Using Narrative Evidence to Convey Health Information on Social Media: The Case of COVID-19

"Narrative is a human and pluralistic means that appeals to everyone. Hence, by using existing narratives on social networks while simultaneously creating new narratives to transmit information, health officials and policy makers are more likely to be able to influence actual health attitudes and behaviors."

During disease outbreaks or pandemics, authorities must convey effective information that will move members of the general public to cooperate with guidelines and even change their behaviour, as in the need for social distancing and isolation during the COVID-19 crisis. In addition, they must compete for the public's attention with other sources that may be manufacturing misinformation. In such a complex multimedia environment, the use of narrative has advantages. However, when authorities have diverged from the tradition of conveying dry, statistics-based health information during disease outbreaks or pandemics, they have tended to employ apocalyptic narratives. This paper proposes an alternative coping narrative and recommends five conditions for using narrative evidence that can support launch of a social media communication campaign. It also proposes criteria for evaluating the effectiveness of such a narrative-based campaign.

Narrative evidence is constructed in the form of a plot that has a beginning, a middle, and an ending (often left open). Stories involve characters who portray life experiences, including challenges emerging from their daily lives or during crises; they also transcend their personal stories to represent communal stories that often entail information about goals, plans, actions, and outcomes. Seven qualities of narratives make them promising in the field of emerging infectious disease communication in that they can:

• Overcome resistance to advocated health behaviour;
• Render complex information comprehensible;
• Reach audiences that are less knowledgeable;
• Engage audiences that are less involved;
• Ground messages in the culture and experiences of the intended audience;
• Use aesthetic means to convey information; and
• Convey a diffused story through social networks, which "generates relationships between people that transcend geographic and linguistic borders. These relationships turn strangers into friends and transform passive audiences into active coparticipants..."

When authorities do go beyond the conveyance of pandemic-related information in a statistics-based and didactic manner, they often turn to a narrative that reflects the fact that pandemics are difficult and complex events arousing fear, panic, and alarm. "Artistic expressions of epidemics in literature, painting, sculpture, and other media symbolize the sense of vulnerability in the face of uncertainty and death, as well as the random nature of death itself. The villain of the plot is the virus that is threatening to destroy humanity, while the 'good guys' or heroes are the lifesaving medical workers. The narrative also includes characters depicted as disease spreaders, usually from disempowered communities....In pandemic narratives, our anxieties are not assuaged; we are invited to struggle rather than to overcome..."

Furthermore, "In recent disease outbreaks, health organizations seem to have strengthened this apocalyptic narrative by using strategies of intimidation to make the public follow instructions and guidelines....This can be seen in the language and tone of information delivery (eg, use of war language to describe COVID-19 as a cruel enemy that needs to be defeated...)." One problem with this type of narrative, as argued here, is that using intimidation without empowering individual self-efficacy runs counter to the extended parallel process model (EPPM). The EPPM tells us that, for fear-based policies to be effective, policymakers "must induce a moderate level of fear alongside a higher level of self-efficacy and response efficacy. When the public's fear exceeds its sense of self-efficacy, the message becomes ineffective."

As opposed to this apocalyptic narrative, this paper proposes an alternative coping narrative, based on health and risk communication approaches and frameworks, which involves:

• Segmenting each subgroup to tailor messages;
• Reducing barriers (e.g., to measures like physical distancing) through narrative;
• Using role models to teach social behaviour and boost self-efficacy through narrative;
• Strengthening collective efficacy through stories that emphasise mutual support;
• Preventing stigmatisation of at-risk populations through narratives of social solidarity; and
• Communicating uncertainty through transparent narratives.

Table 1 in the paper summarises the strategies and components of a pandemic coping narrative. For each apocalyptic pandemic narrative, an alternative pandemic narrative that offers coping strategies is presented to help health organisations transform one narrative into the other.

A narrative media campaign launched on social media can be based on one or both of the following methods: (i) posting personal stories on social networks and distributing them to relevant subgroups in the population via channels designed to reach these groups; (ii) using narratives based on preliminary research that identifies the public's questions and concerns and responds to them through narrative evidence posted on social networks. The paper outlines the five conditions required for each (as well as methods and prospective outcomes):

1. Tailor messages toward targeted behavioural change based on the needs and experiences of different subgroups.
2. Refer separately and distinctly to each information unit or theory arising on social networks.
3. Identify positive deviants: those who have found creative solutions for stress during the COVID-19 crisis, for example, that other members of the community did not find.
4. Create different stories of coping experiences.
5. Maintain a dialogue with skeptical and hesitant groups.

The paper also offers criteria for evaluating the effectiveness of a narrative by addressing narrative mechanisms, rhetorical concerns, and empirical questions to gauge each narrative's potential for change. Formative evaluation focuses on participatory research with the intended audience before, during, and after launching the communication campaign. Such a formative evaluation for narrative building should be preceded by qualitative empirical research (involving, for instance, personal interviews, focus groups, and role playing) among representatives of the intended audience. Table 2 in the paper summarises the questions and issues relevant to examining a narrative through evaluation research.

In conclusion: "The proposed use of narrative as a communication tool will help policy makers more effectively manage how they communicate with the public during disease outbreaks and pandemics."