Using Narratives to Bypass Fatalism in the Context of Sun Protection Behaviors

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Fatalism can be a significant barrier to cancer screening, prevention, and treatment. Given its association with social determinants, and religious and cultural norms, altering fatalistic beliefs is often challenging. Consequently, an alternative approach to promoting healthy behaviors among fatalistic individuals could be to focus on modifying specific behavioral beliefs, rather than attempting to change fatalism itself. This dissertation explores the potential of narrative persuasion to bypass the effects of fatalism on sun protection behavior by enhancing individuals' beliefs in the efficacy of sun protection measures. The study seeks to address three primary questions: (1) Are narratives more effective than non-narrative messages in enhancing behavioral beliefs about sun protection in fatalistic people? (2) Does incorporating fatalistic beliefs about sun protection within narrative and non-narrative messages increase the intention to engage in sun protection, particularly among those with fatalistic views? And (3) What is the role of classic narrative mechanisms—such as transportation, identification, and counterarguing—in these relationships? A 2 (narrative vs. non-narrative) x 2 (fatalistic vs. agentic) between-subjects experiment was conducted to test the hypotheses and research questions (N = 500). Using a sample of predominantly non-Hispanic White American adults, the findings revealed no significant difference between narrative and non-narrative messages in influencing the belief that sunscreen prevents skin cancer. Similarly, the study did not find support for the positive effect of message-viewer consonance (regarding fatalistic/agentic beliefs about cancer prevention) on behavioral beliefs about sunscreen. However, a positive moderating effect of baseline fatalism on the relationship between exposure to narrative stimuli and behavioral beliefs was observed. According to the findings, narratives were more persuasive than non-narratives for people who scored higher on the fatalism scale. Tests for the mediating role of narrative mechanisms, however, yielded unexpected results. The data indicated that narratives had unintended indirect effects on beliefs and post-test cancer fatalism through the mechanism of counterarguing. Participants in the narrative conditions were more likely to counterargue the message, and since counterarguing was negatively associated with beliefs and cancer fatalism, narratives had a negative indirect effect on beliefs and a positive indirect effect on cancer fatalism. The findings illuminate the role of individual characteristics in shaping responses to health messages, raising important questions for future research. Specifically, future studies should explore (1) the underlying mechanisms that make narratives more effective for individuals with fatalistic beliefs, (2) how people's expectations of different message types and formats influence their reactions, and (3) the consequences of violating these expectations. Furthermore, these results prompt a critical discussion on the boundaries of narrative persuasion. Assuming that narrative persuasion is universally effective or appropriate in all contexts may be misguided, especially in health contexts, as it could lead to unintended consequences. Therefore, it is crucial to consider individual differences in baseline beliefs and employ tailored approaches when designing health messages to ensure their effectiveness.
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