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Entertainment-Education in a Media-Saturated Environment: Examining the Impact of Single and Multiple Exposures to Breast Cancer Storylines on Two Popular Medical Dramas

Taylor & Francis
Journal of Health Communication
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In the United States, entertainment-education (E-E) initiatives in primetime television that provide public health information are at risk for diminished impact due to the media-saturated environment in which they must compete. One strategy to overcome this limitation is to use multiple primetime TV shows to reinforce similar health messages in multiple storylines. The current study explores such an approach by evaluating the impact of two separate breast cancer genetics storylines featured on two different TV programs as the result of outreach to writers and producers. These storylines aired within approximately 3 weeks of each other on the popular medical dramas, ER (NBC) and Grey's Anatomy (ABC), and included information about the BRCA1 breast cancer gene mutation and the risks it poses to women who test positive for it. The evaluation used data collected from a panel sample of 599 female survey respondents at three points in time. Results show that while the individual storylines had a modest impact on viewers' knowledge, attitudes, and behaviors related to breast cancer, combined exposure seemed to be most effective at changing outcomes. Implications of our findings for future E-E interventions and evaluations are discussed.
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... One of the most compelling examples comes from a 2000 episode of the medical drama ER [5]. The storyline featured a female character who learns she carries a BRCA1 gene mutation, prompting her to consider prophylactic mastectomy. ...
... The episode aired during prime time on a major network and reached millions. Subsequent studies showed that the episode significantly increased public knowledge of genetic risk and testing [5]. More importantly, it led to measurable increases in conversations between patients and healthcare providers and a documented uptick in BRCA testing. ...
... Viewers tend to use health information in real-life even though their primary motive for watching medical television dramas was not to collect medical information (Lee & Taylor, 2014). Past studies emphasized on educational aspects of medical information through media representation, such as learning about emergency contraception, human papilloma virus (HPV), breast cancer, reproductive health, among others (Bodoh-Creed, 2017; Brodie et al., 2001;Hether et al., 2008;Kinsler et al., 2019). ...
... Health literacy refers to "the capacity to obtain, process, understand, and communicate about health-related information needed to make informed health decisions" (Berkman et al., 2010, p. 16 (Bavin, & Owens, 2016;Brodie et al., 2001;Hether et al., 2008;Kato et al., 2017;Murphy et al., 2011). Emphasizing the importance of media representation of underserved groups in relation to viewers' perceptions or assessments, Garretson (2015) documented the change in television portrayals from 1970 to 2000 and the finding pointed out negative attitudes among frequent television viewers when they find low recurring portrayals of underserved groups. ...
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Contents: Preface. Part I: History and Theory. A. Singhal, E.M. Rogers, The Status of Entertainment-Education Worldwide. D. Poindexter, A History of Entertainment-Education, 1958-2000. P.T. Poitrow, E. de Fossard, Entertainment-Education as a Public Health Intervention. M. Sabido, The Origins of Entertainment-Education. A. Bandura, Social Cognitive Theory for Personal and Social Change by Enabling Media. W.J. Brown, B.P. Fraser, Celebrity Identification in Entertainment-Education. S. Sood, T. Menard, K. Witte, The Theory Behind Entertainment-Education. Part II: Research and Implementation. S. Usdin, A. Singhal, T. Shongwe, S. Goldstein, A. Shabalala, No Short Cuts in Entertainment-Education: Designing Soul City Step-by-Step. W.N. Ryerson, N. Teffera, Organizing a Comprehensive National Plan for Entertainment-Education in Ethiopia. B.S. Greenberg, C.T. Salmon, D. Patel, V. Beck, G. Cole, Evolution of an E-E Research Agenda. V. Beck, Working With Daytime and Prime-Time Television Shows in the United States to Promote Health. M. Bouman, Entertainment-Education Television Drama in the Netherlands. M.J. Cody, S. Fernandes, H. Wilkin, Entertainment-Education Programs of the BBC and BBC World Service Trust. A.C. La Pastina, D.S. Patel, M. Schiavo, Social Merchandizing in Brazilian Telenovelas. E.M. Rogers, Delivering Entertainment-Education Health Messages Through the Internet to Hard-to-Reach U.S. Audiences in the Southwest. Part III: Entertainment-Education Interventions and Their Outcomes. R.A. Abdulla, Entertainment-Education in the Middle East: Lessons From the Egyptian Oral Rehydration Campaign. Y. Yaser, The Turkish Family Health and Planning Foundation's Entertainment-Education Campaign. N. McKee, M. Aghi, R. Carnegie, N. Shahzadi, Cartoons and Comic Books for Changing Social Norms: Meena, the South Asian Girl. A. Singhal, D. Sharma, M.J. Papa, K. Witte, Air Cover and Ground Mobilization: Integrating Entertainment-Education Broadcasts With Community Listening and Service Delivery in India. A. Singhal, Entertainment-Education Through Participatory Theater: Freirean Strategies for Empowering the Oppressed. T. Tufte, Soap Operas and Sense-Making: Mediations and Audience Ethnography. J.D. Storey, T.L. Jacobson, Entertainment-Education and Participation: Applying Habermas to a Population Program in Nepal. Epilogue.
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Entertainment-education initiatives face unique problems in media-saturated countries such as the United States. Five media theories (uses and gratifications, cultivation, agenda setting, knowledge gap, and diffusion of innovations) are reviewed for guidance in creating effects in such environments. Recommendations for entertainment-education initiatives in media-saturated countries are suggested including: reconsideration of the type of effects possible, the use of individual differences to target and effect audiences, consideration of competing social factors in choice of message and sender, and combining efforts of campaigners to create a cultivation-level theme message.
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