Testing the effectiveness of narrative messages using critical health communication

ABSTRACT

Background:

Latinos suffer from health disparities associated with excessive consumption of sugar-sweetened beverages. This study aimed to test the effectiveness of messaging using critical health communication approaches and delivered by two narrative modalities (video and comic book) with similar content that aims to empower Latinos to advocate for social change and to make individual behavior change related to sugary beverage consumption.

Methods:

Participants (N = 129 Mexican American women between 18 and 29 years) completed an online survey before and after exposure to an embedded stimulus. Participants were randomly assigned to a stimulus, a narrative message in video or comic book format, both developed using critical health communication approaches that focused on individual harms and social causes of sugary beverage consumption.

Results:

Paired sample t-test results showed that both narrative messages increased intentions to reduce sugary beverage consumption (Video: P < 0.01; d = 0.43; Comic: P = 0.03; d = 0.28). Both groups also demonstrated significant improvements in sugary beverage-related media literacy (Video: P = 0.01, d = 0.34; Comic: P = 0.05, d = 0.25), public health literacy (Video: P = 0.05, d = 0.24; Comic: P = 0.01, d = 0.32), and empowerment to engage in sugary beverage-related community movements (Video: P = 0.003, d = 0.38; Comic: P = 0.034, d = 0.27).

Conclusions:

This study provides initial evidence indicating the effectiveness of narrative messages in two modalities using critical health communication for promoting individual behavioral intention and social activation in reducing sugary beverage consumption.

KEYWORDS:

• Message modality
• comic book
• sugar-sweetened beverage
• empowerment
• graphic medicine
• commercial determinants of health

Acknowledgements

We are grateful to Dr. Christina Lux for her assistance working with Sequential Potential to develop the comic book. We are also grateful to the youth poet Monica Mendoza for composing the original poem and participating in the adaptation to the comic book format. We are also grateful to the funding for the development of the comic book provided by University of California, Merced, Center for the Humanities.

Authorship

MZ developed the study idea, collected and managed data, conducted the analyses, and wrote the manuscript; DC identified the intervention stimuli, developed and pre-tested the outcome measures; DS and SH assisted with data analyses, theoretical conceptualization, and critically revised the manuscript; ASR conceptualized the study, obtained the funding, and supervised the entire research process.

Ethics statement

This study was approved by the institutional review board (IRB) of University of California on Merced March 23, 2018, with the reference number UCM15-0017.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This project was supported by the National Cancer Institute under Award No. K01CA190659, by the National Institute of Diabetes and Digestive and Kidney Diseases under Award No. P30DK092924 and 2P30DK092924, and by the National Institute of Health under Award No R01DK116852. Content is solely the responsibility of the authors. Funding for the development of the comic book was provided by University of California, Merced, Center for the Humanities. The funders have/had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

Notes on contributors

Mi Zhou

Mi Zhou is an assistant professor at the San Jose State University. Her current research explores the effects of food and beverage marketing and different communication media and technologies on health outcomes for underserved populations.

A. Susana Ramírez

Susana Ramírez is an associate professor of public health communication at the University of California, Merced. She applies communication science to advance public health goals for rural and Latino populations and is a nationally recognized expert on media, inequality and dietary health, and Latinx culture.

Deepti Chittamuru

Deepti Chittamuru is a postdoc researcher at the University of California, Merced. Her current research examines how technology might be leveraged to improve health outcomes for marginalized and underserved populations both globally and locally.

Dean Schillinger

Dean Schillinger is a primary care physician, scientist, author, and public health advocate at the University of California, San Francisco. He is an internationally recognized expert in health communication and has been widely recognized for his work related to improving the health of vulnerable populations.

Sandie Ha

Sandie Ha is an assistant professor of public health at the University of California, Merced. Her research interests center on identifying and understanding environmental risk factors for adverse pregnancy outcomes and investigating how prenatal exposures affect subsequent health for both mothers and babies