Entertainment as a Tool for Health Behavior Change

By Sapna Suresh

The radio soap opera Toma mi Mano, a 156-episode Spanish-language program broadcast across all 22 departments in Guatemala, features Ruth: a young woman who suffered years of sexual abuse at the hands of her uncle. Although for a while she believed him to be completely out of her life, he returns to Guatemala and soon turns his attention to Ruth’s teenage sister. Scarred by her own past abuse, Ruth tries to speak up but is quickly dissuaded by her mother. Despite the potential backlash, Ruth’s partner supports her decision to take a stand, pushing her to stop the cycle of abuse from perpetuating. To many Guatemalans, this story struck a personal chord. Several participants in a listener focus group expressed horror at Ruth’s mother’s indifference to her daughter’s pain and felt emboldened to take a more active role in parenting their own children so as to build a more trusting relationship. The resonance of this plotline is especially plausible given the pervasiveness of male chauvinism, or machismo culture, in contemporary Guatemala – an issue that the radio drama’s producers intentionally sought to address with Ruth’s character arc. This storyline and the other narratives featured in Toma mi Mano are typical examples of social behavior change interventions that seek to transmit knowledge, update attitudes, and change behaviors in order to facilitate better outcomes for health and wellbeing.

Toma mi Mano was developed by Population Media Center (PMC), a non-profit organization promoting pro-social change in countries around the world through the production of “entertainment-education”. This type of communication campaign seeks to address a range of health-related issues, including sexual and gender-based violence, reproductive health, family planning, and environmental sustainability, through the use of scientifically grounded approaches to behavior change. Specifically, when characters in PMC’s radio and television programs demonstrate the consequences of undesired behaviors and adopt norm-upending behaviors to a beneficial end, they boost listeners and viewers’ efficacy to enact such changes in their own lives.

PMC’s programming employs several methods to bolster the likelihood of persuasive effects on audiences. One technique they use is presentation of the story over many sequential episodes to draw in audiences’ attention, thereby allowing their cognitive and emotional resources to become fixed on the slowly advancing plot. Another approach involves including positive, negative, and transitional role models who make evident the consequences of different behavioral choices and provide diverse characters onto whose experiences audiences can map their own. By virtue of both the serial format and character identification process, audiences are also able to develop para-social relationships. Specifically, as the narrative progresses and consumers of the program become increasingly involved and invested in the lives of the people in the story, they develop connections with these characters that mimic interpersonal relationships. This process enables the characters to spur motivation within the audience members by serving as friends, mentors, and aspirational figures.

The success of PMC’s programming in moving the needle on topics like child marriage (Mai Sari Sunakhari, Nepal), substance abuse (East Los High, United States), nutrition (Pambazuko, Democratic Republic of Congo), HIV/AIDS (Último Año, Latin America), and disability rights (Jolokoto, Nigeria) provides evidence of the power of entertainment-education. Given their measurability, cost-effectiveness, multi-dimensionality, and reproducibility, interventions like those produced at PMC demonstrate significant strength and potential in supporting global public health initiatives.

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Sapna Suresh is a second year PhD student in the School of Communication at Northwestern University. She conducts research on the many ways in which we can persuade people to change their attitudes and behaviors, including through the use of narratives and emotions. Her outreach work includes at a prior internship with Population Media Center, participation in the NPR SciCommers network, and serving as a mentor to Northwestern undergraduates concentrating in health communication.

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References

Bandura, Albert. “Social cognitive theory for personal and social change by enabling media.” Entertainment-education and social change. Routledge, 2003. 97-118.

Green, Melanie C., and Timothy C. Brock. “The role of transportation in the persuasiveness of public narratives.” Journal of personality and social psychology 79.5 (2000): 701.

Horton, Donald, and R. Richard Wohl. “Mass communication and para-social interaction: Observations on intimacy at a distance.” Psychiatry 19.3 (1956): 215-229.