Content-conditional effects in patient story advertising : a dual-mechanism approach to healthcare narrative persuasion
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Each year, nearly 2 million Americans receive a cancer diagnosis, a life-altering event fraught with uncertainty. Many turn to cancer center advertising, particularly patient story advertising, for reassurance and hope. This type of advertising employs emotionally compelling patient success stories to promote healthcare brand quality, potentially misleading vulnerable consumers by oversimplifying complex healthcare realities and creating unrealistic expectations. Existing research on patient story advertising primarily consists of descriptive analyses, leaving significant gaps in understanding the causal influence of story features on consumer decision making. This dissertation addressed the problem of how patient story advertising influences vulnerable healthcare consumers' decision making in the high-stakes context of cancer care. Through two complementary experiments, this dissertation systematically examined how intrinsic features of cancer patient stories--content (what information they convey), characters (how patients are portrayed), and plot structure (how the story unfolds)--influence consumer perceptions and decision making. Study 1 (N = 1498) deconstructed patient stories into their component content types to understand how content (physical outcome, psychological outcome, experience) and character presence function in isolation. This systematic deconstruction revealed content-conditional effects that challenge universal enhancement assumptions. Study 2 (N = 1058) examined how plot structure (high vs. low narrativity) and character presence influence narrative persuasion in complete patient stories that integrate all content types. Structural equation modeling was used to analyze relationships between story features, psychological mechanisms, and brand outcomes. The findings revealed more complex patterns than predicted by existing narrative persuasion theories. Study 1 demonstrated that content type fundamentally moderates how story elements function, with physical outcome content showing unexpected versatility, psychological outcome content triggering critical evaluation, and experience content activating competing observational and simulation routes. Study 2 revealed that transportation and identification function as parallel rather than sequential processes with different downstream consequences--transportation primarily reducing resistance and identification primarily enhancing emotional engagement. Healthcare attitudes emerged as a critical moderator, with narrative effects stronger for consumers with less positive attitudes toward healthcare. These findings collectively support the Patient Story Advertising Model (PSAM) developed through this research. This theoretical framework integrates theory from marketing, medical decision making, and psychology to explain how different story features work through distinct but complementary mechanisms to influence consumer healthcare decisions. The PSAM transforms understanding of narrative persuasion in healthcare contexts while providing evidence-based guidelines for developing more effective and ethical patient stories. This research informs debates about healthcare advertising regulation while fostering ethical storytelling practices that balance emotional engagement with informed decision making.
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Ph. D.