What constitutes evidence that fear appeals have positive effects on health behaviour? Commentary on Kok, Peters, Kessels, ten Hoor, and Ruiter (2018)

The central argument of the provocative article by Kok et al. (2018) is that fear appeals usually do not work to change health-related behaviour. The main basis for the argument is that (1) there are no convincing studies with experimental methods (the gold standard of research) that show fear appeals work in the absence of high-self-efficacy to change the health behaviour and (2) smokers have low self-efficacy for quitting. I agree with the authors that experimental methods are good for reaching causal conclusions. I also agree that the higher the self-efficacy individuals have for changing a health-related behaviour, the more likely they are to make the change. Finally, I agree that behaviour change is the most important type of change a person can make with regard to reducing health risks. I will describe briefly below my disagreements with aspects of the article. The disagreements relate to ways to show causation, how much self-efficacy smokers have, the importance of stages of change in quitting, and the importance of prevention.