condoms.

l 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree

When answering the statements below, please think of the messages you read. Please answer all questions
truthfully and completely.

37. The minute I realized that this message is about HIV, my ﬁrst thoughts were “oh please, not
another HIV/AIDS message!”

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree
38. To be honest, this message on AIDS makes me want to ‘switch off’ and think of something other
than HIV/AIDS!
1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree

39. Frankly, this message makes me feel like saying “stop, tell me no more about HIV/AIDS. l have
had enough! ’

l 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree

40. While I was reading the message on HIV/AIDS, I thought to myself “I do not want to know
anything more about HIV/AIDS; I'm just going to block out anything I hear about it.”

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree
41. HIV/ AIDS is not as big a deal as the message makes it out to be.

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree

42. This message blows HIV/AIDS out of proportion.

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree

70

 

43. This message is trying to make me feel aﬁaid for no reason.

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree , Agree

44. In my opinion, there is no such thing as HIV/AIDS.

l 2 3 4 5

Strongly Disagree Neutral Agree Strongly

Disagree Agree

45. There is a lot of wrong information about facts on AIDS in the message I read.
1 2 3 4 5

Strongly Disagree Neutral Agree Strongly

Disagree Agree

46. According to me, this message does not give correct information about how HIV/AIDS spreads.
1 2 3 4 5

Strongly Disagree Neutral Agree Strongly

Disagree Agree

47. The message I read, gives wrong information about what HIV/AIDS does to an infected person.
1 2 3 4 5

Strongly Disagree Neutral Agree Strongly

Disagree Agree

48. I feel there is a lot of wrong information about facts on condoms.
l 2 3 4 5

Strongly Disagree Neutral Agree Strongly

Disagree Agree

49. This message does not correctly describe how HIV/AIDS can be prevented by the use of condoms.
1 2 3 4 5

Strongly Disagree Neutral Agree Strongly

Disagree Agree

50. This message gives a lot of wrong information on how useful a condom is in preventing

HIV/AIDS.
l 2 3 4 5

Strongly Disagree Neutral Agree Strongly

Disagree Agree

51. This message on HIV/AIDS is just trying to control my feelings, and I am not going to allow it.
1 2 3 4 5

Strongly Disagree Neutral Agree Strongly

Disagree Agree

71

52. This message on HIV/AIDS is trying to exploit my feelings, so I am going to ignore it.

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree
53. This message is trying to manipulate (play with) my feelings.

I 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree

54. I feel that HIV/AIDS is really a foreign country’s plot against us.

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree
55. I believe that getting or not getting HIV/ AIDS is not in our hands.

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree
56. The truth is, no matter what one does or does not do, one can get HIV/AIDS.

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree

57. In reality, there is little one can do to prevent the spread of HIV/AIDS.

l 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree

58. The fact is, getting HIV/ AIDS is not in our control.

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree

59. If I am destined to get HIV/AIDS, then I will get it, no matter what.

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree

72

Please indicate which of the following is true for you.
1. Which of the following best describes your sexual experiences? (Circle only one number.)
1. I have never had sex

2. I have had sex

N

. How often you use condoms? (Circle only one number).

. Never

. Rarely

. Sometimes

. Most of the time

. Always

. Not Applicable (1 have never had sex.)

ON'JIJBUJN—

3. I am currently involved in a sexual relationship.
1. Yes 2. No

4. I am currently involved in multiple (many) sexual relationships.
1. Yes 2. No

5. Have you ever-used needles to shoot up drugs , steroids, etc.? (Circle only one number)
1. Yes 2. No

6. Have you ever had unprotected sex with someone who uses needles to shoot up drugs or steroids?
(Circle only one number)

1. Yes 2. No 3. Probably

7. How many different people did you have sex with during the past three months?

 

8. Have you got tested for HIV? (Circle only one number)
1. Yes 2. No
9. What is your gender?

1. Male 2. Female

10. What is your age?

 

11. Currently, which year of university are you in?

 

12. What is your marital status?

 

13. Are you currently involved in long term relationship (three or more months?)

1. Yes 2. No

73

 

14. Do you know a family member or friend who is Mg HIV+ or has AIDS?
1. Yes 2. No
15. Do you know a family member or friend who has djpg from AIDS?
1. Yes 2. No.
16. How many people in your friends and family circle do you know who have been affected by the virus?
17. Are you Namibian?
1. Yes 2. No

17a. If you are Namibian, then what region of the country do you belong to?

 

17b. If you are not Namibian, what country do you come from?

 

18. If you are not Namibian, how many years have you been living in Namibia?

 

19. Have you come across any advertisement (radio, TV, Posters) on HIV/AIDS?
1. Yes 2. No.
20. Do any of these HIV/AIDS advertisements scare you? (Circle only one number)

1. Yes 2. No, not really

74

 

Questionnaire 2
Phase II

The statements below are designed to get responses about your behavior since you completed the ﬁrst part of the
stuoy. Please answer all questions truthﬂlly and completely. No one will ever be able to connect your
questionnaire with you. Please circle on_ly one number per sentence.

 

1. After I participated in the ﬁrst part of the study, I talked to my partner about using condoms
1. Yes 2. No

2. After I took part in this study, I convinced my partner to use condoms.
1. Yes 2. No

3. I talked to my partner about the advantages of using condoms aﬁer participating in this study.
1. Yes 2. No

4. After I participated in this study, I/my partner bought condoms.
1. Yes 2. No

5. After I participated in this study, I/my partner used condoms.

1. Yes 2. No

75

 

References

76

 

References

Bargh, J. (1989). Conditional automaticity: Varieties of automatic inﬂuence in
social perceptions and cognitions. In J. S. Uleman & J. A Bargh (Eds), Unintended
thought. (pp. 3- 51). New York: Guillord Press.

Beck, J. (1984). The effects of risk probability outcome severity, efﬁcacy of
protetion and access to protection on decision making: A further test of Protection
Motivation theory. Social Behavior and Personality, 12, 121-125.

Brehm, J. (1966). A theory of reactants. New York: Academic Press

Boster & F ., & Mongeau, P. (1984). F ear-arousing persuasive messages. In R. N.
Bostrom & Westley (Eds), Communication yearbook 8. (pp. 330-375) Newbury Park,
CA: Sage.

Cameron, K., Witte, K., Lapinski, M., & Nzyuko, S., (1999). Preventing HIV
transmission along the trans-Africa highway in Kenya: Using persuasive message theory
in formative education. International Quarterly of Community Health Education, 18,
331-356.

Casey, M. K. (1995). F atalism and the modification of the extended parallel
process model. Paper presented at the annual meeting of the Speech Communication
Association, San Antonio, Texas.

Easterling, D.V., & Levanthal, H. (1989). Effects of varying the
recommendations in a fear arousing communication. Journal of Personality and Social
Psychology, 4, 525-531.

Grobler, E. (2000). Critical social factors which inﬂuence HIV /AIDS campaigns:
A social work front line research report from Namibia. In B. Otala (Eds), HIV/AIDS: The
challenge for tertiary institutions in Namibia. Printech, Windhoek, Namibia.

Grotzinger, E., Mainga, M. & Pietersen, C. (2000). Shedding the old skin: Some
experiences on HIV/AIDS issues at UNAM. In B. Otala (Eds), HIV/AIDS: The
challenge for tertiary institutions in Namibia. Printech, Windhoek, Namibia.

Hale, J ., & Dillard, J. (1995). Fear appeals in health promotion campaigns: Too
much, too little, or just right? In. E. Maibach, & R. Parrott (Eds) Designing health
messages: Approaches ﬁom communication theory and public health practice. (pp. 65-
80) Thousand Oaks, CA, Sage Publications Inc.

Haoses, L. (2000). Research Activities on HIV /AIDS: Involvement of the
department of nursing, faculty of medical and health sciences. In B. Otala (Eds),
HIV /AIDS: The challenge for tertiary institutions in Namibia. Printech, Windhoek,
Namibia.

77

 

Hovland, C., Janis I., & Kelly, H. (1953). Communication and persuasion. New
Haven. CT: Yale University Press.

Hill, D., & Gardner. (1980). Repression-sensitization and yielding to threatening
health communication. Australian Journal of Psychology, 32, 183-193.

Janis, 1., (1967). Effects of fear arousal on attitude change: Recent developments
in theory and experimental research. In Berkowitz (Ed.), Advances in experimental Social
Psychology. New York: Academic Press.

Janis, I.L., & F eshbach, S. (1953). Effects of fear-arousing communications. The
Journal of Abnormal and Social Psychology, 48, 78-92.

Janis, I., & Mann, L (1977). Decision making: A psychological analysis of
conflict, choice and commitment. New York: Free press.

Katjire, M., Langa, P., Siwa, L., Mbuche, R., & Tjongarero, J. (2000). The moral
outlook and world view of the Namibian youth in the age of HIV/AIDS. In B. Otala
(Eds), HIV/AIDS: The challenge for tertiary institutions in Namibia. Printech,
Windhoek, Namibia.

Kline, K. N. (1995, November). Applying Witte ’s extended parallel process model
to pamphlets urging women to engage in BSE: Where are the eﬂicacy messages? Paper
presented at the armual meeting of the Speech Communication Association, San Antonio,
Texas.

Kohn, P., Goodstadt, M., Cook, G., Sheppard, M., & Chang, G. (1982).
Ineffectiveness of threat appeals about drinking and driving. Accident Analysis and
Prevention, 14, 457-464.

Krisher, H., Darley, S., Darley, J. (1973). Fear-provoking recommendations,
intentions to take preventive actions, and actual preventive actions. Journal of
Personality and Social Psychology, 26, 301-3 08

Lang, P.J. (1984). Cognition in emotion: Concept and action. In C.E. Izard, J.
Kagan, & R.B. Zajonc (Eds), Emotions, cognition, and behavior (pp. 192-226).
Cambridge: Cambridge University Press.

Lazarus, R. (1991). Cognitions and motivation in emotion. American
Psychologist, 46, 352-367.

Levanthal H. (1970). Findings and theory in the study of fear communications. In

L. Berkowitz (Eds), Advances in experimental Social Psychology. New York: Academic
Press.

78

 

Murray-Johnson, L., Keulder, E., & Witte, K. (2004a).1ndividual-level
perceptions, attitudes, and behaviours regarding HIV/AIDS: Strategic information for
Emergency Plan Programs in Oshikuku, Onanab'okwe, and Rehoboth (Wave 1, Round
1). Baltimore, MD: Johns Hopkins University Centre for Communication Program.

Murray-Johnson, L., Witte, K., and Keulder, E. (2004b). Individual-level
perceptions, attitudes and behaviours regarding HIV/AIDS: Strategic information for
emergency plan programs in Andara, Rundu and Nyangana (Wave 2, Round 1).
Baltimore, MD: Johns Hopkins University Centre for Communication Programs.

Murray-Johnson, L., Witte, K., Liu, W., & Hubbel, A. P. (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, 335-358.

O'Keefe, D.J.(1990). Persuasion: Theory and research. Newbury Park, CA: Sage.

Ortony., A., & Turner, J. (1990). What’s basic about basic emotions?
Psychological Review, 9 7, 3 15-331 .

Rippetoe, P., & Rogers, R. (1987). Effects of components of protection-
motivation theory on adaptive and maladaptive coping with a health threat. Journal of
Personality and Social Psychology, 52, 596-604.

Rogers, W. (1975). A protection motivation theory of fear appeals and attitude
change. Journal of Psychology, 91, 93-114.

Rogers, W. (1983). Cognitive and physiological processes in fear appeals and
attitude change: A revised theory of protection motivation. In J. Cacioppo & R. Petty
(Eds), Social psychophysiology. (pp. 153-176) New York: Guildford.

Rogers, R., & Mewbom, C. (1976). Fear appeals and attitude change: Effects of a
threat’s noxiousness, probability of occurrence, and the efﬁcacy of the coping responses.
Journal of Personality and Social Psychology, 34, 54-61.

Stainback, & Rogers, R. (1983). Identifying effective components alcohol abuse
prevention. Programs. Effects of fear appeals, message style and source expertise.
International Journal of the Addictions, 18, 393-405.

Stephenson, M., & Witte, K. (1997). Fear, threat, and perceptions of eﬂicacy
ﬁomﬁightening skin cancer messages. Paper presented at the annual meeting of the

International Communication Association, Montreal.

Stephenson, M., & Witte, M. (1998). Fear, threat, and perceptions of efﬁcacy
from frightening skin cancer messages. Public Health Review, 26, 147-1 74.

79

 

Report on the Global H1 V/AIDS epidemic (2002). United Nations Agency for
International Development. New York, New York.

Thesenvitz, J. (2000). Understanding and using fear appeals for tobacco control.
Toronto, Ontario, Canada: Council for a tobacco-free Ontario, The program training and
consultation center and health communication unit. University of Toronto.

Witte, K. (1991). Preventing AIDS through persuasive communications: Fear
appeals and preventive action eﬁ‘icacy. Unpublished doctoral dissertation. University of
California, Irvine.

Witte, K. (1992a). The role of threat and efﬁcacy in AIDS prevention.
International Quarterly of Community Health and Education, 12, 3, 225-249.

Witte, K. (1992b). Putting the fear back into fear appeals: Reconciling the
literature. Communication Monographs, 59, 329-349.

Witte, K. (1994). Fear control and danger control: A test of the extended parallel
process model (EPPM). Communication Monographs, 61 , 113-132.

Witte K. (1998). Fear as motivator, fear as inhibitor: using the extended parallel
process models to explain fear appeal successes and failures. In P.A Andersen & L. K
Guerrero (Eds), The handbook of communication and emotion: Research, theory,
applications, and contexts. (pp. 423-450) San Diego, CA: Academic Press. .

Witte, K., & Allen, M. (2000). A meta-analysis of fear appeals: Implications for
effective public health campaigns. Health Education & Behavior, 27, 5, 591-615.

Witte, K., Berkowitz, J ., McKeon, J ., Cameron, K., Lapinski, M. K., & Liu, W. Y.
(1998). Radon awareness and reduction campaigns for African-Americans: A
theoretically-based formative and summative evaluations. Health Education and
Behavior, 25, 284-303.

Witte, K., Cameron, K.A., Lapinski, M. K., Nzyuko, S (1998). A theoretically
based evaluation of HIV/AIDS prevention campaigns along the trans-Africa highway in
Kenya. Journal of Health Communication, 4, 345—363

Witte, K., Cameron, K. A., McKeon, J., & Berkowitz, J. (1996). Predicting risk
behaviors: Development and validation of a diagnostic scale. Journal of Health
Communication, 1, 317-341.

Witte K., Girma, B., & Girgre, A., (2002). Addressing the KAP-Gap in Ethiopia

HIV/AIDS prevention behaviors: The underlying mechanisms to behavior change.
Unpublished Manuscript.

80

 

Witte, K., Meyer, G., & Martell, D. (2001). Eﬁizctive health risk messages: A
step-by-step guide. Thousand Oaks, CA: Sage Publications.

Witte, K., & Morrison, K. (1995). The use of scare tactics in AIDS prevention:

The case of juvenile detention and high school youth. Journal of Applied Communication
Research, 23, 128-142.

Witte, K., Sampson, J ., Liu, W. Y., & Morrison, K. (1995). Addressing cultural
orientations in fear appeal: Promoting AIDS-protective behaviors among Hispanic
immigrant and A ﬁican-A merican adolescents. Unpublished manuscript presented to
Michigan State University, East Lansing, MI.

USAID, 2002: Country Proﬁle: Namibia. Retrieved from the World Wide Web,
August 5‘“, 2004:
http://www.synergy-aids.com/Profiles Web/Proﬁles PDFs/Namibiaproﬁle2003rev1.pdf

UNDP Report (2002). Retrieved from the World Wide Web:
http://hdr.undp.org/statistics/data/cty/cty f NAM.html

http://chora.virtualavenet/aidsboston1a.htm: Retrieved ﬁ'om the World Wide
Web. August 6‘“, 2004.

 

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