Abstract: Developing Theoretically Informed, Narrative Messages in Health Communication: A Rigorous, Step-by-Step Process

◆ Marleah Dean, University of South Florida
◆ Courtney L. Scherr, Northwestern University
◆ Lindy Davidson, University of South Florida

A narrative, in the simplest terms, is a story. It is a recounted experience, which includes a strategic plot and characters (Hinyard & Kreuter, 2007; Kreuter et al., 2007). Narratives help us understand who we are and cope with life experiences. Narratives can help individuals navigate and adapt to new identities, especially when shaken by news of an illness or potential illness (Frank, 2013). For stories to assist individuals in moving forward in their illness crises, they must be well told and resonant with the individuals.
While the benefits of narratives in health-promotion and behavior change interventions are evident, the process for creating narrative messages is less clear (Perrier & Martin Ginis, 2018). One challenge in creating narratives involves taking personal stories and reconstructing them to address theoretical constructs known to impact behavioral outcomes. Thus, to assist researchers in developing theoretically informed, narrative messages based on personal stories, this manuscript reports a rigorous, six-step process: (1) collecting personal testimonials, (2) immersing self into testimonials, (3) identifying central narratives, (4) piecing quotes into cohesive stories, (5) filling in the gaps, and (6) checking for resonance. To exemplify this process, we provide an example from our research project ePOWER (Table 1 upon request). The goal of ePOWER is to identify the psychosocial information needs of women who tested positive for a genetic variant predisposes them to hereditary cancer in order to help them manage their psychological, chronic cancer-related uncertainty and make preventive health decisions.
To begin, the research team utilizes a theory which assists in accomplishing the intervention’s overarching goal. Yet, the target population’s experiences, voices, perspectives should guide the intervention. Therefore, the purpose of steps one through three is to understand the population’s lived experiences (Patton, 2002). Step one involves collecting personal testimonials. We believe the richest source to collect personal testimonials are qualitative methods (Merriam, 2009). In step two, the team immerses themselves into the lived experiences by seeking an in-depth understanding of the testimonials. Step three involves identifying the central narratives that emerge across the target population’s experiences. To do so, the research team distinguishes broad story elements—characters, motives, plots, scenes, time, and life lessons (Yamasaki, Geist-Martin, & Sharf, 2016). In step four, the research team develops the narratives by piecing together cohesive narratives that utilize as much of the participants’ actual language from the data. Step five encompasses filling in the gaps by the research team writing their own words into the narratives, while ensuring those words also reflect participants’ experiences. The research team returns to theory at this point by analyzing individuals’ experiences alongside multiple theoretical frameworks to ensure the narrative messages best reflect the individuals’ lived experiences. Step six includes checking for resonance through pilot-testing (Atkin & Freimuth, 2013; Harrison, 2014) or performing member checks (Hesse-Biber & Leavy, 2006).