The story against smoking:An exploratory study into the processing and perceived effectiveness of narrative visual smoking warnings

Objectives: This study compared the effects of two types of health warnings on cigarette packages: 'narrative visual warnings', showing an image portraying people plus a corresponding slogan that could evoke a story-like interpretation, and 'non-narrative visual warnings' with non-narrative content (i.e. body parts). Moreover, the mechanisms underlying the effects of these health warnings were explored. Design: A within-participants experiment was conducted comparing narrative and non-narrative visual warnings. Path analyses were performed to investigate the relationship between the narrative concepts transportation and identification, the emotions evoked by the health warning and the perceived effectiveness of the message. Method: Participants (N = 200) were presented with one narrative warning and one non-narrative warning. After each warning, they answered questions on narrative perception, transportation, identification, emotions and perceived effectiveness. Results: The narrative warnings were seen as more story-like than the non-narrative warnings. There was a statistical trend for narrative warnings to be perceived as more effective than the non-narratives. The narrative warnings caused more transportation, fear, sadness, compassion and anger; the non-narrative warnings evoked more disgust and surprise. For the narrative warnings, both narrative concepts of transportation and identification were directly related to perceived effectiveness, and also indirectly via sadness. For the non-narrative warnings, transportation was related to perceived effectiveness, both directly and indirectly via disgust. Conclusion: Seeing a story in a still picture with a slogan helps to increase the effectiveness of the antismoking message. Both narrative and non-narrative visual warnings may persuade receivers directly, but also by the evoking of emotions, although the specific emotions responsible for the persuasive effects may differ

The story against smoking : an exploratory study into the processing and perceived effectiveness of narrative visual smoking warnings

CITATION: Ooms, J. A., Jansen, C. J. & Hoeks, J. C. 2020. The story against smoking: An exploratory study into the processing and perceived effectiveness of narrative visual smoking warnings. Health Education Journal, 79(2):166–179. doi:10.1177/0017896919867436.The original publication is available at https://journals.sagepub.com/home/hejObjectives: This study compared the effects of two types of health warnings on cigarette packages: ‘narrative visual warnings’, showing an image portraying people plus a corresponding slogan that could evoke a story-like interpretation, and ‘non-narrative visual warnings’ with non-narrative content (i.e. body parts). Moreover, the mechanisms underlying the effects of these health warnings were explored. Design: A within-participants experiment was conducted comparing narrative and non-narrative visual warnings. Path analyses were performed to investigate the relationship between the narrative concepts transportation and identification, the emotions evoked by the health warning and the perceived effectiveness of the message. Method: Participants (N = 200) were presented with one narrative warning and one non-narrative warning. After each warning, they answered questions on narrative perception, transportation, identification, emotions and perceived effectiveness. Results: The narrative warnings were seen as more story-like than the non-narrative warnings. There was a statistical trend for narrative warnings to be perceived as more effective than the non-narratives. The narrative warnings caused more transportation, fear, sadness, compassion and anger; the non-narrative warnings evoked more disgust and surprise. For the narrative warnings, both narrative concepts of transportation and identification were directly related to perceived effectiveness, and also indirectly via sadness. For the non-narrative warnings, transportation was related to perceived effectiveness, both directly and indirectly via disgust. Conclusion: Seeing a story in a still picture with a slogan helps to increase the effectiveness of the antismoking message. Both narrative and non-narrative visual warnings may persuade receivers directly, but also by the evoking of emotions, although the specific emotions responsible for the persuasive effects may differ.https://journals.sagepub.com/doi/10.1177/0017896919867436Publishers versio

"Don't Make My Mistake":On the Processing of Narrative Fear Appeals

In this study, we examined the mechanism underlying the processing of narrative fear appeals. Participants (N = 564) read a story about a protagonist dealing with the consequences of cancer (Study 1: testicular cancer; Study 2: breast cancer; Study 3: skin cancer). Path analysis revealed that (1) attitude and behavioral intention toward performing self-exams were directly and positively associated with a form of transportation we identified as attention-focused transportation; (2) this form of transportation was positively associated with four emotions (fear, sadness, surprise, and compassion), whereas identification positively correlated with only one emotion (compassion); and (3) only the emotion of fear was a predictor of intention to perform self-exams. Taken together, these findings suggest that attention-focused transportation is a very important factor in the processing of narrative fear appeals, and that it can even, under some circumstances, replace the persuasive power of fear

How Do Patients Understand Questions about Lower Urinary Tract Symptoms?:A Qualitative Study of Problems in Completing Urological Questionnaires

Lower urinary tract symptoms are common complaints in ageing people. For a urological evaluation of such complaints in men, the International Prostate Symptom Score (IPSS) is used worldwide. Previous quantitative studies have revealed serious problems in completing this questionnaire. In order to gain insight into the nature and causes of these problems, we conducted a qualitative study. Not only the purely verbal IPSS was studied but also two alternatives, including pictograms: the Visual Prostate Symptom Score (VPSS) and the Score Visuel Prostatique en Image (SVPI). Men aged 40 years and over with an inadequate level of health literacy (IHL; n = 18) or an adequate level of health literacy (AHL; n = 47) participated. Each participant filled out one of the three questionnaires while thinking aloud. The analysis of their utterances revealed problems in both health literacy groups with form-filling tasks and subtasks for all three questionnaires. Most noticeable were the problems with the IPSS; the terminology and layout of this form led to difficulties. In the VPSS and SVPI, the pictograms sometimes raised problems. As in previous research on form-filling behavior, an overestimation by form designers of form fillers' knowledge and skills seems to be an important explanation for the problems observed

Improving Health Literacy Responsiveness:A Randomized Study on the Uptake of Brochures on Doctor-Patient Communication in Primary Health Care Waiting Rooms

Presenting attractive and useful health education materials in waiting rooms can help improve an organization's health literacy responsiveness. However, it is unclear to what extent patients may be interested in health education materials, such as brochures. We conducted a three-week field study in waiting rooms of three primary care centers in Groningen. Three versions of a brochure on doctor-patient communication were randomly distributed, 2250 in total. One version contained six short photo stories, another version was non-narrative but contained comparable photos, and the third version was a traditional brochure. Each day we counted how many brochures were taken. We also asked patients (N = 471) to participate in a brief interview. Patients who consented (N = 390) were asked if they had noticed the brochure. If yes (N = 135), they were asked why they had or had not browsed the brochure, and why they had or had not taken it. Interview responses were categorized by two authors. Only 2.9% of the brochures were taken; no significant association with brochure version was found. Analysis of the interview data showed that the version with the photo narrative was noticed significantly more often than the non-narrative version or the traditional version. These results suggest that designing attractive and comprehensible health materials is not enough. Healthcare organizations should also create effective strategies to reach their target population

Sweet Temptations:How Does Reading a Fotonovela About Diabetes Affect Dutch Adults with Different Levels of Literacy?

Recent studies suggest that health-related fotonovelas-booklets that portray a dramatic story using photographs and captions-may be effective health communication tools, especially for readers with a low level of literacy. In this experiment, effects on knowledge and behavioral intentions were assessed of a fotonovela originally developed for a Latin-American audience. Dutch readers from a low literacy group (N = 89) and a high literacy group (N = 113) were randomly assigned to one of three conditions: a fotonovela condition (all captions translated into Dutch), a traditional brochure condition (also in Dutch), and a control condition. On knowledge about diabetes, participants in the fotonovela condition outperformed participants in both other conditions. This finding was consistent across literacy levels. On behavioral intentions, however, readers of the fotonovela did not score significantly higher than participants in the other conditions. We also evaluated hypotheses proposed in the Entertainment Overcoming Resistance Model (EORM; Moyer-Guse, 2008) on the possible mechanisms underlying persuasion through narratives. No support was found for the mechanisms proposed in the EORM. The outcomes of this study suggest that a fotonovela may be a valuable health education format for adults with varying levels of literacy, even if it was developed for a target group with a different cultural background.</p

Health literacy among older adults is associated with their 10-years' cognitive functioning and decline - the Doetinchem Cohort Study.

Many older adults have low levels of health literacy which affects their ability to participate optimally in healthcare. It is unclear how cognitive decline contributes to health literacy. To study this, longitudinal data are needed. The aim of this study was therefore to assess the associations of cognitive functioning and 10-years' cognitive decline with health literacy in older adults

Psychoneurological Symptoms and Biomarkers of Stress and Inflammation in Newly Diagnosed Head and Neck Cancer Patients:A Network Analysis

Psychoneurological symptoms are commonly reported by newly diagnosed head and neck cancer (HNC) patients, yet there is limited research on the associations of these symptoms with biomarkers of stress and inflammation. In this article, pre-treatment data of a multi-center cohort of HNC patients were analyzed using a network analysis to examine connections between symptoms (poor sleep quality, anxiety, depression, fatigue, and oral pain), biomarkers of stress (diurnal cortisol slope), inflammation markers (c-reactive protein [CRP], interleukin [IL]-6, IL-10, and tumor necrosis factor alpha [TNF-α]), and covariates (age and body mass index [BMI]). Three centrality indices were calculated: degree (number of connections), closeness (proximity of a variable to other variables), and betweenness (based on the number of times a variable is located on the shortest path between any pair of other variables). In a sample of 264 patients, poor sleep quality and fatigue had the highest degree index; fatigue and CRP had the highest closeness index; and IL-6 had the highest betweenness index. The model yielded two clusters: a symptoms—cortisol slope—CRP cluster and a IL-6—IL-10—TNF-α—age—BMI cluster. Both clusters were connected most prominently via IL-6. Our findings provide evidence that poor sleep quality, fatigue, CRP, and IL-6 play an important role in the interconnections between psychoneurological symptoms and biomarkers of stress and inflammation in newly diagnosed HNC patients

Dutch National Round Robin Trial on Plasma-Derived Circulating Cell-Free DNA Extraction Methods Routinely Used in Clinical Pathology for Molecular Tumor Profiling

BACKGROUND: Efficient recovery of circulating tumor DNA (ctDNA) depends on the quantity and quality of circulating cell-free DNA (ccfDNA). Here, we evaluated whether various ccfDNA extraction methods routinely applied in Dutch laboratories affect ccfDNA yield, ccfDNA integrity, and mutant ctDNA detection, using identical lung cancer patient-derived plasma samples. METHODS: Aliquots of 4 high-volume diagnostic leukapheresis plasma samples and one artificial reference plasma sample with predetermined tumor-derived mutations were distributed among 14 Dutch laboratories. Extractions of ccfDNA were performed according to local routine standard operating procedures and were analyzed at a central reference laboratory for mutant detection and assessment of ccfDNA quantity and integrity. RESULTS: Mutant molecule levels in extracted ccfDNA samples varied considerably between laboratories, but there was no indication of consistent above or below average performance. Compared to silica membrane-based methods, samples extracted with magnetic beads-based kits revealed an overall lower total ccfDNA yield (-29%; P < 0.0001) and recovered fewer mutant molecules (-41%; P < 0.01). The variant allelic frequency and sample integrity were similar. In samples with a higher-than-average total ccfDNA yield, an augmented recovery of mutant molecules was observed. CONCLUSIONS: In the Netherlands, we encountered diversity in preanalytical workflows with potential consequences on mutant ctDNA detection in clinical practice. Silica membrane-based methodologies resulted in the highest total ccfDNA yield and are therefore preferred to detect low copy numbers of relevant mutations. Harmonization of the extraction workflow for accurate quantification and sensitive detection is required to prevent introduction of technical divergence in the preanalytical phase and reduce interlaboratory discrepancies