The lack of health literacy in the United States represents a widespread and serious health threat (1). Entertainment Education (EE) embeds health information into entertaining narratives (2) and holds promise for increasing health literacy among large audiences. This study will investigate the effects of manipulating three narrative elements in audio soap operas that incorporate breast and colorectal cancer screening messages as EE recommends. Study participants will be African American women over 50 years old, an audience that has reported getting health information from soap operas (54) and for whom screening for these diseases is recommended (6). The research will be guided by the Transportation/Imagery Model (4) which theorizes that exposure to narratives changes health behavior and its determinants only when an audience member feels carried away or """"""""transported"""""""" into a narrative world. We hypothesize that there will be higher scores on outcome measures among soap opera listeners than among members of a control group who listen to an expert interview. Among soap opera listeners, we expect higher levels of transportation when: (a) cancer screening messages are embeded in a central plot that involves main characters rather than in a subplot that deals with minor characters, (b) the narrative is a drama with a consistently serious tone instead of a comedy, and (c) the plot rewards the character for being screened with an immediately negative test result instead of with an eventually successful outcome of treatment that began early because of a positive screening result. When transportation scores increase, we predict increases in cancer literacy, other psychosocial screening determinants, intentions to seek information and screening, and actual information-seeking and screening behavior such as appointment- making. Formative research will guide the development of various versions of audio soap operas that will incorporate breast and colorectal screening messages. Then two randomized experiments will be conducted. Six hundred women will each hear one version of a soap opera in a small, face-to-face group. Participants will complete questionnaires immediately before and after exposure to the audiotape and one month later.
African Americans have lower levels of health literacy compared to whites and African American women suffer negative breast and colorectal cancer disparities with regard to screening rates, late-stage diagnosis and death (8,9). The long-term objective of this study is to develop more effective ways to deliver health messages to and promote health literacy among African American women. The public health relevance of such knowledge lies in its potential to decrease health disparities in a significant minority population.