1. History

Protection motivation theory was developed by R.W. Rogers in 1975 in order to better understand fear appeals and how people cope with them.^[1] However, Dr. Rogers would later expand on the theory in 1983 to a more general theory of persuasive communication. The theory was originally based on the work of Richard Lazarus, who researched how people behave and cope during stressful situations. In his book, Stress, Appraisal, and Coping, Richard Lazarus discusses the idea of the cognitive appraisal processes and how they relate to coping with stress. He states that people "differ in their sensitivity and vulnerability to certain types of events, as well as in their interpretations and reactions".^[2] While Richard Lazarus came up with many of the fundamental ideas used in the protection motivation theory, Rogers was the first to apply the terminology when discussing fear appeals. In modern times, the protection motivation theory is mainly used when discussing health issues and how people react when diagnosed with health related illnesses.

2. Theory

2.1. Threat-appraisal Process

The threat appraisal process consists of both the severity and vulnerability of the situation. It focuses on the source of the threat and factors that increase or decrease likelihood of maladaptive behaviours.^[3] Severity refers to the degree of harm from the unhealthy behavior. Vulnerability is the probability that one will experience harm. Another aspect of the threat appraisal is rewards. Rewards refer to the positive aspects of starting or continuing the unhealthy behavior. To calculate the amount of threat experienced take the combination of both the severity and vulnerability, and then subtract the rewards. Threat appraisal refers to children's evaluation of the degree to which an event has significant implications for their well-being. Theoretically, threat appraisal is related to Lazaraus' concept of primary appraisal, particularly to the way in which the event threatens the child's commitments, goals, or values. Threat appraisal is differentiated from the evaluation of stressfulness or impact of the event in that is assesses what is threatened, rather than simply the degree of stress or negativity of an event. Threat appraisal is also differentiated from negative cognitive styles, because it assesses children's reported negative appraisals for specific events in their lives rather than their typical style of responding to stressful events. Theoretically, higher threat appraisals should lead to negative arousal and coping and to increased psychological symptomatology.

2.2. Coping-appraisal Process

The coping appraisal consists of the response efficacy, self-efficacy, and the response costs. Response efficacy is the effectiveness of the recommended behavior in removing or preventing possible harm. Self-efficacy is the belief that one can successfully enact the recommended behavior. The response costs are the costs associated with the recommended behavior. The amount of coping ability that one experiences is the combination of response efficacy and self-efficacy, minus the response costs. The coping appraisal process focuses on the adaptive responses and one's ability to cope with and avert the threat. The coping appraisal is the sum of the appraisals of the responses efficacy and self-efficacy, minus any physical or psychological "costs" of adopting the recommended preventive response. Coping Appraisal involves the individual's assessment of the response efficacy of the recommended behavior (i.e. perceived effectiveness of sunscreen in preventing premature aging) as well as one's perceived self-efficacy in carrying out the recommended actions.^[4] (i.e. confidence that one can use sunscreen consistently).

The Threat and coping appraisal variables combine in a fairly straightforward way, although the relative emphasis may vary from topic to topic and with target population.

In Stress, Appraisal, and Coping, Richard Lazarus states that, "studies of coping suggest that different styles of coping are related to specific health outcomes; control of anger, for example, has been implicated in hypertension. Three routes through which coping can affect health include the frequency, intensity, duration, and patterning of neurochemical stress reactions; using injurious substances or carrying out activities that put the person at risk; and impeding adaptive health/illness-related behavior.".^[5]

2.3. Response Efficacy

Response efficacy concerns beliefs that adopting a particular behavioral response will be effective in reducing the diseases' threat, and self-efficacy is the belief that one can successfully perform the coping response.^[6] In line with the traditional way of measuring the consequences of behavior, response efficacy was operationalized by linking consequences to the recommended behavior as well as to whether the subject regarded the consequences as likely outcomes of the recommended behavior.^[7] Among the 6 factors (vulnerability, severity, rewards, response efficacy, self-efficacy, and response costs), self-efficacy is the most correlated with protection motivation, according to meta-analysis studies.^[8][9]

Cognitive process of protection motivation theory developed by Ronald W. Rogers in 1983. By Suminshin00 - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=31418310

3. Applications

3.1. Measures

Each influential factor is generally measured by asking questions through a survey. For example, Boer (2005) studied on intention of condom use to prevent from getting AIDS guided by protection motivation theory. The study asked the following questions to individuals: "If I do not use condoms, I will run a high risk of getting HIV/AIDS." for vulnerability, "If I became infected with HIV or get AIDS, I would suffer from all kind of ailments." for severity, "Using condoms will protect me against becoming infected with HIV." for response efficacy, and "I am able to talk about safe sex with my boyfriend/girlfriend."^[10]

3.2. Applied Research Areas

Protection motivation theory conventionally has been applied in the personal health contexts. A meta-analysis study on protection motivation theory categorized major six topics: cancer prevention (17%), exercise/diet/healthy lifestyle (17%), smoking (9%), AIDS prevention (9%), alcohol consumption (8%), and adherence to medical-treatment regimens (6%).^[8] As the minority topics, the study presented prevention of nuclear war, wearing bicycle helmets, driving safety, child-abuse prevention, reducing caffeine consumption, seeking treatment for sexually transmitted diseases, inoculation against influenza, saving endangered species, improving dental hygiene, home radon testing, osteoporosis prevention, marijuana use, seeking emergency help via 911, pain management during and recovery after dental surgery, and safe use of pesticides.^[8] All these topics were directly or indirectly related to personal physical health.

Aside from personal physical health research, the application of protection motivation theory has extended to other areas. Namely, researchers focusing on information security have applied protection motivation theory to their studies since the end of the 2000s. The general idea here has been to use threats or information security policies to encourage protection security behaviors in the workplace.^{[11][12][13][14][15][16][17]} Accordingly, a more recent security application of protection motivation theory by Boss et al. (2015), returned to use of the full nomology and measurement of fear in an organizational security context with two studies. A process-variance model of protection motivation theory was strongly supported in this context, as depicted in Figure 1.^[18]