Abstract: (Un)Like Strategies: Combining Narratives and Didactic Messages to Improve Attitudes Towards Effective Contraception

◆ Camille Saucier, Northwestern University
◆ Sapna Suresh, Northwestern University
◆ John J. Brooks, Northwestern University
◆ Nathan Walter, Northwestern University
◆ Emerald Snow, Sentient Research
◆ Aaron Plant, Sentient Research

INTRODUCTION. Adolescents in the United States experience one of the highest rates of unintended pregnancies in the developed world, with a disproportionate number falling on Latina and Black teens. This disparity can partially be attributed to differences in access to sexual health information. Notably, young women of color tend to rely on riskier contraceptive methods such as condoms (Kusunoki et al., 2016) as opposed to more effective Long-Acting Reversible Contraceptives (LARCs) such as IUDs and implants (e.g., Dehlendorf et al., 2014) Thus, understanding how to craft messages regarding effective contraceptive methods may go a long way in reducing racial/ethnic health disparities.

Narratives have been useful when communicating health-related messages to diverse populations, positively affecting knowledge, attitude, and behavior (e.g., Murphy et al., 2015). Recent meta-analyses that assessed the impact of narrative versus didactic health messages, however, found only limited evidence for the superiority of narratives (Shen, Sheer, Li, 2015). Moreover, it is still unclear whether narratives are best utilized as a substitute for or complement to didactic information. To address these gaps, the current study examines the combined use of narratives and didactic messages and their potential to improve reproductive outcomes.

METHOD. To test the effect of content format on attitudes and behavioral intentions toward using LARCs, a sample of 482 Black, Latina, and non-Hispanic White adolescent women aged 16 to 19 were recruited from Qualtrics. Participants were randomly assigned to watch one of three film conditions (narrative, didactic, or narrative+didactic) or to a no-message control. The narrative film condition consisted of three vignettes that followed four young Black and Latina women as they helped each other navigate relationships while modeling positive and negative behavior. The didactic version of the film provided the same health-related information with two PSA-style messages. Participants in the narrative+didactic condition were exposed to a film that incorporated the aforementioned vignettes and PSAs.

RESULTS. The results of the ANOVA indicated a significant effect of the experimental manipulation on attitudes toward IUDs (F(3,481) = 5.84, p = .001) and implants (F(3,481) = 4.54, p = .004), as well as intent to use implants (F(3,481) = 5.52, p = .001), but not IUDs (F(3,481) = 2.33, p = .074). Post-hoc comparisons using the Tukey HSD test indicated the scores for all outcomes were significantly higher among those exposed to the different versions of the stimulus compared to the no-message control condition but there were no significant differences between participants in the experimental conditions. Further, a two-way ANOVA with experimental condition and race/ethnicity as fixed factors did not retrieve significant interactions, indicating that all racial/ethnic groups equally benefited from exposure to information regarding LARCs, irrespective of whether it was presented in narrative, didactic, or narrative and didactic format.

CONCLUSION. The findings add further nuance to the interplay between narrative and didactic messages, suggesting that stories and didactic information can go together without interfering with circumventing the influence of each format.