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

Moral wrongs, disadvantages, and disability: a critique of critical disability studies

Critical disability studies (CDS) has emerged as an approach to the study of disability over the last decade or so and has sought to present a challenge to the predominantly materialist line found in the more conventional disability studies approaches. In much the same way that the original development of the social model resulted in a necessary correction to the overly individualized accounts of disability that prevailed in much of the interpretive accounts which then dominated medical sociology, so too has CDS challenged the materialist line of disability studies. In this paper we review the ideas behind this development and analyse and critique some of its key ideas. The paper starts with a brief overview of the main theorists and approaches contained within CDS and then moves on to normative issues; namely, to the ethical and political applicability of CDS

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

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

Social learning in multilevel flood risk governance: Lessons from the Dutch Room for the River Program

Although social learning is a key element of multilevel flood risk governance, it is hardly studied. This paper addresses this knowledge gap. The paper aims to identify enabling conditions for social learning in multilevel flood risks governance arrangements.We first conceptualize social learning and draw up a conceptual framework consisting of enabling conditions for social learning, using the literature on adaptive co-management, sustainable land and water management, and integrated flood risk management. Next, we apply this framework to analyze social learning in the context of the Dutch Room for the River program. Our interview results reveal that social learning about integrated flood protection measures took place at multiple levels. We found that a strong personal commitment to learning and mutual interpersonal trust in working groups are key conditions for successful social learning. Based on our analysis, we conclude with some recommendations for enhancing social learning processes in future flood protection programs

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

"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

Reduction of prevalence of patients meeting the criteria for metabolic syndrome with tirzepatide: a post hoc analysis from the SURPASS Clinical Trial Program

Background: Metabolic syndrome is characterized as the co-occurrence of interrelated cardiovascular risk factors, including insulin resistance, hyperinsulinemia, abdominal obesity, dyslipidemia and hypertension. Once weekly tirzepatide is approved in the US and EU for the treatment of type 2 diabetes (T2D) and obesity. In the SURPASS clinical trial program for T2D, tirzepatide demonstrated greater improvements in glycemic control, body weight reduction and other cardiometabolic risk factors versus placebo, subcutaneous semaglutide 1 mg, insulin degludec, and insulin glargine. This post hoc analysis assessed the effect of tirzepatide use on the prevalence of patients meeting the criteria for metabolic syndrome across SURPASS 1–5. Methods: Metabolic syndrome was defined as having ≥ 3 of 5 criteria according to the US National Cholesterol Education Program: Adult Treatment Panel III. Analyses were based on on-treatment data at the primary endpoint from patients adherent to treatment (taking ≥ 75% study drug). A logistic regression model with metabolic syndrome status as the response variable, metabolic syndrome status at the baseline visit as an adjustment, and randomized treatment as fixed explanatory effect was used. The effect of tirzepatide use on the prevalence of patients meeting the criteria for metabolic syndrome by categorical weight loss, background medication and gender were assessed. Results: In SURPASS, the prevalence of patients meeting the criteria for metabolic syndrome at baseline was 67–88% across treatment groups with reductions at the primary endpoint to 38–64% with tirzepatide versus 64–82% with comparators. Reductions in the prevalence of patients meeting the criteria for metabolic syndrome was significantly greater with all tirzepatide doses versus placebo, semaglutide 1 mg, insulin glargine, and insulin degludec (p &lt; 0.001). Individual components of metabolic syndrome were also reduced to a greater extent with tirzepatide vs comparators. Greater reductions in body weight were associated with greater reductions in the prevalence of patients meeting the criteria for metabolic syndrome and its individual components. Background SGLT2i or sulfonylurea use or gender did not impact the change in prevalence of patients meeting the criteria for metabolic syndrome. Conclusions: In this post hoc analysis, tirzepatide at all doses studied was associated with a greater reduction in the prevalence of patients meeting the criteria for metabolic syndrome compared to placebo, semaglutide 1 mg, insulin degludec, and insulin glargine. Although more evidence is needed, these data would support greater potential improvement in cardiovascular risk factor profile with tirzepatide treatment in people across the continuum of T2D