Fear Appeals in Promoting Cervical Cancer Screening Information: An Analysis of Public Service Announcements On Youtube

Theoretical Background and research questions/hypothesis:  Pap test is an effective tool in detecting cervical cancer, a major health concern for women in the world, at early stage. However, half of the women diagnosed with cervical cancer have never had a Pap test, and an additional 10% haven't had a screening in the past five years. Therefore, promoting Pap test through health education to raise women's awareness of and enhance their efficacy for taking it is essential. Fear appeals have been widely adopted in designing campaign messages to promote healthy behaviors. However, whether fear appeals will work in persuading people to take recommended behaviors is not determined. YouTube provides a cost-effective way for health educators to test the effectiveness of campaign messages before launching them in real world. No studies have examined the use of fear appeals in cervical cancer screening public service announcements (PSAs) and how audience evaluates these PSAs in social media environment. The present study bridge the gap by scrutinizing the message features of PSAs on YouTube and the audience's responses. The analysis was conducted under the Extended Parallel Process Model (EPPM), with the purpose of exploring to what extent these PSAs represent the four components in it, i.e. susceptibility, severity, self-efficacy, and response efficacy. The interaction between PSAs' cultural orientation and use of fear appeals was also examined. 

Methods: On December 25, 2012, YouTube data including PSA videos, sources, upload dates, the number of likes/dislikes, and comments were collected through YouTube's built-in search engine. The keywords used for searching were “cervical cancer,” “cervical cancer prevention,” “cervical cancer screening,” and “Pap test.” 120 PSA videos were obtained. Quantitative content analysis was applied.

Results: 52% of the PSAs were from private organizations. Only one-fifth of the PSAs adopted fear appeals. The relationship between the number of likes and video source was statistically significant (p=0.043). The relationship between video source and use of fear appeals was also statistically significant (χ2= 16.69, df = 3, p-value < 0.001). 62.5% of the PSAs mentioned "self-efficacy," which was the least mentioned component. There was a statistically significant relationship between cultural orientation and use of fear appeals (p=0.033).

Conclusions: PSAs produced by private for-profit organizations were the most liked. Pharmaceutical companies were most likely to use fear appeals, whereas government was least likely to use fear appeals. Relative to PSAs from individualistic culture, PSAs from collectivistic culture were more likely to use fear appeals. Components in EPPM were widely used in these PSAs, regardless of video sources. However, self-efficacy, the most robust predictor for behavioral intention identified by previous meta-analysis, was the least mentioned in PSAs.

Implications for research and/or practice: Whether use of fear appeals is a reason why PSAs produced by private organizations were more liked than those produced by government agencies needs further exploration. When target audience is from collectivistic cultural orientation, using fear appeals may work better in changing people's behavioral intentions and behaviors. Without enhancing people's perceived self-efficacy, PSAs are less likely to generate behavioral changes in the recommended direction. Therefore, including content that could raise people's self-efficacy in designing messages is important.