New Study: Fear and Guilt Messaging Increases HPV Vaccination Intentions

In a recent joint study by Sylvester Comprehensive Cancer Center, the University of Miami School of Communication and Missouri State University, a team of scientists analyzed the impact of using a combination of guilt and fear messaging compared to a traditional fear appeal on human papillomavirus (HPV) vaccination intentions.

The results detail the mechanism through which people process combination messages and fear appeals differently, and clarify when and how guilt-based messaging strategies can facilitate or inhibit persuasive effectiveness. The study was published recently in the journal Communication Research.

“The overwhelming majority of intervention research, particularly in the context of health, attempts to elicit a fear response. This is understandable because fear is a negative-motivational emotion that people feel compelled to reduce,” said Nick Carcioppolo, Ph.D., a Sylvester Comprehensive Cancer Center member, assistant professor at the University of Miami School of Communication and first author of the study. “This research shows that incorporating a guilt-appeal message into a traditional fear-appeal framework can be an efficacious strategy to influence vaccination intentions.”

The Centers for Disease Control and Prevention recommends the HPV vaccine for preteen boys and girls at age 11 or 12, so they are protected before ever being exposed to the virus. The HPV vaccine also produces a more robust immune response during the preteen years, and older teens are less likely to get health checkups than preteens.

As part of the study, the team of scientists constructed two types of ads that were shown to 407 individuals between the ages of 18 and 26 who had never been vaccinated for HPV and never been diagnosed with HPV. One appeal used a fear-based message featuring a headline to increase perception of guilt (hybrid appeal), while the other appeal used the same fear-based message, but with a fear appeal headline designed to increase perceptions of HPV susceptibility. The hybrid appeal headline read, “It didn’t affect me until it destroyed us,” and the fear headline read, “50% of sexually active people will become infected with HPV at some point in their lives.”

“We found that there was a significant three-way interaction between guilt, personal responsibility and issue involvement on intentions, where high perceived guilt and high personal responsibility led to the highest scores on vaccination intentions – an effect which tended to increase as issue involvement increased,” said Carcioppolo. “However, we also found that this effect was true except at the highest level of issue involvement and personal responsibility, when increased guilt actually decreases vaccination intentions. This finding suggests that guilt may not be an effective addition to fear appeals for those who are already highly vested in an issue and who feel personally responsible for enacting protective behavior.”

The study clearly demonstrates the utility of a hybrid guilt-fear message to influence persuasive outcomes. The scientists suggest that hybrid guilt-fear messages specifically, and perhaps multi-emotion appeals more broadly, can be viable persuasive messaging strategies in the fight against HPV infections.

“I’m excited about this research line as it directly relates to the efforts under way by others at Sylvester to increase HPV vaccination among the local Miami community,” said Carcioppolo. “I plan on extending this research to assess different types of messaging materials among parents living in Miami to increase the likelihood that they vaccinate their children for HPV.”

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