What caused Pinocchio’s nose to grow longer? What was the name of your 2nd-grade teacher?
If the first question seemed much easier to answer, you’re not alone, which is why communication professor and principal investigator Sheila Murphy (pictured, right) and joint-principal investigator Lourdes Baezconde-Garbinati (below left) and their colleagues will research narratives as a way to learn and retain information about important topics such as cancer. Baezconde-Garbinati is an assistant professor of research at the USC Keck School of Medicine.
The proposal, “Transforming Cancer, Knowledge, Attitudes and Behavior through Narrative,” was awarded a 5-year $3.075 million grant from the National Institutes of Health.
Others involved with the grant include Sandra Ball-Rokeach (co-PI), Ph.D., USC Annenberg; Robert Haile (co-PI), Ph.D., USC Norris Comprehensive Cancer Center; Sandra de Castro Buffington (co-PI), 
This team of medical researchers, script writers, artists, physicians, psychologists, anthropologists, communication scholars and public health professionals will examine and reinvent how health-related information is conveyed. The purpose of the research is to challenge the underlying assumption that the traditional straightforward recitation of the facts is the optimal way to convey health-related information.As Murphy points out, the power and perseverance of a narrative or story structure has been recognized and utilized for thousands of years, but when it comes time to craft health messages designed to convey crucial, potentially life-saving health information, Western medicine all but ignores the use of narrative. The proposed research empirically tests whether utilizing a narrative format might produce a greater and longer lasting impact on knowledge, attitudes and prevention behavior.
The research also questions the assumption of a “one-size-fits-all” message strategy by testing whether narratives may be particularly effective for cultures with a strong oral history, for recent immigrants, for older generations and for populations with low literacy.
“Although the research will focus on breast and cervical cancer, the results have clear implications for virtually all health care communication,” Murphy said. “This research could radically change how health messages are conveyed across different ethnic groups, generations and modalities."
The grant is classified under the NIH Director’s new T-R01 Program that strives to accelerate the current pace of discovery through the support of highly innovative. T-R01s provide a new opportunity for scientists that is unmatched by any other NIH program. Since no budget cap is imposed and preliminary results are not required, scientists are free to propose new, bold ideas that may require significant resources to pursue. They are also given the flexibility to work in large, complex teams if the complexity of the research problem demands it.
NIH director Francis S. Collins, M.D., Ph.D., said the appeal of this and other recent NIH grants is that investigators are encouraged to challenge the status quo with innovative ideas, while being given the necessary resources to test them.
"The fact that we continue to receive such strong proposals for funding through the programs reflects the wealth of creative ideas in science today,” Collin said.
Grant timeline:
Years 1-2:
Focus on understanding existing cancer portrayals by analyzing the frequency and type of cancer depictions on the 10 most popular primetime television programs. To assess the impact these primetime portrayals have on between 10 to 20 million viewers each week, they will work with Hollywood, Health and Society and the television networks to identify upcoming episodes involving breast and cervical cancer. By measuring any change in viewers’ cancer-related knowledge, attitudes and behavior before and after these episodes air, they can determine the key elements that make a story or narrative more or less effective.
Year 3:
Empirically test whether utilizing a narrative format produces a greater and longer lasting impact on cancer knowledge, attitudes and prevention behavior. Four hundred females between the ages of 25-65 with no pre-existing cancer history will be presented with a narrative involving a young woman who is diagnosed with cervical cancer. The same factual information will be presented to another 400 women in the non-narrative control condition.
Because they also question the assumption of a “one-size-fits-all” message strategy, the sample will be equally divided among four ethnic groups – African Americans, European Americans, Korean Americans and Mexican Americans – all of whom are at elevated risk for breast or cervical cancer. In addition to cultural differences, they predict that narratives may be particularly effective for cultures with a strong oral history, for recent immigrants, for older generations, and for those with low literacy. They will add context and depth to these findings by using qualitative techniques such as focus groups and consulting with medical anthropologists to further understand how women of different ages, ethnicities, acculturation and education levels understand cancer, its cause, prevention and treatment.
Years 4-5:
Examine the effect of communication modality to determine which communication channel or channels might produce the strongest and longest-lasting changes in information retention and motivation. More specifically, they will conduct a field experiment in which a fresh sample of 800 females will be randomly assigned to the same cancer narrative but 200 (50 of each ethnicity) will be exposed to the narrative in a print format, 200 in an audio format (similar to radio), 200 in an audiovisual format (similar to television or YouTube), and 200 in an interactive format requiring responses from the individual (similar to a videogame). This design will allow them to test whether the effectiveness of a narrative may vary as a function of channel and whether there is an interaction between modality and key demographic factors such as generation, level of acculturation and education. In sum, each of these methodological tools provides an important piece to the overall puzzle of how to best convey health information to increasingly diverse audiences. The final year of the project will be devoted to widely disseminating the results of the research in both academic and nonacademic venues.
National Institutes of Health
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