Narratives, Information and Manifestations of Resistance to Persuasion in Online Discussions of HPV Vaccination

"...evidence for the potential of narratives to inhibit counterarguing in authentic health-related discourse..."

There are both theoretical accounts and empirical evidence for the fact that, in health communication, narratives (story telling) may have a persuasive advantage when compared with information (the provision of facts). The dominant explanation for this potential advantage is that narratives inhibit people's resistance to persuasion, particularly in the form of counterarguing. Evidence in this area to date has often been gathered through lab or field experiments. This study instead gathered data from naturally occurring, non-experimental, and organically evolving online interactions about vaccinations - specifically, on threads on the parenting forum Mumsnet Talk that centred on indecision about the human papillomavirus (HPV) vaccine. Hesitancy around HPV vaccination has been attributed to a variety of factors, including efficacy concerns, reports of vaccine harms, and the perceived link between HPV infection and sexual activity.

Narratives are hypothesised to be persuasive because of the cognitive and emotional involvement that can ensue from being drawn into a story and engaging with its characters. There are a number of different models of the particular cognitive processes by which this involvement takes place. Some characteristics of narratives are particularly relevant to the potential for perceptions of similarity and identification with characters. First-person narratives and narratives with a single protagonist have been found to have greater persuasive potential than third-person narratives and narratives involving multiple characters.

It is well documented that parenting websites and social media generally are used as spaces for discussion and sources of information and advice about (childhood) vaccinations. Founded in 2000, the online parenting website Mumsnet includes a community forum section, Mumsnet Talk, which, at the time of this writing, hosted 230 topics. Interactions on Mumsnet Talk are associated with an open, straight-talking communicative style. Contributors (known as "posters") respond to requests for advice from an "original poster" (who posed the question that begins the thread). In the five unique threads under study here, the original posters are undecided about whether to consent to their child receiving the HPV vaccine in a United Kingdom (UK) school. This uncertainty leads them to ask for advice on Mumsnet Talk.

For the study, an instance of "narrative" was operationalixed as the telling of one or more actions or events involving personal experiences of vaccination, HPV infection, HPV-related health concerns and illness, and other related topics. An instance of "information" was operationalised as the provision of generic and potentially verifiable facts concerning vaccination, HPV infection, and/or HPV-related illness. An individual post could in principle contain one or more narratives and/or one or more instances of information, or no instances of either (posts can consist of questions, expressions of personal opinion, and so on).

Table 1 in the paper illustrates the distinct characteristics of the five threads, showing, for example, the wide range in the number of replies to the original post (from 17 to 209), the time lapse between when the posts were made (2008 to 2017), the fact that the two threads that result in a decision not to vaccinate have the lowest numbers of replies prior to the announcement of a decision (17 and 25), and the fact that the Talk topics in which they occurred were different. The cumulative total of the 520 posts across the five threads was used to investigate patterns in the quantity and quality of the posts (supportive vs. challenging) that engaged with narrative versus information provided in others' posts, as well as with different types of narratives.

The analysis revealed that narratives and information were used by posters in similar quantities as a means of providing vaccination-related advice. There were also similar frequencies of direct engagement (e.g., by responding to another user) with both narratives and information. However, narratives resulted in a significantly higher proportion of posts exhibiting supportive engagement, such as responses to illness narratives, manifested in expressions of gratitude, advice, and sympathy, which is consistent with the claim in the literature, noted earlier, that narratives facilitate cognitive and emotional involvement with the predicament of narrators and characters. In contrast, information resulted in posts exhibiting a significantly higher proportion of challenges, including counterarguing and other manifestations of posters' resistance to persuasion.

One explanation for why the narratives may have elicited fewer challenges is that narratives are presented and understood by Mumsnet users as drawing from authentic lived experience, which is generally agreed and understood to involve considerable personal disclosure. In that context, and especially when problems or hardship are being narrated, direct challenges may be perceived as face-threatening, insensitive, rude, or unnecessarily combative.

In other words, based on the proportion of supportive versus challenging engagement in these data, the researchers conclude that narratives are less likely than information to result in challenges. By challenges, they mean resistance in the form of counterarguments or other critical reactions. Previous studies have shown this to be the case in experimental settings, but this study provides data from naturally occurring online interactions, triangulating experimental findings on resistance to persuasion from non-naturalistic data collected and reported in earlier studies.

In conclusion: "Given the importance of online parenting forums and Mumsnet specifically as authentic settings and sources of vaccine-related information", this study "has provided evidence that personal story-telling has an important role in providing pro-vaccination advice, and that, depending on the nature of the story that is told, some narratives are rarely explicitly challenged."