Understanding the effectiveness of the entertainment-education strategy: an investigation of how audience involvement, message processing, and message design influence health information recall

Evaluating the programme and behavior change theories of a community alcohol education intervention in rural Sri Lanka: a study protocol

Risky alcohol use is a major public health problem globally and in Sri Lanka. While a reduction in alcohol consumption can result in physical, mental, and social benefits, behaviour change is difficult to achieve. Effective, context-adapted interventions are required to minimise alcohol-related harm at a community level. THEATRE is a complex, community-based intervention evaluating whether a promising Sri Lankan pilot study that utilised arts-based research to moderate alcohol use can be scaled up. While the scaled-up pilot study protocol is presented elsewhere, the aim of this protocol paper is to describe the intervention programme theory and evaluation design, and modifications made to the study resulting from COVID-19 and the financial crisis. Drawing on the Behaviour Change Wheel (BCW) and Theoretical Domains Framework, behaviour change theories are presented with potential pathways to guide implementation and evaluation. Alcohol consumption patterns and context of drinking is detailed. The multifaceted intervention targets individuals and communities using arts-based interventions. Four of nine BCW functions are employed in the design of the intervention: education, persuasion, modelling and enablement, and training. Modifications made to the study due to COVID-19 and the financial crisis are described. Ethical approval was obtained from the Ethics Review Committee, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka (ERC/2018/21-July 2018 and Feb 2022) and the University of Sydney (2019/006). Findings will be disseminated locally to community members and key stakeholders and via international peer-reviewed publications.

The Use of Narrative in Science and Health Communication: A Scoping Review

BACKGROUND

Many people deny science and reject health recommendations despite widely distributed facts and statistics. Didactic science and health communication is often dry, and relies on the false assumption that people make purely evidence-based decisions. Stories can be a powerful teaching tool by capturing attention and evoking emotion.

OBJECTIVE

We explore the impact and appeal of, and describe best practices for, using narrative (storytelling) versus didactic methods in science and health communication.

PATIENT INVOLVEMENT

No patients were involved in the review process.

METHODS

We searched PubMed and Web of Science for articles either: assessing effectiveness of narrative science/health communication; assessing acceptability of (or preference for) narrative science/health communication; giving advice on how best to use narrative; and/or providing science-based explanations for how/why narrative succeeds.

RESULTS

Narrative science/health communication is effective and appealing for audiences across a variety of topics and mediums, with supporting evidence across fields such as epidemiology, neuroscience, and psychology. Whether narrative or didactic messaging is most effective depends on the topic, audience, and objective, as well as message quality. However, combining narrative with didactic methods is likely to be more effective than using either strategy alone.

DISCUSSION

Narrative science/health communication merits wider implementation and further research. Narrative communication creates openness to information by delaying the formulation of counterarguments.

PRACTICAL VALUE

Science and health communicators should collaborate with cultural and storytelling experts, work directly with their target audiences throughout the message development and testing processes, and rely on popular story elements (e.g., first-person point of view, relatable protagonists) to improve the comprehension, engagement, and thoughtful consideration of their intended audience.

FUNDING

This work was funded by Thirty Meter Telescope, with which two authors (GKS and SD) were affiliated. Otherwise, the funding organization had no role in the study and/or submission.

COVID-19 messages in sponsored social media posts: The positive impact of influencer-brand fit and prior parasocial interaction

This study explores the dissemination potential of a COVID-19 message embedded in a sponsored social media post. The moderating role of prior parasocial interaction and influencer-brand fit were considered. 365 respondents participated in the study. A 3 (control, congruent, incongruent brand) × 2 (control, COVID-19 message) between-subject online experiment was designed and executed. Data were analyzed using a mediated moderation model. Results indicated that the three-way interaction of the COVID-19 message, brand presence and prior parasocial interaction affected the perceived influencer credibility, attitudes towards the social media post, and the behavioral engagement with the post. When the COVID-19 message was included in the post, increased prior parasocial interaction intensified the positive effect of influencer-brand fit on influencer credibility, which in turn resulted in a more positive attitude towards the post, and a higher behavioral engagement. Theoretical and practical implications were discussed.

Effects of Exposure to an Entertainment-Based Genetic Testing Narrative on Genetic Testing Knowledge, Attitudes and Counseling Discussion Intentions

This study explores the effects of exposure to a reality television narrative depicting genetic testing on attitudes and intentions, looking particularly at the effects of narratives containing elements of misinformation on genetics-related knowledge accuracy. In an experiment, participants completed a baseline survey, viewed a high versus low-accuracy narrative, then completed a follow-up survey. Exposure to a low-accuracy narrative was associated with lower knowledge accuracy. Indirect effects of identification and transportation on intentions to talk to a doctor about genetic testing also were detected via attitudes and reduced message counterarguing. Results illustrate the negative implications of inaccurate narratives on knowledge, which is concerning given the public's low level of genetic literacy, as well as the critical role narrative engagement may play in shaping public attitudes and intentions regarding genetic testing.

"It Encourages Family Discussion": A Mixed-Methods Examination of the This Is Us Alzheimer's Disease & Caregiving Storyline

The average United States (U.S.) adult spends approximately one hour interacting directly with a healthcare professional but 2,000 hours watching primetime television annually. Thus, television storylines may be a powerful vehicle for promoting awareness about Alzheimer's disease and caregiving, which affect an estimated 9 million U.S. adults. We used a mixed-methods approach consisting of an online survey of U.S. adult This Is Us viewers (n = 720) and 4 focus groups (n = 12) with a subset of survey respondents to systematically assess viewer perceptions of an Alzheimer's disease and caregiving storyline from the This Is Us television show and the storyline's influence on viewer behavioral intent toward planning for aging. Triangulation of survey and focus group results suggests the storyline may motivate viewers to discuss plans for aging with their family because of a reduction in stigma and seeing on-screen family tensions related to senior care. Results suggest investments in collaborative partnerships between public health and the entertainment industry may be a valuable way to positively impact those affected by Alzheimer's disease and caregiving. Clips from this storyline could also be used as part of health communication campaigns to encourage advanced care planning discussions.

Testing Narrative Persuasion of a Culturally Grounded, School-Based "Dale Se REAL" Entertainment-Education Intervention and Peer Communication on Nicaraguan Adolescent Substance Use

Guided by narrative engagement theory and social cognitive theory, the present study investigates effects of narrative persuasion and peer communication on Nicaraguan adolescent substance use. Eighth-grade students in Nicaragua were recruited to participate in the culturally grounded, school-based prevention intervention Dale se REAL and to watch five entertainment-education intervention videos that teach drug refusal communication strategies. Using the cross-sectional survey (N = 224), a path analysis was run to examine the mediated moderation effects of narrative engagement (e.g., interest, realism, and identification with main characters) and peer communication about the intervention videos (e.g., frequency and valence of communication) on adolescent refusal self-efficacy and substance use behaviors. Results revealed that realism was significantly related to adolescent refusal self-efficacy and frequent peer communication moderated the association between refusal self-efficacy and the past 30-day marijuana use. Findings suggest that health communication scholars should take into consideration social factors and cultural contexts for adolescent substance use prevention research.

How Interactive Data Visualization and Users' BMI (Body Mass Index) Influence Obesity Prevention Intentions: The Mediating Effect of Cognitive Absorption

The current study examines how interactive data visualization can augment the persuasive potential of health information. In an experiment using an obesity-awareness website (N = 248), we manipulated the level of interactivity in a data visualization tool that featured obesity prevalence in the U.S. and measured participants' absorption into the website, perceived issue severity, content perceptions, and intentions to prevent/treat obesity. Our data demonstrated that lower BMI participants reported greater cognitive absorption when highly interactive data visualization was available on the website. Subsequently, greater cognitive absorption into the website led to higher perceived issue severity, greater content perceptions, and higher obesity prevention intentions among lower BMI participants but not among higher BMI participants.

Investigating Public Discourses Around Gender and COVID-19: a Social Media Analysis of Twitter Data

We collected over 50 million tweets referencing COVID-19 to understand the public’s gendered discourses and concerns during the pandemic. We filtered the tweets based on English language and among three gender categories: men, women, and sexual and gender minorities. We used a mixed-method approach that included topic modelling, sentiment analysis, and text mining extraction procedures including words’ mapping, proximity plots, top hashtags and mentions, and most retweeted posts. Our findings show stark differences among the different genders. In relation to women, we found a salient discussion on the risks of domestic violence due to the lockdown especially towards women and girls, while emphasizing financial challenges. The public discourses around SGM mostly revolved around blood donation concerns, which is a reminder of the discrimination against some of these communities during the early days of the HIV/AIDS epidemic. Finally, the discourses around men were focused on the high death rates and the sentiment analysis results showed more negative tweets than among the other genders. The study concludes that Twitter influencers can drive major online discussions which can be useful in addressing communication needs during pandemics.

Emotional experiences of reading health educational manga encouraging behavioral changes: a non-randomized controlled trial

OBJECTIVE

Educational health manga are used to promote health behavior change. This study thus seeks to achieve the following objectives: identify the emotional experience of reading educational health manga, understand the effects of facilitating the psychological mediators of behavior change through emotional experiences, and compare the effectiveness of educational health manga with conventional materials.

DESIGN

A non-randomized controlled trial with six conditions was conducted. Target behaviors were physical activity and healthy diet. Individuals aged 20-69 years (n = 1,680) were assigned three manga intervention conditions and three control conditions (visual image-based, narrative text, and general text material).

MAIN OUTCOME MEASURES

Participants were asked about their emotional experience while reading either intervention material or control material and its perceived positive influence on enhancing psychological mediators.

RESULTS

Four factors relevant to emotional experiences were identified: risk perception, familiarity, satisfaction, and realism. Emotional experience strongly predicted the psychological mediators of behavior change. Analysis of differences among the six conditions revealed that exposure to educational health manga led to greater satisfaction and increased knowledge. Participants assigned manga conditions experienced superior emotional experiences and outcomes.

CONCLUSIONS

Those assigned manga conditions experienced superior emotional experiences and outcomes. The efficacy of educational health manga in encouraging psychological mediators of change was confirmed.Trial registration: UMIN Japan identifier: UMIN000034369.

Green Marketing Strategies on Online Platforms: A Mixed Approach of Experiment Design and Topic Modeling

This study aimed to examine the effects of two types of green information conveyed via online platforms and the moderating role of environmental consciousness on customers’ green perceptions, positive attitudes, and behavioral intentions. This study performed a 2 (firm-initiated green information: absent, present) × 2 (customer-generated green information: absent, present) experiment. These mixed methods were further implemented by using both open-ended surveys and structured measurements. Open-ended survey answers were analyzed with structural topic modeling to discover customers’ green perceptions. The results highlighted the importance of customer-generated green information to support firm-initiated green marketing, consequently leading to enhanced customer satisfaction and behavioral intentions. Although displaying green information generated by both the company and its customers is effective in enhancing green perceptions, customers may react differently depending on their levels of environmental consciousness.

First-Person, Third-Person, or Bystander? Exploring the Persuasive Influence of Perspective in Mental Health Narratives

As evidence suggests that college students are particularly vulnerable to mental health distress and illness, guidance for designing messages that inspire help-seeking behavior is needed. The purpose of this study was to evaluate the influence of perspective of storytelling on health message involvement and persuasion. A controlled experiment (N= 430) compared the influence of online mental health narratives targeted to college students that featured a bystander perspective to those that used first- and third-person perspectives. Evidence suggests that the bystander perspective was more effective for producing persuasive outcomes, including mental health information recall and beliefs. Results also indicate that self-referencing mediated the effects of message involvement on outcomes across all message conditions. People with experience with mental illness became involved with and were influenced by mental health narratives in different ways.

Designing Ambient Narrative-Based Interfaces to Reflect and Motivate Physical Activity

Numerous technologies now exist for promoting more active lifestyles. However, while quantitative data representations (e.g., charts, graphs, and statistical reports) typify most health tools, growing evidence suggests such feedback can not only fail to motivate behavior but may also harm self-integrity and fuel negative mindsets about exercise. Our research seeks to devise alternative, more qualitative schemes for encoding personal information. In particular, this paper explores the design of data-driven narratives, given the intuitive and persuasive power of stories. We present WhoIsZuki, a smartphone application that visualizes physical activities and goals as components of a multi-chapter quest, where the main character's progress is tied to the user's. We report on our design process involving online surveys, in-lab studies, and in-the-wild deployments, aimed at refining the interface and the narrative and gaining a deep understanding of people's experiences with this type of feedback. From these insights, we contribute recommendations to guide future development of narrative-based applications for motivating healthy behavior.

The Use of Narratives to Deliver Information in Direct-To-Consumer Prescription Drug Commercials: A Content Analysis

Information communicated through a narrative format is typically processed and evaluated differently compared to non-narrative formats. Therefore, differences in the use of narratives across various information categories within direct-to-consumer prescription drug advertisements (DTCA) could have significant implications for consumers' processing of that information. Such differences could have further implications regarding the "fair balance" rule put forth by the Food and Drug Administration (FDA). This study sought to document the presence and nature of narrative and non-narrative messages in a content analysis of 61 U.S.-based broadcast DTCA airing during 2016. Specific narrative styles (classic drama, vignette, first person, second person, third person) were distinguished from non-narrative styles (lecture, directive, endorsement, graphic/demonstration) according to key characteristics of each (chronology and character, showing versus telling). Results indicated widespread use of narrative styles in DTCA overall, but the styles used differed substantially between different types of information. Narrative styles were delivered prominently to present health condition and drug benefits information while non-narrative styles primarily reinforced drug benefits and presented drug risks. These differences offer a new frame through which to view an imbalanced presentation of drug risks and benefits and provide a foundation for future research to test the effects of various narrative and non-narrative forms on patient understanding and message recall.

The Potential for Narrative Correctives to Combat Misinformation†

Misinformation can influence personal and societal decisions in detrimental ways. Not only is misinformation challenging to correct, but even when individuals accept corrective information, misinformation can continue to influence attitudes: a phenomenon known as belief echoes, affective perseverance, or the continued influence effect. Two controlled experiments tested the efficacy of narrative-based correctives to reduce this affective residual in the context of misinformation about organic tobacco. Study 1 (N = 385) tested within-narrative corrective endings, embedded in four discrete emotions (happiness, anger, sadness, and fear). Study 2 (N = 586) tested the utility of a narrative with a negative, emotional corrective ending (fear and anger). Results provide some evidence that narrative correctives, with or without emotional endings, can be effective at reducing misinformed beliefs and intentions, but narratives consisting of emotional corrective endings are better at correcting attitudes than a simple corrective. Implications for misinformation scholarship and corrective message design are discussed.

Improving Adherence to Colorectal Cancer Screening: A Randomized Intervention to Compare Screener vs. Survivor Narratives

Interventions are needed to increase colorectal cancer screening (CRCS) uptake. Narratives may have advantages over didactic information. We tested different narratives for increasing CRCS intentions and behaviors, and examined their mechanisms of influence. We randomized 477 unscreened adults 50-75 years old to one of three groups: CRCS information only (1) or CRCS information plus a photo and text narrative of a CRC survivor (2) or CRC screener who did not have cancer (3). Photos were tailored on participants' sex, age group, and race/ethnicity. Participants completed online surveys before and after intervention exposure, and 1-, 6-, and 12-months follow-up. Thirty percent of participants completed CRCS. Narrative conditions (vs. information only) were negatively associated with intention, but also positively influenced intentions through greater emotional engagement. Survivor (vs. screener) narratives were positively associated with CRCS, and had mixed effects on intention - positively through emotional engagement and negatively through self-referencing engagement to self-efficacy. Survivor narratives elicited more negative affect, which had positive and negative influences on intention. Continued research using path models to understand the mechanisms of narrative effects will inform theory development and message design. Additional measurement evaluation is needed to adequately capture and then compare the effects of different components of narrative engagement.

The Transformative Power of Authentic Conversations About Cancer

Entertainment-education (E-E) assumes that actors performing content should be ethnically and culturally homogeneous with targeted audiences. The present study challenges this basic E-E assumption. Findings are presented from audience members who viewed When Cancer Calls… This theatrical production was constructed from verbatim transcriptions of naturally occurring telephone conversations between White family members as they communicated about and through their cancer journey. Non-White audience members were significantly more likely than White audience members to (a) regard the performance as authentic, (b) find it would influence "people like me," and (c) recommend the production to others. These findings suggest that all people must rely on communication when facing health challenges together. Such interactions that are fundamental to family membership are thus primal for the human social condition, regardless of differences in race and ethnicity. These findings also suggest innovative approaches to E-E health interventions that may contradict traditional market segmentation theories based on cultural differences and the principle of homophily.

A Transmedia Storytelling Intervention With Interactive Elements to Benefit Latinas' Mental Health: Feasibility, Acceptability, and Efficacy

BACKGROUND

Latinos report higher rates of depression and anxiety than US whites but are less likely to receive care. Transmedia storytelling interventions accessible on the Internet via smartphones, tablets, and computers hold promise for reducing reluctance to explore or get help for symptoms because they are private, convenient, and can reach large numbers of people, including Latinas with mental health needs.

OBJECTIVE

The purpose of this study was to examine the feasibility, acceptability, and preliminary efficacy of a mental health transmedia intervention for Latinas with elevated symptoms of depression, anxiety, or both.

METHODS

A total of 28 symptomatic English-speaking Latina women aged 21 to 48 years participated in a 6-week study using a within-group design. All aspects of the study were completed via telephone or Internet. Participants used their personal devices to engage the Web-based transmedia intervention (in English) that included story-based videos, a data-informed psychotherapeutic video, an interactive video sequence, and a blog written from the point of view of one of the characters with links to mental health resources. Perceived confidence to get help and perceived importance for seeking immediate help were both measured using single-item questions. Participants completed surveys at baseline (via telephone) and 1 and 6 weeks after media engagement that measured various factors, including depression (Patient Health Questionnaire; PHQ-9 and PHQ-8) and anxiety (Generalized Anxiety Disorder scale; GAD-7). A telephone interview was conducted within 72 hours of media engagement. Action taken or intentions to get help (single-item question) and talking about the videos with others (single-item question) were measured 1 and 6 weeks after media engagement. Repeated measures analysis of variance was used to assess change in depression (PHQ-8) and anxiety (GAD-7) before transmedia engagement and 1 and 6 weeks after. Spearman correlations evaluated the association of confidence and importance of getting help with action taken, anxiety, and depression.

RESULTS

All 28 Latinas (English speakers) who engaged with the transmedia remained in the 6-week study. Within 1 week of transmedia engagement, 39% of women took action to get help, and 82% discussed the media with others. Symptoms of depression (F2,54=9.0, P<.001) and anxiety (F2,54=18.7, P<.001) significantly reduced across time. Higher levels of confidence were significantly associated with actions taken at 1 (P=.005) and 6 weeks (P=.04), and higher levels of importance were significantly associated with actions taken at 1 (P=.009) and 6 weeks (P=.003). Higher levels of confidence were associated with lower levels of depression (P=.04) and anxiety (P=.01) at 6 weeks.

CONCLUSIONS

Preliminary findings indicate a culturally tailored mental health transmedia intervention is a feasible approach that holds promise for engaging large numbers of symptomatic English-speaking Latina women to begin the process of seeking help, as well as decreasing symptoms of anxiety and depression.

Optimizing the Presentation of Mental Health Information in Social Media: The Effects of Health Testimonials and Platform on Source Perceptions, Message Processing, and Health Outcomes

Using social media for the purpose of disseminating mental health information is a critical area of scientific inquiry for health communication professionals. The purpose of this study was to investigate whether the presence of a first-person testimonial in educational mental health information placed in Facebook and Twitter messages influenced college students' (N = 257) source perceptions, information processing, cognitive elaboration, health information recall, beliefs, and behavioral intentions. Results show that exposure to social media messages that featured mental health information embedded with a testimonial predicted less source homophily and more critical thoughts about the social media source, less systematic message processing, and less cognitive elaboration. Health information recall was significantly impacted by both the social media platform and message content such that participants in the testimonial condition on Facebook were more likely to recall the health facts in those messages whereas participants who viewed the testimonial in Twitter were less likely to recall the facts in those tweets. Compared to those who read Facebook messages, participants who read Twitter messages reported higher levels of systematic message processing. These findings suggest that the integration of health testimonials into social media messages might inadvertently provoke psychological resistance to mental health information, thereby reducing the persuasive impact of those messages.

Argument Strength and the Persuasiveness of Stories

Stories are a powerful means to change people’s attitudes and beliefs. The aim of the current work was to shed light on the role of argument strength (argument quality) in narrative persuasion. The present study examined the influence of strong versus weak arguments on attitudes in a low or high narrative context. Moreover, baseline attitudes, interindividual differences in working memory capacity, and recipients’ transportation were examined. Stories with strong arguments were more persuasive than stories with weak arguments. This main effect was qualified by a two-way interaction with baseline attitude, revealing that argument strength had a greater impact on individuals who initially were particularly doubtful toward the story claim. Furthermore, we identified a three-way interaction showing that argument strength mattered most for recipients who were deeply transported into the story world in stories that followed a typical narrative structure. These findings provide an important specification of narrative persuasion theory.