Formulas for Prevention, Narrative Versus Non-Narrative Formats. A Comparative Analysis of Their Effects on Young People's Knowledge, Attitude and Behaviour in Relation to HPV

Numerous research studies on persuasion and the media have shown the importance of message format and its effects on change in health-related knowledge, attitudes, and behaviours. This article presents the results of a study that empirically compared the effectiveness of narrative and non-narrative formats on Facebook to influence knowledge about human papillomavirus (HPV) and to promote more preventive attitudes and behaviours.

A univariate inter-subject experimental design was used with 114 volunteer students from the Complutense University of Madrid, Spain, whose ages ranged from 18 to 23 years. The independent variable, with a 2-level treatment, was "format type", and the stimulus was 2 Facebook profiles presenting the same information about HPV but in 2 different formats: an "expository" or non-narrative format profile and a "narrative" format profile.

These 2 profiles addressed the relation of HPV with cervical cancer, general information, importance of check-ups and cervical smear/Papanicolaou test, the prevalence of the virus in men, and prevention. Both profiles contained the same number and types of publications (videos, images, links to specialised sources, and informative posters), following the recommendations of previous research on social networks and mediation, which recommend the use of multimedia, links to specialised sources, short publications, and frequent interventions to create an attractive Facebook profile about health matters.

In the narrative profile, the information was presented through the story of a real subject, a girl diagnosed with HPV who, while waiting for the results to know whether the infection is high or low risk, tells her own story and gives information on the profile through posts and videos. In the expository profile, the information was the same but had an informative tone and more impersonal language. To guarantee the internal validity of the stimulus, the time of exposure to the profile, the header of the page, and the profile picture remained constant in both profiles.

Subjects were randomly distributed to independent experimental groups, balancing sex and age. They were given questionnaires for the evaluation of the dependent variables - knowledge of HPV, attitude, and intention of behaviour towards HPV prevention - before exposure to the Facebook profiles. Both groups were exposed to the Facebook profiles for 15 minutes as they were projected and navigated by the researcher. After being exposed to the profiles, participants were asked to answer once again the questionnaire, allowing for pre- and post-treatment analysis.

The data show that young people in general have low knowledge about HPV and do not to take the necessary preventive measures. The study found that the non-narrative (expository) profile produced a greater increase in knowledge, while the narrative profile led to greater change in more responsible preventive attitudes and behaviours. Significant changes in both Facebook profiles show the effectiveness of the interventions made in this social network by means of different and attractive resources that combine media, short texts and links to experts, and varied, simple, and accurate information.

More specifically:

• Although both profiles significantly increased users' knowledge, contrary to expectations, the participants who viewed the expository profile showed greater increase - above all, in the case of technical names such as the Papanicolaou test. These data contradict the results obtained in previous research studies, where the narrative format was associated with greater awareness. This fact could be due to the way the viewer engages with the narrative profile, which is infused with emotions and can make other psychological mechanisms, such as narrative transportation and identification, interfere with message processing. Future research could consider the way of presenting the information or make it more repetitive in the narrative formats to achieve greater acquisition of relevant knowledge when it is more technical and specialised.
• The narrative format produced a more responsible attitude in relation to HPV prevention - above all, in the importance of check-ups. In addition, the narrative format proved to be more effective in more responsible behaviour change - above all, in the disposition to get tested for HPV.
• With regard to condom use, no significant changes resulted, no matter which profile was being viewed; this may be due to the fact that the initial values were already quite high. However, it is notable that, after viewing the stimuli, between 20% and 30% of the young participants would still have sexual intercourse without a condom. According to the analysis, these cases are due in part to the fact that participants, particularly women, reported feeling embarrassed to ask their partners to use condoms during sex. The researchers suggest that these data should be considered for future interventions in sexual education in order to change certain beliefs and deep-rooted prejudices among women on sexuality issues and to allow for open dialogue among young people.

In conclusion, "due to the scarcity of research that analyse[s] these persuasive differences in social networks like Facebook, this work provides crucial information for future research in the field of persuasion and mediation, and for the creation of better interventions in health and other sectors."