Stories: A Powerful Tool for Treating Unhealthy Behaviors

Source: Robert Robinson / Public Domain

The last time you convinced somebody of stopping or avoiding an unhealthy behavior, what was it that got them to go along? Let me bet: At least half the time it was a story. That’s because stories can convince, unlike any other form of communication.[i]

What is it about narrative, psychologically, that persuades someone to take better care of their health? If you back away from the detail in a host of studies, scientists have looked at that question from two points of view.

Disarming and Transporting

From one, they have asked how stories lower people’s tendency to take issue with what the healthy-living message says. From another, they have asked how stories sweep people off their rational feet—essentially charming them to go along for the narrative ride.

How, in the first case, do stories disarm people’s internal skepticism? Research shows that, above all, they reduce “counterarguing.”[ii] That is, they dissuade people from debating the details of what’s communicated.

They also cut what researchers call “threats to freedom,” in which people reject what’s being said rather than cede their freedom to judge for themselves.[iii] Beyond that, they also reduce people’s impulse to gratuitously—even angrily—criticize a message coming from the outside.[iv]

From another point of view, researchers have asked how stories increase the likelihood of people getting caught up more in the plot than facts. Researchers call this “transportation.”[v] In experiments, the degree of transportation is measured by how much people agree with statements like, “I could picture myself at the scene of the events described in the narrative.”[vi]

Stories can also increase what researchers call “identification,” in which readers or listeners see similarities in themselves or their situation to what they’re reading.[vii] Beyond that, stories also spur “elaboration,” in which readers explicitly reflect on what the story means to them.[viii]

The Persuasive Effect

How well do stories do both jobs—disarming and transporting—and in turn change unhealthy behaviors? In a 2023 review article, Matthew Dudley and others at Johns Hopkins and Cal Tech found that, in 54 of 78 previous studies (69 percent), the use of narrative improved the effectiveness of science and health communication. The use of narrative cut effectiveness in only 12 percent of the studies.[ix]

Kurt Braddock and James Price Dillard at Pennsylvania State University assessed the impact of narrative on four indices of persuasion: changes in beliefs, attitudes, intentions, and behavior. Their meta-analysis in 2016 consistently showed that stories exhibited significant effects on all four variables. They wrote, “We can categorically conclude that narrative does exert a causal influence on four of the most common indices of persuasion.”

Jie Xu at Villanova directly compared the effectiveness of narrative and statistical evidence in a 2022 meta-analysis of 50 studies. A narrative had a significant advantage in improving the effectiveness of health messages advocating prevention behaviors. The same was not true for cessation behaviors.[x]

Fuyuan Shen at the University of Pennsylvania and others found roughly similar results.[xi] After an analysis of 25 studies in 2015, they wrote, “The average effect size was significant for disease prevention and detection but not for the cessation of addictive behaviors.”

A Quality Story

Given the variation in research results, a key question emerges: What about the quality of the story? A good story ordinarily features a sympathetic protagonist, facing a problem, trying a few solutions, coming to a realization, and walking a path to a better life. It features action and emotion, then insight and resolution. How much does each element of quality—aside from the story form itself—make a difference?

Researchers don’t yet have the data to say. But while we wait for further evidence, we can learn from existing research the answer to one crucial question: If you’re preparing to talk someone out of unhealthy habits with a story, how do you best go about it?

The first finding, which like others comes from experiments with public health communications, is that you should tell the story in the first person (“I”). Either chronicle your own first-hand experience or have someone else chronicle theirs. By using the first person, as shown in several studies, your message comes across much more powerfully than by using the third person.

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An example comes from a 2020 study of smoking cessation by Juan-José Igartua and Laura Rodríguez-Contreras in Spain. The two researchers gave one of two versions of a smoking-cessation message to 525 smokers. One version was written in the first person, the other in the third. The first-person version won handily, apparently from spurring less counterarguing and more identification with the protagonist.[xii]

Second, you should tell a story about healthy behavior, as opposed to unhealthy. Be positive. In a study of 153 experiments led by Anneke de Graaf at Radboud University Nijmegen in the Netherlands, researchers sought to identify which features matter most in story effectiveness. Their results showed the importance of focusing on healthy instead of unhealthy behaviors (and like the work of Igartua and Rodríguez-Contreras, singled out the effectiveness of the first person in doing so).[xiii]

Third, you should choose a character your audience can identify with. Research reported in 2019 led by Joëlle Ooms at the University of Groningen in the Netherlands, for example, found that in health messages about breast and testicular cancer, college-student-age people responded best to characters their own age. (Interestingly, this was not true of older adults in the same study.)[xiv]

Fourth, you should focus on a single character, not several or a bunch. Chelsea Ratcliff and Ye Sun at the University of Utah synthesized the results of 25 studies of narrative. They found a primary single character had more effect. They speculated that it allowed the audience greater immersion in the story and identification with the protagonist.[xv]

Other factors probably count, too—for example, emotion.[xvi] But research to isolate particulars remains in process. For now, we at least know that if you want to help someone with their health, you cut yourself short if you go with facts alone. A story’s ability to disarm and transport will help you to win the battle of personal persuasion.