UNASSIGNED: Entertainment-education interventions remain underutilized in sexual and reproductive health (SRH) despite evidence that they can be effective and place a low burden on staff. This study explores perceived facilitators and barriers for implementing an entertainment-education video intervention for 18- to 19-year-old African American and Latina women in SRH clinics.
UNASSIGNED: Cross-sectional online survey (n=100) and telephone interviews (n=19) were completed May through August 2018.
UNASSIGNED: SRH clinics were located across 32 US states and 1 Canadian province.
UNASSIGNED: SRH clinic staff were diverse in type of clinic, role, and geography and were recruited using purposive sampling.
UNASSIGNED: Bivariate analyses were used for quantitative data, and thematic analysis was used for qualitative data.
UNASSIGNED: Intervention acceptability, perceived feasibility, and likely uptake were assessed using agreement statements (survey) and open-ended questions (interviews and survey).
UNASSIGNED: Interviewed clinic staff described the intervention as engaging, educational, and promising for improving client SRH knowledge and behaviors. Nearly all (95%) survey respondents said showing the video would be feasible. Most (56%) indicated likely uptake, which was significantly associated with perceived feasibility (P=.000), acceptability (P≤.001), and working at a public health clinic (P=.023). Implementation barriers included the video\'s potential relevance to only certain clients and the need for additional information or staff and/or management buy-in.
UNASSIGNED: This is the first study to assess perceived implementation facilitators and barriers of an entertainment-education video intervention among SRH clinic staff. The intervention was well received, with certain barriers potentially alleviated by offering information about entertainment-education and multiple implementation methods. These findings can help improve dissemination efforts for video-based entertainment-education interventions in clinics serving young women of color.

UNASSIGNED: Mental health conditions and psychiatric disorders are among the leading causes of illness, disability, and death among young people around the globe. In the United States, teen suicide has increased by about 30% in the last decade. Raising awareness of warning signs and promoting access to mental health resources can help reduce suicide rates for at-risk youth. However, death by suicide remains a taboo topic for public discourse and societal intervention. An unconventional approach to address taboo topics in society is the use of popular media.
UNASSIGNED: We conducted a quantitative content analysis of mainstream news reporting on the controversial Netflix series 13 Reasons Why Season 1. Using a combination of top-down and bottom-up search strategies, our final sample consisted of 97 articles published between March 31 and May 31, 2017, from 16 media outlets in 3,150 sentences. We systematically examined the news framing in these articles in terms of content and valence, the salience of health/social issue related frames, and their compliance with the WHO guidelines.
UNASSIGNED: Nearly a third of the content directly addressed issues of our interest: 61.6% was about suicide and 38.4% was about depression, bullying, sexual assault, and other related health/social issues; it was more negative (42.8%) than positive (17.4%). The criticism focused on the risk of suicide contagion, glamorizing teen suicide, and the portrayal of parents and educators as indifferent and incompetent. The praise was about the show raising awareness of real and difficult issues young people struggle with in their everyday life and serving as a conversation starter to spur meaningful discussions. Our evaluation of WHO guideline compliance for reporting on suicide yielded mixed results. Although we found recommended practices across all major categories, they were minimal and could be improved.
UNASSIGNED: Despite their well intentions and best efforts, the 13 Reasons Why production team missed several critical opportunities to be better prepared and more effective in creating social impact entertainment and fostering difficult dialogs. There is an urgent need to train news reporters about established health communication guidelines and promote best practices in media reporting on sensitive topics such as suicide.

UNASSIGNED: While there has been a marked increase in measurement and scholarship surrounding social norms in recent years, there is little evidence related to social norms measurement in the context of health campaigns utilizing entertainment-education. Entertainment-education goals and objectives have shifted over time to include social norms and an update is needed to merge contemporary practice with the most recent measures from the literature. The aim of the present study was to analyze commonly used quantitative measures and their properties for social norms and entertainment-education, specifically on the topic of family planning, to bolster ongoing research and practice efforts by validating items for social norms measurement in entertainment-education programs.
UNASSIGNED: The study used data from a survey conducted with 438 married women aged 19-34 in the Central Province of Zambia in 2019 who were exposed to the entertainment-education initiative Kwishilya (Over the Horizon), a Bemba-language, 156-episode radio program designed to shift social norms on family planning. Multiple items were included to measure descriptive norms, injunctive norms, and outcome expectations. Exploratory factor analysis and estimates of scale reliability were conducted to understand the properties and structure of the social norms items.
UNASSIGNED: Results showed a five-factor solution best fit the data, which accounted for 45.7% of the variance, exhibited fair reliability, and loaded largely as expected.
UNASSIGNED: This study provides a useful tool for practitioners and scholars to use globally to measure important social norms constructs in entertainment-education.

Overweight is one of the major health-related challenges in industrialized countries and mostly preventable through a healthy diet and regular engagement in physical activity. Health communication practitioners and researchers, therefore, started using the media\'s persuasive potential by creating entertainment-education (E-E) programs that promote healthy nutrition and exercise. By observing the characters in E-E programs, audience members can learn vicariously and eventually develop personal bonds with them. The current study investigates the effects of parasocial relationships (PSRs) with characters of a health-related E-E show, as well as the impact of parasocial breakups (PSBUs) on health-relevant outcomes. Using the setting of the show The Biggest Loser (TBL), we conducted a quasi-experimental longitudinal field study. Participants (N = 149) watched shortened episodes of the show once a week for 5 weeks. Results showed that PSRs with the reality TV characters did not increase over time and after repeated exposure. Findings furthermore suggest that PSR did not influence self-efficacy perceptions or exercise behavior over time. Parasocial breakup distress intensity was neither related to self-efficacy nor to exercise behavior. Interpretations of these findings and implications for better understanding the effects of PSRs and PSBUs are discussed.

Cancer is a primary societal challenge worldwide, with over 23 million new cases/year, and 10 million deaths/year. Estimates of preventable cancer deaths rise as high as 70%, but such estimates rely heavily on individual behaviors, which in turn are correlated with knowledge and attitudes towards health and cancer. This paper describes the iterative evidence-based development of the first entertainment-education series on cancer prevention to be televised, and reports its effectiveness evaluation. A nominal group defined the guiding principles that were translated into key characteristics for a series named \'2\' Life-changing minutes\'. Pilot episodes were produced and evaluated in two complementary studies-a focus group study with medical doctors and a survey study with prospective viewers. Results from these studies guided the optimization and production of the full series, which was broadcast on national public TV, in prime time. An evaluation study was performed afterwards with naturally-occurring viewers and results show audience reach on par with purely entertainment series, that health messages can be clearly conveyed through fictional narratives, and that the series has high levels of appreciation and health promotion potential. \'2\' Life-changing minutes\' constitutes a novel and effective proposal for health promotion, that challenges the primacy of information and statistics still common in health communication, with a new format based on stories, characters and social contexts to successfully promote health.

Black women in the Southern U.S. account for 67% of all new HIV diagnoses across women of all races and ethnicities. In comparison to women of other racial and ethnic identities, Black women disproportionately experience internalized stigma, lower levels of disclosure self-efficacy, and lower rates of medical adherence. The disclosure processes model hypothesizes that persons living with HIV can be disclosure avoidance oriented or disclosure approach oriented. Disclosure avoidance is facilitated by various forms of stigma and negative outcome expectations. While disclosure approach orientation is facilitated by factors such as positive disclosure attitudes and disclosure self-efficacy. Despite the important role of disclosure in ending the HIV epidemic, extant interventions are limited. Recent research suggests entertainment-education (EE) may be an effective intervention for HIV status disclosure. Entertainment-education is a persuasive strategy that consists of intentionally embedding health and social messages into entertaining content.
The present study evaluated the comparative efficacy of the 90 DAYS film for improving internalized HIV stigma, disclosure beliefs, positive disclosure attitudes, disclosure self-efficacy, HIV disclosure intentions, and medical adherence intentions. A randomized controlled trial was employed consisting of 130 Black women living with HIV in the Southern U.S. Participants were recruited primarily via a Qualtrics panel and randomly assigned to either view the 90 DAYS film or a standard of care brochure.
Results indicated the EE condition significantly outperformed the brochure condition on the following outcomes: disclosure beliefs (p = .046), positive disclosure attitudes (p = .008), disclosure self-efficacy (p = .007), and intentions to disclose to an intimate partner (p = .038). Statistically significant differences were not observed for internalized stigma or medical adherence intentions.
Findings suggest that EE is an effective strategy for improving psychosocial influences of disclosure and disclosure intentions. Theoretical and practical implications of this work are discussed.

In this article, we examine primetime television as a source of entertainment-education on death. Using directed (deductive) and conventional (inductive) approaches to content analysis, we describe how death and dying are being depicted on two primetime medical television series, Grey\'s Anatomy and Saving Hope. We then discuss what kinds of information viewers may be taking from these series. Our deductive content analysis suggests that much of the messages obtained are fairly representative of what occurs in real hospital settings, with the exception of emotional display. From the inductive analysis, we identified four thematic categories: \'the person dies, but life goes on\', \'the tragic death\', \'the purposeful death\', and \'the well-timed death\'. Regardless of category, no rituals are conducted at the moment of death and little space is made for grieving on primetime medical television shows. While death is often present, displays of grief are avoided.

Adolescents in Mexico experience high pregnancy and birth rates. A collaboration with Grupo Televisa led to the development of an entertainment-education telenovela intervention, Overcome the Fear (OTF), which aired in 2020 to a national audience and addressed adolescent sexual and reproductive health (SRH) topics. This study details the development and evaluation of OTF\'s impact on adolescent contraceptive practices and parent-adolescent SRH communication in Mexico.
We conducted cross-sectional survey interviews (street-intercept and telephone) with 12-19-year-olds (n = 1640) and parents of adolescent children (n = 820) post-broadcast across Mexico\'s five most-populated metropolitan zones. Quotas were implemented for gender, zone, and OTF viewership (viewer vs. non-viewer). Bivariate statistics and multivariable binary logistic regression models assessed the relationship between OTF viewership (including parent-adolescent co-viewing) and adolescent contraceptive practices and parent-adolescent SRH communication. Adolescent and parent data are not dyadic and were analyzed separately.
Nearly half of adolescents (47.9%) and parents (47.7%) were viewers. Among adolescents, bivariate analyses suggest that viewers had less negative attitudes towards contraception (p < .001). Logistic regression models suggest that adolescent viewers were more likely to seek out information about contraception (p < .001) and unhealthy romantic relationships (p = .019), and to use contraception other than condoms (p = .027) and dual contraception (p = .042) in the last 3 months. Among parents, bivariate analyses suggest that non-viewers had more positive attitudes towards abstinence (p = .045) and more negative attitudes towards contraception and communication with adolescents about sex (p = .001). Logistic regression models suggest that parent viewers were more likely to have talked with adolescent children about sexual relations (p < .001), contraceptive methods (p = .01), condoms (p = .002), and abstinence (p = .002) in the last 3 months. Parent-adolescent co-viewing of OTF was also significantly related to certain outcomes in bivariate analyses.
This study suggests that viewership of a high-quality entertainment-education telenovela informed by extensive formative research is related to adolescent health outcomes and to parent-adolescent SRH communication on a country-wide scale in Mexico. Entertainment-education remains an underutilized public health strategy, despite its promise to engage viewers and motivate healthful behaviors.

BACKGROUND: In the Netherlands, all women aged 30-60 years are invited to participate in the national cervical cancer screening programme, which is aimed at early detection and treatment of precancerous lesions. One fourth of the Dutch population has a migration background, with Turkish and Moroccan immigrants being the largest immigrant populations. Turkish- and Moroccan-Dutch women show lower screening participation rates and a higher incidence of cervical cancer, compared to native Dutch women. Since current information materials are not tailored to these women\'s needs, we developed a short culturally sensitive educational video to facilitate informed decision-making for cervical cancer screening among Turkish- and Moroccan-Dutch women. This article describes the development process of this video and the lessons learned.
METHODS: Using the Entertainment-Education communication strategy, we collaborated with an interdisciplinary team of Turkish- and Moroccan-Dutch women, researchers, public health experts, and creative media professionals. We developed the video following the different stages of the Media Mapping model: Orientation, Crystallization, Design/Production, Implementation, and Dissemination. Each stage is described in the paper.
RESULTS: The video was developed in Moroccan-Arabic, -Berber and Turkish, and emphasized three main themes: (1) more certainty about having cervical (pre)cancer and the possibility to prevent treatment, surgery, or premature death, and because of this, being there for the children, (2) according to the Islam, a woman should take good care of her health, and (3) anxiety, shame, and privacy.
CONCLUSIONS: A short culturally sensitive educational video, delivered as part of a larger intervention together with the current information brochure, was developed based on theory and grounded in the needs of Turkish- and Moroccan-Dutch women. The value and effectiveness of this intervention to facilitate informed cervical cancer screening decisions are evaluated in a randomised controlled trial. PATIENT OR PUBLIC CONTRIBUTION: We collaborated with Turkish- and Moroccan-Dutch women during the development process of a short culturally sensitive educational video. Turkish- and Moroccan-Dutch women were also invited to watch the raw footage to verify whether the content and presentation matched their needs and requirements.

The present study examined direct and indirect effects of adolescent narrative engagement on substance use behaviors via refusal self-efficacy. This study also tested moderation effects of communication about substance use with parents, siblings, and friends on substance use behaviors. Students in 8th grade (N = 225) participated in surveys at two different time points. Path analyses revealed a positive association between identification with main characters and refusal self-efficacy as well as negative associations between refusal self-efficacy and the past 30-days substance use. Communication with parents and friends significantly moderated the relationship between refusal self-efficacy and the past 30-days substance use.