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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
Journal of Health Communication
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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... 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. ...
Information accuracy is imperative for the media representation regardless of what information or context is. A variety of health-related information is conveyed to viewers through television news and entertainment programs, which include but not restrict to the information about healthcare structure and health professionals, knowledge regarding general health issues, specific illnesses, or topics, and health-promoting behaviors. It is crucial to examine what messages viewers perceive through television programs given the impact on their perceptions, expectations, and actions in reality. Apart from the portrayal of health information, the framing of characters within a context can significantly contribute to the understanding of how exposure to media influences viewers’ lives. By conducting a critical content analysis, this qualitative study has explored media portrayals of individuals from underrepresented groups within the context of health in a fictional medical television drama. The findings provide a critical understanding of media exposure on how viewers perceive the social positioning of underrepresented groups in the context of health identity. Portrayals of underrepresented groups are understood through the discourses of condescension, cultural appropriation, stereotyping, and negativity.
Background
Alcohol misuse is linked to numerous health and socioeconomic harms. Edutainment and docutainment television programmes can act as health promotion tools, influencing health perceptions and behaviours. Inaccurate portrayals can engender misinformation. Limited research has assessed alcohol-related illnesses and prevention in edutainment/docutainment, with none examining British medical documentaries.
Methods
A quantitative content analysis assessed the portrayal of alcohol-related attendances (ARAs), behaviours, and prevention in the series 24 hours in A&E. Main series episodes broadcast 2011–2022, depicting ARAs, were coded. Descriptive statistics and a Fisher’s exact were then undertaken.
Results
ARAs featured 38 patients in 23 episodes (8.3% episodes total). Significantly more ARA episodes were broadcast from 2011 to 2016 than 2017–2022 (P = 0.002). ARAs were mainly portrayed in males (63.2%), young adults (73.7%) and White ethnic groups (78.9%). Binge drinking and pubs/bar/nightclubs/‘nights out’ were the main behaviours and settings depicted. ARAs encompassed predominantly accidents/injuries (72.7%). Prevention featured infrequently (15.8% patients) and involved secondary (50.0%) or tertiary prevention (50.0%) for alcohol-use disorders (AUDs).
Conclusion
ARAs were under-portrayed. While prevention portrayals and demographics were largely consistent with reality, ethnic minority groups, AUDs and chronic alcohol-related illnesses were underrepresented. Binge drinking and night-time economy settings were over-portrayed. Inaccurate depictions could lead to misperceptions of alcohol-related health harms.
The article analyzes the theoretical and methodological grounds for the effectiveness of film content in changing socially significant human behavior in relation to health and to the problems of the healthcare system in general. Based on specific examples, the possibilities of the entertainment masses of the media and the film industry in solving public health problems are demonstrated. The main directions of the effective use of cinema in the field of public health are considered with the aim of changing social behavior as well as determining specific social actions in relation to health. The place and role of cinema as an integral part of the content of public health programs in history and modernity is explored. The inclusion of cinema, as well as other social media, in the arsenal of instruments of influence on public health is considered in a broader aspect as a consequence of the emerging gap and contradiction between science and society, theory and practice, knowledge, and social ideas about health. The range of public health problems is determined, for the solution of which the use of film content is considered effective: prevention and treatment of socially significant diseases, birth control, and treatment of addictions. The main theoretical and methodological approaches in the use of film content as a tool for changing behavior models and attitudes towards their health are described. The entertainment education approach developed on the basis of the theory of social learning is used as the main methodological tool. The analysis of specific television series developed on the basis of this methodology makes it possible to identify new directions in solving public health problems, in particular the sociocultural features of health attitude models. Prospects for the development of the studied methodology in the modern expanding space of entertainment media masses are outlined.
The eighth season of the American medical drama series Chicago Med (2015–) represented the application of artificial intelligence (AI) in a hospital environment with multiple storylines. Born in the 1950s, medical dramas are among the most popular forms of serial television. Traditionally, the genre aims for a certain amount of accuracy and has educational goals. Former studies investigated the entertainment education and cultivation effects of these series, concluding that these dramas have the potential to contribute information and shape viewers’ opinions on various health-related topics. Chicago Med is a long-running broadcast production with a worldwide audience and considerable viewership. This paper analyzes the series’ representation of medical AI and discusses how this portrayal potentially shapes the audience’s opinion. The research started by identifying artificial intelligence-related storylines in the 22 episodes of the season. The analysis focused on the reasons and outcomes of AI applications, the character’s attitudes, and the ethical issues, including transparency, selective adherence, automation bias, responsibility gap, hallucination, unequal access, and political dimensions. The storyline analysis concluded that Chicago Med provided thought-provoking positive and negative scenarios about applying different types of AI in the surgical and emergency departments. The complex portrayal included groundbreaking opportunities, challenges, dangers, and ethical considerations. The main characters’ attitudes varied, from strong support or opposition to more nuanced, shifting opinions. The educative and engaging content has a potential for knowledge transfer and encourages critical thinking about medical AI.
The primary goal of this study is to grasp the evolution of research surrounding medical drama TV series, delineate prevalent research domains along with their evolving approaches, and unearth potential gaps and emerging trends within the field. The research methodology employs a semi-systematic literature review to comprehensively explore the evolving landscape of medical drama TV series research. It follows structured, comprehensive, and transparent principles, including the definition of research questions, the explicit description of research methodology, and a multi-step screening process to classify the literature. Five research areas were defined for literature classification: Narrative Analysis, Pedagogy and Bioethics, Linguistics and Communication, Gender Studies, and Reception Studies. Analyzing 269 papers from 1964 to 2023, the review reveals medical dramas’ significant impact on audiences’ understanding of healthcare and their pedagogical value in teaching medical and ethical concepts to students across disciplines.
Cancer is one of the most important societal challenges in the world, with over 23 million new cases/year and 10 million deaths/year, that will only be properly tackled with a stronger focus on prevention. This calls for an informed population, aware of risk factors and willing to adopt preventive behaviors and early cancer screenings. For that purpose, 2’ Life-changing minutes was created, the first ever televised Entertainment-Education series on cancer prevention. This study aims to evaluate the impact of 2’ Life-changing minutes, a novel E-E format for cancer prevention, on knowledge gains and behavior changes. Two complementary studies were performed involving a total of 1314 participants: a test-screening (TS) study targeting potential viewers of the series, and a natural-screening (NS) study targeting those that spontaneously watched the series on television. We found (i) very high levels of appreciation and narrative engagement, and also willingness to see more episodes; (ii) statistically significant knowledge gains, ranging from 17% to 44%, on all four topics tested; (iii) evidence of effective behavior change. Regression analysis showed that narrative engagement was the best predictor of behavior change [NS: odds ratio (OR) = 3.38, 95% confidence interval (CI) = 1.70–6.74, p = 0.001; TS: OR = 2.05, 95% CI = 1.13–0.371, p = 0.018]. This study demonstrates the series’ real impact and serves as a proof-of-concept for a novel strategy of cancer prevention that is based around compelling health narratives, rather than information or data, to engage viewers, increase knowledge and induce behavior change.
Introduction
The influence of medical dramas could extend beyond the realm of entertainment and potentially strengthen/orient the knowledge, attitudes and hopefully practice of health professionals and the public, despite often depicting unrealistic medical outcomes and scenarios.
Methods
This study examined the portrayal of public health issues in two popular international medical series, “Grey’s Anatomy” and “House, MD,” selected for their awards and viewership ratings. Individual episodes were double-rated by clinicians for patient characteristics, public health issues, and infection risk management.
Results
94 episodes with 286 clinical cases were analyzed. A wide range of conditions and pathologies were depicted, with a focus on acute clinical events, trauma and mental disorders, which contrasts with real-life causes of hospitalization and highlight the dramatization in these series. Public health issues such as organ donation and substance abuse were frequently addressed, but prevention and health promotion received little attention. Proper use of personal protective equipment was mostly observed, although hand hygiene was underrepresented.
Conclusion
The study highlights the dual role of medical dramas as an entertainment medium and a potential educational tool. While they can raise awareness and encourage healthier behavior, their portrayal of medical practices and patient care often deviates from reality and can create unrealistic expectations. The influence of these dramas also extends to viewers’ perceptions of healthcare and medical professionals, underscoring the need for accurate and responsible portrayal of health issues in the media.
Medical dramas offer unique insights into the way popular media makes sense of genetic technology and the ethics of its applications. In this paper we evaluate the contrasting depictions in television medical dramas of reproductive genetic screening and eugenics—two medical themes that some commentators see as closely related. By conducting a content analysis of 32 episodes of doctor shows featuring eugenic and/or genetic screening themes, we put the medical drama landscape in conversation with bioethics scholarship and mark a significant divergence between the two. While the academic literature has been parsing the possible relationship between genetic screening and eugenics for over 50 years, doctor shows tend to champion genetic screening as a powerful tool for promoting individual reproductive choice and criticise eugenics as a socially unjust infringement of reproductive freedom. In doing so, medical dramas mark a subtle but important moral distinction between the population-level implications of eugenics and the highly personal, emotional impact of genetic screening.
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.