Abstract: Recent Evidence Regarding Vignettes as Interdisciplinary Tools for Measuring Social Norms in Health Communication Research

◆ Amy Henderson Riley, Thomas Jefferson University
◆ Steven Buffer, Thomas Jefferson University
◆ Nichole Holmes, Thomas Jefferson University
◆ Katherine Senter, Thomas Jefferson University

Introduction: Vignettes are interdisciplinary research tools that use short, hypothetical narratives to gather participant responses on a range of indicators including knowledge, attitudes, and behavioral intention. Vignettes have been used across social science disciplines for decades in both quantitative and qualitative settings and have theoretical roots in storytelling and narrative persuasion. Several recent international publications, including UNICEF (2019), have suggested vignettes may be valid tools for measuring social norms in formative, process, and impact evaluation of behavior change communication programming, but the evidence supporting vignettes as a measurement tool for social norms specifically in health communication is unknown. A systematic review was conducted to understand how vignettes have been applied in health communication over the last ten years, with a particular focus on the evidence regarding social norms measurement.
Method: A three-person team searched four academic databases, and conducted a Google Scholar search, to identify empirical articles utilizing vignettes in health communication. Articles had to be peer-reviewed, in English, and published from 2009-2018 to be included. As the systematic review did not include human subjects, it was exempt from institutional review board approval. Two hundred and forty articles emerged from the search and 168 remained after removing duplicates. Each article was screened by title and abstract and excluded if our institutional library did not have access, if the article had no mention of vignettes, if the article was not about health communication, or if the article did not report on peer-reviewed primary research. The full text of 45 studies were included in the final review and analysis.
Results: Social norms were measured in just three of the 45 studies. In a study of HIV stigma in India, Vlassoff et al. (2012), applied a vignette in focus groups to gauge social acceptance of a fictional woman living with HIV. In Lillie, Tarini, Janz, and Zikmund-Fisher (2015), an online survey study of adults used a vignette about muscular dystrophy to measure respondents’ intention in participating in genetic testing; two survey questions measured subjective norms on the topic. And in Winskell et al. (2018) vignettes were included in a randomized controlled trial of a smartphone game on the topic of HIV in Kenya for children age 11-14. A survey conducted at three time points measured perceived social norms with six items.
Discussion: With only three articles making any mention of social norms, this review suggests there is not yet a strong evidence base in the academic literature for measuring social norms in health communication with vignettes. When considering the grey literature, however, it is possible to hypothesize that vignettes may indeed be currently utilized in health communication practice, but a delay exists in demonstrating evidence of their effectiveness in the peer-reviewed literature. This review thus identifies both a potential practice-research gap in health communication and offers suggestions for increasing research efforts to better understand if, why, and how vignettes operate as interdisciplinary tools for measuring social norms in health communication research.