Using stories to battle unintentional injuries: Narratives in safety and health communication

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Abstract

After 14 years of rising death rates due to unintentional injuries in the U.S., it is time to ask how safety messages can be redesigned to have a greater impact on risky behavior. To this end, many researchers have called for a new, narrative approach to prevention messages—based on persuasive stories about people who have suffered injuries and illnesses in the past. Still, there is scant evidence that story-based communications are more effective than equivalent non-narrative messages at changing actual (rather than self-reported) safety and health behavior. Our research examined the impact of injury stories on actual safety behavior in a controlled experimental setting at a US university. Teams of participants assembled a product (a child's swing) using written instructions. The instructions contained safety messages targeting assembly mistakes that have been linked to serious injuries in children who play on swings. Participant teams were randomly assigned to three conditions: assembly instructions containing story-based safety messages, instructions with concrete (but non-anecdotal) safety messages, and instructions with traditional abstract safety messages. After adjustment for covariates, story-based messages resulted in a 19 percent improvement in safety behavior, compared with non-narrative communications. Importantly, injury stories did not create undue fear of the message object, demonstrating that brief anecdotes about accident victims can convince people to take reasonable precautions without creating unwarranted alarm about risks.

Section snippets

Previous research on story-based safety and health communication

Many scholars have recommended using stories in safety and health messages (e.g., Cullen and Fein, 2005, Singhal et al., 2004). Still, there is little direct evidence that stories are superior at changing behavior, compared with equivalent non-narrative information. This statement may seem surprising to those familiar with the notable accomplishments of past investigations. Most research, however, has been limited to case studies, comparisons with no-treatment controls, and studies in which the

Theories of story-based communication

Besides examining whether stories are effective, our study sought to shed light on how they work. For instance, Green and Brock (2000) suggested stories psychologically “transport” readers into the scene of a narrative. Good stories trigger vivid images and strong emotions reminiscent of first-hand experience. Based on Green and Brock's transportation-imagery model, we might expect the following response from someone reading our story about the girl who fell from her father's lap while mowing:

Overview of the experiment

Participants assembled a product (a preschooler's swing, see Fig. 1) using printed instructions with embedded safety messages. The experimental setting allowed us to measure behavior objectively while controlling potentially confounding factors. We chose the swing assembly task because research has linked swing injuries to hazards that can be addressed during assembly (U.S. Consumer Product Safety Commission, 1997, Tinsworth and McDonald, 2001).2

Research questions

Our main purpose was to examine the behavioral impact of stories. Thus, the focal question was:

  • 1.

    How is behavior affected when traditional abstract safety messages are supplemented with stories or, alternatively, concrete non-anecdotal information about injuries?

A secondary purpose was to examine the psychological impact of stories:

  • 2.

    What is the relationship between message impact and the following psychological variables?

    • a.

      Narrative transportation (being absorbed in the reading experience, Green &

Participants

Because of its size, the swing was assembled by two-person teams. To ensure at least two participants were present, three volunteers were solicited for each experimental session. When all three attended, one observed silently.

Participants included 142 individual students (44 males; 98 females) comprising 54 teams, with 18 teams assigned to each of the 3 conditions. Mean age was 20.01 years (SD = 3.53). Participants were volunteers who received credit toward courses at Kansas State University. The

Initial analyses of covariates and results of random assignment

Since we examined team behavior, we created team covariate scores. Team age was the average age of the two assemblers. Individual and team childcare experience were positively skewed (individuals reported a median of 161.25 days providing childcare). We corrected skewness by averaging the log of the two assemblers' childcare experience to create the team score. Play-equipment assembly experience was positively skewed, but could not be corrected (individuals reported a median of 1.00 prior

Discussion

Our safety messages were more effective when they contained brief stories about people who were injured in the past. This effect occurred even when we controlled for message concreteness, informational content, reading difficulty, message length, use of personal pronouns, message channel, and level of participant activity and interaction.

In contrast to our results, Mazor et al. (2007) observed no behavioral effects for story-based messages, compared with equivalent non-narrative communications.

Conclusions

Despite an overall decline in nonfatal injuries, accidental death rates are on the rise. This upward trend in serious injuries demands preventive approaches with proven impacts on safety and health behavior. In the last two decades, practitioners and researchers have developed new communication methods based on stories of injury and illness victims. Story-based approaches are now common in a range of contexts, including workplace safety, community-based health, patient education, and mass media

Acknowledgements

This report was based in part on Mitch Ricketts' Ph.D. dissertation. Appreciation is expressed to the dissertation committee for their many contributions to study design and interpretation of data. Committee members included James Shanteau (major advisor), Brian Niehoff (committee chair), Laura Brannon, Clive Fullagar, Richard Harris, and Paula Peters, Kansas State University.

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