The Art and Science of Patient Storytelling: Harnessing Narrative Communication for Behavioral Intervention

Emotive Storytelling: Narrative communication is a powerful strategy for influencing health behavior.

Emotive Storytelling:
Narrative is a powerful strategy for influencing health behavior.

With the increasing interest in the use of narrative communication as a strategy for influencing health behavior, there has been an effort to develop standardized protocols for creating engaging stories and to determine the successful components of an effective story. 

Dr. Thomas Houston, who is associated with the Department of Veterans Affairs, and the University of Massachusetts Medical School, with several colleagues, have published an interesting study describing a protocol for developing narratives  that are consistent with theoretical principles of behavior change that also transport the viewer.  In this study, “the authors evaluated a protocol of editing narratives for a multimedia intervention to promote smoking cessation in the African American community that maintains fidelity to the original message and was related to behavioral constructs from social cognitive theory.”

The authors point out that stories that maximize emotional and intellectual engagement in the story, perceived authenticity of the story, and a sense of identification with the storyteller increase the likelihood that the viewer of the story will remain focused and engaged.  They videotaped real, unscripted personal narratives from individuals from the same community to develop their protocol for creating effective and engaging narratives associated with smoking secession messages.  Here is a summary of their four part protocol for developing effective behavior change narratives:

  • Collect the narratives (videotape interviews with actual smokers and former smokers who were having health problems related to cardiovascular issues)
  • Narrative review (select content that was consistent with social cognitive theory of behavior change–see below)
  • Narrative editing (create a narrative that followed dramatic documentary style).
  • Pilot testing (assess usability and dramatic engagement).

The authors edited the narratives so that their content reflected four constructs from social cognitive theory:

  • Direct verbal persuasion (encouraging others to quit smoking)
  • Outcome expectations (risks of smoking and benefits of quitting)
  • Direct experience with (physicians, family, medications, behaviors or habits)
  • Outcome expectancies (personal relevance, desire to quit smoking)

The authors’ conclusions?  “Although challenging and time intensive, our preliminary evaluation suggests that we successfully captured statements mapping to behavioral constructs and that an engaging product was created that, even after editing, was still considered engaging by the target audience.”

We are fortunate that research is being conducted on how to develop effective stories. These authors followed this research with another study on how effective their stories were in actually impacting smoking behavior.  More on that soon.

Bottom line — It’s important that science address these issues; there may be more that we can learn regarding how to be more efficient at creating effective, persuasive stories.  In addition, we believe that science will confirm what we have known for millennia, stories are effective at teaching and changing behavior.



(Publication style reference)  Houston, T., Cherrington, A., et. al.  The art and science of patient storytelling– Harnessing narrative communication for behavioral interventions:  The ACCE Project.  (2011). Journal of Health Communication: International Perspectives, 16, 686-697.

(Recommended reference)  Thomas K. Houston , Andrea Cherrington , Heather L. Coley , Kimberly M. Robinson , John A. Trobaugh , Jessica H. Williams , Pamela H. Foster , Daniel E. Ford , Ben S. Gerber , Richard M. Shewchuk & Jeroan J. Allison (2011) The Art and Science of Patient Storytelling—Harnessing Narrative Communication for Behavioral Interventions: The ACCE Project, Journal of Health Communication: International Perspectives, 16:7, 686-697, DOI: 10.1080/10810730.2011.551997

 Storytelling uses Narrative Communication to drive Behavior Change.

Emotive Storytelling™ encourages behavior change through the use of narrative communication, neuroscience, digital media, games and mobility.  Narrative Communication as a source of emotive persuasion and education has a long history and a sound scientific underpinning.  Emotive Storytelling™ integrates the emotional power of the storytelling, cinematic technique, neuroscience, health games, mhealth (mobile health), digital tools and internet technology to drive user engagement, adherence and behavior change in healthcare delivery, marketing, education, and business.

See how storytelling can help harness narrative communication for behavior change


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