Encouraging perspective taking: Using narrative writing to induce empathy for others engaging in negative health behaviors

Good reasons for bad behavior: a randomized controlled experiment on the impact of narrative reading and writing on empathic concern, perspective-taking, and attitude

Background

Empathic concern and perspective-taking may contribute to avoiding stigmatization of adverse health behavior. Narrative writing has been shown to be effective in promoting perspective-taking and empathy. But since narrative writing is time consuming, we tested in the present study narrative reading as an alternative, more parsimonious approach.

Methods

In a randomized controlled experiment, we compared writing a narrative text about a fictitious person who displays disapproved of health behavior to reading such a text and to a control condition in which participants wrote about an unrelated topic. With a sample of n = 194 participants, we investigated the impact of writing and reading a narrative text on promoting empathic concern and perspective-taking as well as on attitude change.

Results

We found that both writing and reading a narrative text about the fictitious character increased empathic concern, F(1, 191) = 32.85, p < 0.001, part. η2 = 0.15, and perspective-taking, F(1, 191) = 24.76, p < 0.001, part. η2 = 0.12, more strongly than writing about an unrelated topic. Writing and reading a narrative text also resulted in a more positive attitude toward this person, F(1, 191) = 17.63, p < 0.001, part. η2 = 0.08. Simply reading a narrative text was equally efficient as narrative writing with respect to empathic concern, p = 0.581, perspective-taking, p = 0.629, and attitude, p = 0.197.

Conclusion

The finding that narrative reading is as effective as narrative writing suggests that the readers appear to be able to comprehend and engage with the story being told. When narrative reading is as effective as narrative writing, it can succeed with reduced effort in increasing empathic concern, perspective-taking, and attitude. We discuss the benefits of this approach for reducing stigmatization of adverse health behavior.

'You just emotionally break': understanding COVID-19 narratives through public health humanities

News reports that feature the experiences of healthcare workers have shaped public conversations about the pandemic from its earliest days. For many, stories of the pandemic have been an introduction to the way public health emergencies intersect with cultural, social, structural, political and spiritual determinants. Such stories often feature clinicians and other providers as characters in pandemic tales of heroism, tragedy and, increasingly, frustration. Examining three common categories of provider-focused news narratives-the clinician as a uniquely vulnerable front-line worker, clinician frustration with vaccine and masking resistance, and the clinician as a hero-the authors argue that the framework of public health humanities offers useful tools to understand and potentially shift public conversation of the pandemic. Close reading of these stories illuminates frames that relate to the role of providers, responsibility for the spread of the virus and how the US health system functions in a global context. Public conversations of the pandemic are shaped by and shape news stories and have important implications for policy. Acknowledging that contemporary health humanities in all its iterations considers how non-clinical factors, such as culture, embodiment and power, impact our understanding of health, illness and healthcare delivery, the authors locate their argument amid critiques that focus on social and structural factors. They argue that it is still possible to shift our understanding of and telling of those stories towards a more population-focused frame.

Fluctuations and individual differences in empathy interact with stress to predict mental health, parenting, and relationship outcomes

Introduction

Empathy is a complex, multifaceted ability allowing for the most basic forms of social communication and plays a prominent role in multiple aspects of everyday lives. In this intensive longitudinal study, we assessed how empathy interacts with stress to predict central domains of psychosocial functioning: mental health, romantic relationships, and parenting.

Methods

Fluctuations and individual differences in empathy were assessed across eight time points, where participants from the general population (N = 566) self-reported their empathy, stress, depressive symptoms, romantic satisfaction, and parental functioning.

Results

Both trait and state aspects of empathy were associated with all psychosocial outcomes, with state empathy showing a stronger effect. Additionally, empathy components interacted with stress-emotional empathy better-predicted outcomes under high stress, while cognitive empathy under low stress.

Discussion

Our findings advance the theoretical understanding of empathy, emphasizing the effects of state-dependent empathy fluctuations on our everyday mental and social lives.

Activities to promote empathy for patients among pharmacy learners: A scoping review

BACKGROUND

Provider empathy has been shown to be directly linked to improved patient outcomes. The objective of this scoping review of the literature was to identify and describe learning activities that promote empathy for patients among pharmacy learners.

METHODS

This scoping review was conducted using the following inclusion criteria: publication in English, activities conducted in any academic pharmacy training program (professional degree program, experiential, residency, or fellowship), description of the learning activity(ies) provided, and focus on the experience of empathy/caring/compassion for patients, either human or animal. Articles were excluded if they focused only on skills such as empathic responding or if they did not describe the learning experience. All study designs other than reviews were included.

RESULTS

The scoping review revealed 89 full-text articles that met the inclusion criteria. Included studies demonstrated a wide variety of approaches to the design of learning experiences as well as methods of measurement of empathy. Various types of learning modalities have been used to develop empathy in pharmacy learners, with reflection being the most common. A large proportion of studies that assessed empathy development used quasi-experimental or qualitative designs and did not report tests of statistical significance, which would make it difficult to compare the effectiveness of the different learning activities.

IMPLICATIONS

A variety of approaches have been used among pharmacy learners to develop empathy for patients. Due to the high level of variability in approaches, more rigorous studies are needed to assess the effectiveness of these learning activities.

Palliative care stay room - designing, testing and evaluating a gamified social intervention to enhance palliative care awareness

INTRODUCTION

The message of palliative care can be promoted using creative thinking and gamification. It can be an innovative strategy to promote changes in behaviour, promote thinking, and work on skills such as empathy.

AIM

Design, test and evaluate a gamified social intervention to enhance palliative care awareness among young university students from non-health background.

METHODS

Participatory action research study with mixed methods, Design Thinking and using the Public Engagement strategy. Forty-three undergraduate students participated in a Palliative Care Stay Room and completed the Test of Cognitive and Affective Empathy (TECA) before and after the game. At the end of the game, a ten-minute debriefing was held with the participants, which was concluded with an open conversation. The content analysis was done independently and the sum of the scores of each dimension was compared before and after the activity.

FINDINGS

The Stay Room improved the participants' knowledge and new perspectives about palliative care. Before the game, their views focused on the end of life and after the game on their values, highlighting the dedication of the healthcare professionals who do not treat death but the life until death. After de game, participants (N = 43: female = 23; male = 20; x̄ 19.6 years old) presented higher values in perspective adoption (intellectual ability to put oneself in the other's place) p = 0.046 and in emotional understanding (ability to recognize emotional states) p = 0.018, and had high scores on empathic joy (p = 0.08).

CONCLUSION

Gamification can be used in teaching and transmitting positive attitudes. Palliative Care and can help young university students to think positively about care issues.

Influence of agent's self-disclosure on human empathy

As AI technologies progress, social acceptance of AI agents, including intelligent virtual agents and robots, is becoming even more important for more applications of AI in human society. One way to improve the relationship between humans and anthropomorphic agents is to have humans empathize with the agents. By empathizing, humans act positively and kindly toward agents, which makes it easier for them to accept the agents. In this study, we focus on self-disclosure from agents to humans in order to increase empathy felt by humans toward anthropomorphic agents. We experimentally investigate the possibility that self-disclosure from an agent facilitates human empathy. We formulate hypotheses and experimentally analyze and discuss the conditions in which humans have more empathy toward agents. Experiments were conducted with a three-way mixed plan, and the factors were the agents' appearance (human, robot), self-disclosure (high-relevance self-disclosure, low-relevance self-disclosure, no self-disclosure), and empathy before/after a video stimulus. An analysis of variance (ANOVA) was performed using data from 918 participants. We found that the appearance factor did not have a main effect, and self-disclosure that was highly relevant to the scenario used facilitated more human empathy with a statistically significant difference. We also found that no self-disclosure suppressed empathy. These results support our hypotheses. This study reveals that self-disclosure represents an important characteristic of anthropomorphic agents which helps humans to accept them.

No Less of a Man: Inducing Empathy to Reduce Male Rape Myth Acceptance

Male sexual assault is an understudied area. Interventions aimed at reducing negative attitudes toward male survivors have received relatively little attention in the field of sexual assault and violence. This may be related to underreported or insufficient data on male survivors or possibly the acceptance of male rape myths. The current research examines the effect of a hypothetical male sexual assault survivor story and empathy writing task on changes in male rape myth acceptance (MRMA) among U.S. men and women (N = 95). Further, the researchers sought to understand the differences between men and women in MRMA change scores and state emotional empathy for the hypothetical survivor after the empathy induction. Finally, the researchers examined whether state emotional empathy would predict reductions in MRMA and whether participant sex would predict state emotional empathy for the hypothetical survivor after accounting for knowing a male survivor and preinduction MRMA. The results indicated that both men and women experienced significant decreases in MRMA postinduction, and men and women experienced similar levels of change. Additionally, state emotional empathy and preinduction MRMA were the only significant predictors of change scores. Although women reported higher state emotional empathy for the hypothetical survivor, sex was not a significant predictor of state emotional empathy after accounting for personally knowing a male survivor and preinduction MRMA. This research fills a gap in the literature by identifying men's stories of sexual assault and empathy writing as potential methods to reduce MRMA.

Integration of Arts and Humanities in Medical Education: a Narrative Review

This narrative review aims to identify and review the extant literature describing methods and outcomes of embedding the arts and humanities (AH) into medical school curricula. The Association of American Medical Colleges changed the Medical College Admission Test (MCAT) in 2015 to place new emphasis on the role of liberal arts in the process of developing well-rounded physicians. Consequently, medical schools have been implementing more connections to creative writing, literature, theater, movies, music, and the visual arts into their curricula. To review the current literature, we focused on methods medical educators used to embed content related to AH into their curricula to shape and drive associated learning outcomes. We conducted searches in PubMed, CINAHL, PsycINFO, and ERIC for peer-reviewed articles from 2011 to 2020. The authors selected three dyads in medical humanities and reviewed articles independently followed by discussion to identify thematic links to major findings. Out of 261 articles, a total of 177 full-text articles were reviewed with 34 selected for final inclusion. Our review included articles describing curriculum development and delivery in publications from Australia, Canada, India, New Zealand, and the USA. This review showed medical educators are implementing didactic and experiential instructional approaches to embedding the arts, humanities, and social sciences into the medical school classroom. Medical educators' attempts to embed AH into medical school curricula show promising results. Unfortunately, small sample sizes, short-term interventions, and an over-reliance of subjective assessment measures limit our knowledge of the true impact of these interventions. More rigorous assessments of required and longitudinal coursework are necessary to know the true impact of participation in AH coursework for medical students.

Medical Students' Creation of Original Poetry, Comics, and Masks to Explore Professional Identity Formation

INTRODUCTION

This study examines differences in students' perceived value of three artmaking modalities (poetry, comics, masks) and whether the resulting creative projects offer similar or different insights into medical students' professional identity formation.

METHODS

Mixed-methods design using a student survey, student narrative comments and qualitative analysis of students' original work.

RESULTS

Poetry and comics stimulated insight, but masks were more enjoyable and stress-reducing. All three art modalities expressed tension between personal and professional identities.

DISCUSSION

Regardless of type of artmaking, students express concern about encroachments of training on personal identity but hoped that personal and professional selves could be integrated.

The impact of narrative writing on empathy, perspective-taking, and attitude: Two randomized controlled experiments on violations of Covid-19 protection regulations

Objective

Two randomized controlled experiments investigated if writing a narrative text about a fictional person who shows disapproved of behavior in the Covid-19 pandemic influenced empathy, perspective-taking, attitude, and attribution of causes regarding that person’s behavior.

Methods

In both studies, a fictional scenario was described, and participants answered questions regarding empathy, perspective-taking, attitude, and attribution regarding a fictional person’s disapproved of behavior (pre-post-measurement). Participants were randomly assigned to one of two conditions. In the experimental condition, they wrote a narrative text about the fictional person. In the control condition, they wrote about an unrelated topic.

Results

We found that writing a narrative text increased empathy more strongly than writing about an unrelated topic; Study 1: p = 0.004, _part.η² = 0.06, Study 2: p < .001, _part.η² = 0.19. This did not apply to perspective-taking; Study 1: p = 0.415; Study 2: p = 0.074. We also found that writing a narrative text about a fictional person resulted in a more positive attitude toward this person; Study 1: p = 0.005, _part.η² = 0.06; Study 2: p<0.001, _part.η² = 0.10. Finally, in Study 2 we found that participants who wrote a narrative text attributed the person’s behavior to internal causes to a lesser degree; p = 0.007, _part.η² = 0.05.

Conclusion

Our findings indicate that empathy and attitude are positively modifiable through narrative writing tasks. Empathy training could potentially prevent discrimination related to Covid-19.

Trial registration

The studies presented in this article were pre-registered on the pre-registration platform AsPredicted (aspredicted.org) before we began data collection; registration numbers and URL: #44754 https://aspredicted.org/vx37t.pdf (Study 1), and #44753 https://aspredicted.org/ig7kq.pdf (Study 2).

Do Personal Stories Make Patient Decision Aids More Effective? An Update from the International Patient Decision Aids Standards

BACKGROUND

This article evaluates the evidence for the inclusion of patient narratives in patient decision aids (PtDAs). We define patient narratives as stories, testimonials, or anecdotes that provide illustrative examples of the experiences of others that are relevant to the decision at hand.

METHOD

To evaluate the evidence for the effectiveness of narratives in PtDAs, we conducted a narrative scoping review of the literature from January 2013 through June 2019 to identify relevant literature published since the last International Patient Decision Aid Standards (IPDAS) update in 2013. We considered research articles that examined the impact of narratives on relevant outcomes or described relevant theoretical mechanisms.

RESULTS

The majority of the empirical work on narratives did not measure concepts that are typically found in the PtDA literature (e.g., decisional conflict). Yet, a few themes emerged from our review that can be applied to the PtDA context, including the impact of narratives on relevant outcomes (knowledge, behavior change, and psychological constructs), as well as several theoretical mechanisms about how and why narratives work that can be applied to the PtDA context.

CONCLUSION

Based on this evidence update, we suggest that there may be situations when narratives could enhance the effectiveness of PtDAs. The recent theoretical work on narratives has underscored the fact that narratives are a multifaceted construct and should no longer be considered a binary option (include narratives or not). However, the bottom line is that the evidence does not support a recommendation for narratives to be a necessary component of PtDAs.

'Attorneys of the poor': Training physicians to tackle health inequalities

The stellar gains in life expectancy and health over the past century have been accompanied by an increase in societal and health inequalities. This health gap between the most and least fortunate in our society is widening, driven by complex social determinants of health, as well as healthcare systems themselves. Physicians are not just well-qualified and well-placed to act as advocates for change, but have a moral duty to do so: to stand by silently is to be complicit. Following a workshop on health inequalities and medical training at the Royal College of Physicians Trainees Committee, we sought to examine how health inequalities could be addressed through changes to the medical education system. We discuss the arguments for reform in recruitment to medicine, and changes to undergraduate, postgraduate and continuing medical education in order to equip the profession to deliver meaningful improvements in health inequalities. We propose a population health credential as a mechanism by which specialists can gain additional skills to take on leadership roles addressing health inequalities, allowing them to support colleagues in public health and bring in specialty-specific knowledge and experience.