Narrative Persuasion and Social Norms in Entertainment-Education: Results from a Radio Drama in Mozambique

ABSTRACT

Narrative persuasion and social norms are part of the most recent theorizing behind the health communication strategy known as entertainment-education. There is little research, however, that compares these theoretical constructs from Mozambique, a setting that has not been researched to the same extent as other EE practice locations. This study uses mixed methods data from the midline evaluation of Ouro Negro (English translation: Black Gold), an EE radio program for individual health and social change in Mozambique to answer two research questions: what is the relationship between exposure to Ouro Negro and narrative persuasion?, and what is the relationship between narrative persuasion with Ouro Negro and social norms? Quantitative results related to the first question indicated that exposure significantly predicted three narrative persuasion constructs in multivariate regression models, results confirmed by a storytelling activity in focus groups. Quantitative results for the second question, which utilized propensity score matching, were not significant, and findings from a qualitative 2 × 2 table activity confirmed that behaviors were not normative in the directions promoted by the radio drama. Implications and recommendations for future entertainment-education research are discussed.     

NekNominate: Social Norms,Social Media,and Binge Drinking

This study examines the social-media-based binge drinking game NekNominate and how this phenomenon is related to social norms. NekNominate is a game wherein players are nominated to film themselves “neking” or chugging copious amounts of alcohol or drinking alcohol in a novel or humorous manner. The player then nominates other players via social media who then have a specific timeframe in which they must complete their challenge or face ridicule. Health communication research on drinking behaviors has often looked at the role of social norms in determining these behaviors. News stories (n = 44) of NekNominate and tweets (n = 851) culled using the hashtag #NekNominate during three different time periods are analyzed to identify the normative forces at play in this recent phenomenon.     

Social Norms,Collective Efficacy,and Smoking Cessation in Urban Neighborhoods

Objectives. We examined the separate and combined relations of neighborhood-level social norms and collective efficacy with individuals’ cigarette smoking cessation.Methods. We modeled the hazard of quitting over a 5-year period among 863 smokers who participated in the 2005 New York Social Environment Study.Results. In adjusted Cox proportional hazard models, prohibitive neighborhood smoking norms were significantly associated with higher rates of smoking cessation (second quartile hazard ratio [HR] = 1.17; 95% confidence interval [CI] = 0.59, 2.32; third quartile HR = 2.37; 95% CI = 1.17, 4.78; fourth quartile HR = 1.80; 95% CI = 0.85, 3.81). We did not find a significant association between neighborhood collective efficacy and cessation or significant evidence of a joint relation of collective efficacy and smoking norms with cessation.Conclusions. Neighborhood social norms may be more relevant than is collective efficacy to smoking cessation. The normative environment may shape health behavior and should be considered as part of public health intervention efforts.Cigarette smoking is one of the most important causes of preventable morbidity and premature mortality worldwide. Restrictions on permissible locations for smoking have increased in scope and number over the past 2 decades in the United States, and rates of smoking have declined. Nonetheless, an estimated 45.3 million (19.3%) adults in the United States still smoke, and each year, smoking-related diseases claim 443 000 American lives.1a-b Given the continued high prevalence of smoking and the reduction in risk of disease and premature mortality provided by quitting,2,3 there is a need to identify factors that support smoking cessation that interventions could target. Past studies have documented the importance of social networks in the cessation of smoking.4,5 Further study of social determinants of smoking cessation has the potential to inform interventions that promote health by altering the structural context (e.g., changing norms and taxation practices) to complement more traditional individual behavior change approaches.6Substantial variations in the rates of disease by region, state, county, and neighborhood have long been noted.7–9 There is growing evidence that variations in rates of disease are determined not only by different distributions of individuals between places but also by the social and physical environments in which people live.10,11 Neighborhoods have long been studied as geographic units wherein residents have distinct social ties, common exposures, and access to resources. Indeed, smoking patterns vary by geographical location, suggesting that aspects of the social and physical environment influence individual smoking behavior.12 Existing research suggests that characteristics of neighborhoods shape the risk of smoking.13–15 There is evidence that smoking is associated with neighborhood deprivation and low socioeconomic status.14–19The role of neighborhood factors in smoking cessation has been less frequently studied. The only study to examine the relations between the neighborhood environment and smoking cessation found that there was more quitting in areas with higher socioeconomic status.14 Examining other social environment characteristics in relation to smoking cessation may increase our understanding of how the social environment shapes smoking cessation and suggest avenues for structural intervention.Social norms, broadly defined as rules that dictate acceptable behavior within a group, are one aspect of the neighborhood social environment that merits study in relation to smoking cessation. Research suggests that social networks may influence smoking cessation through group social smoking norms.4,5 Similarly, the neighborhood social environment may influence individual smoking cessation by giving rise to social norms that define the boundaries of permissible or desirable behaviors. Situational norms and attitudes have been linked to alcohol consumption,20 dietary intake,18 and smoking prevalence.16,18,21Community social norms are considered a contextual influence in the smoking literature16,18,22–25; however, studies examining the role of norms typically use individual perceptions of norms rather than group-level measures of norms. Of the few studies that have examined social norms and smoking cessation, 1 found that individual perception of social norms surrounding smoking contributed to smoking behavior, including cessation, among adolescents.24 Another study found greater quit ratios in immigrant communities in the United States, pointing to a possible role of social norms influencing behavior.26 The limited existing research suggests that neighborhood social norms are worth examining as a potential factor that shapes smoking cessation.The closeness of social relationships in a neighborhood is another aspect of the neighborhood social environment that merits study in relation to smoking cessation. Collective efficacy is a neighborhood construct that measures the cohesiveness of a group (social cohesion) and the group''s ability to act to achieve goals (informal social control).27 Groups with higher efficacy have agency to produce desired effects and limit undesired ones through their collective action.28 Analyses have shown that higher levels of collective efficacy in a neighborhood protect against negative health outcomes.29 Higher levels of collective efficacy have been associated with lower levels of violent crime and homicide rates,27 obesity in youth,30 and heart disease mortality.31There is limited research on smoking and collective efficacy. Although studies have shown that smoking risk is higher in neighborhoods with lower levels of collective efficacy, these studies did not investigate smoking cessation.32–34 Related constructs of individual perception of social capital and social participation have been associated with smoking cessation.35–37Thus, the literature supports the possibility that neighborhood smoking norms and collective efficacy are important in shaping smoking cessation, but the associations have not yet been examined.Existing research also suggests a potential convergence of these neighborhood characteristics in shaping smoking cessation. The impact of social norms on smoking cessation may depend on the closeness and influence of social relationships within a neighborhood environment. This notion is supported by a qualitative study in a community in Glasgow, Scotland, that found that high cohesion and strong prosmoking norms combined not only to foster smoking but also to discourage or undermine cessation.38 This convergence was also supported by a quantitative multilevel study that found that in neighborhoods where norms were strongly antismoking, higher collective efficacy protected against smoking and the individual odds of smoking were lower.16Informed by the existing literature, we examined relations between the social environment of a neighborhood, as characterized by smoking norms and collective efficacy, and individual smoking cessation. We tested 3 specific hypotheses: (1) neighborhood norms that are less accepting of smoking are positively associated with the incidence of individual smoking cessation, (2) higher levels of neighborhood collective efficacy are positively associated with the incidence of smoking cessation, and (3) neighborhood smoking norms and collective efficacy interact such that smoking cessation is highest where levels of collective efficacy are high and norms are less accepting of smoking.     

Framing in Entertainment-Education: Effects on Processes of Narrative Persuasion

Nowadays, entertainment-education (E-E) is often used as a persuasive strategy to stimulate prosocial behavior. Although E-E is mostly regarded as a persuasive strategy in itself, in an increasing number of E-E programs several persuasive strategies are used to communicate the educational message to the audience. This study investigates the effects of a strategy widely used in health communication, but not previously studied in the field of E-E: framing. To this means we examined the effect of two different ways an E-E message can be framed: by emphasizing either the losses of not performing the behavior in question or the gains of performing this behavior. A serial multiple mediation model showed that framing affected intention to refrain from drunk cycling via counterarguing and attitude toward drunk cycling; the use of a gain frame decreased counterarguing, which decreased the attitude toward drunk cycling. This subsequently resulted in a higher intention to refrain from this behavior. Implications of these results are discussed.     

Social Norms,Acculturation, and Physical Activity Among Latina Women

Physical activity promotes health and is important for preventing chronic conditions, such as obesity and cardiovascular disease. Little is known about factors associated with different types of PA among Latina women, particularly Dominicans, who now constitute the fifth largest group of Latinos in the United States. The purpose of this study was to examine whether occupational physical activity, acculturation, familism, and norms held by family and friends are associated with three types of PA: vigorous and moderate leisure-time physical activity (LTPA), and resistance training. Interviews were conducted with 418 Dominican women. We assessed self-reported PA using standardized measures. Data were collected between July 2010 and July 2012 in New York City. Most women reported no vigorous LTPA or resistance training (74.5 and 73.1?%, respectively); about half (52.1?%) reported no moderate LTPA. After adjusting for sociodemographic factors, occupational physical activities were associated with greater LTPA. Acculturation was not associated with any outcome. Positive family norms about exercise were associated with increased LTPA and resistance training. Family norms may play a critical role in PA and should be included in programs to increase PA among Latina women.     

Perceived Harms and Social Norms in the Use of Electronic Cigarettes and Smokeless Tobacco

Perceptions of harms and social norms influence the use of conventional tobacco cigarettes, but little research is available about their combined relationship with e-cigarette and smokeless tobacco use. We conducted a cross-sectional survey of 309 individuals from central Illinois. We explored (1) demographic predictors of perceived harms and social norms related to e-cigarette and smokeless tobacco use, and (2) whether perceived harms, social norms, or both were important predictors of e-cigarette and smokeless tobacco use. E-cigarette perceptions of harm were consistent across all demographic characteristics. Smokeless tobacco perceptions of harm were unrelated to age, race, and sex, but lower education and income were associated with lower perceived harm (p < .05). E-cigarette social norms were less favorable among non-whites (p < .05) but did not vary by other demographic characteristics. Only less education was associated with more favorable social norms of smokeless tobacco (p < .05). Higher perceived harms were related to lower use of e-cigarettes and smokeless tobacco (p < .05). Perceived social norms were not associated with product use. This study provides preliminary support for implementing broad-based health messaging efforts that focus more on the potential harms of e-cigarette and smokeless tobacco use than on social norms.     

Evaluation of a Social Norms Approach to a Suicide Prevention Campaign

Suicide is a leading cause of death for college-aged youth, and university counseling centers (UCC) strive to educate students about mental health issues and available campus services. The current research evaluates a college campus social norms campaign that used both peer and celebrity sources to promote help seeking among college students as a suicide prevention strategy. Postcampaign surveys of this quasi-experiment (n = 391) revealed that compared to students in the control neighborhood condition, students exposed to the campaign messages in the experimental neighborhood conditions were more likely to perceive students would refer a friend to the UCC and more likely to visit the UCC for a mental health concern. Students living in the intervention neighborhood with a peer message source reported a greater willingness to refer friends to the UCC compared to those who lived in the celebrity and control neighborhoods. Regardless of condition, students who reported seeing UCC messages reported greater effects than those who reported not viewing the messages (e.g., greater intentions to seek help and to talk to others about the UCC). Results of this study are discussed within a social norms framework and support the need for continued exposure to campaign messages to impact health outcomes.     

Survey of Condom-Related Beliefs, Behaviors, and Perceived Social Norms in Mexican Migrant Laborers

This study reports findings from a survey of condom-related beliefs, behaviors, and perceived social norms in Mexican migrant laborers that live and work in the United States for extended periods of time. Snowball sampling was used to recruit 501 Mexican migrants from five sending towns in Jalisco, Mexico, with historically high rates of out-migration to the United States. Results showed that subjects reported few negative beliefs about condom use and high efficacy to use condoms in challenging sexual situations but social norms sanctioning condoms were limited. Results also revealed mixed knowledge of HIV transmission, poor knowledge of condom use, and higher condom use with occasional versus regular sex partners. Forty-four percent of male migrants reported sex with prostitutes while in the U.S., with married men reporting less condoms use with prostitutes than single men. It was concluded that condom promotion efforts with Mexican migrants should concentrate on men to encourage consistent use with occasional sex partners, including prostitutes. AIDS prevention education should be provided with sensitivity to the language needs, limited education, and extreme social and geographic marginality of this highly underresearched Latino population.     

Investigating the Potential Impact of Social Talk on Prevention Through Social Networks: the Relationships Between Social Talk and Refusal Self-Efficacy and Norms

Interpersonal communication among participants plays an important role in the impact and effectiveness of prevention programs (Southwell & Yzer, Communication Theory 19:1–8, 2009). This study focused on adolescents’ informal conversations about a prevention program, referred to as social talk, from a social network perspective. We provide both a conceptualization of social talk in relation to prevention programs and an operationalization of it by examining adolescents’ social networks. Participants (N?=?185) were eighth-grade students attending a middle school substance-abuse prevention program called keepin’ it REAL (kiR). Participants engaged in both positive and negative social talk about kiR. Students with higher friendship indegree centrality were more likely to have greater positive social talk indegree centrality (r?=?.23 p?<?.01). These results indicated that youth considered as friends by most of their classmates were also reported as being positive in their comments with respect to kiR. Youth who talked positively about kiR tended to report personal anti-substance injunctive norms (b?=?0.71, p?<?.05). On the other hand, youth who were nominated as negative social talkers by their peers appeared to have less personal anti-substance injunctive norms (b?=??0.92, p?<?.05). Furthermore, youth who were more likely to talk negatively about kiR were less likely to perceive that their best friends (b?=??1.66, p?<?.05) or most youth in their age (b?=??1.49, p?<?.05) disapprove of substance use.     

Identification With Characters,Elaboration, and Counterarguing in Entertainment-Education Interventions Through Audiovisual Fiction

The aim of this article is to further knowledge of the explanatory processes of narrative persuasion in the field of health communication, using data obtained in a research study of entertainment-education based on audiovisual fiction. Participating in the study were 208 young persons between the ages of 14 and 20, randomly distributed to three different groups. Each of the groups was exposed to a different episode of the Colombian television series Revelados, desde todas las posiciones. The results showed that greater identification with the main character of the episode transmitting a prevention message was associated with greater cognitive elaboration, which in turn led to more favorable attitudes toward the topics addressed. However, counterarguing was not observed to play a significant mediating role. The findings of this study allow us to conclude that getting people to think and reflect can help persuade them, which suggests that narrative persuasion models and dual models of rhetorical persuasion can be compatible in certain contexts, such as when messages are designed in such a way that characters make explicit arguments that endorse a prosocial message through dialogues.     

Personal Communication Networks and the Effects of an Entertainment-Education Radio Soap Opera in Tanzania

The personal networks of listeners and nonlisteners to an entertainment-education radio soap opera in Tanzania are examined to determine the effects of interpersonal discussion of the soap opera's educational themes of family planning and HIV prevention. Listeners are more likely to discuss these two educational issues in their personal communication networks and are also more likely to have other listeners to the radio program in their personal communication networks. Respondents demonstrate a relatively high degree of homophily with their network partners and are more likely to discuss matters arising from the radio program with their network partners who are of similar tribal membership, religious affiliation, and gender, and those who are equally or more highly educated than themselves.