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潜在的假设，即传统的直接陈述事实是传达健康相关信息的最佳方式。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对癌症的描述的频率和类型来理解现有的癌症描述。为了评估这些黄金时段的节目对每周1000万至2000万观众的影响，我们将与好莱坞、健康与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。通过测量观众在这些剧集播出前后对癌症相关知识、态度和行为的任何变化，我们可以确定影响故事或叙事效果的关键因素。在第三年，我们通过实证检验使用叙事形式是否会对癌症知识、态度和预防行为产生更大、更持久的影响。400名年龄在25-65岁之间、之前没有癌症病史的女性将观看一段动画叙事，其中涉及一名被诊断患有宫颈癌的年轻女性（实验叙事条件）。同样的事实信息将呈现给另外400名在非叙述控制条件下的妇女。因为我们也质疑“一刀切”信息策略的假设，我们的样本将被平均分为四个种族——非裔美国人、欧裔美国人、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。除了文化差异之外，我们预测叙事可能对具有强烈口述历史的文化、新移民、老一辈和识字率低的人特别有效。我们将利用诸如焦点小组等定性技术，并与医学人类学家协商，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及其原因、预防和治疗，从而为这些发现增添背景和深度。在第4年，我们考察了沟通方式的影响，以确定哪种或哪种沟通渠道可能会在信息保留和动机方面产生最强和最持久的变化。更具体地说，我们将进行实地实验，其中800名女性将被随机分配到相同的癌症叙事中，但200人（每个种族50人）将以印刷形式播放叙事，200人以音频形式（类似于广播），200人以视听形式（类似于电视或YouTube）， 200人以需要个人回应的互动形式（类似于电子游戏）。这个设计将使我们能够测试叙事的有效性是否会随着渠道的变化而变化，以及模式与关键的人口因素（如代际、文化适应水平和教育程度）之间是否存在相互作用。总而言之，这些方法工具中的每一种都为如何最好地向日益多样化的受众传达健康信息这一总体难题提供了重要的一部分。

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.