Identification with Characters of a National Narrative Health Communication Campaign Targeting Type 2 Diabetes

ABSTRACT

Type 2 diabetes mellitus (T2DM) has a high prevalence in Germany. Tailored health communication campaigns are part of preventing T2DM at a societal level, with narrative approaches as a promising communication strategy. The aim of this study was to qualitatively examine identification with characters as a potential narrative effect mechanism within a national T2DM communication campaign (Slogan: “Diabetes – not only a question of type”). In doing so, characters’ liking and perceived similarity were explored as antecedents of identification. For this purpose, nine focus groups comprising a total of 76 participants diagnosed with T2DM were conducted. Two of these focus groups consisted entirely of participants of Turkish descent. An assessment was developed to measure the extent to which participants liked, perceived themselves to be similar to, and identified with different characters presented via three videoclip formats (live action, animated cartoons, and celebrity testimonials) from a national diabetes communication campaign. Live action and celebrity testimonial characters were mostly perceived as likeable. However, level of identification was low, and participants felt an overall lack of similarity regarding both personal and disease-related characteristics as compared to these characters. Animated cartoons were perceived as less stigmatizing, but also as less engaging. The study indicates that liking without a feeling of similarity to a character is not sufficient to elicit identification. Further, the reinforcement of harmful T2DM stereotypes should be avoided in health communications to prevent reactance and to increase generalizability.

An elderly woman is standing in a smoky kitchen, when her husband enters and asks what happened. She replies: “I’ve just burned 2000 calories. I forgot the pizza in the oven.”

- Scene from a videoclip of the German diabetes communication campaign “Diabetes – not only a question of type.”

About 8 million people in Germany have type 2 diabetes mellitus (T2DM), and approximately 13 million people in Germany are prediabetic (Tönnies et al., 2019). Further, an estimated 2 million people with T2DM in Germany are not aware that they have diabetes (Heidemann et al., 2016). This highlights the importance of increasing awareness of T2DM and the identification of individuals at high risk or with undetected diabetes, with a goal of both preventing long-term diabetic complications (Zheng et al., 2018) and reducing mortality (Tönnies et al., 2018). The consequences of T2DM are burdensome at both the individual and societal level, including high costs for the health care system (Köster et al., 2011). Tailored communication campaigns are an important component in the prevention of T2DM to address at-risk individuals. At-risk individuals include for example those with prediabetes and ethnic minorities, such as the Turkish migrant community in Germany (Icks et al., 2011; Timpel et al., 2019). The latter group exhibits a particularly high prevalence of T2DM and shows worse outcomes after diagnosis (Icks et al., 2011; Laube et al., 2001). The reasons for this include a reduced access to health care (Balbale et al., 2014; Betancourt et al., 2012; O’Loughlin et al., 2019), and disadvantages with regard to socioeconomic status (Fassbender & Leyendecker, 2018; Williams et al., 2010), education (e.g., Hartmann, 2016; Schneebaum et al., 2015), language proficiency (Schwei et al., 2016), and health literacy (Beauchamp et al., 2015; Bergman et al., 2021).

Health communication campaigns generally aim to change knowledge, attitudes, and behaviors of defined target groups to promote health and prevention (Bonfadelli & Friemel, 2010). They are usually designed to reach large numbers of individuals and are deployed both when other measures seem insufficient in addressing a given health problem, and to support existing interventions (Friemel & Frey, 2019). Meta-analyses show significant effects of communication campaigns on diverse health behaviors (Anker et al., 2016; Snyder et al., 2004). However, effect sizes across different health topics tend to be small (Snyder et al., 2004), and evidence is lacking for T2DM prevention, emphasizing the need for developing and investigating communication strategies for health campaigns addressing this topic.

Within health communication campaigns, the use of narrative evidence is a common communication strategy. Narrative evidence focuses on a cohesive story from the perspective of one or more protagonists to achieve health-related goals and has gained popularity in recent years (Hinyard & Kreuter, 2007; Zebregs et al., 2015).

Different strategies are subsumed under the concept of narrative health communication, such as entertainment-education, storytelling, and the use of testimonials. These strategies commonly focus on the identification of the recipient with a given media character (Brown & Fraser, 2004; Moyer-Gusé, 2008). Identification is frequently defined as “a mechanism through which audience members experience reception and interpretation of the text from the inside, as if the events were happening to them” (Cohen, 2001, p. 245). Thus, identification refers to the mental engagement with a specific character, which is accompanied by a loss of self-awareness (Cohen, 2001; Tal-Or & Cohen, 2010). Existing studies suggest that identification may determine the extent to which a recipient becomes engaged with a narrative and further influences their perception of the story (Cohen, 2001; Tal-Or & Cohen, 2010). The process of identification is thereby affected by the recipient’s perception of the character, which is reflected in the extent to which they both like and perceive themselves to be similar to that character (Chory, 2013; Cohen, 2001; Moyer-Gusé, 2008; Tian & Hoffner, 2010). Liking is defined as a positive evaluation of media characters (Cohen, 2001; Moyer-Gusé, 2008), whereas perceived similarity is characterized by the extent to which a person perceives themselves as similar to the character (Moyer-Gusé, 2008). Perceived similarity can refer to demographic, physiological or psychological attributes (Moyer-Gusé, 2008). Liking and perceived similarity could both be considered antecedents of identification (Chory, 2013; Cohen, 2001; Moyer-Gusé, 2008; Tian & Hoffner, 2010), with states of liking and perceived similarity being associated with greater self-awareness and psychological distance from the character than with identification (Cohen, 2001; Moyer-Gusé, 2008).

Identification is a powerful mechanism in overcoming resistance. This has been demonstrated not only in theory (Cohen, 2001; Moyer-Gusé, 2008; Tal-Or & Cohen, 2010), but in frameworks of narrative health communication (Borrayo et al., 2017; Murphy et al., 2013). Several studies suggest that identification may be particularly effective when targeting stigmatized health topics such as sexual health (Moyer-Gusé et al., 2011), human papilloma virus (HPV) vaccination (Frank et al., 2015), and HIV prevention (Smith et al., 2007). Some evidence points to the effectiveness of narrative approaches for T2DM prevention, as well as indicating the importance of identification of the target group with the depicted media characters (Kline et al., 2016; Unger et al., 2009).

There is generally limited evidence on the impact of identification with media characters within diabetes communication campaigns on engaging in healthier behaviors. The present study therefore qualitatively investigated identification with characters (including the antecedents of liking and perceived similarity) as a possible effect mechanism of narrative communication within a T2DM prevention campaign (“Diabetes – not only a question of type;” German slogan: “Diabetes – Nicht nur eine Typ-Frage”) using different videoclip formats. The following research questions were examined:

RQ1:

How do participants evaluate the likability of the characters?

RQ2:

How do participants evaluate personal similarity with the characters in terms of demographic, physiological, and psychological attributes?

RQ3:

What factors promote and inhibit identification with the characters?

This study thus contributes to a deeper understanding of the role of identification (including the antecedents of liking and perceived similarity) in both the potential benefits of and obstacles to using narrative communication approaches in effective T2DM campaigns.

Materials and methods

We developed the following qualitative research design to examine liking, perceived similarity, and identification with the characters of the campaign “Diabetes – not only a question of type” in individuals diagnosed with T2DM.

Campaign

In February 2020, the German federal government launched its national awareness and prevention strategy on diabetes. As part of this strategy, the German Diabetes Center (Deutsches Diabetes-Zentrum; DDZ) developed the diabetes communication campaign “Diabetes – Nicht nur eine Typ-Frage” (“Diabetes – not only a question of type”). This campaign aims to increase knowledge and awareness of diabetes and to facilitate healthy behavior and diabetes self-management. Target groups consist of people at risk for developing pre-diabetes, people at risk for developing diabetes, and individuals diagnosed with T2DM.

The campaign comprised 19 videoclips, which were distributed through websites and social media channels. These videoclips fall into three categories: live action, animated cartoons, and celebrity testimonials¹.

Live action

Twelve videoclips follow an elderly white couple (“Ruth and Rainer”) giving humorous takes on everyday situations like preparing dinner or watching TV. These videoclips educate on the causes, detection, symptoms, and treatment of diabetes, with a focus on self-management.

Animated cartoons

Five videoclips depict the same couple (“Ruth and Rainer”) as cartoon characters. The videoclips include information on diabetic complications such as retinopathy, nephropathy, neuropathy, diabetic foot, cardiovascular diseases, and fatty liver.

Celebrity testimonials

Two videoclips present testimonials by Matthias Steiner and Christine Theiss. Matthias Steiner is a former weightlifter and Olympic champion who has type 1 diabetes mellitus. Following his athletic career, he lost a significant amount of weight and has since worked as a nutrition and fitness coach, author, and presenter. Christine Theiss is a trained physician and former world champion in kickboxing. She became more widely known as the host of a weight-loss show on German private television (“The Biggest Loser”). In the videoclip, she discusses her career as a professional athlete without explicitly referencing her profession as a physician. At the time of the campaign’s initial broadcast, the celebrity testimonials were in their thirties.

Overall evaluation of the campaign

The objective of the overall evaluation was to attain a comprehensive assessment of the effectiveness of the videoclips used in this diabetes communication campaign, with a goal of using these findings to adapt the campaign and improve its effectiveness for the target groups. To assess the effectiveness of these videoclips, separate focus groups were conducted with both individuals with T2DM, and with experts in the field of diabetes and health communication. Two focus groups of individuals with T2DM comprised individuals with Turkish descent (as indicated by participants who indicated that Turkish was their primary language; see Ulusoy et al., 2016). As the current study focuses on the perspective of individuals with T2DM, the experts’ data were not considered within the analysis. Focus groups were semi-structured to capture a broad picture of perceptions of the campaign, allowing groups to organically engage but also to follow similar areas of discussion (see Appendix B). The participants of the T2DM focus groups also completed questionnaires on diabetes-specific themes to capture different facets of the videoclips (e.g., perceived comprehensibility; see Appendix C).

Recruitment and inclusion criteria

Participants were recruited via flyers in diabetes clinics, hospitals, and pharmacies; Facebook groups for people with diabetes; and a press release made by the Johannes Gutenberg University Mainz. Inclusion criteria were: Diagnosed with T2DM for at least one year, age 18 to 85 years, capacity for consent, and sufficient German language skills in spoken and written language to understand the videoclips and to participate fully in all study activities. The study was approved by the Medical Association of Rhineland-Palatinate (ID: 2018–13145-Epidemiologie) and followed the Declaration of Helsinki Ethical Principles for Medical Research Involving Human Subjects. Personal data was pseudonymized and not stored together with personally identifying data. Audio and video recordings made during the focus groups were securely deleted after transcription and analysis were completed. Participants received €250 compensation for participation in all study activities. The study was commissioned and funded by the German Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufklärung; BZgA).

Focus groups

The present study examines a total of nine focus groups, all of which comprised individuals with T2DM. Of these nine focus groups, two of these groups comprised only individuals who reported Turkish as their first language. Each group watched 13 to 14 videoclips (see Appendix A) and completed questionnaires, followed by a guided focus group discussion. Quantitative findings based on questionnaire responses were not analyzed within the present study.

Data analysis

Focus groups were videotaped and later transcribed. Transcripts were doublechecked by an independent rater. Based on the definitions in literature, a deductive code system was created that encompasses identification and its antecedents of liking and perceived similarity in the three videoclip formats (Cohen, 2001; Moyer-Gusé, 2008; see Appendix D for code system).

An inductive analysis of the transcripts identified topics for liking, perceived similarity, and identification (Table 2). The first researcher categorized all focus group transcripts, and one other researcher independently reviewed one focus group transcript to ensure interrater reliability. Kappa (Brennan & Prediger, 1981) was used to determine interrater reliability, and disagreements were resolved by discussion until consensus was reached. An interrater reliability of 94% was ultimately achieved. In a last step, participant quotations for inclusion in the present publication were translated into English and reviewed by co-authors.

Demographics

Participants (N = 76) were on average 56 years old (SD = 14 years), 54% identified as male and 46% as female, and 16% had a college degree (Table 1). Participants had been diagnosed with T2DM for an average of 11 years (SD = 8 years) and 41% reported experiencing complications relating to their diabetes 18 participants were of Turkish descent; these participants had lived in Germany for 38 years on average (SD = 6 years).

Table 1. Demographic characteristics of the study sample.

Variable	N	M	SD
Age (years)	76	56.06	13.76
Diabetes duration (years)	75	11.14	7.92
HbA1c-value (mmol/mol (%))	69	7.27	1.10
	N	%
Gender
Female	35	46.1
Male	41	53.9
Turkish migrant background	18	23.7
Education
Lower than College degree	63	82.9
College degree	12	15.8
Employment
(Self-)employed	36	47.4
In education	1	1.3
Unemployed	11	14.5
Retired	28	36.8
Glucose monitoring
Blood glucose self-monitoring	63	82.9
Continuous glucose monitoring	1	1.3
Intermittent scanning glucosemonitoring	4	5.3
Medication
Oral medication	46	60.5
Insulin therapy	33	43.4
Diabetes long-term complications
Retinopathy	12	15.8
Nephropathy	4	5.3
Diabetic Neuropathy	17	22.4
Cardiovascular diseases	10	13.2
Diabetic food syndrome	16	21.1
Other	6	7.9

N: Absolute frequency. %: Relative frequency.

Results

The inductively generated topics for liking, perceived similarity, and identification are displayed in Table 2.

Table 2. Inductively generated topics for Identification, Liking, and Perceived Similarity.

Construct	Inductive Topics
Liking	Sympathy Humor/entertainment/appeal Authenticity
Perceived similarity	Demographic attributes: age, life in retirement, family structures, profession of an athlete, diagnosis of diabetes/diabetes types Physical attributes: Body composition Psychological attributes: Willpower, motivation
Identification	Setting/partnership dynamics Stigmatization/stereotypes Familiarity of testimonials Non-famous testimonials/medical experts Target group fit

RQ1: Liking

In general, the live action characters were well liked, with “Ruth and Rainer” described as “funny” and “likeable.”

The celebrity testimonials had a more mixed reception. Matthias Steiner’s testimonials were perceived as “likeable” and “authentic.” Said one participant: “I liked him as a person. It was nothing staged, like these sketches.” However, few participants described Christine Theiss positively, particularly emphasizing her charisma on TV. By contrast, according to other participants, she appeared “too clean” and “artificial.” In general, multiple participants criticized the “superficial” and “advertisement-like” style of the testimonial videoclips. Their responses included that these videoclips were: “Too Hollywood-like. […] It seemed so superficial,” and “He’s an athlete, you can believe someone like him, but for me it was […] like some kind of advertising.”

By contrast, participants described the animated cartoons as more neutral, but “boring” and unable to facilitate an “emotional connection.”

RQ2: Perceived similarity

Participants did not feel sociodemographic similarity with either the live action characters or the celebrity testimonials. “Ruth and Rainer” were older than most participants, and their “retirement lifestyle” did not resonate with the everyday stressors like family or job issues that were so important to these participants’ lives. Participants specifically pointed out how having kids and a job makes it hard to find time to exercise (“It’s easier for older people. They have their structured everyday life. But if you have two children, if you have […] two jobs and a husband, it’s not so easy to squeeze a sports day into the week.”) and lamented how “Ruth and Rainer” perpetuate the myth that diabetes is a problem for older adults (“In terms of age: I can’t identify with them. That you only get diabetes in old age.”) Participants suggested instead depicting “A genuine family that really has these problems.”

Participants of Turkish descent were particularly disappointed in how different the characters’ families were from their own:

I miss the connection to reality. These […] two actors, who […] have a pensioner’s life … . If I compare that with a commercial in Turkey, there is, for example, a grandfather who wants to play with his grandchild and then suddenly has heart problems […]. These are scenes from everyday life.

Unsurprisingly, participants also felt very different from the celebrity athletes who shared their stories. Participants understandably saw both athletes as not only being in much better physical shape than they were (“There is no world champion kickboxer sitting here;” “I thought it was completely unrealistic. To show a super-slim model as a diabetic…”), but as having more opportunities and support to stay fit (“He might have a trainer and a sports physician supporting him”). Participants also did not relate to the psychological characteristics of “ambition” and “willpower” that they attributed to the celebrity testimonials. For example, referring to Steiner’s higher weight during his Olympic weightlifting career: “The kilos […], he needed them for sports, right? He didn’t gain them […] like me because I can’t control myself.”

While some participants felt that having celebrities come out in support of greater diabetes awareness and acceptance was helpful regardless of whether those celebrities indeed have T2DM, others expressed their doubt about the appropriateness or helpfulness of celebrity testimonials. Their criticisms included: “Celebrities who have as much to do with diabetes as Mars has to do with the moon, namely nothing at all;” “I’m not sure if they [the actors] have diabetes;” and “The protagonists make this seem implausible.”

This criticism was exacerbated by the fact that Matthias Steiner has diabetes mellitus type 1 (not T2DM), which appeared to diminish his potential as a role model. Participants particularly noted that the diabetes management behaviors presented in the videoclips were criticized as not suitable and “dubious,” for someone who has T2DM: “If you have diabetes, you are told that you can just inject a little more and that’s it. There is a personal responsibility for this disease, right? I miss that.”

However, some participants appreciated Matthias Steiner sharing his story; these participants found it “motivating” that he was raising awareness and fighting stigma against the disease by emphasizing that anyone can be affected by diabetes mellitus:

I think that from a very specific point of view, you can consider him a very good testimonial. This says: it can happen to anyone. Even to such shining lights. These athletes are healthy per se. They can’t get sick […]. This is the […] best lifestyle that you can have. And he has something like that [diabetes].

RQ3: Identification

Many participants criticized the outdated gender roles depicted by the live action “Ruth and Rainer”, whose “50s atmosphere” was described as not “modern.” The comic effect of this couple’s “exaggerated” behavior caused many participants to perceive these videoclips as “downplaying” T2DM, which is why they could not “take them seriously.” Criticisms included: “I don’t believe that the husband waits for dinner and the wife […] hurries, so that it’s on the table on time. That is simply not up to date;” “No one would want to identify with that;” and “The presentation was somewhat bizarre.”

Participants of Turkish descent particularly criticized how the role of women was portrayed, especially when it came to the dynamic between male and female partners. In their view, women have “to motivate the men” in their diabetes management. Said one participant: “That was nice, in the films, that there was a partner… but mostly you’re standing there alone in your kitchen […], thinking: ‘[…] What can I eat today?’”

However, other participants felt that the live action characters demonstrated everyday life and partnership situations in a realistic manner. They found the presentation of characters to be “respectful” and communicated in an everyday tone that was able to engage them emotionally: “This couple is from everyday life; you can identify with them.”

While some participants agreed that there are days “when I behave like those two people,” others felt that “Ruth and Rainer” reproduced harmful stereotypes about diabetes, and found it difficult to relate to the unhealthy behaviors presented in the videoclips. They complained that they “didn’t find it funny” and that “It’s not always just the fast-food-eating people who get that [diabetes].” They were distressed that these depictions validated “this stigmatization [that], somehow, all fat people will die at 50 anyway” and disliked the fact that “Ruth and Rainer” seemed to have so little motivation or awareness regarding the importance of a healthy lifestyle: “I don’t have the impression that […] [“Ruth and Rainer” think] that they have to exercise more, that they have to lose weight […]. They do not provide information about diabetes, but […] showcase poor behavior.”

Overall, the animated cartoons were perceived as “neutral” and less stigmatizing. Participants could “take them more seriously” and the animated figures left room for individual interpretation. Said one participant: “The cartoon figures were thin and for me it’s more engaging than […] the two actors.” Said another: “I’m more of a friend of abstract art, so I liked the animated films a lot, because you’re actually able to emphasize certain character traits […], and you’re not tied down to a particular type of person.”

However, some participants found the cartoon format inappropriate for the target population of adults with T2DM (“I find it rather silly for certain target groups”), and they suggested that it was more suitable “for children.”

Participants, overall, did not identify with the athletic celebrities that provided patient testimonials, chafing at both the psychological and physiological differences they perceived. One participant felt that Christine Theiss – who had hosted a sensational and controversial weight loss television show – “spoke in a very lecturing way.” In her tone, one participant said, “I always hear: You can’t.” Overall, participants wanted testimonials from “more popular people, perhaps those, who actually have to deal with this condition.,” or otherwise give more “background information” on the celebrity testimonials’ characters. Said another, “I would have rather preferred a film where you have average people talking about diabetes. Those who are working on it, those who have made it and those who have difficulties.” This was echoed in the desire for “real people who are actually affected by it and deal with it in a real way.” Some participants of Turkish descent also expressed a desire for more medical experts, which would increase the credibility of the testimonials: “I would have liked a doctor [...] who would give a bit of clarification.”

Discussion

This study qualitatively examined identification and its antecedents in a German T2DM communication campaign (“Diabetes – not only a question of type”).

Most participants perceived the protagonists presented by live actors and celebrity testimonials as likable but unrelated. Although some participants identified with the presented behaviors and interpersonal dynamics, most participants criticized a lack of resemblance with the actors (e.g., life in retirement) and the testimonial’s protagonists (e.g., life as a professional athlete). In general, the animated cartoons were perceived as less stigmatizing, but also as less appealing.

In line with existing evidence (Chory, 2013; Cohen, 2001; Moyer-Gusé, 2008; Tian & Hoffner, 2010), the present study highlights the significance of character perception (namely, liking and similarity) to foster identification and to increase the effectiveness of narrative T2DM communication campaigns. However, although liking and identification seem to be connected processes within media reception (Chory, 2013), findings from our study indicate that liking is not sufficient to evoke the deeper process of identification. While the live actors and celebrity testimonials’ characters were mostly perceived as likeable, the level of identification reported by participants was low. Instead, previous research indicates that similarity between the character and the message recipient seems to be more important than liking to elicit identification (Kline et al., 2016). In line with other research (Lundell et al., 2013), results of the current study suggest that the majority of participants did not perceive characters as a “normal person” with a “normal life,” thus reducing identification with them. Although participants may find characters entertaining, liking characters without perceiving there to be similarity will likely not result in a feeling of connection. Lundell et al. (2013) emphasize the risk that narratives may reinforce stereotypes by presenting particular individuals and their specific motivations, which may limit recipients’ ability to generalize to other contexts. de Graaf et al. (2012) similarly hypothesize that identification may not occur when recipients’ perspectives are too different from those of a media character.

Consistent with Basil (1996), participants in the present study argued that public figures providing testimonials must be well known to elicit identification. Effective testimonial providers must also share multiple demographic characteristics (e.g., age) if they wish to effectively encourage message recipients to change their health-relevant behaviors.

The current study is not without limitations. Only individuals diagnosed with T2DM were examined, but no other at-risk groups (such as persons with prediabetes) were involved. Further, the two focus groups comprising people of Turkish descent were not representative of Turkish migrants in Germany, as the study participants had a higher level of German language skill than the general population (Schührer, 2018). Therefore, results from this specific focus groups cannot be meaningfully contrasted with the results of the German native-speaking population, with any observed differences serving only as possible indications of differences between the groups for deeper exploration. Overall, because the present study used a qualitative approach, no causal conclusion could be drawn, and only patterns of identification and its antecedents for the effectiveness of narrative health communication for T2DM were discussed. The effective detection of these patterns was further limited by difficulty disambiguating between identification, liking, and perceived similarity within the present study.

Future research should seek out participants from diverse backgrounds (including individuals from ethnic minorities and with pre-diabetes) whose demographic and personal characteristics align with those of the characters featured in the narrative diabetes communication campaigns of study. Concrete narrative communication interventions should be evaluated in a formative way, and particular features (e.g., characters’ age) could be investigated using experimental designs. In such experimental studies, validated instruments should be used to assess media reception variables in order to delineate them clearly. Researchers could focus on various narrative formats (e.g., live actors, animated cartoons, testimonials) and their potentials and limitations to evoke identification with characters.

Communication campaigns can reach large numbers of people, and play an important role in T2DM prevention. However, the effects of communication campaigns in healthcare are generally small (Snyder et al., 2004), highlighting the need to use appropriate communication strategies to increase the impact of these campaigns. The current study contributes to the understanding of effective communication strategies in T2DM communication campaigns. In investigating an actual campaign implemented in Germany, the study indicates both potential benefits and obstacles to promoting identification with characters in T2DM narrative communication. The results of the current study suggest that liking a character without perceiving them to be similar is not sufficient to elicit identification; in fact, featuring characters that are too different from message recipients in T2DM communication may limit generalizability and even reinforce harmful stereotypes about diabetes. In the context of T2DM, these harmful stereotypes often result in overestimating the importance of individual responsibility and behaviors (e.g., diet and exercise) as compared to environmental conditions (e.g., socioeconomic class, the availability of healthy food; Hill-Briggs et al., 2020; The Lancet Diabetes & Endocrinology, 2018). Thus, when creating narratives within T2DM communication interventions, campaign developers should use likeable and appealing characters who are similar to the target population with regard to both demographic and diabetes-specific characteristics. Effective celebrity testimonials should utilize characters who are not only well known by the target group, but who resemble them in key ways (e.g., being diagnosed with the same type of diabetes). Thus, although this study supports the need to implement positive and credible role models for narrative T2DM communication, results are preliminary and further research in this domain is needed.

Disclosure statement

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

Data availability statement

Video recordings and audio recordings are not available due to privacy reasons. Anonymized transcripts in German language can be provided on request.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/10410236.2024.2378256.

Additional information

Funding

This work was supported by the German Federal Centre for Health Education [Bundeszentrale für gesundheitliche Aufklärung; BZgA].

Notes

1. The videoclips can be watched via the following link: https://www.youtube.com/watch?v=-j26FT40H7E&list=PLptzgER9GMbjdNztzSxUrmU1dPCH2v5Md&index=1.