Researcher and student team up to explore a strategy that uses storytelling to creatively and effectively communicate about health issues.
Many countries around the world, including the U.S., are experiencing record-breaking numbers of coronavirus cases and deaths. The alarming surge of the pandemic comes as millions of Americans travelled over the Thanksgiving holiday, despite the CDC and health officials urging everyone to stay at home and celebrate in the safety of smaller social bubbles. Another surge is possible after the December holiday break, as record numbers travelled despite similar warnings. The sights of crowded airports left public health officials pondering how to better get the message across. Communicating about the pandemic has been a significant challenge worldwide, with information about the virus changing and evolving rapidly, and misinformation hampering uniform enforcement of safety measures.
We talked to health communication experts, Dr. Amy Henderson Riley, assistant professor at Jefferson’s College of Population Health, and Elizabeth Critchlow, a current MD-MPH student working with Dr. Riley, about a strategy called “entertainment-education.” The pair, along with researchers around the globe, recently published a study exploring how the strategy has been used to effectively communicate about COVID-19.
Q: What is entertainment-education, and what makes it different and maybe more effective than other communication strategies?
AHR: Entertainment-education is a theory and evidence-based health communication strategy that embeds educational information into fictional storytelling using a cast of entertaining characters. The idea of using storytelling for change has existed for centuries. Think of stories with a purpose that you were taught as a child and that exist across culture and time, such as Aesop’s Fables. This is the underlying idea of entertainment-education: using stories to impart knowledge and influence behavior. This approach has been used to address a host of public health issues in the past including HIV/AIDS, family planning, maternal and child health and others. Unlike a public service announcement where messages are overt and direct, entertainment-education education stories must be entertaining first and foremost.
Q: Are there examples of entertainment-education campaigns we might come across in our everyday lives?
AHR: Absolutely. Sesame Street is probably the best known example, and Sesame Workshop operates in over 150 countries around the world. But entertainment-education is not just for children. For example, there have been planned entertainment-education episodes in U.S. shows including Grey’s Anatomy and E.R., and there was a long-running series a few years back on Hulu called East Los High, which was very popular and designed around sexual and reproductive health topics for Latinx youth.
Q: Has the entertainment-education strategy been used in other health crises?
AHR: One example we cover in the article was how entertainment-education was used successfully during the 2014 Ebola outbreak. Messages were broadcast in local languages across impacted communities in West Africa to quickly disseminate critical information using existing channels and programs.
EC: One strategy that stuck with me from the 2014 Ebola outbreak were songs that were created in Liberia, most by local artists, to provide culturally-relevant information to keep people safe. These songs were also very catchy – one is still stuck in my head!
Q: What were lessons learned from examples where entertainment-education was used successfully in other health crises?
EC: Our colleagues on this paper shared how Sésamo (Sesame Workshop in Latin America) responded to the local Zika outbreak. Sésamo created short PSA-style clips on YouTube, using some of their well-loved characters to share safety messages about Zika and mosquito avoidance that were relevant for their young audience and their parents. These videos helped underscore one of the main ways entertainment-education can work in an emerging health crisis – by leveraging existing and loved characters and storylines to create content quickly that resonates with the audience.
AHR: Another lesson from previous health crises is that entertainment-education programs were tailored to the local culture and created by local teams of actors and writers. This is critical to this health communication approach.
Q: What are examples of entertainment-education being used during COVID? What are the challenges that came up?
AHR: Our paper highlights case studies from three global organizations that implemented entertainment-education programs for COVID-19. PCI Media adapted and produced a radio series in Mozambique that included call-in shows with local health workers to answer questions about the virus on the air in local languages. BBC Media Action created a series of two-minute radio shows for rural and peri-urban audiences across India that used riddles to explain social distancing, symptoms, and treatment-seeking behavior (Paheli Pahelwan). And Sésamo produced content for learning at home, including a web series with Cookie Monster learning about how to protect himself from the virus. Some of the challenges that came up were producing mass media under lockdown conditions, reaching diverse audiences across large geographical areas, rapidly changing information and balancing other work unrelated to COVID-19.
Q: What does your research say about how to craft effective entertainment-education messages?
AHR: Our research found that it is important to start with existing infrastructure to build capacity, support, and trust, which is critically important in times of fear and misinformation.
EC: From this project, I learned that entertainment-education leads with entertainment, and therefore incorporating this factor of enjoyment and narrative in health messaging can be important for combatting misinformation around COVID-19 by engaging people first. As Dr. Riley mentioned, tailoring to the audience and including local stakeholders at every step of programming is also vital in entertainment-education, especially to rebuild trust in this era of public doubt in science. Because entertainment-education centers on a core of storytelling, it can be utilized in a variety of different media types and therefore reach people across socioeconomic spaces, including in low resource areas.
Q: What do you think is next for entertainment-education and COVID?
AHR: We have to keep thinking about what entertainment looks like today and what that means for theory and practice. For example, newer entertainment-education programs that use formats such as TikTok and social media are very different than a traditional 22-minute television show or a long-running radio series. My hope is that these conversations can be ongoing and include both academics and practitioners.
Q: You had co-authors on several different continents. How did that come about?
AHR: My first email was to my colleague Angeline (LeeAnn) Sangalang, a communication professor at the University of Dayton. Together, we invited colleagues from our professional networks including Neemesha (Meesha) Brown from PCI Media, Radharani Mitra from BBC Media Action and Brenda Campos Nesme from Sesame Workshop Latin America.
EC: This project was ideal in a scenario like this pandemic in which travel is out of the question and technology is key. It was exciting to be able to meet on ZOOM and engage with our colleagues from around the world. It was especially interesting to be able to understand how they framed COVID in their work.
Q: Can you both share what it was like working on this project together?
AHR: Elizabeth is a dual degree MD-MPH student who started working with me as a graduate assistant at our college on July 1, 2020. At our first meeting, I told her about this project and soon threw her right in! This is my style when working with graduate students: I add them into applied research projects where they can “learn by doing” and apply what they are learning in the classroom, but with support and encouragement at every step. Having Elizabeth on this project was critical to its success.
EC: I learned so much! This was my first opportunity being on a research project that spanned the timeline from project inception to publication. I feel so fortunate that Dr. Riley provided space for me to be involved at almost every step. I helped create the items that went to our practitioners, collected the information on our case studies, worked on the literature review for and wrote part of our background. I also assisted with our “response to reviewers” document during the manuscript review stage.
What kind of feedback have you received on the article so far?
AHR: Two professors at other universities shared they are adding it to their winter course syllabi, as they are interested in adding in recent published work on COVID to health communication courses.
EC: I have heard some very kind feedback from professors in the college who have congratulated us on the article. Even my mom, who is not used to reading academic pieces at all, read the article and enjoyed it!