A Meta-Analysis of Fear Appeals: Implications for Effective Public Health Campaigns

Witte, Kim; Allen, Mike

doi:10.1177/109019810002700506

Cited by 3,216Behavioral Health and InterventionsMedia Influence and HealthRisk Perception and Management

A Meta-Analysis of Fear Appeals: Implications for Effective Public Health Campaigns

Witte, Kim, Allen, Mike·2000·Health Education & Behavior

DOI 10.1177/109019810002700506

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Abstract

The fear appeal literature is examined in a comprehensive synthesis using meta-analytical techniques. The meta-analysis suggests that strong fear appeals produce high levels of perceived severity and susceptibility, and are more persuasive than low or weak fear appeals. The results also indicate that fear appeals motivate adaptive danger control actions such as message acceptance and maladaptive fear control actions such as defensive avoidance or reactance. It appears that strong fear appeals and high-efficacy messages produce the greatest behavior change, whereas strong fear appeals with low-efficacy messages produce the greatest levels of defensive responses. Future directions and practical implications are provided.

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Three prior meta-analyses found support for the weak efficacy-statement hypothesis.
“Three meta-analyses have tested whether the inclusion of efficacy statements in fear appeals leads to increased effectiveness, and all found support for the weak hypothesis (de Hoog et al., 2007; Mongeau, 1998; Witte & Allen, 2000).”
From Appealing to fear: A meta-analysis of fear appeal effectiveness and theories (2015) · cites this paper as Witte & Allen, 2000
Existing data have consistently supported the linear model of fear appeals but not the curvilinear model.
“The linear and curvilinear models have been tested in prior meta-analyses, and the linear model has consistently been supported by existing data, whereas the curvilinear model has not (e.g., Witte & Allen, 2000).”
From Appealing to fear: A meta-analysis of fear appeal effectiveness and theories (2015) · cites this paper as Witte & Allen, 2000
Prior meta-analyses of fear appeals have reported positive effects on some outcomes, null effects, and negative effects.
“Although some meta-analytic examinations have found positive effects of fear appeals on some outcomes (Witte & Allen, 2000), others have found null effects (de Hoog et al., 2007) or even negative effects (Peters et al., 2012).”
From Appealing to fear: A meta-analysis of fear appeal effectiveness and theories (2015) · cites this paper as Witte & Allen, 2000
These results confirm the conclusions of prior meta-analyses concerning the use of efficacy statements.
“These results confirm the conclusions of prior meta-analyses concerning the use of efficacy statements (de Hoog et al., 2007; Peters et al., 2012; Witte & Allen, 2000).”
From Appealing to fear: A meta-analysis of fear appeal effectiveness and theories (2015) · cites this paper as Witte & Allen, 2000
Appealing to fear leads to defensive reactions when people feel helpless to act.
“leads to defensive reactions when they feel helpless to act 8”
From Using social and behavioural science to support COVID-19 pandemic response (2020) · cites this paper as [8]

Appealing to fear leads people to change their behaviour if they feel capable of dealing with the threat.
“appealing to fear leads people to change their behaviour if they feel capable of dealing with the threat”
From Using social and behavioural science to support COVID-19 pandemic response (2020) · cites this paper as [8]
Strong fear appeals with low-efficacy messages produce the greatest levels of defensive responses.
“strong fear appeals with low-efficacy messages produce the greatest levels of defensive responses.”
From Using social and behavioural science to support COVID-19 pandemic response (2020) · cites this paper as [8]
Strong fear appeals produce the greatest behaviour change only when people feel a sense of efficacy.
“strong fear appeals produce the greatest behaviour change only when people feel a sense of efficacy”
From Using social and behavioural science to support COVID-19 pandemic response (2020) · cites this paper as [8]
Individuals with low GSE may view the same loss-framed messages as intimidating or demotivating, since they do not believe their actions will make a significant difference.
“Conversely, individuals with low GSE may view the same loss-framed messages as intimidating or demotivating, since they do not believe their actions will make a significant difference [45].”
From The power of loss: message framing, climate anxiety, and engagement in personal carbon trading (2025) · cites this paper as [45]
Fear appeals increase fear as a mechanism for attitude, intention and behavioural change.
“This is consistent with previous research and theory on fear appeals, which has found that such appeals increase fear as a mechanism for attitude, intention and behavioural change.87”
From Pictorial cigarette pack warnings: a meta-analysis of experimental studies (2016) · cites this paper as [87]
Previous fear appeal research and theory suggest that fear-oriented communications can elicit reactance.
“Previous fear appeal research and theory also suggest that fear-oriented communications can elicit reactance.87”
From Pictorial cigarette pack warnings: a meta-analysis of experimental studies (2016) · cites this paper as [87]
Fear appeals can increase the perception of the severity of the health threat, inducing behaviour changes, at least as long as individuals believe they can protect themselves.
“An early meta-analysis by Witte and Allen [34] revealed that fear appeals can actually increase the perception of the severity of the health threat inducing behaviour changes, at least as long as the individuals believe that they are able to protect themselves and avert the threat.”
From Misinformation lingers in memory: Failure of three pro-vaccination strategies (2017) · cites this paper as [34]

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Some Effects of Fear-Arousing Communications on Preventive Health Behavior
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The Effects of Fear Appeal and Communication upon Attitudes toward Alcohol Consumption
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A Comparison of the Effects of Punishment-Oriented and Reward-Oriented Messages in Persuasive Communication
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Effects of a Fear Appeal on Arousal, Self-Reported Anxiety, and Attitude towards Smoking
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Audience Response to Religious Fear Appeals
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Attitude Change as a Function of Perceived Arousal
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Using social and behavioural science to support COVID-19 pandemic response
Bavel, J. J. V., Baicker, K., Boggio, P. S., Capraro, V., Cichocka, A., Cikara, M., Crockett, M. J., Crum, A. J., Douglas, K. M., Druckman, J. N., et al. (2020) · Nature Human Behaviour · doi:10.1038/s41562-020-0884-z · Cited by 4,964 · see citing works
Health and climate change: policy responses to protect public health
Watts, N., Adger, W. N., Agnolucci, P., Blackstock, J., Byass, P., Cai, W., Chaytor, S., Colbourn, T., Collins, M., Cooper, A., et al. (2015) · The Lancet · doi:10.1016/s0140-6736(15)60854-6 · Cited by 2,055 · see citing works
Effective messages in vaccine promotion: a randomized trial
Nyhan, B., Reifler, J., Richey, S., & Freed, G. L. (2014) · Pediatrics · doi:10.1542/peds.2013-2365 · Cited by 1,300 · see citing works
Protection motivation and deterrence: a framework for security policy compliance in organisations
Herath, T. C., & Rao, H. R. (2009) · European Journal of Information Systems · doi:10.1057/ejis.2009.6 · Cited by 1,251 · see citing works
Appealing to fear: A meta-analysis of fear appeal effectiveness and theories
Tannenbaum, M. B., Hepler, J., Zimmerman, R. S., Saul, L., Jacobs, S., Wilson, K., & Albarracín, D. (2015) · Psychological Bulletin · doi:10.1037/a0039729 · Cited by 1,203 · see citing works
“The linear and curvilinear models have been tested in prior meta-analyses, and the linear model has consistently been supported by existing data, whereas the curvilinear model has not (e.g., Witte & Allen, 2000).”
BackgroundInfluential
Health warning messages on tobacco products: a review
Hammond, D. (2011) · Tobacco Control · doi:10.1136/tc.2010.037630 · Cited by 1,162 · see citing works
Election Night’s Alright for Fighting: The Role of Emotions in Political Participation
Valentino, N. A., Brader, T. A., Groenendyk, E. W., Gregorowicz, K., & Hutchings, V. L. (2011) · The Journal of Politics · doi:10.1017/s0022381610000939 · Cited by 1,022 · see citing works
Striking a Responsive Chord: How Political Ads Motivate and Persuade Voters by Appealing to Emotions
Brader, T. A. (2005) · American Journal of Political Science · doi:10.1111/j.0092-5853.2005.00130.x · Cited by 974 · see citing works
Does heightening risk appraisals change people’s intentions and behavior? A meta-analysis of experimental studies.
Sheeran, P., Harris, P. R., & Epton, T. (2013) · Psychological Bulletin · doi:10.1037/a0033065 · Cited by 964 · see citing works
Framing and communicating climate change: The effects of distance and outcome frame manipulations
Spence, A., & Pidgeon, N. (2010) · Global Environmental Change · doi:10.1016/j.gloenvcha.2010.07.002 · Cited by 792 · see citing works
Interventions to change health behaviours: evidence-based or evidence-inspired?
Michie, S., & Abraham, C. (2004) · Psychology and Health · doi:10.1080/0887044031000141199 · Cited by 783 · see citing works
The Relative Persuasiveness of Gain-Framed Loss-Framed Messages for Encouraging Disease Prevention Behaviors: A Meta-Analytic Review
O’Keefe, D. J., & Jensen, J. D. (2007) · Journal of Health Communication · doi:10.1080/10810730701615198 · Cited by 745 · see citing works
Are Current Health Behavioral Change Models Helpful in Guiding Prevention of Weight Gain Efforts?
Baranowski, T., Cullen, K. W., Nicklas, T. A., Thompson, D., & Baranowski, J. C. (2003) · Obesity Research · doi:10.1038/oby.2003.222 · Cited by 715 · see citing works
Threatening communication: a critical re-analysis and a revised meta-analytic test of fear appeal theory
Peters, G.-J. Y., Ruiter, R. A. C., & Kok, G. (2013) · Health Psychology Review · doi:10.1080/17437199.2012.703527 · Cited by 679 · see citing works
Factors associated with uptake of vaccination against pandemic influenza: A systematic review
Bish, A., Yardley, L., Nicoll, A., & Michie, S. (2011) · Vaccine · doi:10.1016/j.vaccine.2011.06.107 · Cited by 685 · see citing works
Pictorial cigarette pack warnings: a meta-analysis of experimental studies
Noar, S. M., Hall, M. G., Francis, D. B., Ribisl, K. M., Pepper, J. K., & Brewer, N. T. (2016) · Tobacco Control · doi:10.1136/tobaccocontrol-2014-051978 · Cited by 674 · see citing works
Considering Emotion in COVID-19 Vaccine Communication: Addressing Vaccine Hesitancy and Fostering Vaccine Confidence
Chou, W. S., & Budenz, A. (2020) · Health Communication · doi:10.1080/10410236.2020.1838096 · Cited by 673 · see citing works
What Do Systems Users Have to Fear? Using Fear Appeals to Engender Threats and Fear that Motivate Protective Security Behaviors1
Boss, S. R., Galletta, D. F., Lowry, P. B., Moody, G. D., & Polák, P. (2015) · MIS Quarterly · doi:10.25300/misq/2015/39.4.5 · Cited by 683 · see citing works
Scary warnings and rational precautions: A review of the psychology of fear appeals
Ruiter, R. A. C., Abraham, C., & Kok, G. (2001) · Psychology and Health · doi:10.1080/08870440108405863 · Cited by 632 · see citing works
Message Properties, Mediating States, and Manipulation Checks: Claims, Evidence, and Data Analysis in Experimental Persuasive Message Effects Research
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Lessons Learned from Public Health Mass Media Campaigns: Marketing Health in a Crowded Media World
Randolph, W. M., & Viswanath, K. (2004) · Annual Review of Public Health · doi:10.1146/annurev.publhealth.25.101802.123046 · Cited by 609 · see citing works
Affect and emotions as drivers of climate change perception and action: a review
Brosch, T. (2021) · Current Opinion in Behavioral Sciences · doi:10.1016/j.cobeha.2021.02.001 · Cited by 609 · see citing works
Fear appeals in social marketing: Strategic and ethical reasons for concern
Hastings, G., Stead, M., & Webb, J. (2004) · Psychology and Marketing · doi:10.1002/mar.20043 · Cited by 595 · see citing works
Sixty years of fear appeal research: Current state of the evidence
Ruiter, R. A. C., Kessels, L. T. E., Peters, G.-J., & Kok, G. (2014) · International Journal of Psychology · doi:10.1002/ijop.12042 · Cited by 586 · see citing works
Studying users' computer security behavior: A health belief perspective
Ng, B.-Y., Kankanhalli, A., & Xu, Y. C. (2008) · Decision Support Systems · doi:10.1016/j.dss.2008.11.010 · Cited by 588 · see citing works
The role of emotion in global warming policy support and opposition
Smith, N., & Leiserowitz, A. (2014) · Risk Analysis · doi:10.1111/risa.12140 · Cited by 580 · see citing works
Is a Worried Citizen a Good Citizen? Emotions, Political Information Seeking, and Learning via the Internet
Valentino, N. A., Hutchings, V. L., Banks, A. J., & Davis, A. K. (2008) · Political Psychology · doi:10.1111/j.1467-9221.2008.00625.x · Cited by 569 · see citing works
Anxious Politics
Albertson, B. L., & Gadarian, S. K. (2015) · Cambridge University Press eBooks · doi:10.1017/cbo9781139963107 · Cited by 564 · see citing works
Age and gender differences in risky driving: The roles of positive affect and risk perception
Rhodes, N. D., & Pivik, K. (2010) · Accident Analysis & Prevention · doi:10.1016/j.aap.2010.11.015 · Cited by 553 · see citing works
Interdependence with the environment: Commitment, interconnectedness, and environmental behavior
Davis, J. L., Green, J. D., & Reed, A. (2008) · Journal of Environmental Psychology · doi:10.1016/j.jenvp.2008.11.001 · Cited by 545 · see citing works
Virtual Self-Modeling: The Effects of Vicarious Reinforcement and Identification on Exercise Behaviors
Fox, J., & Bailenson, J. N. (2009) · Media Psychology · doi:10.1080/15213260802669474 · Cited by 494 · see citing works
Age Differences in COVID-19 risk perceptions and mental health: Evidence from a National U.S. survey conducted in March 2020.
Bruine de Bruin, W. (2021) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbaa074 · Cited by 477 · see citing works
Theory and language of climate change communication
Nerlich, B., Koteyko, N., & Brown, B. J. (2009) · Wiley Interdisciplinary Reviews Climate Change · doi:10.1002/wcc.2 · Cited by 481 · see citing works
The i-frame and the s-frame: How focusing on individual-level solutions has led behavioral public policy astray
Chater, N., & Loewenstein, G. (2023) · Behavioral and Brain Sciences · doi:10.1017/s0140525x22002023 · Cited by 710 · see citing works
Framing Climate Change: Exploring the Role of Emotion in Generating Advocacy Behavior
Nabi, R. L., Gustafson, A., & Jensen, R. (2018) · Science Communication · doi:10.1177/1075547018776019 · Cited by 461 · see citing works
Seeking Formula for Misinformation Treatment in Public Health Crises: The Effects of Corrective Information Type and Source
van der Meer, T. G. L. A., & Jin, Y. (2019) · Health Communication · doi:10.1080/10410236.2019.1573295 · Cited by 432 · see citing works
Misleading tests of health behavior theories
Weinstein, N. D. (2007) · Annals of Behavioral Medicine · doi:10.1207/s15324796abm3301_1 · Cited by 418 · see citing works
The Handbook of Behavior Change
Hagger, M. S., Cameron, L. D., Hamilton, K., Hankonen, N. E., & Lintunen, T. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318 · Cited by 420 · see citing works
Effectiveness of mass media campaigns for reducing drinking and driving and alcohol-involved crashes
Elder, R. W., Shults, R. A., Sleet, D. A., Nichols, J. L., Thompson, R. S., & Rajab, W. (2004) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2004.03.002 · Cited by 407 · see citing works
The Relative Persuasiveness of Gain-Framed and Loss-Framed Messages for Encouraging Disease Detection Behaviors: A Meta-Analytic Review
O’Keefe, D. J., & Jensen, J. D. (2009) · Journal of Communication · doi:10.1111/j.1460-2466.2009.01417.x · Cited by 407 · see citing works
The behavioural constellation of deprivation: Causes and consequences
Pepper, G. V., & Nettle, D. (2017) · Behavioral and Brain Sciences · doi:10.1017/s0140525x1600234x · Cited by 387 · see citing works
Using behavioral insights to increase vaccination policy effectiveness
Betsch, C., Böhm, R., & Chapman, G. B. (2015) · Policy Insights from the Behavioral and Brain Sciences · doi:10.1177/2372732215600716 · Cited by 378 · see citing works
Fear, guilt, and shame appeals in social marketing
Brennan, L. L., & Binney, W. (2009) · Journal of Business Research · doi:10.1016/j.jbusres.2009.02.006 · Cited by 373 · see citing works
Fear, Anxiety, Worry, and Breast Cancer Screening Behavior: A Critical Review
Consedine, N. S., Magai, C., Krivoshekova, Y. S., Ryzewicz, L., & Neugut, A. I. (2004) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.501.13.4 · Cited by 373 · see citing works
Efficacy, Emotions and the Habit of Participation
Valentino, N. A., Gregorowicz, K., & Groenendyk, E. W. (2008) · Political Behavior · doi:10.1007/s11109-008-9076-7 · Cited by 360 · see citing works
Psychological responses to the proximity of climate change
Brügger, A., Dessai, S., Devine-Wright, P., Morton, T., & Pidgeon, N. (2015) · Nature Climate Change · doi:10.1038/nclimate2760 · Cited by 327 · see citing works
Impact of graphic and text warnings on cigarette packs: findings from four countries over five years
Borland, R., Wilson, N., Fong, G. T., Hammond, D. G., Cummings, K. M., Yong, H.-H., Hosking, W., Hastings, G., Thrasher, J. F., & McNeill, A. D. (2009) · Tobacco Control · doi:10.1136/tc.2008.028043 · Cited by 350 · see citing works
Why a nudge is not enough: A social identity critique of governance by stealth
Mols, F., Haslam, S. A., Jetten, J., & Steffens, N. K. (2014) · European Journal of Political Research · doi:10.1111/1475-6765.12073 · Cited by 343 · see citing works
Determining Where the Wild Things will be: Using Psychological Theory to Find Tolerance for Large Carnivores
Bruskotter, J. T., & Wilson, R. S. (2013) · Conservation Letters · doi:10.1111/conl.12072 · Cited by 339 · see citing works
Designing Effective Health Communications: A Meta-Analysis
Keller, P. A., & Lehmann, D. R. (2008) · Springer eBooks · doi:10.1007/978-3-031-88060-5_17 · Cited by 333 · see citing works
Analysis of the environmental behavior of farmers for non-point source pollution control and management: An integration of the theory of planned behavior and the protection motivation theory
Wang, Y., Liang, J., Yang, J., Ma, X., Li, X., Wu, J. F., Yang, G., Ren, G., & Feng, Y. (2019) · Journal of Environmental Management · doi:10.1016/j.jenvman.2019.02.070 · Cited by 337 · see citing works
Fear Appeals and Persuasion: A Review and Update of the Extended Parallel Process Model
Maloney, E. K., Lapinski, M. K., & Witte, K. (2011) · Social and Personality Psychology Compass · doi:10.1111/j.1751-9004.2011.00341.x · Cited by 338 · see citing works
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Exemplification Effects in the Promotion of Safety and Health
Zillmann, D. (2006) · Journal of Communication · doi:10.1111/j.1460-2466.2006.00291.x · Cited by 330 · see citing works
Does worry about breast cancer predict screening behaviors? A meta-analysis of the prospective evidence
Hay, J. L., McCaul, K. D., & Magnan, R. E. (2006) · Preventive Medicine · doi:10.1016/j.ypmed.2006.03.002 · Cited by 329 · see citing works
COVID-19: fear appeal favoring purchase behavior towards personal protective equipment
Addo, P. C., Fang, J., Kulbo, N. B., & Li, L. (2020) · Service Industries Journal · doi:10.1080/02642069.2020.1751823 · Cited by 328 · see citing works
Theory and Practice in Health Communication Campaigns: A Critical Interrogation
Dutta, M. J. (2005) · Health Communication · doi:10.1207/s15327027hc1802_1 · Cited by 323 · see citing works
The Role of a Narrative's Emotional Flow in Promoting Persuasive Outcomes
Nabi, R. L., & Green, M. C. (2014) · Media Psychology · doi:10.1080/15213269.2014.912585 · Cited by 328 · see citing works
The implications of death for health: A terror management health model for behavioral health promotion
Goldenberg, J. L., & Arndt, J. (2008) · Psychological Review · doi:10.1037/a0013326 · Cited by 320 · see citing works
Psychometric evaluation of the Arabic version of the Fear of COVID-19 Scale
Alyami, M., Henning, M., Krägeloh, C. U., & Alyami, H. (2021) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-020-00316-x · Cited by 313 · see citing works
Climate Change Disinformation and How to Combat It
Lewandowsky, S. (2020) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-090419-102409 · Cited by 348 · see citing works
The Politics of Threat: How Terrorism News Shapes Foreign Policy Attitudes
Gadarian, S. K. (2010) · The Journal of Politics · doi:10.1017/s0022381609990910 · Cited by 314 · see citing works
The Extended Parallel Process Model: Illuminating the Gaps in Research
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Authors: Witte, K., & Allen, M.
Affiliations: Michigan State University (US)
University of Wisconsin–Milwaukee (US)
ORCID: Allen, Mike
Venue: Health Education & Behavior
Publisher: SAGE Publications
Published: 2000-10
Volume: 27
Issue: 5
Pages: 591-615
ISSN: 1090-1981 (ISSN-L)
1552-6127
DOI: 10.1177/109019810002700506
OpenAlex: W1997092577
Cited by: 3,216
References: 144
Citations by year: 2026: 154 · 2025: 152 · 2024: 141 · 2023: 211 · 2022: 215 · 2021: 269 · 2020: 273 · 2019: 133 · 2018: 154 · 2017: 166 · 2016: 148 · 2015: 156 · 2014: 165 · 2013: 142 · 2012: 119
FWCI: 20.48
Type: journal article
Language: en
Open access: closed
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Health Education & Behavior (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
Social Sciences › Arts and Humanities › Literature and Literary Theory › Media Influence and Health
Social Sciences › Sociology and Political Science › Risk Perception and Management
Keywords: fear appeals, public health campaigns, perceived severity, perceived susceptibility, defensive avoidance, reactance, message acceptance, behavior change, persuasive communication
MeSH terms: Fear, Health Education, Humans, Health Knowledge, Attitudes, Practice, Persuasive Communication, Public Health

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A Meta-Analysis of Fear Appeals: Implications for Effective Public Health Campaigns

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