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Results of the mediation analysis (H2). The figures show the non-standardized regression coefficients, B. The coefficients of the direct effects appear in parentheses. The dashed line represents nonsignificant coefficients. + p < 0.10, * p < 0.05, ** p < 0.01, *** p < 0.001. (a) Dependent variable: perceived message effectiveness. (b) Dependent variable: intention to quit. (c) Dependent variable: self-efficacy. (d) Dependent variable: response efficacy.
Source publication
Narrative messages are increasingly being used in the field of tobacco prevention. Our study is based on narrative persuasion and aims to analyze the psychological mechanisms that explain why the narrative voice is relevant to promote persuasive impact. An online experiment with a 2 (narrative voice) × 2 (message) factorial design was carried out....
Citations
... Specifically, testimonials produce effects on behavioral intentions and are persuasive for health beliefs and attitudes [4]. There is support for using testimonials to encourage health behavior change in a range of health-promoting interventions, including for physical activity [5,6], healthy eating [7], cancer screening [8], smoking cessation [9], and diabetes self-management [10]. ...
... This finding needs to be validated in practice through actual intervention delivery. Although much research supports the behavioral effects of testimonials [3], including for promoting abstinence from maladaptive health behaviors [9], Shen et al [42] found that cessation testimonials did not have significant effects, as opposed to prevention testimonials (eg, using condoms) and detection testimonials (eg, cancer screening), which did produce significant effects. This indicates that intervention designers-especially those who are designing interventions to dissuade maladaptive health behaviors-must continue identifying other elements to influence behavior and design to preempt testimonial pitfalls. ...
... https://formative.jmir.org/2025/1/e59691 JMIR Form Res 2025 | vol. 9 | e59691 | p.9 (page number not for citation purposes) ...
Background
Testimonials from credible sources are an evidence-based strategy for behavior change. Behavioral health interventions have used testimonials to promote health behaviors (eg, physical activity and healthy eating). Integrating testimonials into eating disorder (ED) interventions poses a nuanced challenge because ED testimonials can promote ED behaviors. Testimonials in ED interventions must therefore be designed carefully. Some optimal design elements of testimonials are known, but questions remain about testimonial speakers, messaging, and delivery, especially for ED interventions.
Objective
We sought to learn how to design and deliver testimonials focused on positive behavior change strategies within our multisession digital binge eating intervention.
Methods
We applied human-centered design methods to learn users’ preferences for testimonial speakers, messaging, and delivery (modalities, over time, and as “nudges” for selecting positive behavior change strategies they could practice). We recruited target users of our multisession intervention to complete design sessions. Adults (N=22, 64% self-identified as female; 32% as non-Hispanic Black, 41% as non-Hispanic White, and 27% as Hispanic) with recurrent binge eating and obesity completed individual interviews. Data were analyzed using methods from thematic analysis.
Results
Most participants preferred designs with testimonials (vs without) for their motivation and validation of the intervention’s efficacy. A few distrusted testimonials for appearing too “commercial” or personally irrelevant. For speakers, participants preferred sociodemographically tailored testimonials and were willing to report personal data in the intervention to facilitate tailoring. For messaging, some preferred testimonials with “how-to” advice, whereas others preferred “big picture” success stories. For delivery interface, participants were interested in text, video, and multimedia testimonials. For delivery over time, participants preferred testimonials from new speakers to promote engagement. When the intervention allowed users to choose between actions (eg, behavioral strategies), participants preferred testimonials to be available across all actions but said that selectively delivering a testimonial with one action could “nudge” them to select it.
Conclusions
Results indicated that intervention users were interested in testimonials. While participants preferred sociodemographically tailored testimonials, they said different characteristics mattered to them, indicating that interventions should assess users’ most pertinent identities and tailor testimonials accordingly. Likewise, users’ divided preferences for testimonial messaging (ie, “big picture” vs “how-to”) suggest that optimal messaging may differ by user. To improve the credibility of testimonials, which some participants distrusted, interventions could invite current users to submit testimonials for future integration in the intervention. Aligned with nudge theory, our findings indicate testimonials could be used as “nudges” within interventions—a ripe area for further inquiry—though future work should test if delivering a testimonial only with the nudged choice improves its uptake. Further research is needed to validate these design ideas in practice, including evaluating their impact on behavior change toward improving ED behaviors.
... 39 First-person narratives, in which the narrator expresses their view on topics or their experience, activate identification with the speaker and decrease resistance to cognitive acceptance. 28,40 In addition, the use of 'HIV'/'AIDS' terminology and phrasing such as 'people living with HIV' (i.e., from the third-person standpoint) was minimized in the app. The first-person narrative contributes to reducing the risk of HIV exposure to others by minimizing the use of 'HIV' throughout the app. ...
Objective
Employing three cycles of Design Science Research (DSR) to develop a mobile app ‘ESSC (Excellent Self Supervised HIV Care)’ to improve self-management among people living with HIV (PLWH).
Methods
This study is based on the DSR framework comprising three iterative cycles. In the Relevance cycle, PLWH participated in a survey of mobile health (mHealth) experiences and needs. In the Rigor cycle, the information-motivation-behavioural skills (IMB) model was applied to foundations of the app, and HIV specialists verified the contents. Experts evaluated the heuristic system and the app quality with the Mobile Application Rating Scale (MARS). In the Design cycle, ESSC was built on the findings of the other two cycles, and end-users tested the usability using uMARS.
Results
The contents of the app were developed based on user requirements. The IMB model led ESSC to supplement motivational components for self-management, which built five functions: information contents; health life records including mental and sexual health; interactive counselling with healthcare providers; setting health goals after watching videos; and my page for self-reflection. To reduce social stigma and promote acceptance of the information-driven app, we created animated characters with neutral and bright features. The HIV specialists evaluated content validity as highly appropriate. The MARS score by the overall raters was between 3-acceptable and 4-good: functionality, 4.38; information, 4.12; aesthetics, 3.96; engagement, 3.37; and subjective quality, 3.25.
Conclusions
The DSR approach is effective for implementing usable and useful mHealth. The ESSC app would be feasible and contribute PLWH to retention in care.
... Even though similarity is a multidimensional construct, previous studies in health communication have largely focused on the effect of demographic similarities, such as age and gender, on identification (see Chen & Bell, 2021). Only a few studies accounted for other characteristics like health status similarity (e.g., Igartua & Rodríguez Contreras, 2020). ...
... Because identification requires immersion into the world of the media character and a consequent temporary loss of one's own perspective, counterarguing processes should be incompatible with identification (Moyer-Gusé, 2008). Indeed, research on the effects of narrative health communication has found proof that identification is associated with less counterarguing against smoking prevention testimonial messages (Igartua & Rodríguez-Contreras, 2020) or messages crafted to prevent sexually transmitted infections (Moyer-Gusé et al., 2011). The second hypothesis for this study is therefore that identification is negatively associated with counterarguing (H2). ...
... Thus, individual perceived stress did not have a significant impact on the effect of narrative voice on identification. There is empirical evidence that perceived similarities with a media character (see Chen & Bell, 2021), particularly the audience member's personal experience with a health topic, influence viewer involvement with a healthrelated message (Igartua & Rodríguez Contreras, 2020;Quintero Johnson et al., 2021); this does not, however, appear to be the case for audience-character similarities in explainer-video PSAs in our study. Participants watching a first-person PSA could not more readily identify with the rather generic character in explainer videos if they had experienced the same health issues. ...
Research on health communication shows that audience involvement with media characters displayed in narratives represents a key mechanism that facilitates persuasive outcomes. This study analyses whether different narrative voices trigger identification with story characters and affect counter-arguments against and attitudes toward proposed recommendations. The online experiment (N = 364) investigates the effects of first- and third-person narrative voice in explainer videos using the example of work-related stress, and similarities between the audience’s situations and that of the character are accounted for. The moderated mediation analysis showed no effect of narrative voice on identification and being personally affected by the health issue addressed in the explainer video did not play a moderating role. Furthermore, the results showed that identification was negatively associated with disagreement and positively related to attitudes toward recommendations. Narrative voice did not have a direct impact on attitudes and there is was no effect mediated via identification and disagreement.
... For written text, the narrative voice can be changed by telling the story in first or third person (Kaufman & Libby, 2012;Van Krieken et al., 2017). First-person narratives in tobacco prevention led to increased identification with the protagonist, reducing resistance to the message and increasing persuasive impact (Igartua & Rodríguez-Contreras, 2020). Another approach is to instruct participants to take the perspective of a character, imagining themselves as the protagonist (identification condition) or to remain as spectators. ...
... Both strategies aimed at fostering perspective-taking, a crucial driver of identification (Van Krieken et al., 2017), and increasing attitude change based on persuasive messages (e.g. Igartua & Rodríguez-Contreras, 2020). In the present studies, both techniques raised self-reported perspectivetaking (identification items) and perceived similarity with the model, but failed to influence the size of the vicarious approach-avoidance effects. ...
Social learning plays a prominent role in shaping individual preferences. The vicarious approach-avoidance effect consists of developing a preference for attitudinal objects that have been approached over objects that have been avoided by another person (model). In two experiments (N = 448 participants), we explored how the vicarious approach-avoidance effect is affected by agency (model's voluntary choice) and identification with the model. The results consistently revealed vicarious approach-avoidance effects in preference, as indicated by the semantic differential and the Implicit Association Test. Agency increased the size of the preference assessed through the semantic differential but did not significantly impact preference in the Implicit Association Test. Identification with the model had no significant impact on the vicarious approach-avoidance effect. Theoretical and practical implications of the results are discussed.
... Testimonials generally convey an individual's personal story or lived experience (Braverman, 2008;Dillard & Main, 2013;Winterbottom et al., 2008). They emphasize personal experiences and often aim to persuade the audience to follow (or learn from) their experience (Braverman, 2008;Igartua & Rodríguez-Contreras, 2020;Keer et al., 2013). Testimonials may be a written or audio-visual first-person essay, interview, or documentary; they may be standalone or embedded in a longer informative, entertainment, or persuasive document. ...
... Emotion can be considered intimately interwoven with attitudes and counterarguing in response to persuasive content (Nabi & Green, 2015). Moreover, using a first-person voice can increase affective responses and identification (Igartua & Rodríguez-Contreras, 2020) and testimonials have been shown to reduce stigmatizing beliefs about immigrants, contingent on empathetic responses to the narrative (Igartua & Cachón-Ramón, 2023). ...
Overtly persuasive narratives such as testimonials pose significant challenges for theories of narrative persuasion. Such theories argue that overt persuasive intent diminishes entertainment and entertaining narratives reduce counterarguing. We propose that testimonial narratives instead have persuasive advantages through their ability to arouse message-consistent emotions and reduce affective reactance to the messages. Participants (n = 1478) were randomly assigned to read a testimonial narrative or a non-narrative article about physician-assisted suicide. Articles were perceived as highly persuasive and low in entertainment intent; the testimonial was higher than the non-narrative in perceived eudaimonic intent. As predicted, testimonials reduced counterarguing via increased meaningful affect and decreased affective reactance to the message. Interaction tests showed that these effects were stronger in counterattitudinal participants. Theoretical implications for understanding the effects of testimonial narratives, particularly when the narratives are eudaimonic, are discussed, as are innovations for measuring counterarguing and perceived message intent.
... This process, in turn, would activate different routes to explain the persuasive impact: through identification with the protagonist, through narrative transportation and through reactance. However, in this work, we considered a fourth mechanism: cognitive elaboration [41][42][43]. Cognitive elaboration is defined as a process of reflection on the content of the message and constitutes a measure of the intensity of such reflection during the reception process [44]. Cognitive elaboration is the mechanism that has been least explored to date in narrative persuasion research in health communication (see [45]), despite the fact that health messages are designed to stimulate active cognitive processing in individuals. ...
... The testimonial message elaborated for this study had a clear and causal structure, in such a way that a series of events were presented that were connected in space and time (see Table 2). It was narrated in the first person, since previous research had concluded that the use of the first person was more effective than the second-or third-person narrative voice [42,47]. The message's protagonist was a 23-year-old individual named Alex Sanchez (@sanchez98_alex). ...
... Cognitive elaboration. An adapted version of the cognitive elaboration scale developed by Igartua and Rodríguez-Contreras [42] was used, consisting of four items (e.g., "while reading the narrative, I intensely reflected on the topic of the coronavirus"; from 1 = strongly disagree to 7 = strongly agree). The 4 items were averaged into a reliable scale (α = 0.84, M = 4.66, SD = 1.28). ...
The health crisis caused by COVID-19 resulted in societal breakdowns around the world. Our research is based on determining which features of testimonial messages are most relevant in increasing persuasive impact. An online experiment with a 2 (severity infection narrative: low vs. high) × 2 (infection target: narrative’s protagonist vs. protagonist’s father) between-subject factorial design was carried out. Young people between 18 and 28 years (N = 278) were randomly assigned to one of the four experimental conditions, where they were asked to read a narrative message in the form of a Twitter thread describing a COVID-19 infection (with mild or severe symptoms) that affected either the protagonist of the message (a 23-year-old young person) or their father. After reading the narrative message, the mediating and dependent variables were evaluated. A message describing a severe COVID-19 infection affecting their protagonist to increase the perception of personal risk increased the persuasive impact through an increase in cognitive elaboration and a reduction in reactance. Our study highlights that creating persuasive messages based on social media targeted at young people that describe a careless behavior resulting in a severe COVID-19 infection can be an appropriate strategy for designing prevention campaigns.
... Thus far, studies into the persuasive impact of narrative person in health messages have not yielded consistent findings -with some showing the persuasive advantage of first-person narratives (Chen et al., 2017;Igartua & Rodriguez-Contreras, 2020;Kim & Lee, 2018;Nan et al., 2015Nan et al., , 2017, others detecting no impact of narrative person (Chen et al., 2016;Nazione, 2016) and still others showing conditional effects of narrative person (Chen et al., 2015;Kim & Lee, 2017;Kim & Shapiro, 2016;Ma & Nan, 2018). Nonetheless, several reviews have suggested that first-person narratives tend to be more influential than third-person narratives (Chen & Bell, 2022). ...
An online experiment with two between-subjects conditions was conducted among a convenience sample of American college students to test the impact of first-person internally focalized versus third-person externally focalized risk narratives on the effectiveness of anti-prescription opioid campaigns as well as factors that explain such impact. It found that first-internal vs. third-external narratives increased identification with the character, perceived severity of the dangers of prescription opioids, anticipated guilt, as well as negative attitudes toward prescription opioids. The study also found indirect positive impacts of first-internal vs. third-external narratives on negative attitudes toward prescription opioids and intentions to avoid (mis)using prescription opioids via perceived severity and anticipated guilt but not identification. The findings contribute to our understanding of the impacts of narrative perspectives in the context of health communication and provide guidance in the design of effective anti-prescription opioid campaigns.
... particularly beneficial for early detection and prevention of cancer; they have been shown to influence engagement in cancer prevention 8,9 and screening behaviors. 10,11 One method for increasing the effectiveness of narratives is incorporating behavior change theory. ...
Objective:
Narratives are commonly utilized in health promotion and behavior change interventions due to their efficacy over didactic or expository interventions. While grounding narratives in behavioral theory may render them more effective, balancing the integration of theoretical and creative aspects of the narrative development process while maintaining authenticity is challenging. Thus, this manuscript describes a rigorous process through which researchers can intentionally integrate theory and personal stories for health interventions.
Methods:
The process for creating theory-driven narratives involves the following steps: (1) defining the purpose of the narratives, (2) selecting a guiding theory, (3) collecting personal testimonials, (4) immersing self into testimonials, (5) identifying central narratives and important variations, (6) considering additional theories, (7) piecing quotes into cohesive stories, (8) filling in the gaps, and (9) checking for resonance.
Results:
To exemplify this step-by-step process, we provide a case study from our research involving the development of a psychoeducational intervention to model information seeking strategies for managing cancer-related uncertainty among women who have recently tested positive for pathogenic genetic variants that increase risk for hereditary breast and ovarian cancer.
Conclusions:
We discuss special considerations for developing theory-driven narrative interventions and reflect on how this rigorous step-by-step process can be adapted by other researchers. This article is protected by copyright. All rights reserved.
... Another study (Igartua & Rodríguez-Contreras, 2020) comparing the manipulations of first-person and third-person narrative voice used in tobacco-prevention messages found that narratives written as first-person testimonial accounts were more effective than third-person descriptions in increasing participants' identification with the narrator, as well as boosting cognitive elaboration and decreasing counterarguing. Participants were self-reported current smokers, who had smoked more than 100 cigarettes during their life and five or more cigarettes within the week prior to the study. ...
... Our second hypothesis, H2, predicted that conversion messages compared to advocacy messages would lead to increased source credibility levels and decreased counterarguing levels among high vaccine-hesitant participants. This prediction was built on the ELM (Petty & Cacioppo, 1979a, 1979b, empirical results from testimonial-type narrative studies (e.g., Braverman, 2008;Igartua & Rodríguez-Contreras, 2020), and the literature on two-sided refutational message effects on source credibility of non-sponsored sources (O'Keefe, 1999(O'Keefe, , 2016. Means for source credibility moved in the expected directions but did not reach significance. ...
This study examined two-sided conversion messages in relation to one-sided advocacy messages in reducing vaccine hesitancy related to COVID-19 vaccine uptake. Results demonstrated that, for vaccine-hesitant participants, conversion messages increased pro-COVID-19 vaccination attitudes and behavioral intentions. For high vaccine-hesitant participants, the relationship between conversion messages and attitudes toward COVID-19 vaccinations was mediated through source credibility. For low vaccine-hesitant participants, mediation occurred through counterarguing. Findings have implications for health message tailoring related to COVID-19 vaccine uptake.
... third-person) POV led to higher risk perceptions of HPV. Moreover, Igartua and Rodríguez-Contreras (2020) provided evidence that narrative POV mattered for encouraging smoking cessation: Compared to the thirdperson POV narrative, the first-person POV narrative led to greater character identification, which in turn reduced persuasion resistance and enhanced quitting intentions. A recent meta-analysis also confirmed that health narratives written in the first-person (vs. ...
... A few studies have found that a firstperson (vs. third-person) POV narrative led to greater character identification, which further promoted persuasive effects (Igartua, & Rodríguez-Contreras, 2020;Kaufman, & Libby, 2012). Chen and Bell's (2021) meta-analysis also suggested that a first-person (vs. ...
Sharing the stories of people whose lives are impacted by Opioid Use Disorders (OUDs) can be a promising strategy to reduce stigma and increase support for beneficial public policies. Since a story can be told from a first-person or third-person point of view (POV), this study sought to (1) determine the relative persuasive effects of narrative POV and (2) identify the underlying psychological mechanisms, including character identification and psychological reactance, of such narratives. A one-way between-subjects experiment was conducted among a college student sample (N = 276). Narrative POV was manipulated by describing a college student’s OUD experience from either the first- or third-person POV. Findings demonstrated that POV did not influence identification but had a significant effect on reactance. Specifically, the first-person (vs. third-person) POV narrative led to lower reactance, which was associated with participants’ decreased desire to socially distance themselves from people with OUDs and stronger support for public health-oriented policies regarding OUDs. This study sheds light on the mixed findings revealed in the literature and has practical importance in health message design in the current opioid epidemic.
