Study Finds Storytelling Helps Overcome Cervical Cancer Screening Disparities
, by NCI Staff
Using a narrative story-telling approach to educate women about screening for cervical cancer improved their knowledge about and attitudes toward screening and increased the number of women who were screened or who intended to be screened, according to a recent study.
The study, led by researchers from the University of Southern California Annenberg School for Communication and Journalism and USC Keck School of Medicine, also found that the narrative approach was particularly effective with Mexican American women. Findings from the NCI-funded study were published April 23 in the American Journal of Public Health.
Nationwide, Hispanic and African American women have a substantially higher incidence of and mortality from cervical cancer than non-Hispanic white women. In Los Angeles County, Hispanic women have the highest incidence of cervical cancer among racial/ethnic subgroups and are twice as likely as non-Hispanic white women to be diagnosed with cervical cancer.
Lead investigator Sheila Murphy, Ph.D., and her colleagues decided to test whether an educational video that uses a storytelling approach could improve women's cervical cancer screening rates and knowledge about cervical cancer. They randomly assigned approximately 700 non-Hispanic white, Mexican American, and African American women ages 25 to 45 who lived in Los Angeles to view either an educational video that depicted a fictional Mexican family discussing cervical cancer and screening or a video that provided the same information but used a more traditional, non-narrative approach.
Participants were surveyed about their cervical cancer-related knowledge, attitudes, and behavior (e.g., whether they had been screened recently or ever or were planning to be screened in the future) at the beginning of the study and 2 weeks and 6 months after viewing the video.
Mexican American and African American participants had lower scores at the beginning of the study on these measures than non-Hispanic white participants. At the 6-month follow up, knowledge of and attitudes toward screening were improved regardless of which video they had watched, the researchers reported, with greater improvements among women who had watched the narrative video.
Watching the narrative video also eliminated the disparities in attitudes toward screening and behavior, the researchers found. The effect was particularly pronounced among Mexican American women. “By the 6-month follow up, Mexican American participants exposed to the narrative went from having the lowest rate of screening (32 percent) to the highest (82 percent),” they wrote.
The findings are consistent with other NCI-supported research showing that culturally tailored narrative approaches to education and outreach can be important tools in promoting and changing health-related attitudes and behaviors, including increasing vaccination rates, encouraging people to quit smoking, and improving diet and physical activity, said Sylvia Chou, Ph.D., M.P.H., of NCI’s Division of Cancer Control and Population Sciences.
"The design of a narrative communication intervention is very important," Dr. Chou explained, including factors such as the choice of narrator and the extent to which the audience can relate to the story being told.