Fear appeals, individuals' cognitive-behavioral responses, and willingness to pay for safe water in fluoride-contaminated regions

: In rural areas with high fluoride concentrations in groundwater, affordable and effective de-fluoridation technologies can significantly reduce the likelihood of being affected by fluorosis-related illnesses, such as skeletal fluorosis. This is particularly significant in areas where groundwater is the primary or sole drinking water source, such as the Rift Valley of Tanzania. Despite the availability of technologies, people's use of de-fluoridation devices still needs to be improved. This study investigates the potential impact of fear appeals on promoting protective behaviors and willingness to pay for fluoride-free water. The fear appeal emphasizes the negative health effects of drinking water with high fluoride levels and suggests using water from a specific de-fluoridation device to reduce the risk of being affected by skeletal fluorosis. To analyze the impact of the fear appeal, we use the Extended Parallel Process Model within a contingent valuation survey conducted in the Rift Valley of Tanzania. Results show that the theoretical components of this model have varying roles in the presence and absence of health risk perceptions. Respondents who receive health risk information are more willing to pay for fluoride-free water than other participants and are interested in adopting precautionary behavior. Governmental institutions and donors should collaborate to improve education on the health risks of drinking water with high fluoride concentrations. Additionally, they should work on enhancing de-fluoridation technology and developing effective risk communication strategies, specifically focusing on individuals' cognitive-behavioral outcomes.