The EPPM and HIV / AIDS Prevention 1

Running Head: THE EPPM AND HIV / AIDS PREVENTION

Using Witte’s EPPM to Prevent the

Spread of HIV / AIDS Among Undergraduate Students

Jack Turner

George Mason University

 The EPPM and HIV / AIDS Prevention 2

ABSTRACT

Previous studies indicate that undergraduates are knowledgeable about HIV / AIDS and

infection risks but are not demonstrating sufficiently protective behaviors or concerned

attitudes toward the disease. This study proposes that a fear appeal in poster form, based on

Witte’s Extended Parallel Process Model (EPPM), may increase undergraduate perceptions

of their susceptibility to HIV /AIDS and increase condom use intentions. A 2 X 2 experiment

design exposes undergraduates to four HIV / AIDS poster messages in which threat and

efficacy are manipulated. A significant difference between female and male students’

perceived susceptibility to HIV / AIDS is found. No significant difference is found between

exposure to a fear appeal poster message and three other poster messages. The experiment

results have implications for future EPPM – based poster messages.

 The EPPM and HIV / AIDS Prevention 3

Project Background

Eight previous research studies on seven U.S. campuses, and one Canadian campus,

from 1995 to 2007, indicate that fifty percent or more of undergraduates do not consider

themselves vulnerable to HIV, the cause of AIDS (Campbell & Babrow 2004; Davis et al.,

2007; Desiderado & Crawford, 1995; Gagnon & Gidon, 2000; Grello et al., 2006; LaBrie et

al., 2002; Lance, 2001; National Institute of Allergy and Infectious Diseases [NIAID], 2005;

Rothman et al., 1999). The studies above indicate a consistent pattern of low perceived

susceptibility to HIV / AIDS among college student populations across broad geographical

and chronological boundaries. A consistent lack of condom use is also observed in the noted

studies (See Appendix A for details of studies). The authors of the studies have expressed

concerns about the danger of higher infection rates among undergraduates who may not be

taking effective measures to prevent HIV transmission.

Hightow et al. have reported an HIV “epidemic” occurring across several campuses in

2003, and they question the idea that undergraduates are at low risk for the disease. Hightow

et al. say results from 18 U.S. campuses in 1990 and 1991, showing an HIV prevalence of

0.06 – 0.20 percent in the overall undergraduate population, have been an accepted statistic

(2005). The CDC has confirmed a 0.20 percent infection rate in the college population (CDC,

1995;Gayle et al., 1990; Kotloff et al., 1991).). A National Health and Nutrition Examination

Survey (NHNES) reports a general U.S. population prevalence of 0.43 percent for HIV,

making undergraduates appear to be at low risk in comparison (McQuillan, Kottiri, &

Kruszon-Moran, 2002). According to Hightow et al., the 1990’s statistics may be outdated

and inaccurate, and new research is necessary (2005).

 The EPPM and HIV / AIDS Prevention 4

If undergraduates have a low perceived vulnerability to HIV infection, and their

actual risk is higher, it is important to make them aware of this vulnerability. Research shows

that HIV/AIDS is a debilitating and fatal disease even with highly successful treatment

(Masur, 2002; Yuan, L’Italien, Mukherjee, & Iloeje, 2006). Developing promotional

messages that can influence increased condom use among undergraduates is particularly

important, because research has demonstrated that consistent condom use is highly effective

in preventing the transmission of HIV during sexual intercourse (De Vincenzi, 1994).

Witte’s Extended Parallel Process Model (EPPM)

Previous research has demonstrated that a fear appeal, a type of persuasive

communication strategy, can be successful in increasing awareness about HIV/AIDS

prevention among undergraduates (Dahl, Frankenberger, & Manchanda 2003; Witte, 1994).

Witte has proposed the Extended Parallel Process Model (EPPM) for the purpose of

designing and testing fear appeals on targeted audiences. The EPPM provides a clear

framework for organizing images and language into a persuasive health promotion message

and provides guidelines for testing the messages on target audiences.

The EPPM proposes two dimensions of threat: perceived susceptibility and perceived

severity (See Figure 1 for diagram). Perceived susceptibility is a person’s belief in their risk

of being harmed by the threat (“ I think I could / could not get AIDS”). Perceived severity is

a person’s belief in how serious the threat is (“AIDS is / is not a fatal disease”). In the EPPM,

a threat is defined as something harmful or dangerous to an individual. In contrast, fear is

defined as a separate and distinctive emotional response to a perceived personal threat (Witte,

1992, 1994).
 The EPPM and HIV / AIDS Prevention 5

Next, the EPPM focuses on the importance of efficacy in fear appeals. Response

efficacy is a person’s belief in the effectiveness of a fear appeal’s recommendation for coping

with a threat (“Condom use is highly effective in preventing HIV infection.”). Self-efficacy is

a person’s belief in his own ability to employ the recommended action for handling the threat

(“I think condoms are easy/not easy to use”) (Witte, 1994) (See Figure 1).

The EPPM hypothesizes that perceptions of high threat and high self-efficacy can

motivate a constructive action to avert the threat described in a fear appeal. A successful fear

appeal persuades the message receiver that the recommended action will work, and the

receiver uses the recommendation to cope with the threat (Witte, 1994). For example, this

project’s recommendation is to use condoms consistently to avert the threat of HIV infection.

The experiment’s fear appeal combines graphic photos and language about the threat of

HIV / AIDS with persuasive research about the efficacy of condoms and the personal ease

with which they can be used (self-efficacy) (See Figures 4 and 5 for poster photos).

The EPPM hypothesizes that perceptions of low threat and low efficacy cannot

motivate a constructive action to avert the threat described in the fear appeal. According to

the EPPM, a message without graphic images and explicit written text cannot induce the

perception of personal harm necessary to influence a significant response to the message

(Witte, 1994). This project offers a test of Witte’s theory by using a bland low threat / low

efficacy message as a comparison against the effect of an explicit high threat / high efficacy

message (See Figure 6 for photo of low threat poster).

Testing EPPM Theory in a University Population

Witte’s research on fear appeals has clarified and tested theories first proposed by

Leventhal’s Parallel Process Model (PPM) in 1970. Leventhal, Singer, and Jones have
 The EPPM and HIV / AIDS Prevention 6

previously examined the role of fear in motivating compliance to health recommendations

(1965). Leventhal has broadened the research on fear and persuasion with the PPM theory.

The PPM hypothesizes that individuals respond to messages along separate tracks of

cognitive perception and fear perception (Leventhal, 1970).

Witte has expanded on Leventhal’s theory, giving it more details and expected

outcomes (1992). Witte’s 1994 investigation has tested several aspects of the EPPM with

HIV / AIDS awareness and undergraduates. The 1994 study demonstrated some persuasive

success, which has been built on in subsequent studies. For example, Witte has used the

EPPM for promotional strategies concerning skin cancer (Stephenson & Witte, 1998) and

proper hearing protection for coal miners (Stephenson et al., 2005).

Fear appeals can motivate behavior change by arousing perceptions of a threat in an

individual and by giving a recommendation for action to deal effectively with the threat

(Witte, 1994). Witte describes a Clorox ad as a good example of a commercial fear appeal.

The Clorox ad implies the threat of a serious bacterial infection in a baby’s diaper if the

parents do not use Clorox to clean and sterilize the baby’s diapers. The threat is intended to

arouse a parent’s instinct to protect their child and the fear appeal offers a solution to the

threat: “Use Clorox!” (Witte, Meyer, & Martell, 2001).

Even though Witte has shown successful results in diverse areas of health promotion,

the manipulation of fear in health messages is questioned and criticized by some researchers.

According to Stadler, some researchers caution that fear appeals may unintentionally induce

anxiety and [message] avoidance, and Albarracin et al. state that fear appeals may be counter-

productive to promoting condom use (Stadler, 2004; Albarracin et al., 2005). Witte has

pointed out that investigating failures of threat manipulations in producing a persuasive effect
 The EPPM and HIV / AIDS Prevention 7

is an important part of EPPM research (1994). More research using the EPPM is needed to

investigate the strengths and weaknesses of fear appeals.

Hypothesis I

A fear appeal composed of a high threat and high efficacy message will significantly

increase undergraduate’s perception of the severity of HIV/AIDS and the perception

of their susceptibility to HIV / AIDS. It will also increase undergraduate’s perception

of response and self-efficacy regarding condom use.

Hypothesis II

A “high threat / high efficacy fear appeal will significantly increase undergraduate’s

fear perception of HIV / AIDS and increase intentions to use condoms during sexual

intercourse.

Hypothesis III

A low threat /low efficacy message will be the least effective in changing participant’s

perceptions about severity and susceptibility, and response and self-efficacy regarding

condom use. It will be the least effective in increasing fear perceptions of HIV / AIDS

and condom use intentions.

Methods

Participants

A convenience sample of 120 GMU students has been recruited from communication

and psychology classes. Participants range in age from 18 to 55 year: 88.5 percent of

participants are under 25; 9.2 percent are between 25 and 30, and 15 percent are over 30. The

2006 GMU Factbook reports an undergraduate age range of 77.2 percent under 25, 11.6

percent between 25 and 30, and 11.2 percent over 30 (Ko, 2006). MN & SD
 The EPPM and HIV / AIDS Prevention 8

In this study, 22.5 percent of participants are male (27 total), and 77.5 percent are

female (93 total). Sexual intercourse experience is reported by 72.5 percent of participants

and 27.5 percent report “never” having sexual intercourse. Six percent are married and 47.5

percent report they are in a long-term (three months or more) relationship. The GMU

Factbook reports that 44.1 percent of undergraduates are males and 55.4 percent females,

with 0.5 percent not reported (Ko, 2006).

Procedures

Participants were been assigned to treatment groups non-randomly based on physical

and time limitations, funding for the project, and the convenience of class instructors and

their students. Students were not paid any compensation for their voluntary participation. To

test 120 participants with limited funds and time, the most convenient method of selection

was the most feasible to recruit

Permission for recruiting participants was obtained from the student’s instructors

prior to submitting a research application to the Human Subjects Review Board (HSRB).

Permission was obtained from the HSRB prior to performing the experiment. Each

participant received an informed consent form, a questionnaire to answer after exposure to a

poster message, and a debriefing statement after filling out the questionnaire.

A deceptive manipulation was used in the informed consent form to keep participants

from having any preconceptions about the experiment’s messages. This was explained in the

debriefing statement. Complete confidentiality was guaranteed in the informed consent form.

Four independent treatment groups, labeled Group A, B, C, and D, consisted of 30

students each. Each group was exposed to a poster message in their classrooms by previous

arrangement with their instructors. Exposure time was 30 seconds for each individual,
 The EPPM and HIV / AIDS Prevention 9

measured with a stopwatch by the researcher. Group A was exposed to a high threat / high

efficacy message, Group B was exposed to a low threat / high efficacy message, Group C has

been exposed to a high threat / low efficacy message, and Group D was exposed to a low

threat / low efficacy message (See Figure 2 for diagram).

This project replicated methods and content used in three previous studies. First,

Dahl, Frankenberger, and Manchanda have demonstrated that a fear appeal poster is an

effective method for transmitting an HIV / AIDS awareness message to undergraduates (Dahl

et al., 2003). Second, fear appeal poster designs and EPPM-based analysis questions were

borrowed from Muthuswamy ‘s 2006 research and from Witte, Meyer, and Martell (2001).

Finally, a mirror in each poster relates to Turk, Ewing, and Newton’s study, which indicated

that a mirror placed in an HIV awareness poster increases the viewer’s personal identification

with the message (2006).

Materials

Three posters have been constructed using threat and efficacy levels based on the

EPPM. A fourth poster would have displayed a low efficacy message. No poster is used for

the low efficacy message because the researcher has been advised that influencing any

perception of ineffectiveness among participants is unethical.

The posters follow a 2 x 2 factor design. Two levels of threat and efficacy messages

are used to create four HIV / AIDS prevention messages. The message content ranges from a

high threat / high efficacy fear appeal to a low threat / low efficacy HIV / AIDS message.

The main independent variables in the experiment are four messages constructed with

specific levels of threat and efficacy content. There is a high threat message, a low threat

message, a high efficacy message, and a low efficacy message (no poster displayed for
 The EPPM and HIV / AIDS Prevention 10

ethical reasons). Separate threat and efficacy posters have been constructed to clearly

transmit the level of threat and efficacy to participants during their exposure (See Figures

3 – 6 for photos of posters used).

There are six dependent variables measured in the experiment. Participant’s perceived

severity of HIV / AIDS; perceived susceptibility to HIV / AIDS; perceived efficacy response

of condom use and perceived self-efficacy with condoms; perceived fear of HIV / AIDS; and

their the intention to use condoms in the future. The instrument used to measure the variables

is an EPPM-based questionnaire, with questions answered on a 5 – point Likert scale (See

Appendix B for examples).

The dependent variables are measured by asking participants five redundant questions

for each of six dependent variables. The redundancy insures the validity of responses, which

are recorded by participants after their exposure to one of the messages. Gender is also used

as an independent variable in part of the analysis of variance statistics.

Results

Hypothesis I

A fear appeal composed of a high threat and high efficacy message will

significantly increase undergraduate’s perception of the severity of HIV/AIDS

and the perception of their susceptibility to HIV / AIDS. It will also increase

undergraduate’s perception of response and self-efficacy regarding condom use.

Table C 1 shows the means and standard deviations for participant’s post - exposure

scores for perceived severity, perceived susceptibility, perceived response efficacy, and

perceived self-efficacy. The scores show little variation between treatment groups, indicating
 The EPPM and HIV / AIDS Prevention 11

little change in participant perceptions between different exposure conditions. Statistically,

no significant difference in treatment effect is indicated by these scores.

Table C 2 shows the results of a two – way analysis of variance (ANOVA). Main

effects and interaction effects data for participant’s perceived severity, perceived

susceptibility, perceived response efficacy, and perceived self-efficacy are presented with

related probability values. No statistically significant difference is indicated between four

threat and efficacy conditions manipulated in the experiment. The null hypothesis is not

rejected by the data.

ANOVA Results: Hypothesis I

Perceived Severity F (1, 116) = .253, p < .616, η = .002.

Perceived Susceptibility F (1, 116) = .063, p < .803, η = .001.

Perceived Response Efficacy F (1, 116) = 1.944, p < .166, η = .016.

Perceived Self – Efficacy F (1, 116) = .374, p < .542, η = .003.

(See Table C2 for details).

Hypothesis II

A “high threat / high efficacy fear appeal will significantly increase undergraduate’s

fear perception of HIV / AIDS and increase intentions to use condoms during sexual

intercourse.

Tables C1 and C2 include means, standard deviations, and two – way ANOVA results

for participant’s fear perceptions of HIV / AIDS and condom use intentions after exposure to

four threat and efficacy conditions. Little variation is indicated by the mean scores from four
 The EPPM and HIV / AIDS Prevention 12

treatment groups. The ANOVA results show no statistically significant difference between

exposures to four treatment conditions. The null hypothesis is not rejected by the data.

ANOVA Results: Hypothesis II

Perceived Fear F (1, 116) = .345, p < .558, η = .003.

Condom Intentions F (1, 116) = 1.061, p < .305, η = .009.

(See Table C2 for details).

Hypothesis III

A low threat /low efficacy message will be the least effective in changing participant’s

perceptions about severity and susceptibility, and response and self-efficacy regarding

condom use. It will be the least effective in increasing fear perceptions of HIV / AIDS

and condom use intentions.

Tables C1 and C2 show means, standard deviations, and ANOVA results. No

significant variation is indicated by the mean scores across four treatment conditions.

ANOVA results show no statistically significant difference between treatment conditions.

The null hypothesis is not rejected by the data. Related ANOVA data is listed with

Hypothesis II.

Table D1 shows the means, standard deviations and one – way analysis of variance

results for the total scores recorded by male and female subjects regarding perceptions of

susceptibility to HIV / AIDS. No hypothesis has been offered for this relationship, but an

examination of the data indicated a significant difference in gender. The ANOVA finds a

significant difference between male and female perceptions of susceptibility to

 The EPPM and HIV / AIDS Prevention 13

HIV/AIDS, F (1, 118) = 6.627, p < .011, η = .053. No other statistically significant difference

is demonstrated between male and female perceptions recorded in the experiment.

(See Table D1 for more details).

Discussion

Corcoran has stated that all methods of behavior changing communication can be

used effectively for health promotion messages, and that practitioners basically make

their own choices (Corcoran, 2007). Corcoran, and Kreps and Thorton, say a health

promotion message must clearly present a true threat that can actually be averted by the

recommended action in the message in order to motivate behavior change (Corcoran,

2007; Kreps & Thorton, 1992). This project has tested the EPPM theory because it has

shown previous success with HIV / AIDS awareness promotion among undergraduates,

and it clearly outlines a strategy that focuses on creating threat and efficacy messages for

target audiences.

The results of this study suggest that posters alone may have little effect on

perceptions of threat and vulnerability to HIV / AIDS in an undergraduate population. No

statistically significant differences have been found between participant’s exposure to

four levels of threat and efficacy messages promoting HIV / AIDS awareness and

condom use. No statistical significance is demonstrated by main effects and interaction

effects analyzed for perceived severity of HIV / AIDS and susceptibility to HIV / AIDS;

perceived response and self – efficacy pertaining to condom use; perceived fear of HIV /

AIDS; and intentions for condom use.

A statistically significant difference between gender and perceived susceptibility

to HIV / AIDS has been found as a result of this project. This is notable because research
 The EPPM and HIV / AIDS Prevention 14

has shown that females are at much higher risk for HIV infection as a result of

heterosexual intercourse than males (National Institute of Allergy and Infectious Diseases

[NIAID], 2006). Considering the awareness in the sample group of the severity of

HIV / AIDS and self – efficacy, it seems incongruent that women in the sample are not

knowledgeable about their higher risk for infection compared to men.

A short duration of exposure, common to a poster message, may limit posters

effectiveness in changing perceptions and behavior. This experiment has limited exposure

to the poster messages to 30 seconds in order to replicate the effect of observing a poster

for the first time while passing it in a school hallway. While threat and efficacy content

has been graphically and vividly presented in a high threat / high efficacy message, other

detailed information in the poster may not have been transmitted and received in the time

available. Exposure time factors and participant’s retention of message content could be

the basis for a separate investigation of poster message effectiveness.

Longer duration HIV / AIDS programs and promotions have demonstrated a

significant effect in changing behavior in undergraduate populations. Rothman’s study,

for example, demonstrates an increase in perceived risk of HIV infection in

undergraduates who are exposed to a film of interviews with young adults who are HIV

positive (1999). The results from a longer message exposure suggest that the amount of

time subjects spend with an HIV prevention message may be crucial to changing risky

sexual behavior.

Additionally, Rothman suggests that a strong personal identification with the

film’s subjects may have increased message acceptance by undergraduate participants

(1999). To influence male and female identification with susceptibility to HIV / AIDS,
 The EPPM and HIV / AIDS Prevention 15

this experiment’s fear appeal includes graphic photos of a male and female young adult

who are seriously ill with AIDS. The process of identifying with the subjects in the poster

may have been disrupted by participant’s spending more time on the written text of the

poster.

Posters can play an important part in maintaining a healthy level of awareness of

the threat of HIV infection among undergraduates in conjunction with education and

health promotion programs. Positive poster messages can also stimulate the use of HIV

services available to students. For example, free HIV testing at GMU is advertised with

posters on campus in several public buildings.

This experiment has revealed a relatively high perception of the severity of HIV /

AIDS in the GMU undergraduate population, and also high efficacy scores. GMU

students in all four treatment groups perceive HIV / AIDS as a severe disease,

demonstrated by their scores ranging from 4.3 – 4.6, 5 being “strongly agree” Scores also

reflect that a majority of participants in this study exhibit proactive attitudes regarding

response efficacy of condom use for preventing HIV transmission, self-efficacy with

using condoms, and intentions for using condoms (See Table C1).

It seems unlikely that scores on perceived severity and efficacy, and intentions for

condom use could be increased much higher in the GMU sample population, because

they are presently close to the top of the measurement scale. It seems counter - intuitive

that severity perception does not equate with susceptibility and fear perception in this

population, but descriptive statistics for the majority of participants suggest that this

sample group engages in low – risk sexual behaviors, not high risk behaviors. Low – risk
 The EPPM and HIV / AIDS Prevention 16

behaviors in the sample group may account in part for perceived low – susceptibility to

HIV / AIDS.

For example, compared to other sample groups in the literature review, the GMU

sample has the highest ratio of single sex partners over at least three months (63.3

percent). It also has the only reported ratio of sexually experienced students without a sex

partner for at least three months (22.8 percent) (See Appendix A for details). If the

majority of this sample is knowledgeable about HIV transmission and already engaged in

sufficient preventive measures against it, perceptions of low susceptibility may be a

logical choice.

Limitations

This study is limited to a U.S. undergraduate population that has been expected to

have minimal concerns about HIV/AIDS based on eight previous undergraduate studies.

A sample group with high levels of fear toward HIV / AIDS may have responded

differently. For example, Muthuswamy’s research has demonstrated that African

undergraduates with heightened concerns about HIV / AIDS respond negatively to fear

appeals (Muthuswamy, 2006). Experimentation with regard to cultural factors and their

influence on perceptions of threat and efficacy messages may continue to reveal the range

of flexibility, or lack of, with EPPM theory.

This project has been limited to a convenience sample due to scheduling

constraints, funding limitations, and physical contingencies associated with testing 120

participants. Every step possible within these limitations has been taken to isolate

treatment groups and treatment conditions. A sample ratio of 22.5 percent males to 77.5
 The EPPM and HIV / AIDS Prevention 17

percent females, compared to a 44.1 percent males to 55.4 percent females ratio in the

GMU undergraduate population, is a result of using a convenient sample.

The amount of direct, physically close exposure to the messages in this

experiment has been limited to one 30 – second exposure. This is appropriate for a poster,

but how many exposures to a poster message is enough to change unhealthy behavior?

Can there be over-exposure leading to negative results? What number of posters should

be used, for what number of people, in what time frame? How long does the persuasive

effect of the poster message last? A longitudinal study could be performed to answer

these questions.

It is common knowledge that the size of a health campaign is based on the

size of the health problem being addressed. It is counterproductive to present HIV / AIDS

to undergraduates as a serious threat to them without hard data supporting this claim. HIV

prevention programs, and the students they serve, will benefit from new research if it

provides a more accurate account of the current severity of HIV / AIDS and

undergraduate’s current risk for infection. The final step for health communication

research is to represent this information clearly and persuasively to vulnerable target

audiences.
 The EPPM and HIV / AIDS Prevention 18

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model. Communication Monographs 59.

Witte (1994). Fear control and danger control: A test of the extended parallel process

model (EPPM): Communication Monographs. 61,113-134.

Witte, K., Meyer, A., & Martell, A. (2001). Effective health risk messages. Thousand

Oaks, CA: Sage Publications, Inc.

Yuan, Y., L’Italian, G., Mukherjee, J., Iloeje, UH (2006, April). HIV Medicine 7.3, 156-

162,
 The EPPM and HIV / AIDS Prevention 23

Appendix A

Risky Sexual Behavior Reported in Undergraduate Populations

Year Author(s) Condom Use Sexually Casual Number of Sex Partners Perceived
of as Reported Active Sex Risk for
Stud HIV
y Infection
2008 Turner “Most of the time’ to 72.5 % XX 0 in 3 mo.: 22.8 %. Low
“Always”: 53 %
1 in 3 mo.: 63.3 %
“Rarely” to “Never”:
26.6 % 2 or more in 3 mo.: 8.9%
2007 Davis et “No Intention”: 20% 77 % XX Low
al.
“Frequently”: 42.5 %

2006 Grello et XX 76 % 53 % Multiple Partners XX

al.. 53 %
2004 Campbell XX 67 % 39 % Multiple Partners XX
& Babrow 39 %
2002 LaBrie et XX 62 % XX 2 or more in last 6 mos. XX
al. 100 %

2000 Gagnon & “Always / Almost 69 % XX 1 in 6 mo.: 51 % XX

Gidon “always”: 79%

“Less than half the

time “:69%
1999 Lance None 24.4%: XX XX XX XX

“Sometimes”:
26.8%
1999 Rothman None: 50% 55 % XX XX Low
et al.
1995 Desiderato “Inconsistent or 66 % XX More than 1: 33 % Low
& none”: 75%
Crawford

Note: XX = not reported. mo. = month.

Complete citations in References section..
 The EPPM and HIV / AIDS Prevention 24

Appendix B

Examples of Questions Based on the EPPM

All questions followed by five-point Likert scale as shown below.

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree

Perceived Severity of Threat

I believe that HIV/AIDS is a serious disease.

I think AIDS is a fatal disease.

Perceived Susceptibility to Threat

It is likely that I am at risk for getting HIV/AIDS.

I feel that I may get HIV/AIDS.

Perceived Response Efficacy

I am protected against HIV infection if I use a condom during sex.

Using condoms is an effective way to prevent HIV infection.

Perceived self-efficacy

Condoms are easy for me to use.

I can use condoms without difficulty.

 The EPPM and HIV / AIDS Prevention 25

Muthuswamy, N. (2006). Scaring the already scared: some

problems with hiv/aid fear appeals in africa. Communications
Monographs, unpublished manuscript.
Witte, K., Meyer, A., & Martell, A. (2001). Effective health risk
messages. Thousand Oaks, CA: Sage Publications, Inc.

Appendix B

Examples of Questions Based on the EPPM

All questions followed by five-point Likert scale as shown below.

1 2 3 4 5
Strongly Disagree Neutral Agree Strongly
Disagree Agree

Perceived Fear

I feel frightened of HIV/AIDS.

. The subject of AIDS makes me anxious.

Condom Use Intentions

. I intend to buy condoms or tell my partner to buy condoms in the next couple of weeks.

I will insist that my sex partner and I need to use condoms.

 The EPPM and HIV / AIDS Prevention 26

Muthuswamy, N. (2006). Scaring the already scared: some

problems with hiv/aid fear appeals in africa. Communications Appendix C
Monographs, unpublished manuscript.
Witte, K., Meyer, A., & Martell, A. (2001). Effective health risk
Table
messages. Thousand Oaks,C 1 Sage Publications, Inc.
CA:

Means and Standard Deviations for Treatment Conditions and Variables

Condition

(A) (B) (C) (D)

High Threat / Low Threat / High Threat / Low Threat /

High Efficacy High Efficacy Low EFficacy Low Efficacy

MN SD MN SD MN SD MN SD
Variable

Perceived
Severity 4.393 .4472 4.60 .5367 4.427 .5699 4.293 .6097

Perceived
Suscept 2.146 .833 2.146 .920 2.193 .837 2.113 .906
-ibility

Perceived
Response 4.220 .639 3.986 .787 3.966 .726 4.100 .719
Efficacy

Perceived
Self- 3.953 .611 3.680 .620 3.833 .548 3.706 .816
Efficacy
 The EPPM and HIV / AIDS Prevention 27

Perceived
Fear 3.013 .827 3.067 .822 3.060 1.086 2.900 1.190

Condom
Intentions 3.653 .856 3.506 .878 3.413 .825 3.606 1.040

Note: (A), (B), (C), (D) = Treatment Group Label. Means based on 1 – 5 Likert Scale
Appendix C

Table C 2

Analysis of Variance for Threat an Efficacy: Effects of Six Variables

Variable and Source

Perceived df MS F p η
Severity
.704 .403 .006
efficacy 1 .208

3.405 .068 .029

threat 1 1.008
Perceived df MS F p η
Suscept-
efficacy * threat 116 .075 .253 .616 .002
ibility

efficacy 1 .001. .002 .967 .000

Total 120

threat 1 .048 .063 .803 .001

efficacy * threat
.048 .063 .803 .001

Total 120

Note: Mean scores are on a 5 – point Likert Scale.

 The EPPM and HIV / AIDS Prevention 28

Appendix C

Table C 2

Analysis of Variance for Threat an Efficacy: Effects of Six Variables

Variable and Source

Perceived df MS F p η
Response
Efficacy

efficacy 1 .147 .283 .595 .002

threat 1 .075 .145 .704 .001

efficacy * threat 116 1.008 1.944 .166 .016

Total 120

Perceived df MS F p η
Self-Efficacy

efficacy 1 .065 .151 .698 .001

threat 1 1.200 2.779 .098 .023

efficacy * threat 116 .161 .374 .542 .003

Total 120

Note: Mean scores are on a 5 – point Likert Scale.

 The EPPM and HIV / AIDS Prevention 29

Appendix C

Table C 2

Analysis of Variance for Threat an Efficacy: Effects of Six Variables

Perceived Fear df MS F p η

efficacy 1 .108 .109 .742 .001

threat 1 .085 .086 .770 .001

efficacy * threat 116 .341 .345 .558 .003

Total 120

Variable and Source

Condom df MS F p η
Intentions

efficacy 1 .147 .180 .672 .002

threat 1 .016 .020 .888 .000

efficacy * threat 116 .867 1.061 .305 .009

Total 120

Note: Mean scores are on a 5 – point Likert Scale.

 The EPPM and HIV / AIDS Prevention 30

Appendix D

Table D 1

One Way Analysis of Variance for Gender and Perceived Susceptibility to HIV / AIDS

Males Females

Variable Mean Score SD Mean Score SD

Perceived
Susceptibility 2.5 .80 2.04 .86
to HIV / AIDS

Table D 2

Source df SS MS F p η

Between 1 4.731 4.731 6.627* .011 .053

Groups

Within 118 84.249 .714

Groups

Total 120 643.68

Note: Mean scores are on a 5 – point Likert Scale. * P < .011

 The EPPM and HIV / AIDS Prevention 31

Figure 1. Witte’s Extended Parallel Process Model (EPPM)

Witte, K. (1992). Putting the fear back into fear appeals: the extended parallel process
model. Communication Monographs 59, December 1992.
 The EPPM and HIV / AIDS Prevention 32

Figure 2. Threat and Efficacy 2 X 2 Diagram Showing Treatment Groups

The EPPM and HIV / AIDS Prevention 33

T
HR EAT
MES SAGE
The EPPM and HIV / AIDS Prevention 34
The EPPM and HIV / AIDS Prevention 35

HIGH LOW
The EPPM and HIV / AIDS Prevention 36
The EPPM and HIV / AIDS Prevention 37
 The EPPM and HIV / AIDS Prevention 38

A B

1. HIGH 2. LOW
HIGH THREAT THREAT
EFFICACY 1. HIGH
1.HIGH
MESSAGE EFFICACY EFFICACY
 The EPPM and HIV / AIDS Prevention 39

C D

1. HIGH 2. LOW
THREAT THREAT
LOW

2. LOW 2. LOW
EFFICACY EFFICACY
(NO POSTER) (NO POSTER)

TREATMENT
MESSAGE STRENGTH GROUP LABELS
THREAT 1. HIGH A, B, C, D
2. LOW
EFFICACY 1. HIGH
2. LOW
Figure 3. EPPM Experiment Poster Design
Figure 2 by Author
11/22/07
MIRROR
Mirror

CRYPTOCOCCOSIS / AIDS WASTING SYNDROME /AIDS

THIS COULDHAPPENTOYOU: Medical Research New Quick Test Devices

MAYBE IT’S HAPPENING ALREADY LOWHIVINFECTIONRATE

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AIDS: ACQUIREDIMMUNODEFIENCYSYNDROME, A DISEASE
ACCORDINGTODE VINCEN ZTI'S
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1
1 2
National Health and Nutrition Examination Study, 2002
20 MONTH STUDY, 124 COUPLES. DIVENZI STUDY,1994
3
National Institute of Allergy and Infectious Diseases ,2007
TIPSFORTALKINGABONat
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START BY ACKNOWLEDGING EMBARRASSMENT: "THIS IS DIFFICULT FOR ME TOTALK
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havean STDand not knowit. I'mtrusting you to careabout our health."
THESE TIPSCANHELPYOUPLANYOURTALKABOUT CONDOMS.MAKE IT CLEAR
THAT YOUWON'T HAVE SEXUAL INTERCOURSE WITH
Message
FOR MOREHigh
Designs by Author
INFOABOUTEfficacy Message
USINGCONDOMS AN
06/23/08
D TALKING ABOUT CONDOMS: Low Efficacy Message
High Threat Message
USE SEARCHTERM"TALKINGABOUT C
Figure 4. High Threat Poster

MIRROR

MIRROR

CRYPTOCOCCOSIS / AIDS WASTING SYNDROME /AIDS

THIS COULDHAPPENTOYOU:
YOU CAN
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HAPPEN TG
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Message Designs by Author 06/23/08

 Figure 6. Low Threat Poster

Mirror

Medical Research New Quick Test Devices

LOWHIVINFECTIONRATE
INCOLLEGE STUDENTS
REPORTEDBYTHE NEWENGLANDJ OURNAL OF MEDICINE
ANDAMERICANJ OURNAL OF EPIDEMIOLOGY 1

COLLEGE STUDENTSARE SEVENTIMESLESSLIKELYTOBE INFECTED

THANTHE REST OF THE U.S. POPULATION, ACCORDING TOTHE
NATIONAL HEALTHANDNUTRITIONEXAMINATION STUDY2
HIV: HUMANIMMUNODEFICIENCY VIRUS. HIVCAUSES AIDS3
AIDS: ACQUIREDIMMUNODEFIENCY SYNDROME3

COLLEGE STUDENTS USE CONDOMS FREQUENTLY, ACCORDING

TOGAGNONANDGIDONSTUDY
CONDOMS ARE HIGHLYEFFECTIVE AGAINST HIVINFECTION,
WHENUSEDPROPERLYANDEVERYTIME, ACCORDING TODEVINCENZI RESEARCH. 5

FOR MORE INFORMATIONONHEALTHY LIVING, CONTACT OR VISIT GEORGE MASON'S

STUDENT HEALTHSERVICES, SUB I, ROOM214
1
Gayle, H.D., (1990). The NewEngland Journal of Medicine
Kotloff, K.L, . (1991). American Journal of Epidemiology
2
National Health and Nutrition Examination Study, 2002
3
National Institute ofAllergy and Infectious Diseases ,2007
4
Gagnon and Gidon 2000
5
De Vincenzi Study,1994
Message Designs by Author 06/23/08

Message Designs by Author 06/23/08