Strategies for promoting health — practice questions

(a) Percentage point increase calculation:

• Step 1: Calculate pre-campaign percentage. (1,500 students / 10,000 total students) * 100 = 15%
• Step 2: Calculate post-campaign percentage. (2,500 students / 10,000 total students) * 100 = 25%
• Step 3: Calculate the percentage point increase. 25% - 15% = 10 percentage points. Answer: There was a 10 percentage point increase in weekly gym usage.

(b) Mean TPB component increase calculation:

• Step 1: Calculate the increase for each component.
  • Attitude increase = 5.8 - 4.2 = 1.6 points
  • Subjective Norms increase = 5.1 - 3.5 = 1.6 points
  • PBC increase = 4.1 - 3.8 = 0.3 points
• Step 2: Calculate the mean of these increases. Mean increase = (1.6 + 1.6 + 0.3) / 3 Mean increase = 3.5 / 3 = 1.17 (to 2 d.p.) Answer: The mean increase across the three TPB components was 1.17 points.

(c) Explanation of campaign success:

• Most successful: The campaign was most successful at changing Attitude and Subjective Norms, both of which increased by a significant 1.6 points. This suggests the campaign effectively communicated the benefits of exercise (improving attitude) and created a perception that gym use was a socially desirable and normal activity among peers (improving subjective norms). For example, they might have used posters showing students having fun at the gym and testimonials from student leaders.
• Least successful: The campaign was least successful at changing Perceived Behavioural Control (PBC), which only increased by 0.3 points. This indicates the campaign failed to adequately address the practical barriers students face, such as lack of time due to studies, gym opening hours, or perceived cost. The small increase in PBC suggests that while students' attitudes and intentions became more positive, their confidence in their ability to overcome obstacles to actually go to the gym did not change much.

(a) Strategy and model:

• Primary prevention strategy — aims to prevent smoking-related illness before it occurs.
• Fear appeal persuasive communication — graphic images create emotional response.
• Health Belief Model — targets perceived severity and susceptibility; quitline addresses barriers.

(b) HBM applied:

• Perceived susceptibility: Images link smoking to "this could happen to me."
• Perceived severity: Graphic lung cancer images emphasise serious, life-threatening consequences.
• Perceived benefits: Quitline offers accessible support — benefits of quitting feel achievable.
• Perceived barriers: Quitline reduces barrier of not knowing how to stop; NRT availability lowers withdrawal barrier.
• Cue to action: Warning images on every packet serve as constant reminder.

(c) Evaluation of fear appeals:

• Strengths:
  • Janis (1967) — moderate fear + efficacy message = behaviour change; UK plain packaging evidence shows reduced smoking appeal in youth.
  • Targets System 1 thinking (Kahneman) — emotional gut response bypasses rational denial.
  • Cost-effective at population level — reaches all smokers daily.
• Limitations:
  • Excessive fear → defensive avoidance — smokers may deny relevance ("that won't happen to me" — optimism bias).
  • Individual differences — already-motivated smokers respond; addicted smokers need pharmacological support, not just fear.
  • Ethical concerns — graphic images may cause distress to non-smokers and ex-smokers; paternalistic.
  • Cultural effectiveness varies — HBM developed in individualist US; collectivist cultures may respond better to social norm messages (TPB subjective norms).
  • Does not address social barriers — peer smoking, stress, poverty driving smoking behaviour.

Judgement: Fear appeals work best as part of multi-component campaign combining threat, efficacy, and barrier reduction — not fear alone.