Using a Culturally Tailored Narrative to Increase Cervical Cancer Detection Among Spanish-Speaking Mexican-American Women.

The objective of this study was to determine the feasibility and effectiveness of translating films, and whether the use of narrative is an effective vehicle for producing changes in knowledge, attitudes, and behaviors regarding cervical cancer compared with a nonnarrative film. A randomized controlled telephone trial surveyed the effectiveness of two films our team produced among a sample of 300 monolingual Spanish-speaking women, ages 25 to 45, who were of Mexican origin. Participants were recruited using random digit dialing (RDD) procedures from 2013 to 2014 in Los Angeles County and were randomly selected to view either a narrative or nonnarrative film. Data were collected by phone at baseline, 2 weeks, and 6 months after viewing. On average, participants arrived in the USA 25 years ago. The majority reported having less than high school education and limited English proficiency. Compared with their nonnarrative counterparts, women who received the cervical cancer-related information in the narrative film showed a significantly greater increase in new knowledge (p = 0.01) and in supportive attitudes about Pap tests expense (p = 0.05). Importantly, at 6 months, although not statistically significant, women who viewed the narrative film were also more likely to have had or scheduled a Pap test (62% vs 42%). Narratives are a useful and underutilized tool to communicate information about cancer prevention. These findings have important implications for the delivery of health education among Spanish-speaking, low-literacy immigrant women, and for the reduction of cancer-related disparities.

Neighborhoods and Perceived Norms: Understanding the Impact of Neighborhoods on Perceived Norms and Cancer Screening.

This study examines the importance of urban ethnic neighborhoods as the context of everyday life, where normative influences on health are formed, modified, and maintained. Built on communication infrastructure theory, this study investigates the role of women's connections to their neighborhood storytelling network-consisting of residents, local/ethnic media, and community organizations-in shaping their descriptive normative perceptions regarding cervical cancer screening. Specifically, we explore the communication mechanisms that underlie Latinas' exposure and attention to media information about Pap tests, their discussions with health-care professionals about Pap tests, their perceptions about how normative Pap tests are among "women like them", and their compliance with cervical cancer screening guidelines. Our findings suggest that neighborhood storytelling resources hold promise for health communication research to understand not only the uptake of Pap tests but also health disparities in other domains that affect diverse populations and communities.

Understanding Cervical Cancer Screening among Latinas through the Lens of Structure, Culture, Psychology and Communication.

This study explored how structural and cultural forces work together with psychological and communication factors in influencing Pap test compliance among Latinas in Los Angeles County, a group who face health disparities related to cervical cancer screening, incidence and mortality. By adopting a multilevel approach to obtain a grounded understanding of this issue, this work revealed that structural barriers, fatalism, religious service attendance, perceived susceptibility, perceived costs, and cues to action from health care providers are all associated with Pap test compliance. Financial barriers also influence compliance, with underinsurance having a stronger negative impact compared to no insurance at all. These findings provide insights into how communication efforts can be strategically designed to address both individual- and system-level barriers to promote health-seeking behaviors among Latinas, and potentially among other population groups experiencing health disparities due to similar reasons.

Comparing the Relative Efficacy of Narrative vs Nonnarrative Health Messages in Reducing Health Disparities Using a Randomized Trial.

OBJECTIVES: We compared the relative efficacy of a fictional narrative film to a more traditional nonnarrative film in conveying the same health information. METHODS: We used a random digit dial procedure to survey the cervical cancer-related knowledge, attitudes, and behavior of non-Hispanic White, Mexican American, and African American women, aged 25 to 45 years, living in Los Angeles, California, from 2011 to 2012. Participants (n = 704) were randomly assigned to view either a narrative or nonnarrative film containing the same information about how cervical cancer could be prevented or detected, and they were re-contacted 2 weeks and 6 months later. RESULTS: At 2 weeks, both films produced a significant increase in cervical cancer-related knowledge and attitudes, but these effects were significantly higher for the narrative film. At 6 months, viewers of both films retained greater than baseline knowledge and more positive attitudes toward Papanicolaou (Pap) tests, but women who saw the narrative were significantly more likely to have had or scheduled a Pap test. The narrative was particularly effective for Mexican American women, eliminating cervical cancer screening disparities found at baseline. CONCLUSIONS: Narratives might prove to be a useful tool for reducing health disparities.

Telling stories, saving lives: creating narrative health messages.

Increasingly, health communication practitioners are exploring the use of narrative storytelling to convey health information. For this study, a narrative film was produced to provide information about the human papillomavirus (HPV) and cervical cancer prevention. The storyline centered on Lupita, a young woman recently diagnosed with HPV who informs her family about HPV and the availability of the HPV vaccine for her younger sister. The objective was to examine the roles of identification with characters and narrative involvement (made up of three dimensions: involvement, perceived relevance, and immersion) on perceived response efficacy, perceived severity, and perceived susceptibility to HPV and behavior (discussing the HPV vaccine with a health care provider). A random sample of 450 European American, Mexican American, and African American women between the ages of 25 and 45 years, living in the Los Angeles area, was surveyed by phone before, 2 weeks after, and 6 months after viewing the film. The more relevant women found the narrative to their own lives at 2 weeks, the higher they perceived the severity of the virus and the perceived response efficacy of the vaccine to be. Also at 2 weeks, identifying with characters was positively associated with perceived susceptibility to HPV but negatively associated with perceived severity. At 6 months, identification with specific characters was significantly associated with perceived threat and behavior. These findings suggest that different aspects of narrative health messages should be manipulated depending on the specific beliefs and behaviors being targeted. Implications for narrative message design are discussed.

Conversation and compliance: role of interpersonal discussion and social norms in public communication campaigns.

This study explores the role of interpersonal discussion and social norms in a public health campaign, the BBC Condom Normalization Campaign, designed to promote conversation and change the public perception of condom use in India. Drawing upon the integrative model of behavioral prediction, attitudes, self-efficacy, subjective norms, and descriptive norms were predicted to relate to behavioral intentions to use condoms. It is important to note that the valence of discussion was hypothesized to relate to each of these more proximal predictors. The authors used structural equation modeling to test the model on 3 separate samples of Indian men between the ages of 15 and 49 years: (a) high-risk men who had sex with nonspouses; (b) low-risk, sexually inactive, unmarried men; and (c) low-risk, monogamous, married men. Results were similar for low- and high-risk audiences, with valence of discussion about condoms predicting condom-related attitudes, self-efficacy, and subjective and descriptive social norms with respect to condom use, which, in turn, predicted behavioral intent to use condoms. These findings underscore the need to take not only the frequency but also the valence of interpersonal discussion into account when assessing the effect of health campaigns. Implications for theory and design of future public communication campaigns are explored.

Each Medium Tells a Different Story: The Effect of Message Channel on Narrative Persuasion.

Limited attention has been given to the medium of story presentation in this process of narrative persuasion. The present study (N = 243) fills this gap by directly comparing narrative involvement across print and audiovisual versions of the same cervical cancer-related story. The mediation analysis revealed that exposure to an audiovisual narrative was associated with higher levels of cognitive and emotional involvement, than exposure to the exact same narrative in its printed form. Yet, the higher levels of transportation in the audiovisual condition came at a price of enhancing psychological reactance, eliminating the relative advantage of the film narrative.

Individual, Cultural and Structural Predictors of Vaccine Safety Confidence and Influenza Vaccination Among Hispanic Female Subgroups.

Rates of influenza vaccination among US Hispanics are lower than for non-Hispanic whites, yet little is known about factors affecting vaccination in this population. Additionally, although Hispanics are a diverse population with culturally distinct subgroups, they are often treated as a homogenous population. This study (1) examines how confidence in vaccine safety and influenza vaccine use vary by Hispanic subgroup and (2) identifies individual, cultural and structural correlates of these outcomes. This study analyzed survey data from 1565 Hispanic women who were recruited at clinic- and community-based sites in Los Angeles. Education, healthcare coverage, acculturation, fatalism, and religiosity were predictors of influenza vaccination behavior and predictors varied by subgroup. These findings provide guidance for how influenza vaccine promotion efforts can be developed for Hispanic subgroups. Confidence in the safety of a vaccine is a major predictor of flu vaccination and an important modifiable target for intervention.

Information scanning and vaccine safety concerns among African American, Mexican American, and non-Hispanic White women.

OBJECTIVE: A significant number of parents delay or refuse vaccinating their children. Incidental exposure to vaccine information (i.e., scanned information) may be an important contributor to anti-vaccine sentiment. This study examines the association between scanned information, trust in health information sources and vaccine safety concerns among African American, Mexican American, and non-Hispanic White women. METHODS: Women (N=761) in Los Angeles County were sampled via random digit dial and surveyed regarding use of and trust in health information resources and vaccine safety concerns. RESULTS: Analyses indicate that the sources of information associated with vaccine safety concerns varied by ethnicity. Each ethnic group exhibited different patterns of association between trust in health information resources and vaccine safety concerns. CONCLUSIONS: Information scanning is associated with beliefs about vaccine safety, which may lead parents to refuse or delay vaccinating their children. These relationships vary by ethnicity. PRACTICE IMPLICATIONS: These findings help inform practitioners and policy makers about communication factors that influence vaccine safety concerns. Knowing these sources of information will equip practitioners to better identify women who may have been exposed to anti-vaccine messages and counter these beliefs with effective, vaccine-promoting messages via the most relevant information sources.

A pilot test of the acceptability and efficacy of narrative and non-narrative health education materials in a low health literacy population.

Although entertainment-education narratives are increasingly being used to communicate health information to a diversity of populations, there is limited evidence examining the use of narrative health education videos in low compared with adequate health literacy populations. There are also very few studies directly comparing narrative materials to more traditional, non-narrative materials. Because individuals with low health literacy are less likely than those with adequate health literacy to benefit from health communication interventions, it is especially important to develop an evidence base supporting the use of narrative health education materials in low literacy populations. This study extends knowledge on the use of narrative health education materials in populations with low health literacy by conducting a randomized trial comparing the acceptability and efficacy (knowledge gain) of two fact-equivalent films, one in a narrative and one in a non-narrative format, on individuals with adequate and low health literacy. This study finds that while both films were well-accepted and produced knowledge gains, the narrative film was more effective in this regard. This effect occurred regardless of health literacy level, indicating that narrative health communication materials are appropriate for individuals with low health literacy and do not exacerbate existing health disparities. These findings add to a small but growing body of evidence testing narrative health education materials in individuals with low health literacy, and provide new evidence supporting narrative, entertainment-education style video as a health communication tool to help reduce health literacy-related health disparities.

Social Norms about a Health Issue in Work Group Networks.

The purpose of this study is to advance theorizing about how small groups understand health issues through the use of social network analysis. To achieve this goal, an adapted cognitive social structure examines group social norms around a specific health issue, H1N1 flu prevention. As predicted, individual's attitudes, self-efficacy, and perceived social norms were each positively associated with behavioral intentions for at least one of the H1N1 health behaviors studied. Moreover, collective norms of the whole group were also associated with behavioral intentions, even after controlling for how individual group members perceive those norms. For members of work groups in which pairs were perceived to agree in their support for H1N1 vaccination, the effect of individually perceived group norms on behavioral intentions was stronger than for groups with less agreement.

Narrative versus Non-narrative: The Role of Identification, Transportation and Emotion in Reducing Health Disparities.

This research empirically tests whether using a fictional narrative produces a greater impact on health-related knowledge, attitudes, and behavioral intention than presenting the identical information in a more traditional, nonfiction, non-narrative format. European American, Mexican American, and African American women (N = 758) were surveyed before and after viewing either a narrative or non-narrative cervical cancer-related film. The narrative was more effective in increasing cervical cancer-related knowledge and attitudes. Moreover, in response to the narrative featuring Latinas, Mexican Americans were most transported, identified most with the characters, and experienced the strongest emotions. Regressions revealed that transportation, identification with specific characters, and emotion each contributed to shifts in knowledge, attitudes, and behavioral intentions. Thus, narrative formats may provide a valuable tool in reducing health disparities.

Predictors of Emergency Preparedness and Compliance.

BACKGROUND:: In response to the evolving nature of potential disasters, both human made and natural, this research identifies predictors of individual emergency preparedness and compliance with government requests. METHODS:: A survey of a nationally representative sample of US adults (1629 respondents) revealed which emergency supplies and plans they had in place; their perceived level of preparedness and that of their local health care system; the likelihood of 7 terrorist and 4 naturally occurring events, whether they would evacuate their home; shelter in place at home and work; be quarantined, vaccinated, or take medication; and whether they believed that these actions would increase their chances for survival. RESULTS:: Having supplies was predicted by being male, older, wealthier, and white, living in the western United States, and being exposed to national news. Having plans was related to living in the western United States, having children, and being exposed to national news. Compliance was associated with being female and ill. Holding demographic factors constant, preparedness and compliance with government requests were associated with the perceived likelihood of a natural but not a terrorist event, the perceived efficacy of requested actions, and belief in one's local health care system. CONCLUSIONS:: A focus on natural as opposed to terrorist events and people's perceived efficacy of emergency actions and local health care systems may increase their preparedness and compliance with government requests.