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Perceived severity (also called perceived seriousness) refers to the negative consequences an individual associates with an event or outcome, such as a diagnosis of cancer. These consequences may relate to an anticipated event that may occur in the future, or to a current state such as a pre-existing health problem.
The concept of severity as an important determinant of behaviour has appeared in a number of theories and across different academic disciplines, albeit under a more general name. Within economic theory, the concept of ‘utility’ has been used to understand behavioural choice (e.g. consumer decision-making) where utility refers to the value placed on an object or outcome. Within psychology the concept of ‘valence’ was developed to explain behavioural motivation (Lewin et al., 1944 xClose
Lewin, K., Dembo, T., Festinger, L. & Sears, P. S. (1944). Level of aspiration. In Personality and the Behavior Disorders: A Handbook Based on Experimental and Clinical Research, (ed. J. M. Hunt), pp. 333-378. The Ronald Press: New York.), the hypothesis being that people would avoid areas of negative valence and move towards areas of positive valence. Although these economic and psychological theories developed independently, the similarity between the concepts of utility and valence has been noted (Edwards 1954 xClose
Edwards, W. (1954). The theory of decision making. Psychological Bulletin 51, 380-417.).
Severity can be seen as an example of negative utility and negative valence; however, the specific term appears to have its roots in the Health Belief Model (HBM). According to Rosenstock (1974) xClose
Rosenstock, I. M. (1974). Historical origins of the health belief model. Health Education Monographs 2, 1-8. the HBM draws heavily on the psychological literature and the behavioural motivation theory of Lewin (Lewin et al., 1944 xClose
Lewin, K., Dembo, T., Festinger, L. & Sears, P. S. (1944). Level of aspiration. In Personality and the Behavior Disorders: A Handbook Based on Experimental and Clinical Research, (ed. J. M. Hunt), pp. 333-378. The Ronald Press: New York.). Lewin proposed that behaviour depends on two variables: 1) the value an individual places on a particular outcome, and 2) the likelihood that an individual will be successful in achieving their goal (‘expectancy’). Together, these two factors comprise the central components of 'expectancy-value' theories.
As with severity, the concept of expectancies has also appeared across a number of different disciplines and theoretical models (Feather, 1959 xClose
Feather, N. T. (1959). Subjective probability and decision under uncertainty. Psychological Review 66, 150-164.; Maiman and Becker, 1974 xClose
Maiman, L. A. & Becker, M. H. (1974). The Health Belief Model: Origins and correlates in psychological theory. Health Education Monographs 2, 336-353.), and a number of theories used to understand health behaviour are classified as expectancy-value theories, including the Health Belief Model (HBM) (Hochbaum, 1958 xClose
Hochbaum, G. M. (1958). Public participation in medical screening programs: a sociopsychological study. In (Anonymous), United States Government Printing Office: Washington D.C.; Maiman and Becker, 1974 xClose
Maiman, L. A. & Becker, M. H. (1974). The Health Belief Model: Origins and correlates in psychological theory. Health Education Monographs 2, 336-353.), Protection Motivation Theory (PMT) (Rogers, 1975 xClose
Rogers, R. W. (1975). A protection motivation theory of fear appeals and attitude change. Journal of Psychology 91, 93-114.; Rogers, 1983 xClose
Rogers, R. W. (1983). Cognitive and physiological processes in fear appeals and attitude change: a revised theory of protection motivation. In Social Psychophysiology: A sourcebook, (ed. J. T. Cacioppo and R. E. Petty), pp. 153-176. The Guildford Press: New York.), the Extended Parallel Process Model (EPPM) (Witte, 1992 xClose
Witte, K. (1992). Putting the fear back into fear appeals: the Extended Parallel Process Model. Communication Monographs 59, 329-349.; Witte, 1998 xClose
Witte, K. (1998). Fear as motivator, fear as inhibitor: using the extended parallel process model to explain fear appeal successes and failures. In Handbook of Communication and Emotion: Research, Theory, Applications and Contexts, (ed. P. A. Andersen and L. K. Guerrero), pp. 423-449. Academic Press: San Diego.), the Theory of Reasoned Action (Fishbein and Ajzen, 1975 xClose
Fishbein, M. & Ajzen, I. (1975). Belief, attitude, intention and behavior: An introduction to theory and research. Addison-Wesley: Boston.) and the Theory of Planned Behaviour (Ajzen, 1985 xClose
Ajzen, I. (1985). From intentions to action: a theory of planned behavior. In Action Control: from Cognitions to Behaviors, (ed. J. Kuhl and J. Beckman), pp. 11-39. Springer: New York.). Although these models differ in the types of behaviour they were developed to explain, the variables they include, and how the variables are thought to combine to predict behaviour or behavioural intentions, they all contain concepts that concern the evaluation or value attached to events or behavioural outcomes.
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