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  3. Universiteit Van Amsterdam (UvA)
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  5. Health Communication (77643SP05Y)

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Summary Health Communication: theory exam II / part C

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Summary that includes all material for the exam of Health Communication. The summary is built up through the structure of the articles, supplemented by the most important parts from the micro lectures and reading questions.

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  • 18 november 2021
  • 28 november 2021
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Health Communication UvA | 1




Summary Health Communication
Theory block II / part C
Master: Persuasive Communication
Overview literature
Week 9: Storytelling
- Graaf, A. D., Sanders, J., & Hoeken, H. (2016)
- Moyer-Gusé, E. (2008)
- Murphy, S. T., Frank, L. B., Chatterjee, J. S., & Baezconde‐Garbanati, L. (2013)


Week 10: Framing
- Rothman, A. J., Bartels, R. D., Wlaschin, J. & Salovey, P. (2006)
- Gallagher, K. M., & Updegraff, J. A. (2012)
- Covey, J. (2014)


Week 11: Mode strategies
- Mayer, R. E., & Moreno, R. (2003)
- Bol, N., Van Weert, J. C. M., De Haes, J. C. J. M., Loos, E. F., & Smets, E. M. A.
(2015)
- Meppelink, C. S., Van Weert, J. C. M., Haven, C., & Smit, E. G. (2015)


Week 12: Targeting and tailoring
- Hawkins, R. P., Kreuter, M., Resnicow, K., Fishbein, M., & Dijkstra, A. (2008)
- Van Stralen, M. M., de Vries, H., Mudde, A. N., Bolman, C., & Lechner, L. (2009)
- Kreuter, M. W., & McClure, S. M. (2004). The role of culture in health
communication. Annual Review of Public Health, 25, 439-455.

, Health Communication UvA | 2




Week 9: Storytelling

Graaf, A. D., Sanders, J., & Hoeken, H. (2016). Characteristics of narrative interventions
and health effects: a review of the content, form, and context of narratives in health-related
narrative persuasion research. Review of Communication Research, 4, 88-131

Characteristics of narrative interventions
This study reviews the existing research on health-related narrative persuasion with a
focus on the narrative materials.


Goal of study: research has shown that narratives can serve as a promising health
communication tool, however not all narratives are effective. Therefore they ought to find out
which narratives are used in research, what the differences are and why certain studies have
found persuasive effects and others have not.
● So, the review explores the characteristics of narrative stimuli in existing
health-related narrative persuasion research as potential explanatory factors of their
effectiveness.
● Effectiveness refers to changes in story-consistent beliefs, attitudes, intentions, and
behavior that are directed at the physical and mental health of a person.
● This process is also influenced by characteristics of the recipient and the situation in
which the recipient is exposed to the narrative.


Narratives are increasingly used in health communication to reach public health goals, such
as promoting behaviors that are aimed at the prevention and detection of illnesses.


Definition of narrative: a presentation of concrete event(s) experienced by specific
character(s) in a setting. This definition can also be used outside of the entertainment context.
● Concrete event(s): an event is a transition from one state to another temporally and
causally connected state.
○ Most narratives consist of multiple events that are also connected in such a
sequential, causal way. The term causal here refers not only to causality in a
strictly necessary way (e.g., Mary released the breaks of the car on top of the

, Health Communication UvA | 3




hill and thus it started rolling down), but also to reasons for events (e.g., Mary
was mad at her friend and thus she started spreading rumors about her).
○ Although events may be presented in a non-chronological order, the
underlying structure is one of cause and effect or action and reaction, that
connects the narrative events and characters in a story structure.
● Specific character(s): includes at least one character, who experiences at least one
event. A character is an agent who is human or human-like in that they act with
intentions to achieve goals.
● Setting/spatio-temporal framework: the events take place at a certain time and
place, also called the setting.


Different type of characteristics of narratives:
● Events: positive events versus negative events;
● Perspective: first-person narratives versus third-person stories;
● Content of the narrative: main elements are the characters, events, and setting that
are presented in the story. For instance, characters can be more or less similar to the
target recipients and events can differ in their valence.
● Form of the narrative: the way the content is presented in the narrative. For instance,
the view the reader is given on the story content can vary between different
perspectives; and the events can either be presented chronologically or
non-chronologically.
● Context of the narrative: the context of a narrative can consist of an entertainment
format. In such a context, the reader is generally unaware that the narrative has a
persuasive intention. The context of a narrative can also consist of an advertisement or
a health education brochure, in which the persuasive intent is more explicit.


Several criteria for the selection process:
● The study had to include participants who were exposed to a narrative;
○ They excluded studies on interactive narratives because in these studies the
narrative elements presented to the participants were not stable within
conditions.
● The study had to measure persuasive effects of being exposed to the narrative.
Persuasive effects could be effects on beliefs, attitudes, intentions or actual behaviors.

, Health Communication UvA | 4




● The study had to address a health topic. Health was defined broadly, as any topic
relating to the physical and psychological well being of a person.
● The study had to have a (quasi-) experimental design.
○ The selected studies had one of two different designs:
1. The study compared a narrative condition to a control condition (such
as a non-narrative message or a no message condition);
2. The study compared different versions of a narrative, in which a
characteristic of the narrative or its context was manipulated. Some
studies combined both possibilities.
● The study had to be published since the year 2000.
● The study had to use either college-aged participants or older.


Sample: 141 papers that reported 153 (quasi-)experimental studies.


Results (summarized in table below):
● Comparing Narratives to Control Conditions:
○ Narratives can produce effects on several persuasive outcomes. The
characteristics that seem promising for health-related persuasive effects are a
first-person perspective and the presentation of healthy behavior.
○ An overtly persuasive context does not seem to inhibit persuasive potential.
○ Other characteristics, such as the matching of characters to the target group
and the presentation medium of the narrative, appear to be unrelated to
persuasive impact.
● Comparing Different Versions of Narratives — Content:
○ Studies comparing narrative to non-narrative materials suggested that
narratives that presented the healthy behavior were more often associated with
effects on the intention to carry out the healthy behavior than narratives that
showed the unhealthy behavior.
○ An effect on intention occurred more often for the gain frame, but this effect
was not found for other persuasive outcomes, like beliefs and attitudes.
○ The expression of emotions in the narrative increased persuasive effects.
● Comparing Different Versions of Narratives — Form:

, Health Communication UvA | 5




○ A first-person perspective seems to be a promising characteristic of print
narratives with regard to persuasiveness.
○ The form characteristic of medium did not show promise as an influential
factor in whether narratives have persuasive effects or not.
○ For other form characteristics like the integration of the health message in the
narrative and the use of humor, not enough evidence was yet available to
identify a pattern.
● Comparing Different Versions of Narratives — Context: there are no systematic
indications of factors in the narrative context that are associated with persuasiveness.


Results — content characteristics

Characteristic Outcome variable Effect

Healthy versus unhealthy Intention Healthy more effective

Beliefs & attitude No effect

Frame Intention Gain frame more effective

Beliefs & attitude No effect

Character related (e.g., Beliefs & attitudes (e.g., Inconsistent effects
similarity) perceived risk)

Expression of emotions Perceived risk; intentions Positive effect

Responsibility character Beliefs & attitude Inconsistent effects



Results — form characteristics

Characteristic Outcome variable Effect

Perspective (first versus third Beliefs & attitude First person more effective
person)

Medium Beliefs & attitude; intention No effects

Integration/ embedding of Beliefs & attitude Not enough evidence
health message

Humor Intention Not enough evidence

, Health Communication UvA | 6




Results — context characteristics

Characteristic Outcome variable Effect

Covertness of persuasive Beliefs & attitude; intention No effects
intent


What can we learn from the systematic review of De Graaf et al. (2016)?
● There are two approaches for studying narratives:
○ Compare narratives with a control/non-narrative condition;
○ Compare different versions of narratives.
● Narratives are not a homogeneous concept, but vary across studies on numerous
characteristics.
● The variations in characteristics of narratives may influence effectiveness, but the
exact impact cannot be determined based on the research that is currently available.


Moyer-Gusé, E. (2008). Toward a Theory of Entertainment Persuasion: Explaining the
Persuasive Effects of Entertainment-Education Messages. Communication Theory, 18(3),
407-425.

Entertainment-Education Messages
Entertainment-education is a popular strategy for incorporating health and other
educational messages into popular entertainment media with the goal of positively
influencing awareness, knowledge, attitudes, and/or behaviors.
● Examples of entertainment-education could be:
○ With narrative: Sesame Street;
○ Without narrative: Trivia Crack.


Storytelling in health communication (entertainment-education):
● “A way of informing the public about a social issue or concern, by incorporating an
educational message into popular entertainment content in order to raise awareness,
increase knowledge, create favourable attitudes, and ultimately motivate people to
take socially responsible action in their own lives” (Singhal & Rogers, 1999).
● “Prosocial messages that are embedded into popular entertainment media content”
(Moyer-Gusé, 2008) .

, Health Communication UvA | 7




Researchers have speculated that: ‘‘the insertion of socially responsible messages in
entertainment media is a potentially powerful way of affecting sexual behavior because the
‘selling’ of a particular behavior isn’t as obvious as it may be in a public service
advertisement, and thus, audiences may not be as likely to resist the message’’.
● This idea is supported by Bandura ➔ because of its narrative structure,
entertainment-education facilitates an emotional experience of being swept up into the
narrative itself and becoming involved with the characters therein. This involvement
may help to overcome various forms of resistance to persuasion.


Narrative involvement/transportation: being primarily engaged in the storyline, rather than
in one’s immediate environment, and experiencing vicarious cognitive and emotional
responses to the narrative as it unfolds.
● Transportation is defined as ‘‘a convergent process, where all mental systems and
capacities become focused on events occurring in the narrative’’.
● This notion of being swept up into the storyline distinguishes entertainment-education
message processing from that of overtly persuasive messages.


The literature has brought on conceptual confusion in two ways:
1) Several distinct concepts — identification, similarity, and PSI — have often been used
interchangeably and/or used very differently.
2) A more thorough explanation is needed of why each form of involvement with
characters should increase the effectiveness of entertainment-education programming.


In addition to transportation into a narrative itself, entertainment-education also
facilitates various forms of involvement with characters. Involvement with characters:
● Identification: an emotional and cognitive process whereby a viewer takes on the role
of a character in a narrative. In other words, a process ‘‘in which an individual
perceives another person assimilar or at least as a person with whom they might have
a social relationship”. It increases absorption! This process involves four
dimensions:
○ Empathic: shared feelings with the character;
○ Cognitive: sharing the character’s perspective;
○ Motivational: internalizing the character’s goals;

, Health Communication UvA | 8




○ Absorption: the loss of self-awareness during exposure ➔ overlap with
definition of transportation.
■ Transportation (“losing yourself”) also increases absorption, which is
the end goal. This concept is not clearly defined in the text.
○ Identification is a complex, multidimensional construct:
■ Similarity towards a character is not the same as liking the character;
■ For persuasive effects, emotional involvement with/responses to
characters may be more important than similarity.
■ Take in mind the possible empathetic distress/negative emotional
responses! (Murphy et al., 2013) ➔ both processes reduce
counterarguing.


● Wishful identification: occurs when a viewer wants to be like the character,
experiences an active ‘‘desire to emulate the figure’’, and looks up to the character.
○ Part of the Social Cognitive Theory by Bandura.
○ ​Identification is distinct from wishful identification in that it represents an
emotional and cognitive process, whereby the viewer takes on the role of the
character she or he is viewing, rather than a desire to make himself or herself
more like the character.


● Similarity or homophily: refers to the degree to which an individual perceives that
he or she is similar to a character.
○ This similarity can refer to physical attributes, demographic variables, beliefs,
personality, or values.
○ Though perceived similarity is often considered a prerequisite to
identification, it is nonetheless a distinct concept. Similarity refers to a
cognitive assessment of what one has in common with a character, whereas
identification is characterized by empathy, shared emotions, and a loss of
self-awareness.


● Parasocial interaction (PSI): the interaction between an audience member and a
media figure such that a pseudo relationship forms. The relationships are not

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