The Importance of Being Authentic: Persuasion, Narration, and Dialogue in Health Communication and Education

"...[M]any health messages are not so much incomprehensible or imprecise as they are inauthentic - they do not jibe with what people know about themselves and the world they live in. Accordingly, the challenge health educators and communicators face has less to do with giving the 'right' information than with persuading the learner that information and ideas are relevant to their everyday existence."

This article explores an approach to addressing a challenge health communicators face: the knowledge, attitudes, and practices (KAP) gap. This gap reflects what is described here as a well-known truth in the field: "[I]t may be easy to learn facts, but without the ability and willingness to apply information to the contexts in which the information is relevant, knowledge is wasted....For many public health target audiences, information and messages about illness and disease and exhortations to change risky behaviors can easily become white noise - a droning buzz in the background that only occasionally reaches consciousness."

Author Joseph Petraglia looks into a topic in the field of education called "authenticity" as it relates to health communication and education. Authenticity has been defined as the creation of learning environments that provide learners with richer and more realistic contexts in which to apply knowledge and practice skills - that is, it is a strategy for getting learners to translate knowledge into action. In the health communication context, authenticity involves an appraisal made by a member of the public who is persuaded to view the information as especially relevant to his or her health behaviour and consonant with his or her prior experiences. "Adjusting perceptions of authenticity may be especially important in the public health field, in which health educators and communication professionals often request audiences to change habits, diet, and a range of risk behaviors. Behavior change is, of course, rarely easy and almost always requires some sacrifice on the part of the person being asked to change. This raises the bar in terms of persuasion; the natural inclination of most members of the public is to resist changes that are disruptive, uncomfortable, or that stymie pleasure. Recommendations to change behavior, accordingly, will not be readily seen as authentic..."

In the face of these challenges, Petraglia proposes a narrative strategy that contextualises information in the form of stories, anecdotes, and cases. In such an intervention, behaviour change is accomplished not through the simple awareness of the target behaviour health communicators hope the person will adopt but, rather, through helping would-be risk reducers acquire new strategies for identifying and reaching goals, creating new associations or revising old associations in memory, and increasing their confidence that they can attain and maintain the behaviours they have been persuaded are necessary for avoiding health risk.

But, as Petraglia argues, contextualising behaviour change information in the form of stories is not enough; dialogue plays a key role in both persuasion and authentication. He explains why dialogue is not found in most attempts at tailored health communication (THC) and audience segmentation. For instance, it may not be the case that dialogue is not valued or desired but that its "delivery" is expensive and its quality is difficult to monitor and measure. The "value added" of dialogue is also difficult to quantify, Petraglia contends, and the public health industry is rarely eager to undertake expenses without demonstrating concrete benefits to justify them.

That is to say, in the author's own experience, the narrative and dialogic phases of a behaviour change project complement each other. He shares experiences from 2 HIV/AIDS prevention projects with which he has worked closely: MARCH (Modeling and Reinforcement to Combat HIV/AIDS) and RAMP (Reflection and Action Within Most-at-Risk Populations), which "directly engage the nexus of narrative, dialogue, and consequently, authenticity....[B]oth projects start with the creation of a narrative component that uses serialized drama formats (using radio, comic books, or video) to model individuals confronting behavioral risk and then provide an 'exploratorium' in which audiences can observe the interaction of different variables on that risk. These stories ('role model stories' in MARCH, 'behavior change narratives' in RAMP) are developed by a local creative team....The tools also ensure that the resultant narratives contain a range of contextually appropriate personal, social, and environmental issues that can be mined in subsequent discussions. The narrative component of both MARCH and RAMP is 'designed to describe key characters making their way through life, slowly changing specific attitudes and behaviors. These characters face both positive and negative influences, experience setbacks, seek support in various ways, and, eventually...achieve specific behavioral goals'....But this narrative component is only a springboard for the subsequent 'reinforcement activities' (in MARCH) or 'action phases' (in RAMP) in which health education and communication agents use the stories to prompt dialogue with the audience. This dialogic component is critical to helping listeners see how elements of the serial drama that involve behavior change can help them see their own narratives in a new light." Petraglia describes this process in detail.

In conclusion, Petraglia states that "Creating opportunities for dialogue between behavior change narratives and their audiences has its own challenges, but nonetheless deserves to be a priority in public health."