Understanding narrative effects: the impact of breast cancer survivor stories on message processing, attitudes, and beliefs among African American women

OBJECTIVE

Examine the longitudinal effects of personal narratives about mammography and breast cancer compared with a traditional informational approach.

METHODS

African American women (n = 489) ages 40 and older were recruited from low-income neighborhoods in St. Louis, Missouri, and randomized to watch a narrative video comprised of stories from African American breast cancer survivors or a content-equivalent informational video. Effects were measured immediately postexposure (T2) and at 3- (T3) and 6-month (T4) follow-up. T2 measures of initial reaction included positive and negative affect, trust, identification, and engagement. T3 message-processing variables included arguing against the messages (counterarguing) and talking to family members about the information (cognitive rehearsal). T4 behavioral correlates included perceived breast cancer risk, cancer fear, cancer fatalism, perceived barriers to mammography, and recall of core messages. Structural equation modeling examined interrelations among constructs.

RESULTS

Women who watched the narrative video (n = 244) compared to the informational video (n = 245) experienced more positive and negative affect, identified more with the message source, and were more engaged with the video. Narratives, negative affect, identification, and engagement influenced counterarguing, which, in turn, influenced perceived barriers and cancer fatalism. More engaged women talked with family members more, which increased message recall. Narratives also increased risk perceptions and fear via increased negative affect.

CONCLUSIONS

Narratives produced stronger cognitive and affective responses immediately, which, in turn, influenced message processing and behavioral correlates. Narratives reduced counterarguing and increased cognitive rehearsal, which may increase acceptance and motivation to act on health information in populations most adversely affected by cancer disparities.

The burgeoning field of transdisciplinary adaptation research in Quebec (1998-): a climate change-related public health narrative

This paper presents a public health narrative on Quebec's new climatic conditions and human health, and describes the transdisciplinary nature of the climate change adaptation research currently being adopted in Quebec, characterized by the three phases of problem identification, problem investigation, and problem transformation. A transdisciplinary approach is essential for dealing with complex ill-defined problems concerning human-environment interactions (for example, climate change), for allowing joint research, collective leadership, complex collaborations, and significant exchanges among scientists, decision makers, and knowledge users. Such an approach is widely supported in theory but has proved to be extremely difficult to implement in practice, and those who attempt it have met with heavy resistance, succeeding when they find the occasional opportunity within institutional or social contexts. In this paper we narrate the ongoing struggle involved in tackling the negative effects of climate change in multi-actor contexts at local and regional levels, a struggle that began in a quiet way in 1998. The paper will describe how public health adaptation research is supporting transdisciplinary action and implementation while also preparing for the future, and how this interaction to tackle a life-world problem (adaptation of the Quebec public health sector to climate change) in multi-actors contexts has progressively been established during the last 13 years. The first of the two sections introduces the social context of a Quebec undergoing climate changes. Current climatic conditions and expected changes will be described, and attendant health risks for the Quebec population. The second section addresses the scientific, institutional and normative dimensions of the problem. It corresponds to a "public health narrative" presented in three phases: (1) problem identification (1998-2002) beginning in northern Quebec; (2) problem investigation (2002-2006) in which the issues are successively explored, understood, and conceptualized for all of Quebec, and (3) problem transformation (2006-2009), which discusses major interactions among the stakeholders and the presentation of an Action Plan by a central actor, the Quebec government, in alliance with other stakeholders. In conclusion, we underline the importance, in the current context, of providing for a sustained transdisciplinary adaptation to climatic change. This paper should be helpful for (1) public health professionals confronted with establishing a transdisciplinary approach to a real-world problem other than climate change, (2) professionals in other sectors (such as public safety, built environment) confronted with climate change, who wish to implement transdisciplinary adaptive interventions and/or research, and (3) knowledge users (public and private actors; nongovernment organizations; citizens) from elsewhere in multi-contexts/environments/sectors who wish to promote complex collaborations (with us or not), collective leadership, and "transfrontier knowledge-to-action" for implementing climate change-related adaptation measures.

The forager oral tradition and the evolution of prolonged juvenility

The foraging niche is characterized by the exploitation of nutrient-rich resources using complex extraction techniques that take a long time to acquire. This costly period of development is supported by intensive parental investment. Although human life history theory tends to characterize this investment in terms of food and care, ethnographic research on foraging skill transmission suggests that the flow of resources from old-to-young also includes knowledge. Given the adaptive value of information, parents may have been under selection pressure to invest knowledge - e.g., warnings, advice - in children: proactive provisioning of reliable information would have increased offspring survival rates and, hence, parental fitness. One way that foragers acquire subsistence knowledge is through symbolic communication, including narrative. Tellingly, oral traditions are characterized by an old-to-young transmission pattern, which suggests that, in forager groups, storytelling might be an important means by which adults transfer knowledge to juveniles. In particular, by providing juveniles with vicarious experience, storytelling may expand episodic memory, which is believed to be integral to the generation of possible future scenarios (i.e., planning). In support of this hypothesis, this essay reviews evidence that: mastery of foraging knowledge and skill sets takes a long time to acquire; foraging knowledge is transmitted from parent to child; the human mind contains adaptations specific to social learning; full assembly of learning mechanisms is not complete in early childhood; and forager oral traditions contain a wide range of information integral to occupation of the foraging niche. It concludes with suggestions for tests of the proposed hypothesis.

Promoting Breast Cancer Screening through Storytelling by Chamorro Cancer Survivors

The largest Chamorro population outside of Guam and the Mariana Islands reside in California. Cancer health disparities disproportionally affect Pacific Islander communities, including the Chamorro, and breast cancer is the most common cancer affecting women. To address health concerns such as cancer, Pacific Islander women frequently utilize storytelling to initiate conversations about health and to address sensitive topics such as breast health and cancer. One form of storytelling used in San Diego is a play that conveys the message of breast cancer screening to the community in a culturally and linguistically appropriate way. This play, Nan Nena's Mammogram, tells the story of an older woman in the community who learns about breast cancer screening from her young niece. The story builds upon the underpinnings of Chamorro culture - family, community, support, and humor - to portray discussing breast health, getting support for breast screening, and visiting the doctor. The story of Nan Nena's Mammogram reflects the willingness of a few pioneering Chamorro women to use their personal experiences of cancer survivorship to promote screening for others. Through the support of a Chamorro community-based organization, these Chamorro breast cancer survivors have used the success of Nan Nena's Mammogram to expand their education activities and to form a new cancer survivor organization for Chamorro women in San Diego.

The effect of a multisensory exercise program on engagement, behavior, and selected physiological indexes in persons with dementia

A multisensory exercise approach that evokes the stimulation and use of various senses, such as combining physical and cognitive stimuli, can assist in the management of persons with Alzheimer's disease (AD). The objective of this study was to evaluate the outcomes of a multisensory exercise program on cognitive function (engagement), behavior (mood), and physiological indices (blood pressure, resting heart rate, and weight) in 13 nursing home residents diagnosed with moderate to severe AD. A one-group pretest/post-test, quasi-experimental design was used. The program combined a variety of sensory stimulations, integrating storytelling and imaging strategies. Results showed an improvement in resting heart rate, overall mood, and in engagement of physical activity. The findings suggest that a multisensory exercise approach can be beneficial for individuals with AD.

The power of story

In this guest editorial, the author introduces the reader to the value of stories as a source of vision and inspiration for caregiving.