Abstract: Fear Before Hope: Assessing the Effect of Emotional Flow in a Youth Opioid Prevention Narrative

◆ Elizabeth Troutman Adams, University of North Carolina at Chapel Hill
◆ Seth M. Noar, University of North Carolina at Chapel Hill
◆ Robin L. Nabi , University of California at Santa Barbara
◆ Reina Evans, North Carolina State University
◆ Laura Widman, North Carolina State University

Background. Every day, 1,600 American teens misuse a prescription drug (Center for Behavioral Health Statistics and Quality, 2017). To combat youth opioid misuse, the Know the Truth anti-opioid website features true stories about young people whose opioid addiction led to extreme acts of self-harm.

Emotions are an essential part of the narrative experience (Nabi and Green, 2015) and are used prominently in the Know the Truth ads. Multiple, shifting emotions may work in concert during the course of a narrative to enhance persuasive effects. Nabi and Myrick (2019) found that feelings of hope assuaged negative reactions to fear and related positively to self-efficacy, a predictor of behavior.

However, health communication researchers have yet to address the sequence of emotions - called emotional flow - evoked during the course of a narrative. We asked whether changing the narrative’s emotional sequence would influence the reception of the message. Integrating the extended parallel process model (Witte, 2000) and the emotional flow hypothesis (Nabi, 2015), we posed the following:

• How does the emotional sequence of the Know the Truth narrative effect youth emotional arousal?
• How does the emotional sequence of the Know the Truth narrative effect youth perceptions of opioid risk and efficacy?

We also predicted that both emotional flow conditions (fear to hope or hope to fear) would outperform a static emotional condition on emotional arousal, perceived risk (susceptibility and severity), and efficacy (response and self-efficacy).

Method. We conducted a randomized experiment as part of a larger opioid prevention program disseminated in rural middle schools. After following IRB-approved consenting procedures, students were randomized to one of three text versions of the Know the Truth campaign narrative, “Amy’s Story”: the original fear-to-hope condition (n=161), a reversed hope-to-fear condition (n=183), or a fear-only (n=171) condition. The sample (n = 480) comprised 140 (29%) White students, 98 (21%) Black/African American students, 199 (41.5%) Hispanic/Latinx students, 7 (1.5%) Asian students, and 35 (7%) students who identified as “other.” The sample had 250 (52%) male, 223 (46.5%) female, and 7 (1.5%) identifying as transgender/prefer not to say.

Results. Testing two emotional flow sequences (fear-to-hope and hope-to-fear) of the Know the Truth narrative against a static (fear-only) emotional condition, we found that youth exposed to any emotional flow narrative reported higher levels of hope than those exposed to a fear-only narrative (p<.01). In comparing the two emotional flow conditions, we found that a fear-to-hope narrative elicited higher levels of self-efficacy (p=.03) than the hope-to-fear emotional condition. We did not find significant differences across conditions for response efficacy, susceptibility, and severity.

Conclusion. Our findings demonstrate that emotional shifts in a narrative improve youth self-efficacy to avoid opioid addiction. In particular, our results are the first to empirically demonstrate that the traditional fear-to-hope format outperforms its inverse - a hope-to-fear format. Thus, the shift from fear to hope – not merely the presence of hope in a fear-inducing narrative – improves the message receiver’s sense of self-efficacy. We discuss implications of these findings for Know the Truth and other campaigns.