Revisiting Health Communication Campaigns: Unintended Harms

The purpose behind health communication campaigns is evidently and primarily to sustain public health awareness among the target audiences. There are several approaches, and each campaign chooses its theoretical approach after a careful consideration of the psychological, physiological, and ethical concerns. Nevertheless, these campaigns are still prone to commit unintended but serious mistakes. Health communication campaigns must take into account the psychological and emotional impacts these campaigns can have on their target audiences, for the negative consequences, such as victim blaming, psychological distress, and anger and anxiety, can be severe, and at times, the damages can be irreparable.

Victim Blaming

It is important to begin with the adverse psychological and emotional impacts health communication campaigns are capable to have on their target audiences. Some health campaigns unintentionally result in blaming the victim. We mean by unintentionally that the objective behind the campaign is utterly to spread awareness. However, due to the lack of certain considerations, it results in psychological or emotional harms. Guttman & Ressler (2001) gave exceptional examples to clarify this particular point. HIV prevention messages were used among women to spread awareness about the importance of using condoms (Guttman & Ressler, 2001). Results showed that women in abusive relationships were not able to ask their partners to use condoms, they instead experienced severe physical and verbal abuse which left them in a state of guilt and blame (Guttman & Ressler, 2001). A further example is the Israeli traffic safety campaign whose main slogan was “traffic violations carry the death sentence” (Guttman & Ressler, 2001). This was a big deal in Israel because the only person who has ever been executed is a high-ranking Nazi especially that some of those who acquaint accidents are people who do not deserve death sentences such as children, cyclists, and elderly people etc. (Guttman & Ressler, 2001). These people might actually be the victims in such cases; hence, it takes us back to blaming the victim (Guttman & Ressler, 2001). Therefore, health communication campaigns must be aware of the psychological and emotional damages before launching one.

Psychological Distress

Another unintended fallacy health campaigns have on their target audiences is psychological distress. Psychological distress occurs: 1) when people realize that their desired health state found in a health message and their current state are not similar, and 2) when they find that they lack the means and the ability to reduce this gap (Cho & Salmon, 2007). Behavior change models suggest that on top of the incentive to change, people should also have internal resources in order to perform the recommended behavior (Cho & Salmon, 2007). Hence, when people feel the urge to change but believe that they do not have the necessary environmental supports or the needed abilities, they end up in psychological distress (Cho & Salmon, 2007). It is worth to note that available evidence postulates that similar dissonance experience may be the sharpest among people who are motivated the most but lack the needed abilities (Cho & Salmon, 2007). This key point was also mentioned by Miller & Quick (2010). When people feel the gap between what they are and what they want to be, they will experience unpleasant motivational state of psychological reactance (PR) that consists of a combination of negative cognitions and anger (Miller & Quick, 2010). Cho & Salmon (2007) supported their argument with an example about the Minnesota CANDI Project. This project was created to increase fruits and vegetables consumption in order to reduce cancer risk (Cho & Salmon, 2007). Nonetheless, this study completely disregarded the fact that some people are unable to purchase fruits and vegetables because their low-income neighborhood store only sells commercially prepared food, usually high in calories and fats and low in nutritional values (Guttman & Ressler, 2001). This would render the target audiences in a constant state of psychological distress, rather than motivating them to reach their goal.

Anger and Anxiety

Additional negative consequences communication health campaigns can have on their target audiences are anger and anxiety. It is crucial to understand how to communicate with emotions before starting a communication health campaign. It was proven that emotions’ cognitive appraisals determined that pleasantness, attention, certainty, anticipated obstacles or efforts, and agency attributions can distinguish 13 unique emotions (Turner, 2012). These appraisals have repercussions for how emotions are communicated, and in others, created (Turner, 2012). Two scenarios were given about lung cancer health awareness messages (Turner, 2012). The first communicated the distress (unpleasant), unpredictability (low certainty), and threat of lung cancer (Turner, 2012). Messages as such will cause their target audiences fear and anxiety (Turner, 2012). However, if these health messages were framed as lung cancer only targets smokers and second-hand smokers, there will be unpleasantness, high certainty, and human control which will result in anger rather than anxiety among non-smoking audience (Turner, 2012). Emotional appeals are often used in public health as persuasive devices, and the “frequent themes” are anger and guilt (Turner, 2012). To begin with anger appeals, they are messages that communicate a demeaning offense to the audience (Turner, 2012). They communicate that the intentional negative event caused by another person must be taken care of and paid attention to (Turner, 2012). Anger is provoked by situations where barriers interrupt demeaning offenses and/or goal-congruent behavior (Turner, 2012). Anger appeals may only be used when there is a violation of rights (Turner, 2012). For instance, People for Ethical Treatment of Animals (PETA) elicits the target audiences’ anger through advertisements that depict visual and verbal violence against animals (Turner, 2012). In this case only, resorting to anger appeals is viable. On the other hand, guilt appeals have two components, the material that arouses guilt and the recommended action (Turner, 2012). The target audiences are supposed to be conscious of the discrepancy, anticipate feeling guilty or feel guilty if they act upon a given manner (Turner, 2012). Equivalent to anger appeals, guilt appeals may only be used if a person’s controllable behavior harms others (Turner, 2012). For example, in cases like drunk-driving, guilt appeals make sense, for it can limit the harming behavior and spread awareness with zero emotional damages (Turner, 2012). This shows that anger and guilt appeals result in severe psychological and emotional harms and should be used wisely.

Drawbacks of the IMBP

In spite of the psychological and emotional harms mentioned above, the Integrative Model of Behavioral Prediction (IMBP) has a different opinion. It focuses on the three major cognitions (i.e. attitudes, norms, and control) in order to achieve the optimum results. IMBP is a combination between the Theory of Reasoned Action and the Theory of Planned Behavior (Robbins & Niederdeppe, 2015). It is thought to have more effect on the target audiences than other theories, for it directly controls individuals’ behaviors (Robbins & Niederdeppe, 2015). Some of the limitations of IMBP has are behavioral intention and motivation, i.e., threat, fear, mood, and/or past experience. However, the case Robbins & Niederdeppe (2015) studied here is the promotion of healthy sleep behavior among college students. There were not any vulnerable participants, and the health campaign did not tackle a sensitive issue. Hence, there were not any serious psychological or emotional harms to be taken into account. Results showed that the sleeping behaviors among college students improved (Robbins & Niederdeppe, 2015). Nevertheless, that does not mean that the application of IMBP on other cases would be as useful. For instance, the Israeli traffic safety campaign resulted in blaming the victim after they used fear appeals to prevent traffic violation, and the cancer risk prevention messages resulted in psychological distress after they used motivation appeals to promote fruits and vegetables consumption. Therefore, IMBP, along with other behavioral theories, are effective, but they must be used meticulously, for their misuse can lead their target audiences to encounter severe psychological and emotional risks.


Generally speaking, health communication campaigns are not being accused of causing their target audiences mental and emotional harms, per se. Nonetheless, one has to be cautious while addressing a given audience. Numerous campaigns disregard the adverse consequences of the health communication theory they use; some of which are the psychological and emotional harms. Regardless of the theory’s impact, and the high reach of the targeted individuals, psychological and emotional harms must be considered owing to the severity of the drawbacks. These harms include victim blaming, psychological distress, and anger and anxiety.


Cho, H., & Salmon, C. T. (2007). Unintended effects of health communication campaigns. Journal of communication, 57(2), 293–317.

Guttman, N., & Ressler, W. H. (2001). On being responsible: Ethical issues in appeals to personal responsibility in health campaigns. Journal of health communication, 6(2), 117–136.

Miller, C. H., & Quick, B. L. (2010). Sensation seeking and psychological reactance as health risk predictors for an emerging adult population. Health communication, 25(3), 266–275.

Robbins, R., & Niederdeppe, J. (2015). Using the integrative model of behavioral prediction to identify promising message strategies to promote healthy sleep behavior among college students. Health communication, 30(1), 26–38.

Turner, M. M. (2012). Using emotional appeals in health messages. Health Communication Message Design. Thousand Oaks: Sage Publications, Inc, 59–73.

Ph.D. in Media and Communication Studies|M.A. in Migration Studies|B.A. in Jounalism