Transforming Cancer Knowledge, Attitudes and Behavior through Narrative

描述(由申请人提供)：拟议研究的主要目的是挑战以下基本假设，即传统的直截了当的事实背诵是传达与健康有关的信息的最佳方式。第一年和第二年的重点是通过分析10个最受欢迎的黄金时段电视节目中癌症描述的频率和类型来了解现有的癌症描述。为了评估这些黄金时段的电视剧对每周1000万到2000万观众的影响，我们将与好莱坞、健康和社会以及电视网络合作，确定即将播出的涉及乳腺癌和宫颈癌的剧集。通过衡量观众在这些剧集播出前后与癌症相关的知识、态度和行为的任何变化，我们可以确定使故事或叙事更有效或更不有效的关键因素。在第三年，我们经验性地测试了使用叙事格式是否对癌症知识、态度和预防行为产生了更大、更持久的影响。400名年龄在25岁至65岁之间、没有癌症病史的女性将被呈现给一名被诊断为宫颈癌(实验性叙事条件)的年轻女性的动画叙事。同样的事实信息将被呈现给另外400名处于非叙事控制条件下的女性。由于我们还质疑“一刀切”的信息策略的假设，我们的样本将在四个种族群体中平均分配--非洲裔美国人、欧洲裔美国人、韩裔美国人和墨西哥裔美国人--所有这些人患乳腺癌或卵巢癌的风险都很高。除了文化差异，我们预测，叙事对于口述历史很强的文化、新移民、老一辈人以及识字率较低的人可能特别有效。我们将通过使用诸如焦点小组和咨询医学人类学家等定性技术来增加这些发现的背景和深度，以进一步了解不同年龄、种族、文化适应和教育水平的妇女如何理解癌症、其原因、预防和治疗。在第四年，我们考察了沟通方式的影响，以确定哪一个或哪些沟通渠道可能在信息保持和动机方面产生最强烈和持续时间最长的变化。更具体地说，我们将进行一项现场实验，800名女性的新鲜样本将被随机分配到相同的癌症叙事中，但200人(每个种族的50人)将以印刷格式接触到这种叙事，200人以音频格式(类似于广播)，200人以视听格式(类似于电视或YouTube)，200人以互动格式(类似于视频游戏)要求个体做出反应。这一设计将使我们能够测试叙事的有效性是否会随着渠道的不同而变化，以及情态与关键人口统计因素之间是否存在交互作用，如生成、文化适应水平和教育。总而言之，这些方法工具中的每一个都为如何最好地向日益多样化的受众传达健康信息这一整体难题提供了重要的一块。

DESCRIPTION (provided by applicant): The primary purpose of the proposed research is to challenge the underlying assumption that the traditional straightforward recitation of the facts is the optimal way to convey health-related information. Years 1 and 2 focus on understanding existing cancer portrayals by analyzing the frequency and type of cancer depictions on the 10 most popular primetime television programs. To assess the impact these primetime portrayals have on between 10 to 20 million viewers each week, we will be working with Hollywood, Health and Society and the television networks to identify upcoming episodes involving breast and cervical cancer. By measuring any change in viewers' cancer-related knowledge, attitudes and behavior before and after these episodes air, we can determine the key elements that make a story or narrative more or less effective. In Year 3, we empirically test whether utilizing a narrative format produces a greater and longer lasting impact on cancer knowledge, attitudes and prevention behavior. Four hundred females between the ages of 25-65 with no pre-existing cancer history will be presented with an animated narrative involving a young woman who is diagnosed with cervical cancer (the experimental narrative condition). The same factual information will be presented to another 400 women in the non-narrative control condition. Because we also question the assumption of a "one- size-fits-all" message strategy our sample will be equally divided among four ethnic groups - African Americans, European Americans, Korean Americans and Mexican Americans - all of whom are at elevated risk for breast or ovarian cancer. In addition to cultural differences, we predict that narratives may be particularly effective for cultures with a strong oral history, for recent immigrants, for older generations, and for those with low literacy. We will add context and depth to these findings by using qualitative techniques such as focus groups and consulting with medical anthropologists to further understand how women of different ages, ethnicities, acculturation and education levels understand cancer, its cause, prevention and treatment. In Year 4, we examine the effect of communication modality to determine which communication channel or channels might produce the strongest and longest lasting changes in information retention and motivation. More specifically, we will conduct a field experiment in which a fresh sample of 800 females will be randomly assigned to the same cancer narrative but 200 (50 of each ethnicity) will be exposed to the narrative in a print format, 200 in an audio format (similar to radio), 200 in an audiovisual format (similar to television or YouTube), and 200 in an interactive format requiring responses from the individual (similar to a videogame). This design will allow us to test whether the effectiveness of a narrative may vary as a function of channel and whether there is an interaction between modality and key demographic factors such as generation, level of acculturation and education. In sum, each of these methodological tools provides an important piece to the overall puzzle of how to best convey health information to increasingly diverse audiences.