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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
Abstract and Figures
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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... vaccine (de Wit et al., 2008), organ donation (Reinhart et al., 2007), condom efficacy (Collins et al., 2003), emergency contraception and human papillomavirus (Brodie et al., 2001), HIV (Kennedy et al., 2004), and breast cancer (Beck, 2004;Hether et al., 2008;Wilkin et al., 2007). ...
El rol de la persuasión narrativa en el Edu-Entretenimiento para mejorar la salud en América Latina: Revisión de los últimos cinco años The role of narrative persuasion in Edu-Entertainment to improve health in Latin America: Review of the last five years O papel da persuasão narrativa na Edu-Entretenimento para melhorar a saúde na América Latina: revisão dos últimos cinco anos ARTÍCULO Universidad del Norte (Colombia) Doctora en Ciencias Sociales, es profesora del Departamento de Comunicación Social de la Universidad del Norte y de la Universidad de la Costa. Barranquilla (Colombia). Sus ámbitos de estudio e investigación principales son el estudio en persuasión narrativa y educación entretenimiento en el área de la comunicación para la salud. acamelo@uninorte.edu.co orcid.org/0000-0002-0417-4441 Universidad del Azuay (Ecuador) Doctora en Comunicación por la Universidad de Salamanca, es profesora de la escuela de Comunicación Social de la Universidad del Azuay. Cuenca (Ecuador). Sus ámbitos de estudio e investigación principales son el estudio en persuasión narrativa y educación entretenimiento en el área de la comunicación para la salud.
... The enhanced emotional engagement and cognitive development [5] and moral imagination make students more sensitive to training [22]. Previous investigations about entertainment-education medical dramas and social learning theory indicate that these programs can increase knowledge about health matters, for example about early breast cancer detection [46]. Albert Bandura's social learning theory [47][48][49] indicates that people can learn behaviors vicariously by watching and thinking about characters' behaviors. ...
Background
Medical dramas have been popular since their inception, especially among medical students. We hypothesized that the recent increase in the availability of TV medical series through online streaming platforms has probably changed health science students’ viewing habits as well as the representation of bioethical conflicts and health professionals.
Methods
We invited undergraduate students of medicine, nursing, and human biology to complete a self-administered questionnaire about their viewing habits and perceptions of the depictions of bioethical issues and professionalism in TV medical series.
Results
Of the 355 respondents, 98.6 % had watched TV in the last year, 93.5 % watched TV series, and 49.6 % watched medical dramas more than once a week. The most-viewed medical dramas were The Good Doctor , House MD , and Grey’s Anatomy . The most-remembered bioethical topics were medical errors, inappropriate professional behaviors, and death. Most students considered that ideals of professionalism were depicted positively and professionals were portrayed as intelligent, professionally qualified, and competent.
Conclusions
Medical dramas are very popular with health science students and are potentially useful as teaching tools for discussing issues related to bioethics and professionalism.
... In this context, cultural relevancy is key to quality narrative cancer communication, and minorities may prefer media content produced by and featuring members of their own cultural in-group [15]. However, research on cancer depictions on television has often focused on the impact of individual cancer storylines focusing on cancer prevention, screening, diagnosis, treatment, coping, and using cancer patient navigators [16][17][18][19]. Little is actually known about whether cancer depictions or the television programs they appear in are culturally diverse, which is an important first step to understanding audience identification with cancer narratives, a construct that is central to narrative persuasion theories. ...
Entertainment programming provides a unique opportunity for cancer education, particularly for higher risk racial and ethnic minority groups. Cultural relevancy is key to quality narrative cancer communication, and minorities often prefer media content produced by and featuring members of their own cultural in-group. However, little is known about whether cancer depictions or the television programs they appear in are culturally diverse. Using media content analysis, this study aims to assess the cultural diversity of cancer depictions on primetime scripted television to reveal opportunities to improve cancer education through entertainment. Indicators used to assess cultural diversity at the program level and depiction levels were collected. Out of 111 television programs, 10 (9.01%) programs mentioned cancer, from which 37 cancer depictions were identified. However, the majority of cancer depictions involved White patients and White health providers. Depictions of coping and treatment also dominated with less than 10% of depictions discussing cancer prevention. These patterns reveal a missed opportunity in existing cancer narratives on primetime scripted television and a lack of representation of cultural, social, and environmental factors that affect the health of minority communities, who need to hear these messages the most.
... The most prominent are Public Health England's 'Antibiotic Guardians' (2014) and the WHO's World Antibiotic Awareness Weeks since 2016, with the messages renewing each year (2019). We also examined public health campaigns unrelated to AMR yet that showed efficacy, including television drama campaigns for sexual health and sexually transmitted disease information, breast cancer awareness and malaria prevention (Fedunkiw, 2003;Glik et al., 1998;Hether et al., 2008;Valente & Bharath, 1999;Wang & Singhal, 2016;Whittier et al., 2005). ...
... Since its beginnings, HH&S has collaborated with other health communication scholars to study the impact of the fictional TV storylines on which it consulted. This research has addressed a variety of topics from HIV and other STIs (Kennedy, O'Leary, Beck, Pollard, & Simpson, 2004) to cancer (Hether, Huang, Beck, Murphy, & Valente, 2008) and more. Drawing upon the theoretical frameworks of Moyer-Gusé, Slater and Rouner (2002), and others, this research has incorporated mechanisms of narrative influence such as narrative transportation, character identification, and emotional responses to entertainment (Murphy, Frank, Moran, & Patnoe-Woodley, 2011). ...
In this chapter, we tell the story of the emergence and evolution of a uniquely American form of EE. We discuss how the Hollywood, Health & Society (HH&S) approach differs from both traditional EE as practiced in the developing world and the strategies of advocacy groups in the US. We share several case studies from our outreach to the creative community and research on the content and impact of entertainment narratives. These stories are shared from the perspective of Kate Langrall Folb, an early pioneer in American EE and the director of HH&S since 2012, and Erica Rosenthal, a communication researcher who led HH&S research from 2011 to 2019 and now oversees the broader Lear Center research portfolio. Finally, we conclude with a discussion of lessons learned and best practices.
... One example of EE's evolution is the shift to a single-episode or short story arc approach. For example, initiatives have used guest characters in this way in medical programs such as Grey's Anatomy (e.g., Hether et al., 2008). The digital space has also afforded opportunities for supplemental resources allowing viewers to engage beyond EE messages (Wang & Singhal, 2016). ...
COVID-19 created a substantial set of challenges for health communication practitioners in the process of planning, implementing, and evaluating entertainment-education (EE) campaigns. EE is a theory and evidence-based communication strategy that employs entertainment media for educational messaging. Here, we briefly review EE campaigns in response to previous health emergencies and present three cases of EE responses to the COVID-19 pandemic from leading global organizations (PCI Media, BBC Media Action, and Sesame Workshop). Responses ranged from adaptation and re-distribution of existing content to creating new content under social-distancing restrictions and utilizing transmedia. These cases demonstrate that EE initiatives responding to future pandemics may be well served by starting with existing infrastructure to quickly build capacity, support, and trust; working with partners to tailor programs to the local context; and continuing to focus on good storytelling while simultaneously considering evolving media formats and theory.
Background:
"Cest la Vie!" (CLV) is a serial drama that entertains, educates, and promotes positive health behaviors and social change for West African audiences. The purpose of this study was to evaluate if watching the CLV Season 2 series online had an impact on people's health knowledge, attitudes, and norms, focusing on populations in francophone West Africa.
Methods:
Between July 2019 and October 2019, viewers of CLV and non-viewers were recruited from Facebook and YouTube. We conducted an online longitudinal cohort study that assessed changes in health knowledge, attitudes, and norms (KAN) between these groups. Participants completed a baseline survey prior to the online airing and up to three follow-up surveys corresponding to specific health stories in the series, including sexual violence, emergency contraception, and female circumcision. We used descriptive statistics to describe viewers and non-viewers, and an item response theory (IRT) analysis to identify the effect of viewing CLV on overall KAN.
Results:
A total of 1674 respondents participated in the study. One in four participants (23%, n = 388) had seen one of the three storylines from CLV Season 2 (ie, CLV viewers). At follow-up, viewers were more likely than non-viewers to know when to correctly use emergency contraception (P < 0.001) and to believe that the practice of female circumcision should end (P = 0.001). Compared to people who did not see CLV, viewers of the series had 26% greater odds of answering pro-health responses at follow-up about sexual assault, emergency contraception, and female circumcision. Further, the level of engagement with specific storylines was associated with a differential impact on overall outcome questions.
Conclusions:
As internet access continues to grow across the globe and health education materials are created and adapted for new media environments, our study provides a novel approach to examining the impact of online entertainment-education content on health knowledge, attitudes, and norms.
The entertainment education (EE) approach shows that
entertainment storylines influence people’s attitudes, opinions,
and behavior, and this occurs, among others, when it
comes to health and disease. In the case of TV shows and
movies cancer is the most frequently shown disease, and this
is especially important when considering the rise of VOD
platforms, gaining in subscribers and popularity. The article
aims at signaling Netflix’s EE potential, hence it could be a
starting point for future studies of streaming platform’s EE, a
highly neglected area. Netflix is thus 1) compared with other
popular VODs in terms of the number of cancer content (this
being the main interest of the presented analysis) and 2)
three content categories are indicated. Also, 3) a brief
description of selected texts is presented. The aim of the
article is exploratory, and it highlights the need for future
research, as the potential of Netflix’s EE seems the greatest
when compared to other platforms analyzed. Netflix has the
largest number of contents featuring cancer, and these could
influence audiences, i.e., raise awareness, change attitudes,
and motivate individuals to act.
The rising incidences of breast cancer, high mortality and morbidity rates, and poor knowledgeability level of the disease and low practice intentions of its early detection methods among rural women is constituting serious health challenge in Nigeria. These conditions are often blamed on inadequate infrastructures and poor enlightenment avenues. Consequently, these observed situations demand for planned education in favour of the rural women. Therefore, the study examined the effects of video drama intervention on the knowledge of breast cancer and practice intention of its early detection methods among Aboh Mbaise women of Imo State, Nigeria. A quasi-experiment was conducted on 100 women; (Amaasa, experiment and Ngwuru-Nweke, control). The Aboh-Mbaise women at reproductive age constituted the population of the study. The participants were recruited using simple random sampling by balloting. Data was retrieved using validated questionnaire at pre-test and post-test evaluation with reliability confidence of 0.799. Health belief model and attitude change theory underpinned the study. Data was analysed using paired sampled t-test. The findings showed that the intervention significantly improved participants" knowledge of; breast cancer (=42.02 experimental and =26.02 control), early detection methods (t(49)=22.74, p=0.000<0.05) and intention to practice the methods (t(49)=19.50, p=0.000<0.05), with a significant difference of (t(49)=1.95, p=0.057>0.05). It was concluded that frequent exposure to health based video drama is effective means of enlightening the rural women on breast cancer concerns, while recommending it application on regularly basis.
Rates of sexually transmitted infections (STIs) are on the rise among young women, and a key factor in STI prevention is partner communication about STIs. Because entertainment narratives are shown to positively influence behavior change, the current study examined whether exposure to a romance novel excerpt wherein successful STI communication was modeled (versus one without) was associated with increased STI communication intentions. Guided by the Integrative Model for Behavioral Prediction, we also explored potential cognitive mechanisms of narrative exposure (i.e., self-efficacy, attitudes, normative beliefs) on behavioral intentions. Results of an experimental study with single, sexually-active college aged females (N = 166), showed exposure to a narrative including behavioral modeling was associated with increased perceived injunctive norms for STI communication. Self-efficacy and descriptive norms were also associated with STI communication intentions. Results suggest that when developing text-based STI communication narratives, it may be particularly important to build self-confidence and frame STI communication behavior as something others do.
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.
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.
Social cognitive theory provides an agentic conceptual framework within which to analyze the determinants and psychosocial mechanisms through which symbolic communication influences human thought, affect and action. Communications systems operate through two pathways. In the direct pathway, they promote changes by informing, enabling, motivating, and guiding participants. In the socially mediated pathway, media influences link participants to social networks and community settings that provide natural incentives and continued personalized guidance, for desired change. Social cognitive theory analyzes social diffusion of new styles of behavior in terms of the psychosocial factors governing their acquisition and adoption and the social networks through which they spread and are supported. Structural interconnectedness provides potential diffusion paths; sociocognitive factors largely determine what diffuses through those paths.