Narrative Communication in Cancer Prevention and Control: A Framework to Guide Research and Application

This 15-page article on narrative, or stories, as a form of cancer communication for prevention and control is from the Annals of Behavioral Medicine, 2007, Vol. 33, Issue 3. It asserts that narrative has 4 distinctive capabilities: overcoming resistance, facilitating information processing, providing surrogate social connections, and addressing emotional and existential issues. The research examines whether the different capabilities are applicable to different outcomes across the cancer control continuum (e.g., prevention, detection, diagnosis, treatment, survivorship), identifies variables likely to moderate narrative effects, and raises ethical issues and limitations of using narrative for prevention and control of cancer.


Narrative is categorised here as stories that are a comfortable way for people to communicate and learn from one another, and includes entertainment education, such as soap operas, cartoons, or dramas; journalism; literature; case histories; testimonials; and storytelling. The research explores narratives because, as stated here: "…many Americans do not understand health information well enough to make informed decisions or act on it, cancer survivors and their family members are often unsatisfied with the health information they receive or can access, and traditional expository forms of communication are poorly suited for addressing certain fundamental needs of cancer patients like prioritising values and managing social relationships."

Using existing research on persuasion literature, though generally not specific to cancer prevention and treatment due to a lack of research on narrative health communication specific to cancer, the authors examine the 4 capabilities of narrative. An area where narratives may be useful is overcoming an individual’s resistance, including resisting screening procedures (e.g., mammogram) and altering cancer-related behaviours (e.g., smoking). Immersion of the individual in the story may be a means of reducing their tendency to "counter-argue" the message content. Also, narratives can be persuasive in structure. They can also be concrete and vivid. Narrative messages can reduce fear and distrust and increase the perception of relevancy. Research shows, for example, that celebrity news stories on cancer can increase numbers of screening tests and that personal stories show more engagement than statistical information. "Finding the balance between entertainment and education in narratives is an important practical issue. How strong the explicit message can be without encouraging reactance is an empirical question and may depend on factors such as the resistance level of the audience, existing connections the audience has with the characters or narrator, and the quality of the narrative."

Narratives may help individuals to process cancer prevention and control information by increasing attention and facilitating comprehension. First, according to research cited here, "there is substantial evidence that social information is stored in memory in narrative forms such as scripts, and that such information has distinct advantages with respect to memory and recall." Also, narrative may reach those who have low literacy levels and self-efficacy for understanding information, those whose cultural backgrounds lead to mistrust of medical authorities or whose cultures express knowledge through narrative and wisdom through lived experience, and those reacting emotionally due to treatment.


The document suggests that a "para-social" (a pseudo-relationship with a character or author of a narrative) relationship may "have the potential to provide health benefits similar to those of real social support, at least under some conditions. ...Individuals who might benefit most from social support narratives include those whose own social networks are limited in scope or lack members having firsthand experience with cancer-related issues; who suffer from severe social anxiety; or who feel more comfortable with the anonymity of reading, watching, or hearing about others who have coped with similar cancer-related issues."

The qualities of narrative, especially those that make it accessible, are stated as: expressing the nuances, contradictions, and aesthetics of illness and cancer’s existential dilemmas more effectively than didactic formats; imposing a sense of order over the chaos that cancer imposes; providing the distance and perspective needed to view cancer as a series of solvable problems; enhancing dignity as cancer erodes it; and articulating the human complexity associated with cancer (in the case of “polyphonic” or many-voiced narratives). The document provides a chart of narrative elements: sequence, character, structure, and production techniques; corresponding descriptions; and intended effects and possible benefits to cancer control efforts.

The ethical challenges discussed include the potential for "epidemiological misstatement"; potential inclusion of inaccurate information; misunderstood meanings and disclosures when narratives are used outside the intended audience; and the potential to stigmatise individuals at other points on the cancer control continuum. The ethical dilemma of making composite stories or editing what is the appropriate property of the story teller is also at issue. In conclusion, the authors recognise the potential power of narrative to facilitate connection - social, informational, experiential - in reducing resistance and supporting decision making. The need for appropriateness and accuracy of information is cited along with the need for further research.

Reprints are available from Matthew W. Kreuter at the address in the Contact section below.