Using narratives to correct politically charged health misinformation and address affective belief echoes.

BACKGROUND: In May 2020, news outlets reported misinformation about the Centers for Disease Control (CDC) related to COVID-19. Correcting misinformation about outbreaks and politics is particularly challenging. Affective belief echoes continue to influence audiences even after successful correction. Narrative and emotional flow scholarship suggest that a narrative corrective with a positive ending could reduce belief echoes. Therefore, this study investigated the efficacy of a narrative corrective with a relief ending for correcting misinformation about the CDC. METHODS: Between 29 May and 4 June 2020, we tested the effectiveness of a narrative to correct this misinformation. Participants in the United States (N = 469) were enrolled via Qualtrics panels in an online message experiment and randomized to receive a narrative corrective, a didactic corrective or no corrective. RESULTS: The narrative corrective resulted in lower endorsement of the misinformation compared with the control and the didactic corrective. The narrative corrective had a positive indirect effect on perceived CDC competence and mask wearing intentions for politically moderate and conservative participants via relief. CONCLUSIONS: Public health institutions, such as the CDC, should consider utilizing narrative messaging with positive emotion endings to correct misinformation. Narratives better address affective belief echoes, particularly for counter-attitudinal audiences.

Healthcare Providers' Resilience Communication: A New Type of Patient-Centered Communication.

Patient-centered communication (PCC) is considered a key component of quality healthcare, with reported levels of PCC rising over the last decade. However, engagement with patient emotions and uncertainty have been slower to rise, and healthcare providers at times use PCC behaviors to manipulate patients. Healthcare providers' use of the communication theory of resilience's (CTR) processes could benefit patients. A cross-sectional survey in the United States (N = 486) tested associations between CTR processes and patient satisfaction and perceived physical and mental health. All five core CTR processes were positively correlated with patient outcomes. When controlling for traditional PCC behaviors: (a) crafting normalcy, identity anchors, and alternative logics were positively related to patient satisfaction, (b) no processes were related to perceived mental health, and (c) communication networks, alternative logics, and productive action were positively related to perceived physical health. Condition severity moderated three associations. At moderate-high severity, crafting normalcy and communication networks were positively related to perceived mental health, and crafting normalcy was positively related to perceived physical health. Findings extend CTR into the patient-provider relationship and demonstrate the practical potential of CTR processes for improving patient outcomes. The study also forwards a measure of healthcare provider resilience communication (HPRC).

Political Party Collective Norms, Perceived Norms, and Mask Wearing Behavior: A Test of the Theory of Normative Social Behavior.

The theory of normative social behavior (TNSB) postulates that people are influenced by others' behaviors, which they observe from messages and experience. In addition to focusing on perceived (i.e., descriptive and injunctive) norms, the TNSB was expanded to include collective norms, which represent what people actually do. Testing this expanded theoretical model, the current study examined whether two types of collective norms - collective political norms and collective regional norms - interacted with descriptive norms to influence pandemic mask wearing behavior expectations among U.S. adults (N = 444). The interaction was statistically significant for collective political norms (ß = -.74, p = .009) but not collective regional norms (ß = -.16, p = .85). Specifically, descriptive norms were related to increased mask wearing expectation for all values of political party collective norms, but the effects were stronger when political party collective norms were low (i.e., low mask wearing behavior was normative). The findings support the inclusion of collective norms in the TNSB, clarify the relationships among different types of norms, and provide insights for norms-based interventions.

Developing skin cancer education materials for darker skin populations: crowdsourced design, message targeting, and acral lentiginous melanoma.

Despite decreased susceptibility, darker skin individuals who develop melanoma have worse survival. This disparity in melanoma mortality is the largest for any cancer, and partly driven by a lack of patient education materials targeted to darker skin populations in whom acral lentiginous melanoma (ALM) is the most common subtype. To address this communication disparity, the current study reports a multi-phase design process that leverages crowdsourcing and message testing to develop ALM-focused patient education materials for darker skin populations. Crowdsourced design was utilized to develop a pool of designs (phase 1), the pool was narrowed and thematically analyzed (phase 2), and select designs were evaluated via a message experiment (N = 1877). For darker skin populations, designs that depicted people enhanced knowledge of ALM through message memorability. The current study engages melanoma disparities by providing ALM patient education materials for darker skin populations vetted via a multi-phase process.

People Wear Masks when they Ski: Comparing Congruent and Incongruent Behavioral Context Appeals.

When advocating for a behavior, persuasive messaging typically focuses on the context that behavior is performed in, such as mask-wearing during the COVID-19 pandemic. However, situating the advocated behavior in a different context, termed an incongruent context appeal, may persuade by increasing attention, novelty, and memorability. The current study tested this supposition in a message experiment. Participants (N = 324) were randomized to view an incongruent context (e.g. skiing) or a congruent context (i.e. COVID-19) appeal advocating for mask wearing. The incongruence appeal had a direct, positive effect on mask wearing intentions and indirect, positive effects via two serial mediation pathways: time spent with the message increased attention through novelty and memorability. Findings suggest that an incongruent context appeal is an effective strategy for persuading audiences in information-saturated environments like the COVID-19 pandemic.

Cancer Information Overload Across Time: Evidence from Two Longitudinal Studies.

A majority of U.S. adults report feeling overwhelmed by the amount of available cancer information, termed cancer information overload (CIO). Research has demonstrated CIO is prevalent and negatively related to health behaviors, but no study to date has examined this disposition across time. Two longitudinal studies - a colonoscopy intervention among older U.S. adults (N = 237) and an HPV vaccination intervention among young U.S. women (N = 411) - were utilized to examine CIO stability across time and its relationship to prevention intentions and indifference. CIO increased indifference for non-adherent individuals but had no effect on intentions. CIO was stable in study 1 but not study 2, suggesting CIO stabilizes across the life course. Results also support a five-item measure of CIO.

Increasing Skin Cancer Prevention in Young Adults: the Cumulative Impact of Personalized UV Photography and MC1R Genetic Testing.

Skin cancer has become increasingly common among young adults; however, this population does not consistently adhere to recommended methods for preventing the disease. Interventions in college settings have relied on appearance-focused appeals and have not been able to examine the cumulative effect of multiple behavior change and skin cancer risk communication strategies. The goal of the current study was to examine the unique and combined impacts of personalized ultraviolet (UV) radiation photographs, genetic testing for skin cancer risk, and general skin cancer prevention education. Participants were randomly assigned to one of four conditions: (1) skin cancer prevention education, (2) education + UV photo, (3) education + genetic testing, and (4) education + UV photo + genetic testing. Self-reported sun protection, tanning, and sunburn were assessed at baseline, immediately post-intervention, and 1 month post-intervention. The findings indicated benefits of the interventions to skin cancer prevention behaviors in the overall sample; however, the combined (UV photo + genetic testing) intervention had the most consistent positive effects on behaviors. Intervention effects were distinct across seasons. These results suggest that interventions containing multiple skin cancer risk communication strategies hold promise in benefitting health-promoting behavior changes in an at-risk, young adult population.Trial Registration Number: NCT03979872; Registered 6/5/2019.

'I had a bigger cancer risk than I thought ': The experience of receiving personalized risk information as part of a skin cancer prevention intervention in the college setting.

BACKGROUND: Diagnoses of both melanoma and nonmelanoma skin cancers are becoming increasingly common among young adults. Interventions in this population are a priority because they do not consistently follow skin cancer prevention recommendations. OBJECTIVES: The goal of the current study was to examine college students' perspectives on and experience with receiving a skin cancer prevention intervention that provided personalized skin cancer risk feedback in the form of an ultraviolet (UV) photograph, the results of genetic testing for common skin cancer risk variants, and/or general skin cancer prevention education. METHODS: Qualitative interviews were conducted with 38 college students who received a skin cancer prevention intervention. The interview covered students' feelings about their personal skin cancer risk information, the impact of the intervention on their skin cancer risk perceptions, actions or intentions to act with regard to their sun protection practices and feedback for improvement of the intervention content or delivery. RESULTS: Participants reported that different intervention components contributed to increased awareness of their sun protection behaviours, shifts in cognitions about and motivation to implement sun protection strategies and reported changes to their skin cancer prevention strategies. CONCLUSION: Our findings indicate that college students are interested in and responsive to these types of multicomponent skin cancer preventive interventions. Further, students demonstrate some motivation and intentionality toward changing their skin cancer risk behaviour in the short term. PATIENT OR PUBLIC CONTRIBUTION: Participants involved in this study were members of the public (undergraduate students) who were involved in a skin cancer prevention intervention, then participated in semistructured interviews, which provided the data analysed for this study.

The Impact of Social and Material Resources on Resilience Communication at the Intersection of Race and Gender.

In the communicative theory of resilience (CTR), communication constructs resilience processes that can promote change or continuity during hardship. The enactment of resilience is theorized to depend on available resources. The current study tests this theoretical link in the context of the COVID-19 pandemic, examining differences at the intersection of race and gender (N = 588). Job security, education quality, and friend support positively predicted continuity and change resilience. Four differences based on race/gender emerged: necessities negatively predicted continuity resilience for Black men and White women, healthcare and government representation positively predicted continuity resilience for Black women only, and family support positively predicted change resilience for Black women and White men. Findings support CTR's claim that resource access influences resilience enactment and indicate that theoretical associations differ based on race/gender. The current research emphasizes the importance of considering intersectionality in relation to CTR processes and structural barriers to enacting resilience.

Are some narratives better than others?: The impact of different narrative forms on adolescents' intentions to text and drive.

Psychological reactance theory posits individuals seek to restore freedom when threatened. Communication scholars have hypothesized persuasive messages can constitute threats to freedom. The current study engages questions about the potential for different forms of narratives in public service announcements (PSAs) to trigger freedom threats by examining responses to a PSA campaign that utilized three forms of narrative (celebrity testimonials, peer testimonials, and accident stories) to decrease adolescent texting and driving intentions. Participants (N = 214) watched anti-texting and driving narratives, and completed measures of threat to freedom, anger, negative cognition, and attitudes/intentions toward texting/driving. Compared to celebrity/peer testimonial PSAs, accident stories triggered increased anger and, indirectly, decreased intentions to drive safely. The results also suggest the need for continued examination of the best way to model psychological reactance theory, and the value of further research explicating anger as a mechanism of message effects.

Death Narratives, Negative Emotion, and Counterarguing: Testing Fear, Anger, and Sadness as Mechanisms of Effect.

Narrative messaging research has demonstrated that story outcome (e.g., whether the main character lives or dies) can impact audience behavior, but more research explicating and testing mechanistic pathways is needed. The current study tests fear, anger, and sadness as mechanisms of persuasion, assessing effects on counterarguing, reading flow, and behavioral intention. The current study utilized a 2 (story outcome: death vs. survivor) × 4 (story character: Marla, Erin, Don, and Ray) between-participants experiment (N = 735) to test the effect of story outcome on behavioral intentions via discrete emotion. Death narratives generated greater fear, anger, and sadness. Fear was related to greater behavioral intention and reading flow and diminished counterarguing. Sadness had the opposite effect. Anger produced a mixed persuasive effect, increasing both counterarguing and reading flow. Results have implications for discrete emotions theorizing and underscore the importance of conceptualizing narrative stimuli along multiple affective dimensions rather than single dimensions.

The Dyadic Communicative Resilience Scale (DCRS): scale development, reliability, and validity.

PURPOSE: There has yet to be a quantitative measurement of communicative resilience processes as outlined in the Communicative Theory of Resilience (CTR). This study aims to determine the structure, reliability, and validity of the Dyadic Communicative Resilience Scale (DCRS) in cancer patients and partners. METHOD: The DCRS was administered to 584 participants, including 312 cancer patients and 272 partners of cancer patients along with the common coping subscale of the dyadic coping inventory, the cancer-related communication problems with couples scale, and the resilience promoting scale. RESULTS: Exploratory and confirmatory factor analyses revealed nine dimensions of dyadic communicative resilience within the five resilience processes outlined in the CTR. Structure reliability was shown with Cronbach's alphas between .77 and .88 and good to excellent model fit for the nine factors. Convergent and discriminant validities were demonstrated by significant Pearson correlations with relevant, established coping/resilience measures. CONCLUSIONS: The DCRS has a clear nine factor structure and demonstrates good reliability. The measure has good convergent and discriminate validity indicating its utility in future research examining resilience in cancer populations.

"He would never let me just give up": Communicatively Constructing Dyadic Resilience in the Experience of Breast Cancer.

A breast cancer diagnosis is a significant stressor that impacts both survivors' and their partners' psychological adjustment and well-being. Communication patterns and strategies utilized by survivors and partners are the key determinants of how some couples adjust to a cancer diagnosis. This study employs the Communicative theory of resilience (CTR)(Buzzanell, 2010) to examine the dyadic communicative processes couples enact that contribute to their resilience. Researchers conducted semi-structured interviews with 27 breast cancer survivors concerning communication with their partners. All interviews were transcribed and independently coded using thematic analysis. Findings support and extend the presence of the five communicative processes of resilience outlined by Buzzanell (2010), demonstrating how these processes interact with one another. Results also suggest that couples' communication both promotes and interferes with resilience. Practical and theoretical implications are discussed.

Resilience Communication Mitigates the Negative Relational Effects of Topic Avoidance: Evidence from Parental Caregiving and COVID-19 Pandemic Contexts.

Communicating about hardships with close others can be challenging, leading to avoidance of hardship-related topics. Although typically considered relationally damaging, topic avoidance could serve as a beneficial or neutral strategy when paired with relationally affirming communication. The current research investigates if the resilience communication processes outlined in the communication theory of resilience mitigate the negative relational effects of topic avoidance. Hypotheses are tested in two different contexts: sibling communication during parental caregiving (N=207) and spousal communication in the first months of the COVID-19 pandemic (N=598). The processes of crafting normalcy, communication networks, and productive action were beneficial across contexts. When participants reported higher engagement in these processes, topic avoidance was not significantly related to relationship satisfaction. At lower engagement levels, topic avoidance was negatively related to relationship satisfaction. Nuance between contexts existed. For example, humor moderated the effect of sibling caregiving topic avoidance but not spousal COVID-19 topic avoidance.

Validating Cross-Modal Measures for Comparative Research: Message Veracity, Novelty, and Memorability.

Marketing researchers are interested in the relative persuasiveness of different message modes, such as narratives and arguments. A desire to explicate and compare underlying mechanisms is central to this research, yet progress is hindered by a dearth of measures that can be used meaningfully across modes. In the current project, we identify and validate three cross-modal message perceptions - veracity, novelty, and memorability - that can mediate the relationship between different modes and outcomes. Three studies (Study 1: N = 105; Study 2: N = 322; Study 3: N = 248) confirmed the factor structure, discriminant validity, and cross-modal (narrative vs. argument) value of all three message perceptions. The results of this study provide researchers with three cross-modal measures to support comparative message effects research.

Targeted communication and race: explicating perceived message relevance.

Objectives: Targeting is a communication strategy in which a message is designed to address a particular group. It has been postulated that targeting increases message relevance; however, researchers are still explicating relevance and its impact on downline cognitive processes (e.g. message quality, cognitive cost). The current study addresses both gaps by evaluating the impact of targeted materials for White and African American audiences. Design: Adult women (N = 266) aged 18-74 (Mage = 47.12, SD = 1.40) were recruited to participate in a 2 (targeting: multiracial, African American) × 2 (race: White participants, African American participants) × 2 (topic: Hypertension, Environmental Breast Cancer) message experiment. Results: Across both topics, African American participants in the African American condition had reduced cognitive costs, increased message clarity, and increased message relevance. An indirect serial mediation model was supported wherein the relationship between targeting and behavioral intention was mediated by perceived relevance and perceived message quality. Conclusion: Targeting enhances perceived message relevance which, in turn, impacts behavioral intentions via perceived message quality. This model is consistent with the postulates of relevance theory and informs both intervention design and evaluation.

Explicitness, disgust, and safe sex behavior: A message experiment with U.S. adults.

Sexual health risks are challenging to communicate given the potential negative reactions of target audiences to explicit language. Grounded in research on pathogen avoidance, the current study examined the impact of varying levels of explicit language on message perceptions and safe sex behavioral intentions. U.S. adults (N = 498) were randomly assigned to view messages detailing pandemic safe sexual behavior that contained either low or high levels of explicit language. High explicit language significantly increased perceived disgust which also indirectly linked high explicit language with increased intentions to engage in safe sex behavior. Individual difference variables moderated the impact of message explicitness; dispositional hygiene disgust moderated the impact of high explicit, hygiene-focused messages on safe sex intentions. Those with relatively low levels of dispositional disgust were more positively impacted by explicit language. The results suggest the value of increased message explicitness for sexual health communication and have implications for pathogen avoidance behaviors, the behavioral immune system, and dispositional and affective forms of disgust.

Does it matter if a story character lives or dies?: a message experiment comparing survivor and death narratives.

OBJECTIVE: In narratives, characters often face threats where they either live (survivor narratives) or die (death narratives). Both outcomes have the potential to persuade, and are frequently utilised in mass communication campaigns, yet more research is needed examining the relative effectiveness and underlying mechanisms of each strategy. DESIGN: U.S. adults (N = 1010) were randomly assigned to a 2 (survivor, death) × 2 (non-foreshadowed, foreshadowed) × 2 (within-study replication: narrative 1, narrative 2) between-participants experiment with melanoma stories as stimuli. MAIN OUTCOME MEASURES: Intentions to engage in sun safe behaviour and skin self-examination behaviour were assessed in the pre- and posttest, and then transformed into change scores. RESULTS: Death narratives increased sun safe behaviour intentions. Consistent with the entertainment overcoming resistance model, foreshadowed death narratives were found to increase sun safe behaviour intentions via increased transportation and decreased counterarguing. CONCLUSION: Compared to survivor narratives, death narratives increase intentions to engage in sun safe behaviour. The findings offer support for character death as a key feature of narrative persuasion, and narrative transportation and counterarguing as important mediational pathways.