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This study tests whether the adaptation of a narrative's protagonist to be similar to readers increases narrative effects in the health domain. A between-subjects (N = 220) experiment was conducted that varied the similarity of the protagonist to the participants. Results showed that participants who read the version with a similar protagonist perceived themselves to be more at risk of the disease with which the protagonist was diagnosed and felt more efficacy to deal with the symptoms of this disease, than participants who read the version with a dissimilar protagonist. These effects were mediated by self-referencing, indicating that adaptation of a protagonist to be similar to readers makes readers relate the story to themselves, which in turn increases narrative impact.
Over the past decade, the power of narratives to influence health beliefs has been demonstrated by multiple studies (e.g., Green, 2006; Morgan, Movius, & Cody, 2009; Murphy, Frank, Moran, & Patnoe-Woodley, 2011). In health communication, narratives can be used to influence beliefs like perceived risk for a certain illness, or feelings of efficacy to deal with a medical condition (Kreuter et al., 2007; Kreuter et al., 2010). Because these beliefs underlie health behavior (Rimal & Real, 2003; Witte, 1994), narratives may be effective tools in promoting a healthy lifestyle and reducing unhealthy choices.
Many studies on narrative impact in the health domain have focused on potential underlying processes of narrative effects, such as transportation into a narrative world and identification with characters (e.g., Moyer-Gusé & Nabi, 2010; Murphy et al., 2011). In doing so, these studies have provided valuable insight into the mechanisms by which narratives have effects. However, another important issue in this domain has not yet received as much attention. There is a lack of research into the role of the content of a narrative in narrative processes and effects (Green, 2008). Narratives that include health messages can vary greatly in terms of content, such as the type of events they show, the setting in which they take place, and the characters they are about. For instance, features of characters can differ, like gender and background. Insight into the role of these content elements in narrative effects is important to the goal of predicting which narratives will most likely influence readers' beliefs. This is why Green (2008, p. 48) sees uncovering “the active ingredients of effective narratives” as one of the most important challenges in the research area of narrative impact.
This study takes up on this challenge to identify narrative elements that influence narrative processes and effects in the domain of health communication. An important determinant of message effectiveness that has emerged in research on health communication is the extent to which a message is adapted to characteristics of the recipients (Rimer & Kreuter, 2006). In this research area, a distinction is made between “targeting,” which refers to adapting a message to characteristics of a subgroup of the population and “tailoring,” which refers to adapting a message to characteristics of specific individuals (Kreuter & Wray, 2003). Both types of customization are expected to be effective because the information in a customized message is more relevant for recipients, which facilitates learning and behavioral effects (Kreuter & Wray, 2003; Rimer & Kreuter, 2006). This study connects research on message adaptation—starting with the more general targeting—to research on narrative impact by examining whether a story with a protagonist who has characteristics similar to a group of readers leads to more story-consistent beliefs than a story with a protagonist with dissimilar characteristics. In this way, whether the similarity of the protagonist is a narrative element that makes narratives more effective can be established.
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The main goal of this experiment was to identify an “active ingredient” of narratives that increases the effectiveness of a story (see Green, 2008). The results of this study show that a protagonist who is similar to the reader is such an element that makes a story have a greater impact. Participants who had read the version of the story in which the protagonist had the same living arrangements as themselves had more story-consistent beliefs than participants who had read the version of the story in which the protagonist had different living arrangements. Hypothesis 1 can thus be accepted; readers of a version of a story in which the protagonist was similar to them on an objective characteristic had several beliefs that were more consistent with the story than readers of a version of the same story in which the protagonist was dissimilar. This means that message adaptation, which has already been found effective in other types of health communication (see Kreuter & Wray, 2003), also increases the effectiveness of narrative messages.
In addition, this study set out to establish the mechanism that underlies the effect of a similar protagonist on beliefs. Results demonstrated that the extent to which readers related the story to themselves and their own lives served as a mechanism of narrative effects. Hypothesis 2 can thus be accepted; The effects of character-reader similarity on story-consistent beliefs was mediated by self-referencing. In contrast, identification did not serve as a mechanism of narrative effects in this study. Therefore, hypothesis 3 is rejected; the effect of character-reader similarity on story-consistent beliefs was not mediated by identification. In summary, similarity of the protagonist to the reader led to narrative effects by making readers think about their selves.
These results do not indicate that identification cannot be a mechanism of narrative impact. Prior research has for instance shown that identification can mediate effects of the perspective from which a story is told on story-consistent attitudes (De Graaf et al., 2012). Thus, identification is a mechanism underlying the effect of the story element perspective. This study showed that the story element of character-reader similarity can have effects through a different underlying mechanism, which is self-referencing. These results underscore the importance of looking at the role of narrative elements in narrative effects, because different elements lead to effects through different mechanisms. By establishing these mechanisms, more insight is gained into the underlying processes of narrative impact and the textual features that trigger these mechanisms.
The lack of effects of similarity on identification and the other engagement variables—attention, emotion, and imagery—provided a clean test of the mediating effect of self-referencing. Because similarity did not affect engagement with the protagonist or the story, these could not be responsible for the found effects of self-referencing. This may seem to contradict previous research that showed engagement variables play a role in narrative impact (e.g., De Graaf et al., 2012; Green & Brock, 2000). However, as explained above, the results of this study do not suggest that identification or other engagement variables cannot function as mechanisms of effects. Instead, the lack of effects of similarity on engagement variables and the full mediation effects of self-referencing on story-consistent beliefs, show that self-referencing is a mechanism of narrative effects that is independent of character and story engagement (which can be a mechanism under different circumstances). Hence, focusing on a character in identification is not the only process that can lead to story-consistent beliefs. Relating the story to oneself and one's own life in self-referencing can do so as well. Instead of contradicting previous studies, this study is thus a contribution to the extant literature, showing that self-referencing—in addition to identification—can also be a mechanism of narrative effects.
Importantly, the effects found in this study most likely reflect belief formation. Because the participants were students, who are generally young and healthy, they most likely have never thought about their risk of becoming ill with intestinal cancer, nor have they considered their efficacy of dealing with the disease before reading the story. This means that the story most likely created the risk and efficacy beliefs, rather than changed already existing beliefs about these issues. Because there are several differences between the processes of belief formation and belief change (Bohner & Dickel, 2011), the implications of this study are limited to belief formation, and future research should ascertain whether the same processes lead to belief change.
Although several beliefs were affected by the manipulation, other beliefs were not. A possible explanation for the lack of effects on the belief of perceived efficacy to deal with a diagnosis of intestinal cancer may be that this is quite a general statement (“I would be able to cope with intestinal cancer”). Previous research has shown that stories are more successful at influencing specific beliefs (e.g., De Graaf, Hoeken, Sanders, & Beentjes, 2009; Green & Brock, 2000), which is corroborated by this study that did show effects on the more specific efficacy belief of being able to deal with potential symptoms of intestinal cancer.
Perceived risk and perceived efficacy to deal with symptoms were affected by similarity. This means that several beliefs that are important in motivating health behavior (Rimal & Real, 2003; Witte, 1994) were influenced by the story. The significant effects on perceived risk and specific self-efficacy are both explained by the mediating effect of self-referencing. This mediation indicates that an increase in thoughts relating the story to the self was responsible for the effect of similarity on these beliefs. These results show that not just the narrative content regarding a health issue (e.g., description of symptoms, diagnosis, and treatment, which were the same in both versions of the story) influences readers of narrative, but also the thoughts they have about this content. When readers link the health content to their own lives, the story has a larger impact on important health beliefs.
An explanation of the effects of similarity found in this study may lie in the increased relevance a reader perceives when a story has a similar protagonist. As explained in the introduction, personal relevance, and self-referencing are distinct concepts, but relevance is likely to influence self-referencing (Kreuter & Wray, 2003). Therefore, whether effects observed for personal relevance also hold for self-referencing becomes an interesting question. Petty and Cacioppo (1986) found that when personal relevance is high, strong arguments lead to message effects, but weak arguments lead to boomerang effects. Self-referencing may similarly be effective only when strong arguments are provided in a message. For narratives, however, what would constitute a strong argument remains unclear, because narrative texts are very different from rhetorical texts (see Green & Brock, 2002). Future research should take up on this issue by defining what would be strong and weak “story arguments” and subsequently testing effects under conditions of high self-referencing and low self-referencing.
This study has several limitations that should also be taken into account in future research. First, this study used a single story to test the hypotheses. Therefore, specific features of this story may have influenced the results. For instance, the story was written from a first-person perspective, which plausibly made readers feel close to the protagonist regardless of whether they were similar to her (Sanders & Redeker, 1996). When reading stories written from a third-person perspective, there may be an influence of similarity on identification.
Also, the protagonist of the story was female. Even though results showed that women did not perceive themselves more similar to the protagonist than men, the fact is that women shared more characteristics with the protagonist than men. Accordingly, the role of gender in relating to characters merits further exploration. As another specific feature, the fact that it was a written story may have limited the amount of engagement of university students. Perhaps a similar protagonist in a filmed narrative may have made this group more engaged in the story. Therefore, future research should test the effects of similarity with different types of stories.
In addition, the sample of participants from the specific group of university students may show different effects than the general population. Future research could look at effects in different groups. Finally, some of the measures were not optimal. For instance, identification was measured with a scale that has not formally been validated. Because this is a central construct in studies on narrative impact, a validated scale would have been desirable (Igartua, 2010; Igartua & Barrios, 2012).
The identification scale used in this study did not include items explicitly capturing the aspect of losing awareness of the self and temporarily “merging” with the character (Cohen, 2001). Future research should explore whether this aspect would be influenced by similarity and mediate effects on story-consistent beliefs. In addition, when measuring the story-consistent beliefs, the two items for efficacy did not form a reliable scale. Future research should preferably use validated scales.
In addition to addressing the limitations of the present study, future research should also extend this study. This study focused on one narrative element that was found to make a narrative more effective, but there are many more potential “active ingredients” of narratives. For instance, the structure of a story seems to influence readers' engagement (Brewer & Lichtenstein, 1982; De Graaf & Hustinx, 2011b). Whether this also leads to more effects should be tested. Also, other features of characters, like the morality of their actions, can influence the level of readers' identification or empathy (Tal-Or & Cohen, 2010; Zillmann, 2006). By establishing if and through which mechanisms such narrative elements lead to more story-consistent beliefs, this line of research expands our insight on the causes and underlying processes of narrative effects. As a step forward in this effort, this study showed that a similar protagonist leads to effects through self-referencing.