Joyee S. Chatterjee

Narrative versus Nonnarrative: The Role of Identification, Transportation, and Emotion in Reducing Health Disparities

This research empirically tests whether using a fictional narrative produces a greater impact on health-related knowledge, attitudes, and behavioral intention than presenting the identical information in a more traditional, nonfiction, non-narrative format. European American, Mexican American, and African American women (N = 758) were surveyed before and after viewing either a narrative or non-narrative cervical cancer-related film. The narrative was more effective in increasing cervical cancer-related knowledge and attitudes. Moreover, in response to the narrative featuring Latinas, Mexican Americans were most transported, identified most with the characters, and experienced the strongest emotions. Regressions revealed that transportation, identification with specific characters, and emotion each contributed to shifts in knowledge, attitudes, and behavioral intentions. Thus, narrative formats may provide a valuable tool in reducing health disparities.

Conversation and Compliance: Role of Interpersonal Discussion and Social Norms in Public Communication Campaigns

This study explores the role of interpersonal discussion and social norms in a public health campaign, the BBC Condom Normalization Campaign, designed to promote conversation and change the public perception of condom use in India. Drawing upon the integrative model of behavioral prediction, attitudes, self-efficacy, subjective norms, and descriptive norms were predicted to relate to behavioral intentions to use condoms. It is important to note that the valence of discussion was hypothesized to relate to each of these more proximal predictors. The authors used structural equation modeling to test the model on 3 separate samples of Indian men between the ages of 15 and 49 years: (a) high-risk men who had sex with nonspouses; (b) low-risk, sexually inactive, unmarried men; and (c) low-risk, monogamous, married men. Results were similar for low- and high-risk audiences, with valence of discussion about condoms predicting condom-related attitudes, self-efficacy, and subjective and descriptive social norms with respect to condom use, which, in turn, predicted behavioral intent to use condoms. These findings underscore the need to take not only the frequency but also the valence of interpersonal discussion into account when assessing the effect of health campaigns. Implications for theory and design of future public communication campaigns are explored.

Tamale Lesson: A case study of a narrative health communication intervention

Abstract Cervical cancer is the third most common type of cancer in women globally. Latinas carry a disproportionate burden of this disease. In the United States, when compared with non-Hispanic Whites, Latinas endure much higher incidence rates (13.86 vs. 7.70 per 100 000) with mortality rates 1.5 times greater than for non-Hispanic White women. In order to address this disparity, a multidisciplinary team engaged in a study to test the effectiveness of a narrative, developed in culturally specific ways as a behavioral change communication tool. This case study presents lessons learned from Tamale Lesson, a narrative health communication intervention aimed at Mexican-American women that promotes cervical cancer screening (via Pap test) and prevention (via use of the Human Papillomavirus vaccine). Mexican American women who viewed Tamale Lesson showed a significant increase in cervical cancer screening, reducing a disparities in cancer screening found at baseline. This case study highlights the benefits of creating a culturally grounded narrative intervention, and underscores the powerful potential of narrative/storytelling in eliminating health disparities in the United States and around the world.

Comparing the Relative Efficacy of Narrative vs Nonnarrative Health Messages in Reducing Health Disparities Using a Randomized Trial.

OBJECTIVES We compared the relative efficacy of a fictional narrative film to a more traditional nonnarrative film in conveying the same health information. METHODS We used a random digit dial procedure to survey the cervical cancer-related knowledge, attitudes, and behavior of non-Hispanic White, Mexican American, and African American women, aged 25 to 45 years, living in Los Angeles, California, from 2011 to 2012. Participants (n = 704) were randomly assigned to view either a narrative or nonnarrative film containing the same information about how cervical cancer could be prevented or detected, and they were re-contacted 2 weeks and 6 months later. RESULTS At 2 weeks, both films produced a significant increase in cervical cancer-related knowledge and attitudes, but these effects were significantly higher for the narrative film. At 6 months, viewers of both films retained greater than baseline knowledge and more positive attitudes toward Papanicolaou (Pap) tests, but women who saw the narrative were significantly more likely to have had or scheduled a Pap test. The narrative was particularly effective for Mexican American women, eliminating cervical cancer screening disparities found at baseline. CONCLUSIONS Narratives might prove to be a useful tool for reducing health disparities.

Telling Stories, Saving Lives: Creating Narrative Health Messages

Increasingly, health communication practitioners are exploring the use of narrative storytelling to convey health information. For this study, a narrative film was produced to provide information about the human papillomavirus (HPV) and cervical cancer prevention. The storyline centered on Lupita, a young woman recently diagnosed with HPV who informs her family about HPV and the availability of the HPV vaccine for her younger sister. The objective was to examine the roles of identification with characters and narrative involvement (made up of three dimensions: involvement, perceived relevance, and immersion) on perceived response efficacy, perceived severity, and perceived susceptibility to HPV and behavior (discussing the HPV vaccine with a health care provider). A random sample of 450 European American, Mexican American, and African American women between the ages of 25 and 45 years, living in the Los Angeles area, was surveyed by phone before, 2 weeks after, and 6 months after viewing the film. The more relevant women found the narrative to their own lives at 2 weeks, the higher they perceived the severity of the virus and the perceived response efficacy of the vaccine to be. Also at 2 weeks, identifying with characters was positively associated with perceived susceptibility to HPV but negatively associated with perceived severity. At 6 months, identification with specific characters was significantly associated with perceived threat and behavior. These findings suggest that different aspects of narrative health messages should be manipulated depending on the specific beliefs and behaviors being targeted. Implications for narrative message design are discussed.

Masculinity matters: using entertainment education to engage men in ending violence against women in India

Abstract In this article, R.W. Connells notion of hegemonic masculinity is used to examine the role of male gender norms in perpetuating violence against women. The researchers discuss the implications for entertainment-education (EE) programmes that seek to promote gender equality by modelling alternative forms of masculinity and sparking critical dialogue about gender-equitable masculine norms. First, theories are reviewed that contextualise masculinity and media to establish a strategic foundation for engaging men through EE. Next, a case study is undertaken of media campaigns by Breakthrough, a human rights organisation that has produced a number of media and EE initiatives to address violence against women. The article highlights five specific ways in which men can be represented in media campaigns with EE components: 1) invisible men; 2) men as perpetrators; 3) men as allies; 4) men as agents in challenging hegemonic masculinity; and 5) men as agents in redefining manhood.

Information Scanning and Vaccine Safety Concerns among African American, Mexican American, and Non-Hispanic White Women

OBJECTIVE A significant number of parents delay or refuse vaccinating their children. Incidental exposure to vaccine information (i.e., scanned information) may be an important contributor to anti-vaccine sentiment. This study examines the association between scanned information, trust in health information sources and vaccine safety concerns among African American, Mexican American, and non-Hispanic White women. METHODS Women (N=761) in Los Angeles County were sampled via random digit dial and surveyed regarding use of and trust in health information resources and vaccine safety concerns. RESULTS Analyses indicate that the sources of information associated with vaccine safety concerns varied by ethnicity. Each ethnic group exhibited different patterns of association between trust in health information resources and vaccine safety concerns. CONCLUSIONS Information scanning is associated with beliefs about vaccine safety, which may lead parents to refuse or delay vaccinating their children. These relationships vary by ethnicity. PRACTICE IMPLICATIONS These findings help inform practitioners and policy makers about communication factors that influence vaccine safety concerns. Knowing these sources of information will equip practitioners to better identify women who may have been exposed to anti-vaccine messages and counter these beliefs with effective, vaccine-promoting messages via the most relevant information sources.

A pilot test of the acceptability and efficacy of narrative and non-narrative health education materials in a low health literacy population

Abstract Although entertainment-education narratives are increasingly being used to communicate health information to a diversity of populations, there is limited evidence examining the use of narrative health education videos in low compared with adequate health literacy populations. There are also very few studies directly comparing narrative materials to more traditional, non-narrative materials. Because individuals with low health literacy are less likely than those with adequate health literacy to benefit from health communication interventions, it is especially important to develop an evidence base supporting the use of narrative health education materials in low-literacy populations. This study extends knowledge on the use of narrative health education materials in populations with low health literacy by conducting a randomized trial comparing the acceptability and efficacy (knowledge gain) of two fact-equivalent films, one in a narrative and one in a non-narrative format, on individuals with adequate and low health literacy. This study finds that while both films were well-accepted and produced knowledge gains, the narrative film was more effective in this regard. This effect occurred regardless of health literacy level, indicating that narrative health communication materials are appropriate for individuals with low health literacy and do not exacerbate existing health disparities. These findings add to a small but growing body of evidence testing narrative health education materials in individuals with low health literacy, and provide new evidence supporting narrative, entertainment-education style video as a health communication tool to help reduce health literacy-related health disparities.

Individual, Cultural and Structural Predictors of Vaccine Safety Confidence and Influenza Vaccination Among Hispanic Female Subgroups

Rates of influenza vaccination among US Hispanics are lower than for non-Hispanic whites, yet little is known about factors affecting vaccination in this population. Additionally, although Hispanics are a diverse population with culturally distinct subgroups, they are often treated as a homogenous population. This study (1) examines how confidence in vaccine safety and influenza vaccine use vary by Hispanic subgroup and (2) identifies individual, cultural and structural correlates of these outcomes. This study analyzed survey data from 1565 Hispanic women who were recruited at clinic- and community-based sites in Los Angeles. Education, healthcare coverage, acculturation, fatalism, and religiosity were predictors of influenza vaccination behavior and predictors varied by subgroup. These findings provide guidance for how influenza vaccine promotion efforts can be developed for Hispanic subgroups. Confidence in the safety of a vaccine is a major predictor of flu vaccination and an important modifiable target for intervention.

Mexican-American Mothers’ Perceptions Regarding Vaccinating Their Daughters Against HPV and Recommended Strategies to Promote Vaccine Uptake

Uptake and completion of the HPV vaccine among Latina girls has been relatively low, despite mothers’ generally positive attitudes toward the vaccine. Focus groups were used for an in-depth, qualitative investigation of Mexican-American mothers’ beliefs about and perceived barriers regarding the HPV vaccine and their recommendations for vaccine promotion. Overall, women felt capable and motivated to take care of their daughters’ health, and they noted the family-centered nature of health decisions and made an association between HPV vaccination and a girls first menses. Findings from this study can be used to support woman-centered and culturally specific HPV vaccine promotion efforts.