Skip to main content

Narrative communication in cancer prevention and control: A framework to guide research and application

Abstract

Narrative forms of communication—including entertainment education, journalism, literature, testimonials, and storytelling—are emerging as important tools for cancer prevention and control. To stimulate critical thinking about the role of narrative in cancer communication and promote a more focused and systematic program of research to understand its effects, we propose a typology of narrative application in cancer control. We assert that narrative has four distinctive capabilities: overcoming resistance, facilitating information processing, providing surrogate social connections, and addressing emotional and existential issues. We further assert that different capabilities are applicable to different outcomes across the cancer control continuum (e.g., prevention, detection, diagnosis, treatment, survivorship). This article describes the empirical evidence and theoretical rationale supporting propositions in the typology, identifies variables likely to moderate narrative effects, raises ethical issues to be addressed when using narrative communication in cancer prevention and control efforts, and discusses potential limitations of using narrative in this way. Future research needs based on these propositions are outlined and encouraged.

This is a preview of subscription content, access via your institution.

References

  1. (1)

    Bernhardt J: Communication at the core of effective public health.American Journal of Public Health. 2004,94:2051–2053.

    PubMed  Google Scholar 

  2. (2)

    Freimuth V, Quinn S: The contributions of health communication to eliminating health disparities.American Journal of Public Health. 2004,91:2053–2055.

    Google Scholar 

  3. (3)

    Green M: Narratives and cancer communication.Journal of Communication. (in press).

  4. (4)

    Hinyard L, Kreuter MW: Using narrative communication as a tool for health behavior change: A conceptual, theoretical, and empirical overview.Health Education and Behavior. (in press).

  5. (5)

    Abbott H:The Cambridge Introduction to Narrative. Cambridge, UK: Cambridge University Press, 2002.

    Google Scholar 

  6. (6)

    Polkinghorne D:Narrative Knowing and the Human Sciences. New York: State University of New York Press, 1988.

    Google Scholar 

  7. (7)

    Bruner J:Actual Minds, Possible Worlds. Cambridge, MA: Harvard University Press, 1986.

    Google Scholar 

  8. (8)

    Singhal A, Rogers EM:Entertainment-Education: A Communication Strategy for Social Change. Mahwah, NJ: Lawrence Erlbaum Associates, 1999.

    Google Scholar 

  9. (9)

    Gerrig RJ: Narrative thought?Personality and Social Psychology Bulletin. 1994,20:712–715.

    Article  Google Scholar 

  10. (10)

    National Cancer Institute, U.S. National Institutes of Health:Cancer Control Continuum. Retrieved July 27, 2005 from http://cancercontrol.cancer.gov/od/continuum.html

  11. (11)

    Institute of Medicine:Speaking of Health: Assessing Health Communication Strategies for Diverse Populations. Washington, DC: National Academy Press, 2002.

    Google Scholar 

  12. (12)

    Nielsen-Bohlman L, Panzer AM, Kindig DA:Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academic Press, 2004.

    Google Scholar 

  13. (13)

    Rees CE, Bath PA: The information needs and source preferences of women with breast cancer and their family members: A review of the literature published between 1988 and 1998.Journal of Advanced Nursing. 2000,21:833–841.

    Article  Google Scholar 

  14. (14)

    Howard G: A narrative approach to thinking, cross-cultural psychology, and psychotherapy.American Psychologist. 1991,46:187–197.

    PubMed  Article  CAS  Google Scholar 

  15. (15)

    Knowles ES, Linn J (eds):Resistance and Persuasion. Mahwah, NJ: Lawrence Erlbaum Associates, 2004.

    Google Scholar 

  16. (16)

    Hagen KM, Gutkin TB, Wilson CP, Oats RG: Using vicarious experience and verbal persuasion to enhance self-efficacy in pre-service teachers: “Priming the pump” for consultation.School Psychology Quarterly. 1998,13:169–178.

    Article  Google Scholar 

  17. (17)

    Ng JYY, Tam SF, Yew WW, Lam WK: Effects of video modeling on self-efficacy and exercise performance of COPD patients.Social Behavior and Personality. 1999,27:475–486.

    Article  Google Scholar 

  18. (18)

    Anderson RB: Vicarious and persuasive influences on efficacy expectations and intentions to perform breast self-examination.Public Relations Review. 2000,26:97–114.

    Article  Google Scholar 

  19. (19)

    Slater MD: Entertainment education and the persuasive impact of narratives. In Green MC, Strange JJ, Brock TC (eds),Narrative Impact: Social and Cognitive Foundations. Mahwah, NJ: Lawrence Erlbaum Associates, 2002, 157–181.

    Google Scholar 

  20. (20)

    Anderson RB, McMillion PY: Effects of similar and diversified modeling on African American women’s efficacy expectations and intentions to perform breast self-examination.Health Communication. 1995,7:327–343.

    Article  Google Scholar 

  21. (21)

    Morman MT: The influence of fear appeals, message design, and masculinity on men’s motivation to perform the testicular self-exam.Journal of Applied Communication Research. 2000,28:91–116.

    Google Scholar 

  22. (22)

    Green MC, Brock TC: The role of transportation in the persuasiveness of public narratives.Journal of Personality and Social Psychology. 2000,79:701–721.

    PubMed  Article  CAS  Google Scholar 

  23. (23)

    Slater MD, Rouner D: Value-affirmative and value-protective processing of alcohol education messages that include statistical evidence or anecdotes.Communication Research. 1996,23:210–235.

    Article  Google Scholar 

  24. (24)

    Nisbett R, Ross L:Human Inference: Strategies and Short-comings of Social Judgment. Englewood Cliffs, NJ: Prentice Hall, 1980.

    Google Scholar 

  25. (25)

    Strange JJ, Leung CC: How anecdotal accounts in news and in fiction can influence judgments of a social problem’s urgency, causes, and cures.Personality and Social Psychology Bulletin. 1999,25:436–449.

    Article  Google Scholar 

  26. (26)

    Hamill R, Wilson TD, Nisbett R: Insensitivity to sample bias: Generalizing from atypical cases.Journal of Personality and Social Psychology. 1980,39:578–589.

    Article  Google Scholar 

  27. (27)

    Taylor SE, Thompson SC: Stalking the elusive “vividness” effect.Psychological Review. 1982,89:155–181.

    Article  Google Scholar 

  28. (28)

    McDonough JE: Using and misusing anecdote in policy making.Health Affairs. 2001,Jan/Feb:207–212.

    Article  Google Scholar 

  29. (29)

    Larson RJ, Woloshin S, Schwartz LM, Welch HG: Celebrity endorsements of cancer screening.Journal of the National Cancer Institute. 2005,97:693–695.

    PubMed  Article  Google Scholar 

  30. (30)

    Brown ML, Potosky AL: The presidential effect: The public health response to media coverage about Ronald Reagan’s colon cancer episode.Public Opinion Quarterly. 1990,54:317–329.

    PubMed  Article  CAS  Google Scholar 

  31. (31)

    Lane DS, Polednak AP, Burg MA: The impact of media coverage of Nancy Reagan’s experience on breast cancer screening.American Journal of Public Health. 1989,79:1551–1552.

    PubMed  CAS  Google Scholar 

  32. (32)

    Dal Cin S, Zanna MP, Fong GT: Narrative persuasion and overcoming resistance. In Knowles ES, Linn J (eds),Resistance and Persuasion. Mahwah, NJ: Lawrence Erlbaum Associates, 2004, 175–191.

    Google Scholar 

  33. (33)

    Boulware LE, Cooper LA, Ratner LE, LaVeist TA, Powe NR: Race and trust in the health care system.Public Health Reports. 2003,118:358–365.

    PubMed  Google Scholar 

  34. (34)

    Cox DS, Cox AD: Communicating the consequences of early detection: The role of evidence and framing.Journal of Marketing. 2001,65:91–103.

    Article  Google Scholar 

  35. (35)

    Green M, Strange J, Brock T (eds):Narrative Impact: Social and Cognitive Foundations. Mahwah, NJ: Lawrence Erlbaum Associates, 2002.

    Google Scholar 

  36. (36)

    Peters E, Vastfjall D, Slovic P, et al.: Numeracy and decision making.Psychological Science. 2006,17:407–413.

    PubMed  Article  Google Scholar 

  37. (37)

    Rubin AM, Perse EM: Audience activity and soap opera involvement: A uses and effects investigation.Human Communication Research. 1987,14:246–268.

    Article  Google Scholar 

  38. (38)

    Horton D, Wohl RR: Mass communication and parasocial interaction.Psychiatry. 1956,19:215–229.

    PubMed  CAS  Google Scholar 

  39. (39)

    Picirillo MS: On the authenticity of televisual experience: A critical exploration of para-social closure.Critical Studies in Mass Communication. 1986,3:337–355.

    Article  Google Scholar 

  40. (40)

    Caughey JL:Imaginary Social Worlds: A Cultural Approach. Lincoln: University of Nebraska Press, 1984.

    Google Scholar 

  41. (41)

    Tan ESH:Emotion and the Structure of Film: Film as an Emotion Machine. Mahwah, NJ: Lawrence Erlbaum Associates, 1996.

    Google Scholar 

  42. (42)

    Oatley K: Emotions and the story worlds of fiction. In Green MC, Strange JJ, Brock TC (eds),Narrative Impact: Social and Cognitive Foundations. Mahwah, NJ: Lawrence Erlbaum Associates, 2002, 39–69.

    Google Scholar 

  43. (43)

    Harrison K: Does interpersonal attraction to thin media personalities promote eating disorders?Journal of Broadcasting & Electronic Media. 1997,41:478–500.

    Google Scholar 

  44. (44)

    Brown WJ, Basil MD: Media celebrities and public health: Responses to “Magic” Johnson’s HIV disclosure and its impact on AIDS risk and high-risk behaviors.Health Communication. 1995,7:345–370.

    Article  Google Scholar 

  45. (45)

    Barrera M Jr.: Distinctions between social support concepts, measures, and models.American Journal of Community Psychology. 1986,14:413–445.

    Article  Google Scholar 

  46. (46)

    House JS, Landis KR, Umberson D: Social relationships and health.Science. 1988,241:540–545.

    PubMed  Article  CAS  Google Scholar 

  47. (47)

    Uchino BN, Uno D, Holt-Lunstad J: Social support, physiological processes, and health.Current Directions in Psychological Science. 1999,8:145–148.

    Article  Google Scholar 

  48. (48)

    Lakey B, McCabe KM, Fisicaro SA, Drew JB: Environmental and personal determinants of support perceptions: Three generalizability studies.Journal of Personality and Social Psychology. 1996,70:1270–1280.

    PubMed  Article  CAS  Google Scholar 

  49. (49)

    Giles DC: Parasocial interaction: A review of the literature and a model for future research.Media Psychology. 2002,4:279–305.

    Article  Google Scholar 

  50. (50)

    Bresnahan MJ, Murray-Johnson L: The healing Web.Health Care for Women International. 2002,23:398–407.

    PubMed  Article  Google Scholar 

  51. (51)

    Turner JW, Grube, JA, Meyers J: Developing an optimal match within online communities: An exploration of CMC support communities and traditional support.Journal of Communication. 2001,51:231–251.

    Article  Google Scholar 

  52. (52)

    Barrera M Jr., Glasgow RE, McKay HG, Boles SM, Feil EG: Do internet-based support interventions change perceptions of social support? An experimental trial of approaches for supporting diabetes self-management.American Journal of Community Psychology. 2002,30:637–655.

    PubMed  Article  Google Scholar 

  53. (53)

    Shaw BR, Hawkins R, McTavish F, Pingree S, Gustafson DH: Effects of insightful disclosure within computer mediated support groups on women with breast cancer.Health Communication. 2006,19:133–142.

    PubMed  Article  Google Scholar 

  54. (54)

    Burleson BR: Comforting messages: Significance, approaches, and effects. In Burleson BR, Albrecht TL, Sarason IG (eds),Communication of Social Support: Messages, Interactions, Relationships, and Community. Thousand Oaks, CA: Sage, 1994, 3–28.

    Google Scholar 

  55. (55)

    Israel B, Schurman S: Social support, control, and the stress process. In Glanz K, Lewis F, Rimer B (eds),Health Behavior and Health Education: Theory, Research and Practice. San Francisco: Jossey-Bass, 2002, 187–215.

    Google Scholar 

  56. (56)

    Kreuter MW, Strecher VJ, Glassman B: One size does not fit all: The case for tailoring print materials.Annals of Behavioral Medicine. 1999,21:276–283.

    PubMed  CAS  Google Scholar 

  57. (57)

    Papacharissi Z, Rubin AM: Predictors of internet use.Journal of Broadcasting and Electronic Media. 2000,44:175–196.

    Article  Google Scholar 

  58. (58)

    Block SD: Psychological considerations, growth, and transcendence at the end of life: The art of the possible.Journal of the American Medical Association. 2001,285:2898–2905.

    PubMed  Article  CAS  Google Scholar 

  59. (59)

    Byock I:Dying Well: The Prospect for Growth at the End of Life. New York: Putnam, 1997.

    Google Scholar 

  60. (60)

    Mezirow J:Transformative Dimensions of Adult Learning. San Francisco: Jossey-Bass, 1991.

    Google Scholar 

  61. (61)

    Mathieson CM, Stam HJ: Renegotiating identity: Cancer narratives.Sociology of Health and Illness. 1995,17:283–306.

    Article  Google Scholar 

  62. (62)

    Armstrong L:It’s Not About the Bike: My Journey Back to Life. New York: Putnam, 2000.

    Google Scholar 

  63. (63)

    Frank AW:The Wounded Storyteller. Chicago: University of Chicago Press, 1995.

    Google Scholar 

  64. (64)

    Lin HR, Bauer-Wu SM: Psycho-spiritual well-being in patients with advanced cancer: An integrative review of the literature.Journal of Advanced Nursing. 2003,44:69–80.

    PubMed  Article  Google Scholar 

  65. (65)

    Damasio AR:Descartes’ Error: Emotion, Reason and the Human Brain. New York: Putnam, 1993.

    Google Scholar 

  66. (66)

    Ezzy D: Illness narratives: Time, hope, and HIV.Social Science and Medicine. 2000,50:605–617.

    PubMed  Article  CAS  Google Scholar 

  67. (67)

    Carlick A, Biley FC: Thoughts on the therapeutic use of narrative in the promotion of coping with cancer.European Journal of Cancer Care. 2004,13:308–317.

    PubMed  Article  CAS  Google Scholar 

  68. (68)

    Kleinman A:The Illness Narratives: Suffering, Healing, and the Human Condition. New York: Basic Books, 1988.

    Google Scholar 

  69. (69)

    Pennebaker JW: Telling stories: The health benefits of narrative.Literature & Medicine. 2000,19:3–18.

    Article  CAS  Google Scholar 

  70. (70)

    Chochinov HM: Dignity-conserving care: A new model for palliative care: Helping the patient feel valued.Journal of the American Medical Association. 2002,28:2253–2260.

    Article  Google Scholar 

  71. (71)

    Radley A: The aesthetics of illness: Narrative, horror and the sublime.Sociology of Health and Illness. 1999,21:778–796.

    Article  Google Scholar 

  72. (72)

    Antoni M, Lehman J, Kilbourn K, et al.: Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer.Health Psychology. 2001,20:20–32.

    PubMed  Article  CAS  Google Scholar 

  73. (73)

    Tedeschi RG, Calhoun LG: The posttraumatic growth inventory: Measuring the positive legacy of trauma.Journal of Traumatic Stress. 1996,9:455–471.

    PubMed  CAS  Google Scholar 

  74. (74)

    Spiegel D:Living Beyond the Limits: New Hope and Help for Facing Life-Threatening Illness. New York: Random House, 1993.

    Google Scholar 

  75. (75)

    Lannamann JW, Harris LM, Bakos AD, Baker KJ: Ending the end-of-life communication impasse: A dialogic intervention. In Sparks L, O’Hair D, Kreps G (eds),Cancer Communication and Aging. Cresskill, NJ: Hampton Press, in press.

  76. (76)

    Plexus Institute:Stories: Complexity in Action. Retrieved December 13, 2005 from http://www.plexusinstitute.com

  77. (77)

    Charmaz K: Discoveries of self in illness. In Charmaz K, Paterniti DA (eds),Health, Illness and Healing: Society, Social Context, and Self. Los Angeles, CA: Roxbury, 1998, chapter 9.

    Google Scholar 

  78. (78)

    Frankl VR:Man’s Search for Meaning: An Introduction to Logotherapy (3rd Ed.). New York: Touchstone Books, 1984.

    Google Scholar 

  79. (79)

    Labouvie-Vief G: Wisdom as integrated thought: Historical and developmental perspectives. In Sternberg R (ed),Wisdom: It’s Nature, Origins, and Development. New York: Cambridge University Press, 1990, 52–85.

    Google Scholar 

  80. (80)

    McGregor BA, Antoni MH, Boyers A, et al.: Cognitive-behavioral stress management increases benefit finding and immune function among women with early-stage breast cancer.Health Psychology. 2001,20:20–32.

    PubMed  Article  Google Scholar 

  81. (81)

    Spiegel D, Bloom JR, Kraemer HC, Gottheil E: Effect of psychosocial treatment on survival of patients with metastatic breast cancer.The Lancet. 1989,2:888–891.

    Article  CAS  Google Scholar 

  82. (82)

    Spiegel D, Sephton S: Psychoneuroimmune and endnocrine pathway in cancer: Effects of stress and support.Seminars in Clinical Neuropsychiatry. 2001,6:252–265.

    PubMed  Article  CAS  Google Scholar 

  83. (83)

    Shaw B, Hawkins R, McTavish F, Pingree S, Gustafson D: Effects of insightful disclosure within computer-mediated support groups on women with breast cancer.Health Communication. (in press).

  84. (84)

    Chelf J, Deshler A, Hillman S, Durazo-Arvizo R: Storytelling: A strategy for living and coping with cancer.Cancer Nursing. 2000,23:1–5.

    PubMed  Article  CAS  Google Scholar 

  85. (85)

    Coreil J, Wilke J, Pintado I: Cultural models of illness and recovery in breast cancer support groups.Qualitative Health Research. 2004,14:905–923.

    PubMed  Article  Google Scholar 

  86. (86)

    Bruner J: The narrative construction of reality.Critical Inquiry, 1991,18:1–21.

    Article  Google Scholar 

  87. (87)

    Bennett P, Howard N: Rationality, emotion and preference change: Drama theoretic models of choice.European Journal of Operational Research. 1996,92:603–614.

    Article  Google Scholar 

  88. (88)

    Hatcher J:The Art and Craft of Playwriting. Cincinnati, OH: Storey Press, 1996.

    Google Scholar 

  89. (89)

    Hicks ND:Screenwriting 101: The Essence and Craft of Feature Film Writing. New York: McNaughton and Guner, 1999.

    Google Scholar 

  90. (90)

    Simons H, Berkowitz N, Moyer R: Similarity, credibility, and attitude change: A review and a theory.Psychological Bulletin. 1970,73:1–16.

    Article  Google Scholar 

  91. (91)

    Fleming M, Petty R: Identity and persuasion: An elaboration likelihood approach. In Terry D, Hogg M (eds),Attitudes, Behavior, and Social Context: The Role of Norms and Group Membership. Mahwah, NJ: Lawrence Erlbaum Associates, 2000, 171–199.

    Google Scholar 

  92. (92)

    Chaiken S: The heuristic model of persuasion. In Zanna MP, Olsen JM, Herman CP (eds),Social Influence: The Ontario Symposium (Vol. 5). Hillsdale, NJ: Lawrence Erlbaum Associates, 1987, 3–39.

    Google Scholar 

  93. (93)

    Bailey EJ, Erwin DO, Belin P: Using cultural beliefs and patterns to improve mammography utilization among African-American women: The Witness Project.Journal of the National Medical Association. 2000,92:136–142.

    PubMed  CAS  Google Scholar 

  94. (94)

    Slater MD, Buller DB, Waters E, Archibeque M, LeBlanc M: A test of conversational and testimonial messages versus didactic presentations of nutrition information.Journal of Nutrition Education and Behavior. 2003,35:255–259.

    PubMed  Article  Google Scholar 

  95. (95)

    Campbell RG, Babrow AS: The role of empathy in responses to persuasive risk communication: Overcoming resistance to HIV prevention messages.Health Communication. 2004,16:159–182.

    PubMed  Article  Google Scholar 

  96. (96)

    Shelton ML, Rogers RW: Fear-arousing and empathyarousing appeals to help: The pathos of persuasion.Journal of Applied Social Psychology. 1981,11:366–378.

    Article  Google Scholar 

  97. (97)

    Fiske ST:Social Beings: A Core Motives Approach to Social Psychology. Hoboken, NJ: Wiley, 2004.

    Google Scholar 

  98. (98)

    Erwin DO, Spatz TS, Stotts RC, Hollenberg JA, Deloney LA: Increasing mammography and breast self-examination in African American women using the Witness Project model.Journal of Cancer Education. 1996,11:210–215.

    PubMed  CAS  Google Scholar 

  99. (99)

    Priester JR, Petty RE: The influence of spokesperson trustworthiness on message elaboration, attitude strength, and advertising effectiveness.Journal of Consumer Psychology. 2003,13:408–421.

    Article  Google Scholar 

  100. (100)

    Bayer R: Module 6:Ethics of Health Promotion and Disease Prevention. In Jennings B, Kahn J, Mastroianni A, Parker LS (eds),Ethics & Public Health Module Curriculum. Retrieved September 6, 2005 from http://www.asph.org/document.cfm?page=782.

  101. (101)

    Zillman D, Brosius H:Exemplification in Communication: The Influence of Case Reports on the Perception of Issues. Mahwah, NJ: Lawrence Erlbaum Associates, 2000.

    Google Scholar 

  102. (102)

    Ubel PA, Jepson C, Baron J: The inclusion of patient testimonials in decision aids: Effects on treatment choices.Medical Decision Making. 2001,21:60–68.

    PubMed  CAS  Google Scholar 

  103. (103)

    Fagerlin A, Wang C, Ubel PA: Reducing the influence of anecdotal reasoning on people’s health care decisions: Is a picture worth a thousand statistics?Medical Decision Making. 2005,25:398–405.

    PubMed  Article  Google Scholar 

  104. (104)

    Greene K, Brinn LS: Messages influencing college women’s tanning bed use: Statistical versus narrative evidence format and a self-assessment to increase perceived susceptibility.Journal of Health Communication. 2003,8:443–461.

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Matthew W. Kreuter Ph.D., M.P.H..

Additional information

After the first author, the author order was determined by chance.

This article is a product of the National Cancer Institute (NCI) Working Group on Narrative Communication in Cancer Prevention and Control, which received support through NCI’s Centers of Excellence in Cancer Communication Research (CECCR) initiative. Members of the interdisciplinary Working Group represent the fields of anthropology, communication, internal medicine, nursing, public health, social psychology, and social work.

About this article

Cite this article

Kreuter, M.W., Green, M.C., Cappella, J.N. et al. Narrative communication in cancer prevention and control: A framework to guide research and application. ann. behav. med. 33, 221–235 (2007). https://doi.org/10.1007/BF02879904

Download citation

Keywords

  • Cancer Prevention
  • Behavioral Medicine
  • Narrative Form
  • Cancer Communication
  • Existential Issue