Culture-centric narratives as health message design strategy: Developing an HPV vaccine intervention for college-aged women
Open Access
- Author:
- Hopfer, Suellen
- Graduate Program:
- Communication Arts and Sciences
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- October 08, 2009
- Committee Members:
- Michael L Hecht, Dissertation Advisor/Co-Advisor
Michael L Hecht, Committee Chair/Co-Chair
Michelle E Day, Committee Member
S. Shyam Sundar, Committee Member
Eva Sharon Lefkowitz, Committee Member - Keywords:
- communication
narratives
HPV vaccine - Abstract:
- Narrative forms of communication have been proposed as a promising tool for health behavior change. Since there are limits on the amount of information that can be conveyed in a given space or time, precision must be used in selecting the tools that most clearly and effectively convey necessary health information. This dissertation drew on culture-centric narrative theory (Larkey & Hecht, 2009) and exemplification theory (Zillmann, 1999) to inform the development of a human papillomavirus (HPV) vaccine promotion intervention. The dissertation consists of two studies. The first study identified determinants of HPV vaccine acceptability among college-aged women. The second study, a randomized controlled trial, tested the impact of narrative source on HPV vaccine decision-making and in a second set of analyses, tested mediators of narrative persuasion⎯identification with media characters, narrative transportation, perceived realism, and vividness. Results of the first study identified assumptions underlying college women’s decisions to accept and resist the HPV vaccine. Four assumptions underlying women’s decision to accept the HPV vaccine included: the importance of supportive family messages, the importance of explicit health care provider endorsement of the HPV vaccine, descriptive peer norms normalizing HPV vaccination, and disease framing (i.e., cancer) shaping the benefits of HPV vaccination. Five assumptions underlying college women’s decisions to resist the HPV vaccine included: skepticism of vaccine safety, the idea that alternative prevention strategies provide sufficient protection, stigmatizing messages related to HPV, overcoming self-efficacy barriers, and delay strategies. Common to all women’s narratives was that relationship status framed women’s perceptions of HPV susceptibility. The decision narratives shaped the content and focus of an HPV vaccine video intervention that was developed to reach college-aged women. Results of the second study, a randomized clinical trial of the intervention, tested for the effects of narrative source on vaccination. Findings showed that after controlling for HPV knowledge, sexual activity, and daughter-parent vaccine communication, the combined peer-and-health care provider narrative intervention significantly increased HPV vaccine self-efficacy, intent and uptake. The second set of analyses, which tested narrative mediators, showed that identification with exemplars significantly mediated the relationship between peer narratives and HPV vaccine intent and that identification accounted for 71% of explained variance in a narrative communication model. Narrative transportation accounted for 56% of explained variance in the model, but showed effects only as a precursor of identification. Vividness, defined by the formal properties of video, accounted for 9% of explained variance in vaccine intent. Perceived realism did not significantly contribute to explaining how narrative source impacts HPV intent. Theoretical, methodological, and practical implications for advancing narrative message design for health promotion contexts as well as advancing HPV vaccine communication for practitioners are discussed.