Understanding the Design of Fear Appeals by Applying the Extended Parallel Process Model: A Qualitative Analysis of COVID-19 Public Service Announcements

Abstract

Purpose

Identify how early COVID-19 public health messages incorporated in the tenets of the extended parallel process model (EPPM).

Setting

YouTube videos developed by governmental departments, medical institutions, news organizations, and non-profit organizations in the United States were aggregated.

Method

This qualitative study conducted a keyword search to identify public service announcements (PSAs). The sample was further refined after searching PSAs that contained fear appeals. A thematic analysis was performed by using the constant comparative method.

Sample

A total of forty-three videos was included in the final analysis.

Result

Two themes emerged regarding messages aimed at arousing the perceived severity of threat. These themes include emphasizing the consequences of being infected and utilizing personal narratives. Perceived susceptibility of threat was aroused by emphasizing that some groups have higher risks than others. Two themes emerged around arousing perceived response efficacy: (1) the authority of professionals; and (2) altruism and personal responsibility. One way was identified to arouse perceived self-efficacy, which is informing the protective measures.

Conclusion

Multiple strategies were used in PSAs about COVID-19 to arouse fear during the early stages of the pandemic. The utilization of self-efficacy was oversimplified, by not providing details about the rationale for the recommended behavior.

Keywords

fear appeals extended parallel process model (EPPM)thematic analysis health communications

Purpose

The novel Coronavirus disease 2019 (COVID-19) arrived in January of 2020 and immediately posed a severe global public health risk.^1,2 Information campaigns, also known as public service announcements (PSAs), are commonly utilized to promote safety measures and were prominent during the spread of COVID-19.³

A common tactic of PSAs is to include messaging that contains fear appeals.⁴ Fear appeals refer to the utilization of threatening information to change attitudes and behaviors.^5,6 Multiple meta-analyses suggest that fear appeals are persuasive for most audiences since the psychological foundation of fear appeals utilizes an aversive emotion to induce individuals to avoid certain behaviors.^5,7 An international study found that the fear of COVID-19 was the only predictor of adopting preventive measures.⁸ This finding is in line with the finding from an experiment in which participants received messages with fear appeals and a higher level of willingness to get the COVID-19 vaccine resulted.⁹ One of the most prominent theoretical frameworks related to fear appeals is the extended parallel process model (EPPM).¹⁰

EPPM explains possible responses to fear-based messages¹¹ and posits that individuals will appraise various messages, which leads to two distinct processes—the fear control process and the danger control process.^6,12 If an individual perceives a high level of threat but a low level of efficacy, defensive motivation is aroused. Receivers tend to reject the behaviors recommended in health campaigns, which is the fear control process.^6,12 However, if the receiver perceives a high level of threat and a high level of efficacy, the receiver tends to accept the messages, due to the occurrence of protection motivation.^6,12 This is the danger control process. The danger control process indicates the success of fear appeals.^6,12

Despite its theoretical soundness, utilizing fear appeals does not always lead to desired behaviors.¹³ Because balancing perceived efficacy and severity is difficult in practice, utilizing fear appeals often results in unintended consequences. However, only a limited number of studies have been conducted to explore messages focusing on health threats. This study aims to fill this research gap by developing an operational definition of fear appeals and identifying the way fear appeals are utilized in messages related to COVID-19 incorporating the tenets of EPPM by asking the following research questions:

RQ 1: How do COVID-19-related PSAs exhibit perceived severity?

RQ 2: How do COVID-19-related PSAs exhibit perceived susceptibility?

RQ 3: How do COVID-19-related PSAs exhibit perceived response efficacy?

RQ 4: How do COVID-19-related PSAs exhibit perceived self-efficacy?

Method

Initial Searching

A keyword search strategy was constructed to identify COVID-19-related PSAs from YouTube, the world’s leading video-sharing platform,¹⁴ on February 7, 2021. Keywords included the following terms: “COVID” AND (“PSA” OR “Public Service Announcement”). The first author individually viewed each video one by one until YouTube displayed “no more results.” All videos from search results were manually documented in Excel if they meet the following criteria: (1) published between January 31st, 2020, and January 31st, 2021; (2) a maximum of four minutes in length, because one characteristic of PSAs is using short and simple messages¹⁵ and YouTube considers videos under four minutes to be short videos; (3) published by governmental departments, medical institutions, non-profit organizations or news organizations in the United States; and (4) published in English. The legitimacy of the channel was confirmed through either the verification symbols assigned by YouTube or the social media information displayed on the official website of the organization. The legal status of the non-profit organization was verified through its tax-exempt status.

Developing Criteria to Identify Fear Appeals

The number of PSAs was further refined by the research team viewing each video again to determine if it contained a fear appeal. The constant comparative method (CCM) was used to develop the criteria to identify videos with fear appeals. Initially developed as a part of grounded theory, the CCM is a widely used technique to analyze qualitative data by comparing codes to codes, categories to categories, and concepts to concepts.^16,17 This analysis approach is suitable for generating theoretical properties¹⁶ and can boost the validity of the study by using multiple coders, a triangulation method.¹⁸

First, we used an inductive approach to generate initial codes rather than using codes generated from the theory.¹⁹ Two coders (XC, ZX), trained in this approach, independently watched videos collected from the initial search to become familiar with COVID-19 PSAs. Based on Witte’s theoretical definition,⁶ there are two aspects of fear appeals, including the seriousness of the disease and the personal risks of being infected. Open-coding was performed by noting meaningful ideas or statements²⁰ on an incident reflecting two aspects of fear appeals in each video (e.g., a crying nurse who witnessed many deaths), which were used as preliminary codes. Coders then met to discuss and unify the preliminary codes. A deductive approach was used to integrate unified codes into two theory-driven categories (severity and susceptibility) by comparing the meaning of codes and theoretical definitions extracted from the EPPM. To reduce bias, an additional four coders enrolled in different majors were recruited.¹⁸ A meeting was held to explain the study’s purpose and to train the coders. Six coders analyzed 14 videos together to obtain a general sense of the theoretical definitions of fear appeals, the data and unified codes. Then, each coder was randomly assigned 20-30 videos to confirm the unified codes and whether new codes emerged. Last, based on coders’ responses and theoretical definitions, the first author finalized the criteria (Appendix A). Two researchers tested the reliability of the criteria. Both the percent agreement and proportional reduction of loss (PRL), a direct extension of Cronbach's alpha coefficient for qualitative data, were high²¹ (Table 1). The Krippendorff’s alpha reached an acceptable level for making tentative conclusions.²²

Table 1.

Inter-coder Reliability for the Criteria for Identifying Fear Appeals.

Category: Whether the video contains……	Percent agreement (%)	Proportional reduction of loss (PRL)	Krippendorff's alpha
Perceived severity of threat	88.23	.87	.73
Perceived susceptibility of threat	94.12	.94	.85

Screening

Initially identified PSAs were further screened by the research team by implementing our eligibility criteria of containing a fear appeal. During this process, we realized that some COVID-19-related PSAs may not include the terms “PSA” or “public service announcement” within their descriptions. Thus, to ensure that we captured PSAs from a wide variety of organizations, we identified major U.S. health and non-profit organizations, searched their specific YouTube channels, and screened COVID-19-related videos on their channels by using the same eligibility criteria. The organizations included the Ad Council, CDC, NIH, and 23 departments of health in state or local governments (i.e., Arizona Department of Health Service and New York Department of Health and Mental Hygiene). These 23 departments were identified via using “department of health” to search for channels.

Data Analysis

Thematic analysis was conducted to understand the meaning of the PSAs that utilized fear appeals by using CCM.²³ The inductive approach was used to derive initial codes, and the deductive approach was applied to integrate themes into four theory-driven categories (severity, susceptibility, response-efficacy, self-efficacy).¹⁹

The research team rewatched all videos containing fear appeals for content familiarity. The first author generated initial codes by interpreting PSAs that reflected perceived threat as well as efficacy. Then, to construct prototype themes, a clustering pathway was performed by grouping thematic codes based on similarities.²⁴ Subthemes were developed if they shared essential ideas but were distinct from one another.²⁴ A codebook of preliminary themes was developed. Two researchers (XC, RS) analyzed the same 20 videos independently. Discussions were held to solve the disagreements and finalize the codebook of the themes (Appendix B). To ensure the trustworthiness of the data, the senior author (JA) moderated the discussions between the two researchers and served as the critical peer to challenge the themes presented by the two researchers.²⁰ Then, all videos were analyzed again by using the final version of the codebook to ensure that existing themes reflect the patterns across the data and no new themes emerged.

Results

Among PSAs appearing on YouTube between January 31st, 2020, and January 31st, 2021, we initially identified 140 videos using keyword search techniques. After implementing the eligibility criteria of containing fear appeals, we were left with 28 videos. To ensure we were capturing PSAs from all relevant organizations, we conducted an additional search of each organization’s YouTube channel, resulting in an additional 15 PSAs. In total, 43 PSAs containing fear appeals were used for analysis (Appendix C). More than half of the PSAs (67.44%, n = 29) were created by governmental departments (e.g., Michigan Department of Health and Human Services), followed by non-profit (e.g., Tennessee Medical Association) or medical organizations (e.g., Marian Regional Medical Center) (20.93%, n = 9). The remaining five videos were created by news organizations (e.g., Fox Business) (11.63%).

How Do COVID-19-Related PSAs Exhibit Perceived Severity Messages?

Two main themes emerged: (1) emphasizing the consequences of being infected and (2) using personal stories, and accompanying sub-themes emerged.

Theme 1 - Emphasizing the Consequences of Being Infected

To arouse individuals’ perceived severity, PSAs stated the negative consequences of infection, and also the uncertainty that comes with being infected. To further delineate how the consequences of infection were emphasized, two subthemes are described: (1) severity of symptoms and death; and (2) uncertainty. Table 2 includes quotations related to each PSA.

Table 2.

Quotations for Emphasizing the Consequences of Being Infected.

Subtheme	Supporting Quotations
The severity of symptoms and death	Causing Death
	Video#8: A nurse said, “some patients tell us they didn’t think the virus was real, and then they needed a ventilator to survive. And some patients die on the ventilator.”
	Video#25: A doctor said, “COVID-19 can be deadly, and the virus is not going anywhere soon”
	Video#31 showed some famous last words of patients who died, such as such as “COVID won’t kill me. I am 23,” “I work out every day. COVID-19 won’t kill me,” and “I have antibodies.”
	Video#34: A governor said, “We are facing a killer virus.”
	Video#36: A voice-over said, “you can spread it and people you love could get it and die.”
	Life-threatening symptoms
	Video#8: A nurse said, “we see young healthy people come in (the hospital), early in, middle age.”
	Video#9: A hospital present said, “we are at the hospital’ s emergency department. Right now, patients are fighting for their lives.”
Uncertainty	Video#7: A crying nurse said, “I think the scariest part of COVID is that it is unpredictable. We have had young healthy patients with no underlying health issues die.”
Uncertainty	Video#18: A chief medical officer said, “We really don’t know enough about how it is fully spread and what the full long-term effects of the disease is. Even if you make it a mild case, you don’t know what the long-term consequence of the disease is. So, it’s better to be safe.”

Sub-Theme 1: Severity of Symptoms and Death

PSAs highlighting symptoms and the potentially fatal nature of COVID-19 used explicit descriptions and graphic visuals. Descriptions consisted of calling COVID-19 a “killer” (video#34) or describing it as a deadly disease which leads to admittance to a hospital. PSAs using visuals depicted scenes of patients being treated with ventilators in the emergency room (videos #10, #12, #20). Health providers were shown urgently attempting to save lives, and in one video, a nurse spoke directly into the camera about how some patients did not believe COVID-19 was real, only to end up on a ventilator (video #8).

Sub-Theme 2: Uncertainty

PSAs acknowledged that many aspects of COVID-19 were still unknown. One function of using uncertainty within PSAs was to reiterate the severe threat that COVID-19 posed. A PSA developed by the City of Port St. Lucie, Florida (video #18) recognized that the long-term implications of COVID-19 were unknown. Even “mild” cases were considered “unpredictable,” implying that they could lead to lasting health challenges.

Theme 2- Using Personal Stories

Essential workers, patients, and members of the community used specific, personal stories as a narrative to illustrate the horrors of COVID-19. Healthcare workers described how they were exhausted by caring for so many patients, and a PSA by the Ohio Department of Health (video #8) featured a nurse telling a story:

They beg for us to call their families. We hold their hands while they are speaking into their cell phones, moments before they are going to go on the ventilator. I beg the public to take this virus more seriously.

Another PSA by the Nevada Health Response invited people with a prior infection to talk about their experience. Ronal Pipkins, the first person confirmed with COVID-19 in Nevada, encouraged his fellow residents to stop COVID-19-related misinformation (video #22):

Misinformation can be as dangerous as the COVID-19 virus. After being diagnosed as the first positive case in Nevada, I spent three weeks in a coma and two more weeks in recovery. I survived, but many have not. I urge you to follow the CDC guidelines. These small things can save your and your family’s lives.

How Do COVID-19-Related PSAs Exhibit Perceived Susceptibility Messages?

PSAs with messages of perceived susceptibility were categorized into two themes: (1) everyone is at risk, with the corresponding sub-themes of (a) risky behaviors are common, (b) personalization, and (c) mention that COVID-19 is highly contagious, and (2) targeting high-risk groups.

Theme 1 - Everyone is at Risk

Emphasizing that anyone can be infected, regardless of age, race, or health status, was utilized to increase the belief that all individuals were vulnerable to COVID-19. PSAs underscored the ease and speed with which it the virus could be transmitted. Three main strategies were identified to indicate the characteristics of COVID-19 transmission: (1) risky behaviors are common; (2) personalization; and (3) mention that COVID-19 is highly contagious.

Sub-Theme 1: Risky Behaviors are Common

Emphasizing the prevalence of risky behaviors reminded audiences not to ignore the possible transmission pathways and to practice protective measures. Metaphors were used, such as (video #2) showing stacked wooden blocks representing risky behaviors. The PSA illustrated the blocks falling to indicate how easily everything in one’s life can collapse due to infection. The voice-over asked, “What happens when your luck runs out?” Other PSAs stressed a specific risky behavior, such as persuading people not to gather in large groups during Thanksgiving and Christmas (videos #5, #6). The voice-over in the PSA (video#6) said, “If you get together for the holidays, you will increase the chance you will give others a COVID.”

Sub-Theme 2: Personalization

PSAs often employed personalization by using the word, “you.” In a PSA by NorthShore University Health System, a doctor said, “We don’t want our team to tell you about lost loved ones” (video#9). Another included, “People like your mom, your grandpa, your friends may die” (video#18).

Sub-Theme 3: COVID-19 is Highly Contagious

These PSAs focused on how community outbreaks occur due to the speed and conditions required for COVID-19 transmission. Once again, metaphors were utilized, showing dominos to visualize a community outbreak (videos#4, #15). A fire department chief said (video#4), “One choice can set off a domino effect.” Others used expressions like, “You can spread the COVID-19 virus without realizing” (video#29) and “Just one infected person can give it to 40 who can give it to countless more.” (video#35).

Theme 2 - Targeting High-Risk Groups

PSAs targeted social groups that were considered high-risk for contracting COVID-19. Typically, these included people over the age of 65, cancer patients who may be immunocompromised, and people with serious underlying medical conditions. In one PSA (video #22), 18 African-American doctors explained why people of color were more likely to acquire COVID-19 and die. Dialogue from this PSA includes, “African Americans are more likely to acquire and die from COVID-19. Why? Because people of color suffer a high rate of medical chronic conditions.” Another PSA (video #24) mentioned that tobacco users were susceptible to having severe symptoms if infected. The PSA went on to state, “The coronavirus attacks the lungs. It could pose an especially serious threat to those who use tobacco and those exposed to secondhand smoke.”

How Do COVID-19-Related PSAs Exhibit Perceived Response Efficacy Messages?

Two themes emerged related to response efficacy: (1) the authority of professionals; and (2) altruism and personal responsibility.

Theme 1 - The Authority of Professionals

PSAs attempted to persuade individuals by utilizing the credibility of professionals, including healthcare workers, government employees, and celebrities. Health authorities and experts were the most common narrators in these PSAs. Other PSAs featured front-line doctors or health experts to speak about recommended behaviors. A governor, government employees, and celebrities were also showcased. Table 3 includes quotations from each PSA.

Table 3.

Quotations for the Authority of Professionals.

Spokesperson	Supporting Quotations
Health authorities	Medical Doctors
	Video#3: Dr. Eva Galvez said, “My colleagues and I believe that the vaccine is safe and effective.”
	Health Commissioner
	Video#32: Dr. Oxiris Barbot said, “I am New York City health Commissioner Dr. Oxiris Barbot. As the city’s doctor, I have an urgent plea to new Yorkers.”
	Coronavirus Response Coordinator
	Video#39: Dr Deborah Birx said, “We know that we are asking Americans to do a lot right now. So, we are asking everyone to be selfless for others so that we can protect those who are most susceptible to this virus.”
Politicians and Other government officials	Governor
	Video#38: Governor of Indiana, Eric J. Holcomb said, “My fellow Hoosiers, all of us in state government care about you and your loved ones.”
	Judge
	Video#19: Victoria County Judge, Ben Zeller said, “social distancing helped to limit the spread of COVID-19.”
Celebrities	Video#11: Bun B, a rapper, said, “COVID-19 has hit our community really hard. If we come together we have the power to save what matters to us.”
Celebrities	Video#32: Marcus Scribner, an actor, said, “even with my face covered, you will see me.”

Theme 2 - Emphasizing Altruism and Personal Responsibility

Following recommended behaviors represented a form of moral appeals to persuade people to adopt protective measures. By emphasizing altruism, PSAs encouraged audiences to care about others. These PSAs acknowledged that COVID-19 was not fatal for some people, but they also stressed that performing recommended behaviors could save other people’s lives. For example, phrases included: “Our choices impact those working to keep us safe” (video #4), “Please join us in wearing a face covering to help stop the spread of coronavirus because covering your face is one small act of kindness that can bring us together” (video #32), and“Let’s work together to save lives” (videos #16, #22).

In addition to altruism, PSAs urged people to take personal responsibility. Personal responsibility was demonstrated by observing recommended behaviors. These videos utilized words like, “Do your part” (videos #4, # 19, #29, #42, etc.) and “Our teams (doctors) are fighting for them (patients), and you have a role to play in controlling the spread of COVID-19” (video #9).

How do COVID-19-related PSAs exhibit perceived self-efficacy messages?

Theme - Informing the Public About Protective Measures

One major theme related to perceived self-efficacy emerged, in which PSAs concentrated on protective measures, such as wearing masks, social distancing, washing hands, and getting tested. PSAs either recommended various behaviors or focused on only one specific behavior. Noticeably, the videos included in this theme did not always provide details about why the recommended behavior was essential. Table 4 includes quotations for PSAs within this theme.

Table 4.

Quotations for Informing the Public About Protective Measures.

Protective measures	Supporting Quotations
Packages various recommended behaviors	Video#1: A doctor said, “do your part to stay safe: wearing a mask when outside your home, being mindful of social distancing, and washing your hand.”
Packages various recommended behaviors	Video#14: A voice-over said, “American physicians have three simple steps you can take to stop the spread; first wash your hands; second at least six feet from others; and third mask up.”
Focus on one specific behavior	With Details
	Video#18: While a doctor was a saying, “the benefits of earing a mask are that you are preventing transmission of water droplets when we speak or when we cough,” text “wash your hands before putting on your face covering, and then holding the ear loops or ties, make sure it covers your nose and mouth, and secure it around your chin.”
	Without Details
	Video#16: A voice-over said, “get tested regularly if you work with the public.”

Conclusion

We collected PSAs from YouTube that were produced from January 31st, 2020 to January 31st, 2021, and analyzed how fear appeals were incorporated. We specifically examined how PSAs incorporated elements of the EPPM, and found that various methods were used to arouse individuals’ perceived severity, perceived susceptibility, and perceived response efficacy, such as emphasizing consequences and using personal stories. However, this study only identified one way to arouse perceived self-efficacy, which was informing the public about protective measures.

Perceived threats, which include perceived severity and perceived susceptibility, are considered the key component of fear appeals.²⁵ Our findings connect with results from other studies analyzing threatening messages, such as HIV/AIDS-related and children’s immunization-related PSAs.^26,27 For instance, previous studies found that health campaigns intended to state the destructive threat to physical health to arouse individuals’ perceived severity.^26,27 By using rhetorical analysis, Bush and Boller²⁶ found that AIDS was depicted as a fatal but preventable disease at the beginning of the HIV/AIDS crisis, and people exposed to the HIV virus were framed as “victims”, which is partially consistent with findings from our study. Similarly, Smith²⁷ found that most children’s immunization intervention messages from advertising, PSAs, and other printed materials included severity messages, such as “these childhood diseases can result in lifetime disability, disfigurement, and even death” (p277). Our findings suggest that COVID-19-related PSAs emphasized the severe consequences of being infected. However, compared with previous PSAs, COVID-19-related PSAs also stressed uncertainty by acknowledging limited knowledge about the virus.

Perceived susceptibility messages are used to increase audiences’ awareness of their own risks.⁶ Two strategies identified in our study are in line with previous studies. Targeting high-risk groups is a common strategy in health-related PSAs. In HIV/AIDS-related PSAs, characters were depicted as young and sexually active males to represent the high-risk group.²⁶ Second, personalized language – “you” was identified in both our study and children immunization intervention PSAs.²⁷

Scholars have reached a consensus that fear appeals only work when combining perceived efficacy messages. Moreover, Mongeau⁵ stressed the importance of self-efficacy; he argued that receivers tended to reject messages with high levels of threat and response efficacy if their self-efficacy was low. Our study found that COVID-19-related PSAs invited professionals, including healthcare workers, government employees, and celebrities, to share their knowledge or experience to increase the credibility of recommended behaviors. A prior scoping review found that individuals’ perceptions of crisis management affect their preference for sources.²⁸ Generally, people with low trust in crisis management perceive healthcare professions as more trustworthy than other sources, while those who trust crisis management prefer government officials. Our analysis indicates that both healthcare professionals and government officials were included in COVID-19-related PSAs. Yet, our study also identified celebrities as an information source. Prior studies found that including celebrities can attract audiences’ attention and effectively persuade individuals to complete cancer-related screening.²⁹ We call for future studies to examine how these sources affect perceived credibility of information in a public health crisis. Besides, our study also found that stressing altruism was a widely used strategy to arouse efficacy. However, empirical studies have mixed findings about the effectiveness of altruism.^30,31

Evolving as a protective mechanism, fear is a powerful predictor of attitude and behavior change because individuals are motivated to avoid risks.³² As a common strategy used in health messages, fear appeals are tested to be persuasive for most audiences on most topics.⁵ However, fear appeals may fail without being appropriately tailored to the context (e.g., culture).³³ Moreover, in reality, the public is aware of the threat before receiving messages, which leads to a debate on the need for additional fear appeals.³⁴ Therefore, this study calls for more attention to be paid to the application of fear appeals in campaign message designs. More importantly, additional studies are needed to explore how to contextually and culturally tailor fear appeals. In addition, future studies can explore the differences among geographic regions where fear appeals are employed to gauge audience reactions.

A limitation of this study was that we only analyzed a sub-set of PSAs, as we were unable to account for every PSA that was created with COVID-19 messaging. Further, we examined a specific timeframe and as the public’s understanding of COVID-19 evolved, so did the messaging. In addition, while analyzing PSAs was effective in understanding how organizations communicated about the pandemic, they were just one medium. Information campaigns and fear appeals were also rampant in daily news, out-of-home campaigns, broadcast television, radio, and internet. Lastly, we manually searched videos using keywords. However, it is possible that YouTube’s algorithm may have influenced our results. Thus, it is possible that we did not discover all of the available videos.

So What?

What is Already Known on This Topic?

Fear appeals have been widely used as a persuasive strategy in health campaigns or PSAs.

What Does This Article Add?

Previous studies focused on studying the effectiveness of fear appeals via experiments. Little effort has been made to explore how health communicators apply this technique in the real world. Our study helps future health communicators and message designers understand how constructs from the EPPM impact the population it seeks to inform. We uncovered specific strategies for message design that were employed during the actual health crisis. Additionally, our study provides operationalized definitions of perceived severity of threat and perceived susceptibility of threat, which can be used for future content analysis on fear appeals.

What are the Implications for Health Promotion Practice or Research?

Our analysis also found that COVID-19 PSAs around perceived self-efficacy were oversimplified. Many citizens were already experiencing fear and anxiety during COVID-19.^35,36 As indicated by the affect-as-information model, people in negative moods are less likely to finish a task.³⁷ Thus, health message designers should vary the types of messages used to arouse perceived self-efficacy, such as acknowledging the stress faced by citizens or providing more details about how to correctly perform recommended behaviors. Self-efficacy messages can display support to patients who are more likely to be depressed than the general population during a pandemic.³⁸ Last, we argue that designing effective messages is an inseparable part of promoting health, especially during pandemics. However, health communication research has not received enough support from policymakers.³⁹ We call for more attention and support (e.g., funding) on this area.

Supplemental Material

Supplemental Material - Understanding the Design of Fear Appeals by Applying the Extended Parallel Process Model: A Qualitative Analysis of COVID-19 Public Service Announcements

Supplemental Material for Understanding the Design of Fear Appeals by Applying the Extended Parallel Process Model: A Qualitative Analysis of COVID-19 Public Service Announcements by Xiaobei Chen, MA, Rachel Son, MA, Zhecheng Xiao, MCCI, Debbie Triese, PhD, and Jordan Alpert, PhD in American Journal of Health Promotion.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Xiaobei Chen

Supplemental Material

Supplemental material for this article is available online.

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