“You are Telling the Story Yourself”: Defining and Developing Narrative Pictorial Warning Labels

ABSTRACT

Pictorial warning labels (PWLs) featuring narrative content are promising strategies for communicating health risks and motivating behavior change. The objectives of this study were to (1) identify what intrinsic features a PWL must have to be constructed as a narrative and (2) uncover in what ways narrative PWLs are perceived as being (in)effective. Seven online focus groups were conducted via Zoom with moderate and heavy drinkers (n = 30). Participants discussed a series of mockup PWLs designed to communicate the cancer risk of alcohol. The discussion revealed that a static image must include character, causality, and setting to help individuals construct the story. Specifically, the character should be discernible and believable so that individuals can infer risk information. Moreover, the connection between the image and text should imply a causal relationship between alcohol drinking and cancer risks. Lastly, there should be sufficient relevant background or context information. When discussing the label effectiveness, most participants thought narrative PWLs were more effective than graphic, non-narrative PWLs at informing consumers about the cancer risk of alcohol. Their reasoning included narrative PWLs (1) being easy to understand, (2) evoking curiosity and imagination, (3) eliciting sympathy for the character, (4) not causing aversion, and (5) increasing risk perceptions. This study contributes to the narrative persuasion research and offers practical implications for designing image-based narratives.

Acknowledgements

The authors thank the Alliance of Coalitions for Healthy Communities for helping recruit study participants.

Disclosure statement

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

Data availability statement

The data underlying this article are available in openICPSR (doi: 10.3886/E195441V1).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/10410236.2023.2293324

Notes

1. We posted the recruitment advertisement on two subreddits: a local beer group and a group where users can post and take surveys. We also worked with a local nonprofit organization focused on substance use prevention, which helped us share the recruitment advertisement through their newsletters. The recruitment advertisement provided an explicit information about the inclusion criteria.

2. The research team actively monitored for data saturation. After each focus group session, the moderator and the moderator assistant identified the new information or themes present in the discussion. The research team decided to stop data collection after the last focus group session when no new insights were identified which substantially altered the thematic schema.

Additional information

Funding

The study reported in this paper was supported by the National Cancer Institute of the National Institutes of Health under Award Number [1R03CA273391-01]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.