Why is "Saying more fear always promotes health" a common mistake in Health Promotion?

Why it happens: Fear seems motivating. How to avoid it: Janis & Feshbach found low/moderate fear worked better than high fear (which backfires) — state the inverted-U. Source: 9990 Paper 3 mark schemes

Why is "Assuming information alone changes behaviour" a common mistake in Health Promotion?

Why it happens: It seems logical. How to avoid it: The knowledge–behaviour gap shows information is necessary but not sufficient — attitudes/environment matter.

Why is "Giving only one or two HBM components" a common mistake in Health Promotion?

Why it happens: Partial recall. How to avoid it: Cover susceptibility, severity, benefits AND barriers (plus cues to action / self-efficacy).

Why is "Confusing the HBM with the TPB" a common mistake in Health Promotion?

Why it happens: Both are belief models. How to avoid it: HBM = susceptibility/severity/benefits/barriers; TPB = attitudes/subjective norms/perceived behavioural control → intention.

Why is "Evaluating without the named debate" a common mistake in Health Promotion?

Why it happens: Generic evaluation habit. How to avoid it: Tie points to the named debate (free will–determinism, application, individual vs situational) for the top band on Paper 3.

Health Psychology (A Level)Cambridge International A Level Psychology 9990

Health Promotion

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Health Promotion (Health Psychology) — Cambridge A Level Psychology 9990 Study Notes (2024-2026)

How to encourage healthy behaviour and change unhealthy habits. This note builds the background (prevention vs treatment), then drills health-promotion strategies (information, fear appeals, media), settings, and models of health behaviour (the Health Belief Model, Theory of Planned Behaviour, locus of control) — with the evaluation that scores on Paper 3.

At a glance

Health promotion = strategies to encourage healthy behaviour and prevent illness (prevention, not just treatment).
Strategies: providing information, fear appeals, mass-media campaigns, legislation, and changing environments.
Fear appeals (Janis & Feshbach): very high fear can backfire — moderate fear with a clear action works better.
Media campaigns (e.g. Cowpe — chip-pan fires): can change behaviour but effects can be small/short-lived.
Settings: health promotion in schools, worksites and communities reaches people where they are.
Health Belief Model (Becker): behaviour depends on perceived susceptibility, severity, benefits, barriers (+ cues to action).
Theory of Planned Behaviour (Ajzen): intention from attitudes, subjective norms and perceived behavioural control.
Locus of control (Rotter): internal vs external control beliefs affect health behaviour.

What you’ll learn

Mapped to the Cambridge International A Level 9990 syllabus (2024-2026).

Explain what health promotion is and why prevention matters.
Describe and evaluate health-promotion strategies (information, fear appeals, media).
Describe and evaluate health promotion in different settings (schools, worksites, communities).
Describe and evaluate models of health behaviour (Health Belief Model, Theory of Planned Behaviour, locus of control).
Apply and evaluate health-promotion research, including issues & debates.

Prevention vs treatment — why promote health (background substance)

Health promotion prevents illness by changing behaviour; it is cheaper and healthier than treating disease after it occurs.

Health promotion is the process of enabling people to increase control over, and improve, their health — encouraging healthy behaviours (exercise, healthy eating, not smoking) and discouraging unhealthy ones.

Why prevent? Many major illnesses (heart disease, type 2 diabetes, lung cancer) are strongly linked to behaviour. Preventing them by changing behaviour is usually cheaper, healthier and more effective than treating them afterwards — 'prevention is better than cure'.

Levels of prevention:

Primary — stop illness before it starts (e.g. anti-smoking campaigns, vaccination).
Secondary — catch it early (e.g. screening, encouraging check-ups).
Tertiary — limit damage and manage existing illness (e.g. rehabilitation, adherence).

The core challenge. People often know what is healthy but don't act on it (the knowledge–behaviour gap). So health promotion must do more than give information — it must change attitudes, beliefs and the environment. This is why models of health behaviour (Health Belief Model, Theory of Planned Behaviour) matter.

Why this matters for the exam. Hold the idea that information alone rarely changes behaviour: it explains why fear appeals, media, settings and behaviour-change models are needed, and frames every evaluation.

Health promotion = encouraging healthy behaviour / preventing illness.
Prevention is cheaper/healthier than treatment ('prevention is better than cure').
Primary (before), secondary (early/screening), tertiary (manage existing).
Knowledge–behaviour gap: people know but don't act → information alone isn't enough.
So we need attitude/belief change and behaviour-change models.

Strategies — information, fear appeals and media

Providing information, fear appeals (Janis & Feshbach), and mass-media campaigns (Cowpe) — each with limits.

Providing information. Giving facts about risks/benefits (leaflets, labels, talks). Necessary but rarely sufficient — the knowledge–behaviour gap means information alone seldom changes habits.

Fear appeals. Use fear of negative consequences (e.g. graphic smoking warnings) to motivate change.

Janis & Feshbach (1953) tested high, moderate and low fear messages about dental hygiene. The low-fear group actually changed behaviour most, and high fear was less effective — too much fear caused defensive avoidance (people 'switch off'). The lesson: fear works best at a moderate level with a clear, achievable action (link to advertising's [[advertising]] inverted-U).

Mass-media campaigns. TV/radio/online/posters reach large audiences.

Cowpe (1989) evaluated UK TV campaigns about chip-pan fires: after the adverts, fires fell in target regions — showing media campaigns can change behaviour, though effects can be modest and short-lived.

Other strategies: legislation (seatbelt/smoking laws), incentives, and changing the environment (e.g. healthier defaults) — often more powerful than persuasion alone.

Evaluation in brief. These strategies are applicable and (for media/legislation) can reach many people, but information alone is weak, fear can backfire, effects are often small/short-lived, and it is hard to isolate the campaign's effect (many causes of behaviour change).

Information: necessary but rarely sufficient (knowledge–behaviour gap).
Fear appeals: Janis & Feshbach — moderate fear + a clear action beats high fear (which backfires).
Media campaigns: Cowpe (chip-pan fires) — reduced fires, but effects can be modest/short-lived.
Legislation/incentives/environment change can be more powerful than persuasion.
Evaluation: + applicable, wide reach; − information weak, fear backfires, small effects, hard to isolate.

Health promotion in different settings

Schools, worksites and communities reach people in everyday contexts, each with strengths and limits.

Promoting health where people already are increases reach and relevance.

Schools. Reach children early, when habits form (healthy eating, exercise, hygiene, anti-smoking/drugs education). Can be built into the curriculum and reinforced over time.

+ Reaches all children; shapes lifelong habits. − Effects may not last; depends on home/peer influence.

Worksites. Reach adults for a large part of the day (healthy canteens, exercise schemes, stress management, screening).

+ Captive audience, employer support, can change the environment. − May miss the unemployed/most at-risk; uptake varies.

Communities. Whole-community programmes (local campaigns, screening, environment changes) target a population, sometimes with multiple strategies at once.

+ Wide reach, can change social norms and environments. − Hard to control and evaluate (many influences); needs resources.

Evaluation in brief. Setting-based promotion is applicable and reaches people in context, but outcomes are hard to isolate, effects can fade, and access is uneven (e.g. worksite schemes miss the unemployed).

Schools: reach children early, shape lifelong habits (but effects may fade; home/peer influence).
Worksites: reach adults, change the environment (but miss unemployed; uptake varies).
Communities: wide reach, change norms/environment (but hard to control/evaluate).
Evaluation: + reaches people in context, applicable; − hard to isolate effects, uneven access.

Models of health behaviour

Health Belief Model (Becker), Theory of Planned Behaviour (Ajzen) and locus of control (Rotter).

Models explain why people do (or don't) adopt healthy behaviour — guiding effective promotion.

Health Belief Model (HBM; Becker/Rosenstock). Whether a person acts depends on their beliefs:

Perceived susceptibility ('could this happen to me?'),
Perceived severity ('how bad would it be?'),
Perceived benefits ('will acting help?'),
Perceived barriers ('what are the costs/obstacles?'),
plus cues to action (a symptom, an advert, advice) and self-efficacy. Promotion works by raising perceived susceptibility/severity/benefits and lowering barriers.

Theory of Planned Behaviour (TPB; Ajzen). Behaviour follows intention, which is shaped by:

attitudes to the behaviour,
subjective norms (what important others think),
perceived behavioural control (how easy/possible it feels). Promotion targets these three to strengthen intention.

Locus of control (Rotter). People with an internal locus believe they control their own health (more likely to act on advice); those with an external locus believe health is down to luck/fate/others (less likely). Promotion can encourage a more internal health locus.

Evaluation in brief. These models are testable and applicable (they tell promoters what to target), but they are cognitive/rational (people don't always act on beliefs — the intention–behaviour gap), often rely on self-report, and underplay emotion, habit and environment.

HBM (Becker): susceptibility + severity + benefits − barriers (+ cues to action, self-efficacy).
TPB (Ajzen): intention from attitudes + subjective norms + perceived behavioural control.
Locus of control (Rotter): internal (I control my health) → more likely to act; external → less.
Promotion targets these beliefs/intentions.
Evaluation: + testable, applicable; − too rational (intention–behaviour gap), self-report, ignore habit/environment.

Evaluation and issues & debates

Highly applicable with useful models, but effects are hard to isolate and behaviour is more than rational beliefs.

Bring it together for Paper 3 'evaluate / discuss'.

Strengths

Strong real-world application — campaigns, school/workplace programmes, policy.
Testable models (HBM, TPB) that guide what to target; can reach large populations.

Weaknesses / issues

Hard to isolate effects — many causes of behaviour change, so campaign success is hard to prove (often correlational).
Rational bias — models assume people act on beliefs/intentions, but the knowledge–behaviour / intention–behaviour gap shows they often don't (emotion, habit, addiction, environment matter).
Individual & cultural differences — what motivates one group may not work for another; fear can backfire.

Relevant issues & debates

Application to everyday life (central strength).
Free will vs determinism — promotion assumes people can choose to change (free will), vs habit/addiction/environment that constrain choice.
Reductionism vs holism; individual vs situational (changing beliefs vs changing environments); use of quantitative vs qualitative data.

Strengths: strong application; testable models guide targeting; wide reach.
Weaknesses: effects hard to isolate (correlational); models too rational (intention–behaviour gap); individual/cultural differences.
Debates: application; free will vs determinism; individual vs situational; reductionism vs holism.

How it’s examined

Examined in the Health Psychology option on Paper 3 (Specialist Options: Theory) — describe (a strategy, a setting, a model) and evaluate/discuss with a named issue or debate (application, free will–determinism, individual vs situational). On Paper 4 (Application) you may design a health-promotion study/campaign or apply a model. Examiner guidance: state Janis & Feshbach's inverted-U for fear, give the HBM/TPB components, and use the knowledge/intention–behaviour gap as the key critique.

Sources: Cambridge International AS & A Level Psychology 9990 syllabus (2024-2026); Janis, I.L. & Feshbach, S. (1953) — fear appeals/dental hygiene; Cowpe — chip-pan fire campaigns; Becker — Health Belief Model; Ajzen — Theory of Planned Behaviour; Rotter — locus of control; 9990 Learner Guide, Scheme of Work & past Paper 3/4 mark schemes. Last reviewed 2026-05-21.

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Worked examples, formulae, definitions and the mistakes examiners flag — everything you need to push from a pass to an A*.

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Step-by-step worked examples — Health Promotion

Step-by-step solutions to past-paper-style questions on health promotion, written exactly the way a tutor would explain them at the board.

1State Health Belief Model components (2 marks)
Getting started• models, AO1
Question
State two components of the Health Belief Model. (2 marks)
Step-by-step solution
1. Step 1
  Perceived susceptibility ('could this happen to me?').
2. Step 2
  Perceived severity, benefits or barriers.
Answer
Perceived susceptibility and perceived severity (or benefits/barriers). (2)
Examiner tip
Any two of susceptibility, severity, benefits, barriers (plus cues to action) score.
2Outline a fear-appeal finding (2 marks)
Getting started• strategies, AO1
Question
Outline what Janis & Feshbach found about fear appeals. (2 marks)
Step-by-step solution
1. Step 1
  They compared high, moderate and low fear messages about dental hygiene.
2. Step 2
  Low/moderate fear changed behaviour more than high fear (which backfired).
Answer
Low/moderate fear changed dental behaviour more than high fear (which caused defensive avoidance). (2)
Examiner tip
The 'high fear backfires' point is the key finding.
3Explain the Theory of Planned Behaviour (4 marks)
Building confidence• models, AO2
Question
Explain how the Theory of Planned Behaviour predicts health behaviour. (4 marks)
Step-by-step solution
1. Step 1
  Behaviour follows intention, which has three influences.
2. Step 2
  Attitudes toward the behaviour (is it good/bad for me?).
3. Step 3
  Subjective norms (what important others think I should do).
4. Step 4
  Perceived behavioural control (how easy/possible it feels) — together these shape intention and behaviour.
Answer
Intention (→ behaviour) comes from attitudes + subjective norms + perceived behavioural control (Ajzen). (4)
Examiner tip
All three determinants of intention are needed for full AO1/AO2.
4Explain a media campaign (Cowpe) (4 marks)
Building confidence• strategies, AO2
Question
Explain how Cowpe's chip-pan fire campaign promoted health/safety. (4 marks)
Step-by-step solution
1. Step 1
  TV adverts demonstrated the danger of chip-pan fires and how to respond safely.
2. Step 2
  The campaign reached a large audience via mass media.
3. Step 3
  After the adverts, the number of chip-pan fires fell in target regions.
4. Step 4
  This shows media campaigns can change behaviour, though effects can be modest/short-lived.
Answer
TV adverts showed the danger and safe response; chip-pan fires fell afterwards — media can change behaviour (effects modest). (4)
Examiner tip
Note both the effect (fires fell) AND the limitation (modest/short-lived) for a balanced answer.
5Describe the Health Belief Model (6 marks)
Stretch• models, AO1, Paper 3
Question
Describe the Health Belief Model. (6 marks)
Step-by-step solution
1. Step 1
  The HBM (Becker) says health behaviour depends on a person's beliefs.
2. Step 2
  Perceived susceptibility — how likely they think they are to get the illness.
3. Step 3
  Perceived severity — how serious they think it would be.
4. Step 4
  Perceived benefits — whether they think acting will help.
5. Step 5
  Perceived barriers — the costs/obstacles to acting.
6. Step 6
  Cues to action (a symptom, an advert) and self-efficacy also influence the decision.
Answer
HBM (Becker): behaviour from perceived susceptibility + severity + benefits − barriers, plus cues to action and self-efficacy. (6)
Examiner tip
Top band needs all four core beliefs plus cues to action (and ideally self-efficacy).
6Evaluate — the knowledge–behaviour gap (4 marks)
Stretch• evaluation, AO3, application, exam-technique
Question
Evaluate health-promotion models with reference to the gap between intention and behaviour. (4 marks)
Step-by-step solution
1. Step 1
  Point. Models like the HBM and TPB are too rational.
2. Step 2
  Explain. They assume beliefs/intentions lead to behaviour.
3. Step 3
  Evidence (in context). But the intention–behaviour gap shows people often don't act on intentions (habit, emotion, environment).
4. Step 4
  Link. So changing the environment/legislation (situational) can outperform changing beliefs alone.
Answer
HBM/TPB are too rational: the intention–behaviour gap shows beliefs don't reliably cause action, so environmental/legislative change can work better. (4)
Examiner tip
The intention–behaviour gap is the key critique — link it to situational solutions.

Model Answers — Health Promotion

High-scoring sample answers for health promotion on the Cambridge International A Level 9990 paper, with examiner-style notes mapping each response to the mark scheme and assessment objectives.

Question 1
9990 Paper 3 (describe) style6 marks
Q (6 marks). Describe strategies used to promote health.
Model answer
One strategy is providing information (leaflets, labels, talks) about risks and benefits — necessary but often insufficient, because people frequently know what is healthy yet don't act (the knowledge–behaviour gap). A second is fear appeals, which use fear of negative consequences to motivate change. Janis & Feshbach (1953) tested high, moderate and low fear messages about dental hygiene and found low/moderate fear changed behaviour more than high fear, which caused defensive avoidance — so fear works best at a moderate level with a clear, achievable action.

A third strategy is mass-media campaigns: Cowpe evaluated UK TV adverts about chip-pan fires and found fires fell in target regions afterwards, showing media can change behaviour, though effects may be modest or short-lived. Other strategies include legislation (e.g. smoking/seatbelt laws), incentives, and changing the environment (healthier defaults), which can be more powerful than persuasion alone.
Why this scores
Why this scores well. It describes information, fear appeals (Janis & Feshbach), media (Cowpe) and legislation accurately, with the key inverted-U finding — broad AO1.
Question 2
9990 Paper 3 (evaluate with named debate) style10 marks
Q (10 marks). Evaluate models and strategies of health promotion, including a discussion of free will and determinism.
Model answer
Strength 1 — strong application. Health-promotion research is highly applicable: it guides real campaigns, school/workplace programmes and policy, and testable models (the HBM and TPB) tell promoters what to target (e.g. raising perceived susceptibility, lowering barriers).

Strength 2 — wide reach and evidence. Mass-media campaigns (e.g. Cowpe) can reach large populations, and field evidence shows measurable behaviour change (chip-pan fires fell), supporting the value of the approach.

Weakness 1 — free will vs determinism (named debate). Health promotion assumes people can freely choose to change (free will), but behaviour is often constrained by habit, addiction, emotion and environment — which is more deterministic. This is why the knowledge/intention–behaviour gap occurs: people know and even intend to change but don't, so persuasion aimed at free choice often fails.

Weakness 2 — effects hard to isolate, and individual/cultural differences. Campaign success is usually correlational (many causes of behaviour change), effects can be short-lived, and what motivates one group may not work for another (and high fear can backfire).

Conclusion. Health promotion is applicable and uses testable models, but because behaviour is only partly under free control, the most effective approach combines belief change with situational measures (legislation, environment change) that work even when free choice is constrained.
Why this scores
Why this reaches the top band. Two strengths and two weaknesses, the named debate (free will–determinism) developed via the intention–behaviour gap, plus correlation/individual differences and a reasoned conclusion (AO3).
Question 3
9990 Paper 3 (describe) style6 marks
Q (6 marks). Describe health promotion in different settings.
Model answer
Health promotion in schools reaches children early, when habits form — covering healthy eating, exercise, hygiene and anti-smoking/drugs education, often built into the curriculum and reinforced over years. Its strength is shaping lifelong habits and reaching all children, though effects may fade and can be undermined by home or peer influence.

Promotion in worksites reaches adults for much of the day through healthy canteens, exercise schemes, stress management and screening; employers can also change the environment, but such schemes may miss the unemployed or most at-risk and uptake varies. Promotion in communities targets a whole population through local campaigns, screening and environmental changes, sometimes combining several strategies; it has wide reach and can shift social norms, but is harder to control and evaluate because so many influences are at work. Choosing the setting helps reach people in context, which increases relevance.
Why this scores
Why this scores well. It describes school, worksite and community settings with a strength and limitation each — structured, applied AO1.
Question 4
9990 Paper 4 (application) style8 marks
Q (8 marks). A school wants to test whether a poster campaign increases healthy eating. Suggest how this could be investigated, with reference to research methods.
Model answer
A suitable design is a field experiment with an independent variable of exposure to the poster campaign (a campaign class/year vs a control class/year) and a dependent variable of healthy eating, operationalised objectively as the proportion of healthy items chosen in the canteen (from till/observation data), rather than self-report alone.

Baseline healthy-eating rates would be measured first, then the posters introduced, then rates measured again, comparing the change between campaign and control groups. Using objective canteen data avoids the social-desirability bias of self-report, and a control group helps isolate the campaign's effect. Ethical points include consent (school/parents), confidentiality, and not disadvantaging the control group (offer the campaign later). Strengths include ecological validity and an objective DV; weaknesses include little control over other influences (home, adverts), the knowledge–behaviour gap (posters may change knowledge but not behaviour), and that effects may be short-lived — so a follow-up measure and combining posters with environmental changes (e.g. healthier canteen defaults) would strengthen the study.
Why this scores
Why this scores well. It operationalises the DV objectively, uses a control and baseline, addresses ethics, and shows awareness of the knowledge–behaviour gap — strong Paper 4 application.

Key Definitions and Keywords — Health Promotion

Definitions to memorise and the exact keywords mark schemes credit for health promotion answers — sharpened from recent examiner reports for the 2026 Cambridge International A Level 9990 sitting.

Health promotion
Examiner keyword
Strategies that enable people to improve their health by encouraging healthy behaviour and preventing illness.
Fear appeal
Examiner keyword
Using fear of negative consequences to motivate health behaviour; moderate fear with a clear action works best.
Health Belief Model (Becker)
Examiner keyword
Behaviour depends on perceived susceptibility, severity, benefits and barriers, plus cues to action and self-efficacy.
Perceived susceptibility
Examiner keyword
How likely a person believes they are to develop a health problem (an HBM component).
Theory of Planned Behaviour (Ajzen)
Examiner keyword
Intention (→ behaviour) comes from attitudes, subjective norms and perceived behavioural control.
Perceived behavioural control
Examiner keyword
How easy or possible a person feels a behaviour is — a key influence on intention in the TPB.
Locus of control (Rotter)
Examiner keyword
Belief about control over one's life: internal (I control my health) vs external (luck/fate/others).
Knowledge–behaviour gap
Examiner keyword
People often know what is healthy (or intend to act) but don't change behaviour — a key limit on promotion.
Levels of prevention
Primary (before illness), secondary (early/screening) and tertiary (managing existing illness).
Cues to action
Triggers (a symptom, an advert, advice) that prompt a person to act on their health beliefs (HBM).

Common Mistakes and Misconceptions — Health Promotion

The traps other students keep falling into on health promotion questions — taken from recent Cambridge International A Level 9990 examiner reports and mark schemes — and how to avoid them.

✕Saying more fear always promotes health
9990 Paper 3 mark schemes
Why it happens
Fear seems motivating.
How to avoid it
Janis & Feshbach found low/moderate fear worked better than high fear (which backfires) — state the inverted-U.
✕Assuming information alone changes behaviour
Why it happens
It seems logical.
How to avoid it
The knowledge–behaviour gap shows information is necessary but not sufficient — attitudes/environment matter.
✕Giving only one or two HBM components
Why it happens
Partial recall.
How to avoid it
Cover susceptibility, severity, benefits AND barriers (plus cues to action / self-efficacy).
✕Confusing the HBM with the TPB
Why it happens
Both are belief models.
How to avoid it
HBM = susceptibility/severity/benefits/barriers; TPB = attitudes/subjective norms/perceived behavioural control → intention.
✕Evaluating without the named debate
Why it happens
Generic evaluation habit.
How to avoid it
Tie points to the named debate (free will–determinism, application, individual vs situational) for the top band on Paper 3.

Practice questions

Exam-style questions with step-by-step worked solutions. Try one before checking the method.

Past paper style quiz

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Health Promotion

Detailed Notes

What you’ll learn

How it’s examined

1State Health Belief Model components (2 marks)

2Outline a fear-appeal finding (2 marks)

3Explain the Theory of Planned Behaviour (4 marks)

4Explain a media campaign (Cowpe) (4 marks)

5Describe the Health Belief Model (6 marks)

6Evaluate — the knowledge–behaviour gap (4 marks)

Health promotion

Fear appeal

Health Belief Model (Becker)

Perceived susceptibility

Theory of Planned Behaviour (Ajzen)

Perceived behavioural control

Locus of control (Rotter)

Knowledge–behaviour gap

Levels of prevention

Cues to action

✕Saying more fear always promotes health

✕Assuming information alone changes behaviour

✕Giving only one or two HBM components

✕Confusing the HBM with the TPB

✕Evaluating without the named debate

Practice questions

Past paper style quiz