Genograms as threat appeals: Using the Extended Parallel Process Model with familial cardiovascular disease
Bowles, Betty Carlson
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This study explored the use of genograms as threat appeals in motivating intent to perform health promotion and disease prevention behaviors in participants with a history of cardiovascular disease (CVD) recruited by convenience and snowball sampling. The Extended Parallel Process Model (EPPM) contends that efficacy must exceed threat for protection motivation to dominate resulting in message acceptance and danger control responses. If threat exceeds efficacy, defensive motivation will dominate, resulting in fear control responses and message rejection. Surveys modified from the Risk Behavior Diagnosis Scale, theoretically grounded in the EPPM, assessed threat (perceived severity of and susceptibility to CVD) and efficacy (perceived response efficacy and self-efficacy related to recommended preventive behaviors). These surveys, administered before and after completing a health genogram, determined dominance of threat control or fear control responses, intent to practice health promotion behaviors, and stage of change. There were statistically significant shifts toward fear control for physical activity, tobacco avoidance and total scores, but not for weight maintenance. There were no significant differences in intent to practice health promotion behaviors. Stages of change were advanced for documentation of family health history and for practicing health promotion behaviors. Higher fear scores in those within the fear control spectrum validated that construct of the EPPM. This study has implications for health educators in assisting families to assess susceptibility to disease by documenting family health history. Additionally, health educators should assess perceived threat and perceived efficacy in the client, and intervene at the earliest possible stage with strategies that strengtphen response- and self-efficacy to ensure that fear appeal messages are accepted and behaviors are changed to promote health and prevent disease.