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Our own behavior is killing us.

If you look at the top 10 causes of death, you'll see at the top diseases like heart disease, cancer, and stroke, but it's actually our own behavior, smoking, drinking, not exercising, having a poor diet, which lead to the problems.

If you want to change people's behavior, you have to stop giving them information.

Information alone simply isn't persuasive. Most of the time, people already have a lot of the basic information like smoking causes lung cancer, but it doesn't change their behavior.

If you want to actually change people's behavior, you have to put this information into a story.

Information Overload - Not Always Persuasive

If you've been here for a while, you'll know that my full-time job is as a college professor and my academic specialty is health communication. Health communication is a discipline where we try to help people solve communication problems in healthcare. The discipline was really born after World War Two in the United States where public health officials were trying to get people to engage in certain healthy behaviors. This was even before the Surgeon General's report about cigarette smoking.

One of the earliest health communication campaigns wasn't about smoking cessation. It was actually about tuberculosis screening and back in the '50s, just as it is now, it was difficult to design a persuasive message that would actually get people to take action.

Ever since the '50s until now, there's been limited success in getting people to change their behavior to improve their health. There are some notable successes, especially the smoking cessation programs, which have been a lot more than just persuasive messages because they've been changing laws and norms. But one of the challenges that health communication always has in trying to get people to behave in ways which will make them healthier is that we overload people with information and expect that this will change their minds.

Even though this almost never works, we keep doing it because as academics and as public health people, we tend to think, “Well, if people only knew how bad this behavior was for them, then they would change their behavior.” But people aren't so simple and persuasion isn't so simple. If we think about the problem of vape lung, or people getting a weird sort of pneumonia from using vaping products for nicotine and THC, you might think, “Let’s just tell all these teenagers that vaping is dangerous and how many people have gotten vape pneumonia and died from vape lung” and so on. The information alone should allow them to come to their own conclusions and then they'll change their behavior and stop vaping. But of course, this won't work, and most smart people don't believe anything that simple will work anymore.

Narrative Persuasion

In recent years, people who study health communication and design campaigns to try to persuade people to change their behavior have focused on a new idea. It's not really new in the history of humanity, but it's a new idea in health communication campaigns. They call this idea narrative persuasion.

The basic idea is to embed the information in a story or a believable narrative, sometimes dramatized like a short film or movie. It aims to change the format of the persuasive message from a dry listing of information and warnings and threats and behaviors to something that's embedded in a larger narrative, where we get the message by seeing people's stories unfold.

Screening Study

I want to tell you about one particular recent study that illustrates the general approach to narrative persuasion. One of the most common thing that health communicators try to persuade people to do is to engage in screening behavior – colon cancer screening, cervical cancer screening, all sorts of HIV screening, and many other screening programs. This particular paper by Sheila Murphy and her colleagues from the University of Southern California was about trying to get Hispanic women to sign up for cervical cancer screening tests, also known as the pap test.

The reason that cervical cancer screening is important is that cervical cancer can be a deadly cancer, but if it's detected early through screening like a pap test, then it's almost always curable. In the United States, about 70% of adult women over the age of 18 get pap tests. Obviously, we'd like that number to be 100% so that all these women could benefit and avoid getting cervical cancer. But in addition to the fact that the rate is only 70% instead of 100%, there are significant racial and ethnic disparities. This particular paper talks about how Mexican-American women in the greater Los Angeles area are much less likely to sign up for cervical cancer screening than women in other ethnic groups are.

There's this opportunity with health communication to try and reduce these disparities by encouraging women of Mexican-American ancestry to get the cervical cancer screening test. This particular study was trying to determine whether a cervical cancer screening persuasive message would be more effective if it were a narrative message, if we were wrapped up in a story, or if it would be equally effective if you just gave people a traditional informational message.

The authors identified 900 women in Southern California and randomly assigned half of them to get the traditional informational message and half of them to get the narrative message or the story-based message. Both of the messages were embedded in 11 minute films.

The narrative message featured a Mexican-American woman talking to her sister as they planned a quinceanera for one of their other sisters. One sister tells the other sister that she had recently been diagnosed with HPV, the human papillomavirus, and that she needed to go get more follow-up testing. That when she had been to the doctor, she learned about the importance of a pap test and of all the consequences and so on. She's basically relating all these facts about HPV and about the pap test and about cervical cancer screening to her sister in the context of this discussion as they prepare for the quinceanera. All of the facts are coming out, but it's embedded in this story about two sisters talking about their life. The film ends with the two sisters going to the clinic to get their pap tests and their HPV tests.

The non-narrative version of the message was your traditional health communication message. It had doctors and nurses and patients presenting charts and graphs and talking about risk factors, your basic generic run-of-the-mill boring health communication message. This is the type that health communicators like me had been producing for 50 years, often without much success.

These are the two conditions, either you get the story-based message in a movie, or you get the standard charts and figures, a talking head message about the risks of cervical cancer. To measure the effectiveness of this intervention, the researchers looked at knowledge about cervical cancer and pap testing, as well as actual behavior. Did they sign up and make an appointment for a pap smear or had they actually had the pap smear?

Not surprisingly, people in both groups had increased knowledge. When you give people information, it increases their knowledge, but that isn't often enough to get them to change their behavior. The people in the narrative version of the message remembered a little bit more information, but it was a marginal difference. After six months of having seen these messages, the narrative and non-narrative groups exhibited no difference in how much information they remembered.

But most importantly, the women who saw the narrative version of the message, with the two sisters talking about pap tests and HPV testing, had a higher rate of making appointments to get a pap smear, or actually having had a pap smear at the six month follow-up point.

The narrative message was more effective at persuasion and getting people to actually change their behavior. In addition, the racial and ethnic disparity in which Mexican-American women tend to get pap smears at a lower rate than other ethnic groups had disappeared. In fact, in this study, the Mexican-American women had the highest rate of compliance with pap smear testing guidelines than any other group, which is probably not surprising because the women in the film were Mexican-American women. It had a special appeal and effectiveness to other Mexican-American women who could identify with the women in the film.

Summary

The take home message from this is if you embed your persuasive message in a story or a narrative, it's likely be more effective in actually changing behavior.

Now, lots of advertisers who advertise consumer products already know this. That's why we see in so many commercials these little vignettes of people's stories as they buy a product or use a product and it improves their lives. In health communication, which is dominated by a lot of academics, we still use these informational messages.

But increasingly now, even academics are realizing the power of storytelling to get people to change their health behavior. And in this case, it also reduces racial and ethnic disparities, which are also troubling and which we're so motivated to try to eliminate.

So, if your work involves getting people to change their behavior, to adopt a new healthy behavior, or to stop engaging in an unhealthy behavior, consider a narrative approach to persuasion. The research suggests it will be more effective than your traditional kind of informational approach to persuasion.