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The effects of a COVID-19 narrative message on beliefs and intentions among vaccine hesitant parents

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The effects of a COVID-19 narrative message on beliefs and intentions among vaccine hesitant parents

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Content THE EFFECTS OF A COVID-19 NARRATIVE MESSAGE ON BELIEFS AND
INTENTIONS AMONG VACCINE HESITANT PARENTS
by
Ashley Leone Luth Phelps
A Dissertation Presented to the
FACULTY OF THE USC GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(COMMUNICATION)
May 2024
Copyright 2024 Ashley Leone Luth Phelps

ii
DEDICATION
For Abigail (with 7 letters), Benjamin (with 8 letters), and Nathaniel (with 9 letters),
and for Philly
There will be musicals

iii
ACKNOWLEDGEMENTS
I have found myself crafting dissertation acknowledgements in my head several times
over recent years, but just as often have wondered if the day to put them on a page would arrive.
Now that it has, I find myself somewhat at a loss for words. I hope those mentioned trust the
depth of gratitude I wish to express despite my brevity.
Thank you to Dr. Sheila Murphy for all the lessons and opportunities. I have learned and
grown a great deal as your student and assistant, and I appreciate all your effort to help me finish
this degree. Thank you to Dr. Robin Stevens and Dr. Lindsay Young for your seemingly endless
confidence and support. Thank you to Dr. Tom Valente for asking surprising questions that led
to new ideas. Thank you to the Annenberg faculty members I had the privilege to learn from as a
student or teaching assistant, to Sarah Holterman for everything you do for all of us, and to Anne
Marie Campaign for patiently keeping us all on track.
Thank you to Jeremy Kagan for making the VaccinateLA films, for enthusiastically
inviting me to participate, and for your kindness. Thank you to Alejandro Márquez Vela for your
brilliance with Team Player. Thank you to Annika Dawson and Irina Slepneva for welcoming
me to your team and teaching me along the way. Thank you to the entire cast and crew for a
wonderful experience, for your dedication to this project, and for your COVID-19 compliance.
Thank you to Dr. Lourdes Baezconde-Garbanati and Dr. Michele Kipke for supporting the films
and the studies, and to the entire VaccinateLA team for your support and partnership.
Thank you to my Annenberg peers and friends for your support and comradery,
especially Amber Lynn, Jessica, and Cerianne. Thank you to my “outside” friends for the times
you asked about my work and for the times you did not, especially Lisa, Shoshana, Aya, Lacey,
Kelsey, Melissa, Kim, Marie, and Ashley.

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Thank you to Dr. Jayachandran, Dr. Carr, and Dr. Carey for saving my life. Thank you to
Ron, Sharae, Rachel, and Dr. Mendola for helping me with what happens now. Thank you to all
of you for encouraging me to finish this part.
Thank you to my parents, Tracy and Phil, my in-laws, Pat and Barry, and my sisters,
Renée, Shawta, Kate, and Heather, for more things than I can list.
Thank you to Ben, Nate, and Abby, for your love, patience, support, understanding, and
joy. We did it.

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TABLE OF CONTENTS
Dedication………………………………………………………………………………................ii
Acknowledgements………………………………………………………………………………iii
List of Tables…………………………………………………………………………………….vii
List of Figures…………………………………………………………………………………...viii
Abstract…………………………………………………………………………………………...ix
Introduction………………………………………………………………………………………..1
Chapter 1: Understanding Parental Vaccine Hesitancy and Leveraging Norms to
Change Behavior…………………………………………………………………………………..4
Health Behavior Change and Parental Vaccine Hesitancy………………………………..4
Complacency Beliefs……………………………………………………………...............5
Confidence Beliefs………………………………………………………………..............6
Vaccine Promotion and Risk Communication……………………………………………8
Diffusion of Innovation and Normative Beliefs…………………………………………10
COVID-19 Pandemic and VaccinateLA…………………………………………………11
Source Credibility and COVID-19 Parental Vaccine Hesitancy………………………...13
Introducing Initial Hypotheses…………………………………………………………...15
Chapter 2: Understanding Entertainment-Education and the Development of
COVID-19 Vaccine Promotion Messages, Team Player and Ask a Doctor……………………..17
Message Content Strategies – Framing, Priming, and Persuasion………………………18
Narrative Persuasion……………………………………………………………………. 21
Entertainment-Education………………………………………………………………...23
Introducing the Entertainment-Education Message, Team Player………………………24
Introducing the Nonnarrative Control Message, Ask a Doctor…………………………..26
Explicit Message – Key Points……………………………………………………..........29
Implicit Message…………………………………………………………………………36
Transportation or Engagement with the Message……………………………………......37
Character Identification…………………………………………………………….........38
Emotional Response to the Message…………………………………………………….40
Articulating Remaining Hypotheses……………………………………………………..40
Chapter 3: Methods………………………………………………………………………………46
Design……………………………………………………………………………………46
Materials…………………………………………………………………………………46
Sample…………………………………………………………………………………...47
Measures…………………………………………………………………………………48
Analysis…………………………………………………………………………………..53

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Chapter 4: Results………………………………………………………………………………..54
Confirming Effective Randomization……………………………………………............54
Consideration of Gender as Analytic Factor……………………………………………..55
Hypothesis 1a…………………………………………………………………………….57
Hypothesis 1b…………………………………………………………………………….57
Hypothesis 2………………………………………………………………………...........58
Hypothesis 3………………………………………………………………………...........59
Hypothesis 4………………………………………………………………………...........61
Hypothesis 5a…………………………………………………………………………….62
Hypothesis 5b…………………………………………………………………………….63
Hypothesis 5c…………………………………………………………………………….63
Hypothesis 6………………………………………………………………………...........64
Hypothesis 7a…………………………………………………………………………….65
Hypothesis 7b…………………………………………………………………………….66
Hypothesis 8………………………………………………………………………...........67
Hypothesis 9………………………………………………………………………...........70
Hypothesis 10…………………………………………………………………………….72
Hypothesis 11…………………………………………………………………………….74
Hypothesis 12…………………………………………………………………………….76
Hypothesis 13…………………………………………………………………………….78
Hypothesis 14…………………………………………………………………………….80
Summary of Findings…………………………………………………………………….82
Chapter 5: Discussion……………………………………………………………………………85
Knowledge Stage………………………………………………………………………...86
Moving from Knowledge to Persuasion Stage…………………………………………..87
Persuasion Stage…………………………………………………………………………88
Moving from Persuasion to Behavioral Intent…………………………………………...89
Behavioral Intent Stage…………………………………………………………………..93
Additional Future Research……………………………………………………………...94
Chapter 6: Conclusion……………………………………………………………………………95
Future Agenda for Entertainment-Education Scholars…………………………………..96
Future Agenda for Health Promotion Practitioners……………………………………...98
References………………………………………………………………………………………101
Appendices……………………………………………………………………………………...112
Appendix A: Details about Attention Check and Sample Selection………………........112
Appendix B: Film Credits for Team Player…………………………………………….115

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LIST OF TABLES
Table 1. Details of Nonnarrative Control Message, Ask a Doctor……………………….….…….27
Table 2. Key Points by Messages and Measurements………………………………………….....30
Table 3. Sociodemographic Characteristics of Participants by Condition……………………......54
Table 4. Pretest COVID-19 Experience, Beliefs, and Behavior by Condition……………..…..…55
Table 5. Analysis of Variance of Pretest Measurement of Dependent Variables
by Gender...……………………………………………………………………………………....56
Table 6. Summary of Hypotheses and Statistical Findings………………………………….....…82

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LIST OF FIGURES
Figure 1. Hypothesis 3, Serial Mediation Model……………………………………………….. 16
Figure 2. Hypothesis 8, Serial Mediation Model………………………………………………...42
Figure 3. Hypothesis 9, Serial Mediation Model………………………………………..……….. 42
Figure 4. Hypothesis 10, Serial Mediation Model………………………………………….…… 43
Figure 5. Hypothesis 11, Serial Mediation Model…………………………………………….… 43
Figure 6. Hypothesis 12, Serial Mediation Model…………………………………………….… 44
Figure 7. Hypothesis 13, Serial Mediation Model…………………………………………….… 44
Figure 8. Hypothesis 14, Serial Mediation Model………………………………………………..45
Figure 9. Change in Injunctive Normative Beliefs by Condition for Women…………….…….. 58
Figure 10. Change in Intent to Seek Information by Condition for Women……………….…….59
Figure 11. Significant Paths, Serial Mediation Model, H3 for Women………………………..…60
Figure 12. Knowledge Score by Condition for Women……………………………………..……62
Figure 13. Transportation by Condition for Women……………………………………………..64
Figure 14. Transportation by Condition for Men………………………………………….……..65
Figure 15. Identification with Female Persuasive Sources by Condition for
Women…………….......................................................................................................................66
Figure 16. Identification with Male Persuasive Sources by Condition for Women and
Men………………………………………………………………………………………………67
Figure 17. Significant Paths, Serial Mediation Model, H8 for Women……………………...……68
Figure 18. Significant Paths, Serial Mediation Model, H8 for Men………………………..…….69
Figure 19. Significant Paths, Serial Mediation Model, H9 for Women………………………..…70
Figure 20. Significant Paths, Serial Mediation Model, H9 for Men…………………………..….71
Figure 21. Significant Paths, Serial Mediation Model, H10 for Women…………………..……..73
Figure 22. Significant Paths, Serial Mediation Model, H10 for Men……………………………..74
Figure 23. Significant Paths, Serial Mediation Model, H11 for Women……………..…………..75
Figure 24. Significant Paths, Serial Mediation Model, H11 for Men……………………….……76
Figure 25. Significant Paths, Serial Mediation Model, H12 for Women………………….……..77
Figure 26. Significant Paths, Serial Mediation Model, H12 for Men……………………….……78
Figure 27. Significant Paths, Serial Mediation Model, H13 for Women…………………..……..79
Figure 28. Significant Paths, Serial Mediation Model, H13 for Men………………………..……80
Figure 29. Significant Paths, Serial Mediation Model, H14 for Women…………………..……..81
Figure 30. Significant Paths, Serial Mediation Model. H15 for Men……………………….……82
Figure 31. Data Quality Screen and Sample Selection…………………………………………..114

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ABSTRACT
Parental vaccine hesitancy has been a public health problem for centuries, made more urgent by
the COVID-19 pandemic because previously accepting parents chose to delay or reject the new
vaccine. This dissertation argues that promotion messages that leverage theories of social
influence and narrative persuasion are more likely to initiative behavior change with this
audience than messages that rely on risk communication from health authorities. This claim was
tested with a pretest-posttest experimental study of 548 parents of unvaccinated children,
comparing the impact of a nonnarrative control message, Ask a Doctor, with an entertainmenteducation message, Team Player, that contained the same key facts to address myths about
COVID-19 vaccination. The 133 mothers who viewed Team Player, which portrayed friends
encouraging vaccination, had higher increases in intent to seek additional information about the
COVID-19 vaccine and vaccinate their children than the 144 mothers who viewed the
nonnarrative control message. The effect of message condition on changes in behavioral intent
was mediated by changes in injunctive normative beliefs, meaning how these mothers believe
others want them to behave. These findings are explained by applying theoretical constructs from
theories of health behavior change and narrative persuasion. Specifically, the innovation-decision
process from the Diffusion of Innovation theory is used as the conceptual framework for
behavior change, and theories of transportation, character identification, and emotional response
are proposed as the mechanisms facilitating progress through this behavior change model from
knowledge, persuasion, to behavioral intent. This dissertation concludes by proposing a future
agenda for entertainment-education scholars and health promotion practitioners.

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INTRODUCTION
This dissertation empirically explores the effect of a narrative message on COVID-19
beliefs and intentions among vaccine hesitant parents. Vaccine hesitancy is defined here as the
deliberate delay or refusal of vaccines despite availability of services (WHO SAGE Vaccine
Hesitancy Working Group, 2014). Vaccine hesitancy has been a public health problem since the
18th century, when Edward Jenner developed a new procedure to protect people from contracting
smallpox and coined the term vaccination (Reich, 2016). Scholars attribute hesitancy toward
vaccination to a lack of confidence – or having a low level of trust in vaccines and the systems
that produce and recommend them – and complacency – or challenging the necessity of
vaccination (MacDonald, 2015; WHO SAGE Vaccine Hesitancy Working Group, 2014). Myths
that undermine vaccine confidence and support complacency have circulated in communities
since Jenner proposed cowpox vaccination as a safer alternative to smallpox variolation in 1796
(Kitta, 2011; Reich, 2016). However, the ubiquitous use of social media in the 21st century
allows these myths to circulate faster and more broadly (Broniatowski et al., 2018; Kata, 2012).
The vast majority of parents in the United States accept routine childhood vaccination (Seither et
al., 2023), but the influence of vaccine myths is of growing public health concern. In fact, the
World Health Organization designated parental vaccine hesitancy – delaying or refusing
vaccines for one’s child – as a global public health crisis in 2019 (World Health Organization,
2019). Further, the COVID-19 pandemic both interrupted routine vaccination (Seither et al.,
2023) and revealed the fragile nature of beliefs that support vaccination. Despite pandemic
conditions, parents who had previously regularly accepted vaccines for their children were
hesitant about the COVID-19 vaccine (Hamel et al., 2021).

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For this dissertation, vaccine hesitancy is conceptualized as a behavior that may be
explained by confidence and complacency beliefs, but this behavior is distinct from the antivaccination movement, or the “amorphous group holding diverse views that nevertheless shares
one core commonality: an opposition to vaccines” (Kata, 2012, p. 3778). Rigidly anti-vaccine
attitudes are mostly found among anti-vaccine activists, meaning those who employ a set of
tactics to dissuade vaccination (Kata, 2012). In fact, prior research found that parents may selfidentify as “pro-vaccine” even when exhibiting vaccine hesitant behavior, such as delaying or
adopting alternative vaccination schedules (Wang et al., 2015). Therefore, if vaccine hesitancy is
a behavior, it may be possible to promote behavior change.
Using the development and evaluation of a narrative COVID-19 vaccine promotion
message, this dissertation aims to consider whether and how health communication scholars and
health promotion practitioners can design messages that influence people to adopt a behavior
they have already rejected. Drawing on theories of health behavior change and narrative
persuasion, this dissertation considers the underlying mechanisms of stories and why they may
be a particularly useful health communication tactic for motivating parents to seek additional
information and reconsider vaccination for their children. Specifically, the innovation-decision
process from the Diffusion of Innovation theory (Rogers, 2003) is used as the conceptual
framework for behavior change, and theories of transportation (Green, 2021; Green & Brock,
2000), character identification (Cohen, 2001; Moyer-Gusé, 2008; Tal-Or & Cohen, 2010), and
emotional response (Dunlop et al., 2008; Murphy et al., 2011) are proposed as the mechanisms
facilitating progress through this behavior change model from knowledge, persuasion, to
behavioral intent.

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This dissertation consists of six chapters. The first chapter argues that vaccine promotion
messages tailored to address parental vaccine hesitancy should leverage normative influence to
promote behavior change rather than rely on risk communication from health authorities. Thus,
Chapter 1 reviews scholarly literature related to theories of health behavior, social norms,
parental vaccine hesitancy, and risk communication, and briefly introduces the context of this
dissertation, which is the COVID-19 pandemic and vaccination against the SARS-CoV-2 virus.
The second chapter argues that entertainment-education should be used as a health
communication tactic to address parental vaccine hesitancy. Thus, Chapter 2 reviews scholarly
literature related to health promotion message-design strategies, including narrative persuasion
and entertainment-education, and introduces the narrative message studied in this dissertation,
Team Player. The third chapter details the methods for experimentally testing the narrative
message’s relative efficacy in changing COVID-19 vaccination beliefs and motivating action
compared to a nonnarrative control message, Ask a Doctor. The fourth chapter reports the results
of the proposed hypotheses, including seven proposed models of the effect of the message on
behavioral intentions. The fifth chapter discusses the experimental findings and comments on
aspects of Team Player that should be further studied. Finally, the sixth chapter summarizes
limitations to the dissertation study and points to future directions for creating and studying
vaccine messages.

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CHAPTER 1:
Understanding Parental Vaccine Hesitancy and Leveraging Norms to Change Behavior
This dissertation conceptualizes parental vaccine hesitancy as a behavior that can be
changed and argues that entertainment-education—the intentional use of stories to teach and
persuade (Singhal et al., 2004)—is a promising communication tactic for initiating behavior
change. Given that this dissertation is based on applied research, it is necessary to carefully
articulate the theoretical and empirical foundation for the COVID-19 vaccine promotion message
described and studied in later chapters. Therefore, before articulating hypotheses, this chapter
provides a theoretical explanation for parental vaccine hesitancy and considers limitations to
common vaccine promotion messages. The following sections review empirical research and
draw on theories of behavior and behavior change, with a focus on the Diffusion of Innovations
(Rogers, 2003).
Health Behavior Change and Parental Vaccine Hesitancy
Effective health promotion messages are tailored to produce a desired health behavior
outcome for the intended audience by initiating a process of behavior change. There are four
categories of behavior change: initiating a new behavior, modifying a current behavior, stopping
a current behavior, or avoiding (i.e. never starting) a behavior (Glanz et al., 2015). In the broader
social context of vaccination for children, messages addressing each of these four types of
behavior change are needed. In terms of parental vaccine hesitancy, audiences who are delaying
vaccination need to be encouraged to modify current behavior and audiences rejecting

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vaccination need to be influenced to stop current behavior. Messages to promote behavior
change must therefore address factors underlying the current behavior.
Theory that suggests that attitudes—the way one thinks or feels about something—
predict one’s intention to behave in a specific way (Fishbein & Ajzen, 2010). Thus, parental
vaccine hesitancy would be a result of a negative attitude about vaccination. Further, scholars
theorize that attitudes are driven by beliefs (Fishbein & Ajzen, 2010), defined here as the
acceptance that a statement is true, and existing empirical research supports the notion that
negative attitudes about vaccination are driven by beliefs (e.g., Corben & Leask, 2016). Scholars
have predominantly focused on complacency beliefs and confidence beliefs as drivers of vaccine
hesitancy (Corben & Leask, 2016; MacDonald, 2015; Peretti-Watel et al., 2015).
Complacency Beliefs
As previously stated, complacency refers to whether one believes that vaccination is
necessary (WHO SAGE Vaccine Hesitancy Working Group, 2014). From a medical and public
health perspective, vaccination is a necessary preventive health behavior because it provides
individual and public benefit by reducing risk. Specifically, a vaccine is expected to reduce the
likelihood of morbidity or mortality from a virus (individual risk) and reduce the likelihood that
one continues spread of the virus after infection (public risk) (Centers for Disease Control and
Prevention, n.d.). Complacency is rooted in a rejection of the premise that risk needs to be
reduced. In the context of parental vaccine hesitancy, specific complacency beliefs include that a
child is not at risk of catching a virus and, should unlikely infection occur, the child is not at risk
of serious illness or death from a virus. Brewer and colleagues (2017) propose that parents may
make vaccination decisions by engaging in a complicated disease risk appraisal that triangulates
deliberative risk (likelihood beliefs), experiential risk (susceptibility beliefs), and affective risk

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(worry, anxiety, and fear). Their model suggests that one’s choice to engage in parental vaccine
hesitancy is reinforced each time a vaccine is delayed or refused without a negative consequence
(Brewer et al., 2017). In fact, scholars have found that many vaccine hesitant parents believe
they are capable of accurately assessing and avoiding risk of illness, perceiving themselves to be
experts in providing a healthy environment for their own children (Reich, 2016; Romijnders et
al., 2019; Wang et al., 2015). If a parent believes they can prevent their child from getting sick
and/or prevent serious illness or death following unlikely infection, is it understandable that they
do not believe that vaccination is necessary.
It is important to note that this conceptualization of the self as the expert is reinforced by
contemporary society, which encourages autonomy and self-empowerment to use readily
available information to maximize one’s own life expectancy (Peretti-Watel et al., 2015).
Particularly in the United States, the existence of a healthy child is often a symbol of being a
competent parent (Collett, 2005; Reich, 2016; Song et al., 2012) and socially indicates that one
has extensively reviewed available information from a variety of sources and made the best
decision (Bernhardt & Felter, 2004; Lagan et al., 2010; Song et al., 2012). It is during their
search for answers of how to maximize the health of one’s child that vaccine hesitant parents
may encounter misleading or inaccurate information that form beliefs that undermine their
confidence in vaccination.
Confidence Beliefs
Confidence beliefs are about trust in vaccines and the institutions that produce and
recommend them (WHO SAGE Vaccine Hesitancy Working Group, 2014). This dissertation
differentiates two types of confidence beliefs, to be called efficacy beliefs and harm beliefs.
Efficacy beliefs are whether one accepts that vaccines provide protection against illness and

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reduce the spread of a virus. Vaccination is expected to provide the previously mentioned
individual and public benefits because a vaccine is expected to stimulate an immune response
against a specific virus (Centers for Disease Control and Prevention, n.d.). The medical
community acknowledges that patients may experience unpleasant side effects during this
immune response—such as fever, headache, or muscle ache (Centers for Disease Control and
Prevention, n.d.)—but these temporary side effects are considered a reasonable cost given the
expected benefit of vaccination. An important but admittedly confusing fact is that infection may
still occur after vaccination, but being vaccinated means one is less likely to experience serious
illness (Centers for Disease Control and Prevention, n.d.). Public health and medical authorities
conceptualize serious illness from a biomedical perspective, where the change in health status
refers to outcomes such as hospitalization or death. But there are many conceptions of health and
illness (du Pre & Cook Overton, 2021), and it is certainly possible to imagine parents holding
different thresholds of serious for their child, for example, missing several weeks of school.
Regardless, since illness may still occur following vaccination, one can understand why people
may hold low efficacy beliefs. For vaccine hesitant parents, they may not believe that vaccines
can protect their child or the people around them against illness, so vaccination would not be the
correct behavior, particularly if they believed the vaccine itself would cause harm.
Harm beliefs refer to whether one believes that a vaccine is safe for a human body.
Myths about vaccines causing serious bodily harm date back to the first vaccine in 1796 (Kitta,
2011). In the age of social media, where anyone can write and disseminate information, parents
who search for information to maximize their child’s health can easily find a lot of content that
frames vaccines as harmful (Getman et al., 2018; Himelboim et al., 2020). Some of this content
is intentionally produced to undermine trust in governments and health systems, such as bots that

8
claim conspiracies between governments and pharmaceutical companies to hide evidence of
vaccine injuries (Broniatowski et al., 2018; Kata, 2012).
While some parents form harm beliefs due to exposure to myths about vaccines, for
others, beliefs that vaccines cause harm are rooted in distrust of health care providers and
government agencies as a result of racism and discrimination (Bogart et al., 2021; Quinn et al.,
2017). Racial and ethnic disparities in health outcomes exist (Centers for Disease Control and
Prevention, 2014; Gee et al., 2012; Price-Haywood et al., 2020; Viruell-Fuentes, 2012) because
American scientific and medical institutions have historically (e.g., Brandt, 1978) and continue
to harm on racial and ethnic minorities (Boyd et al., 2020; Ford et al., 2019; Paradies et al., 2015;
Pascoe & Smart Richman, 2009; Williams & Mohammed, 2009). Since pervasive myths about
vaccines causing harm may therefore seem believable due to logical distrust, scholars argue that
harm beliefs may be particularly difficult to influence once they are formed (Larson, 2020).
Thus, vaccine promotion messages often attempt to communicate the risk of negative health
outcomes for those unvaccinated in an effort to motivate action by outweighing any harm beliefs
(Penţa & Băban, 2018).
Vaccine Promotion and Risk Communication
As previously stated, this dissertation conceptualizes parental vaccine hesitancy as a
behavior. Therefore, parental vaccine acceptance is also conceptualized as a behavior. More
specifically, parental vaccine acceptance is a preventive health behavior, meaning it requires a
parent to engage in a set of activities during a time when the child is perceived to be healthy in
order to sustain that status (Kasl & Cobb, 1966). Health behavior scholars theorize that
preventive health behaviors are motivated by perceived susceptibility and/or severity of illness
(Brewer et al., 2007; Penţa & Băban, 2018) and vaccine communication scholarship is generally

9
focused on goal-framing messages, meaning messages that communicate whether something of
value could be gained or lost based on one’s actions (Brewer et al., 2007; Penţa & Băban, 2018).
Since vaccine acceptance is a preventive behavior, some scholars predict that gain-framed
messages—which highlight the benefit of avoiding future risk when accepting a vaccine—should
be most effective (Penţa & Băban, 2018). Others argue that, due to risk concerns about
vaccination itself, loss-framed messages—which highlight the potential increased risk of disease
when rejecting a vaccine—might be more appropriate (Penţa & Băban, 2018). With a lossframed message, the aim of the message would be to present the risk of disease as worse than the
risk of potential side-effects from vaccines. When looking across several independent studies,
Penţa & Băban (2018) did not find a significant effect of gain versus loss goal framing on
vaccine hesitancy, and there is limited empirical support for changing attitudes or intention to
vaccinate by merely communicating risk of disease (e.g., Nyhan et al., 2014).
A risk-based goal-framed approach might be effective if vaccination was an innovation,
meaning a completely new idea (Rogers, 2003), but that would not be the case for parental
vaccine hesitancy because delaying or rejecting vaccination is posited as a behavior following a
decision-making process based on existing beliefs. Fuzzy-trace theory suggests that beliefs and
behavior change are not influenced by the explicit information in a message, but rather by how a
person understands the underlying meaning or gist of the message (Reyna, 2008). When it comes
to vaccination, Reyna (2012) suggests that when people hear about risk, the gist message may be
interpreted as a decision of whether to “feel okay” or “feel not okay.” As Reyna (2012) explains,
both getting a disease and experiencing side-effects from a vaccine could result in feeling “not
okay.” If a parent believes that their child is not likely to get a disease but that there may be sideeffects to vaccination, then delaying or refusing vaccination is the best way to maintain their

10
status of feeling okay or healthy (Reyna, 2012). This clarifies how simply refuting those
beliefs and trying to emphasize that the risk of disease outweighs any risk of vaccination is
not predicted to be effective.
Since vaccine hesitancy is a behavior, the parent has already made their risk assessment
based on existing beliefs and adopted the behavior they deemed to be correct and logical.
Therefore, changing the behavior of vaccine hesitancy into vaccine acceptance is not merely a
matter of trying to change underlying beliefs. Instead, to address parental vaccine hesitancy,
promotion messages would need to convince a parent that it is appropriate and acceptable to
learn new information and change beliefs.
Diffusion of Innovation and Normative Beliefs
The Diffusion of Innovations is a widely accepted model of behavior change (Rogers,
2003) that recognizes the social context of learning, interpreting, and acting on information
(Valente & Pitts, 2017). Like other stage models, it predicts that change occurs over time and
consists of a series of actions (Rogers, 2003). There are five main steps toward enacting behavior
change in what is called the innovation-decision process: (1) knowledge, which includes
exposure to and understanding of a message related to the behavior, (2) persuasion, where one
develops a positive attitude toward the behavior, (3) decision, or behavioral intention, (4)
implementation of the behavior, and (5) confirmation, or seeking social reinforcement to
maintain the behavior (Rogers, 2003). This process is fundamentally an information-seeking and
information-processing activity and emphasizes the role of sources of influence, which
differentiates it from cognitively-focused stage models of behavior change (Valente & Fosados,
2006). This dissertation argues that in the case of parental vaccine hesitancy, peers or

11
perceived peers are more likely to be influential sources to motivate change than health
experts because of the effect of normative beliefs on behavior.
Norms are a set of beliefs about how others behave, called descriptive norms, and how
others want one to behave, called injunctive norms (Cialdini et al., 1991). The Theory of
Normative Social Behavior suggests that normative beliefs directly influence the adoption of a
behavior (Rimal & Real, 2005). This is because people are motivated to build and maintain
social relationships, so will behave in a way that maximizes social rewards and minimizes social
punishments (Cialdini & Trost, 1998). According to Social Cognitive Theory, people learn by
observing the behavior of others, mimicking, and processing perceived positive or negative
feedback from their behavior (Bandura, 1977, 2001). Thus, the behavior of parental vaccine
hesitancy, as well as the underlying complacency, efficacy, and harm beliefs, are likely learned
as a result of what a parent has been directly told or observed in a social context (Corben &
Leask, 2016). In fact, several studies have empirically demonstrated the effect of norms on
vaccine behavior (Bruine de Bruin et al., 2019; Brunson, 2013; Phelps et al., 2023; Sobo, 2015).
When looking at adult acceptance of the COVID-19 vaccine, perception of vaccine acceptance
within one’s social circle predicted earlier initiation of the vaccine series, even when accounting
for the effects of confidence and complacency beliefs (Phelps et al., 2023). These findings
support studying vaccine promotion messages that utilize perceived peers as the source of
influence.
COVID-19 Pandemic and VaccinateLA
In March 2020, the World Health Organization declared that the spread of SARS-CoV-2
– the virus that causes COVID-19 – was a global pandemic. The scientific community mobilized
to respond to this crisis and, by April 2021, vaccination against COVID-19 was available to the

12
general adult population in the United States. By November 2021, vaccines were available for
children and adolescents, and adults who had already completed primary vaccination were
encouraged to get a booster dose. Countless entities collaborated to design and implement
COVID-19 vaccine promotion campaigns throughout the United States. In Los Angeles, CA, one
campaign was called VaccinateLA. Led by Drs. Michele Kipke and Lourdes BaezcondeGarbanati of the University of Southern California, the purpose of VaccinateLA was to develop
culturally tailored messages to combat misinformation and promote COVID-19 vaccination
among Black and Latino Angelenos (Kipke et al., 2023). As part of this campaign, Drs. Kipke
and Baezconde-Garbanati asked Dr. Sheila Murphy and Jeremy Kagan to produce a series of
narrative messages. Dr. Murphy and Mr. Kagan, experts in producing entertainment-education,
invited the author of this dissertation, Ashley Phelps, to collaborate on designing, filming, and
empirically testing the narrative messages.
Entertainment-education (E-E) is a communication tactic for influencing behavioral
change and social norms by intentionally embedding persuasive content into entertaining
messages (Singhal et al., 2004; Singhal & Rogers, 2002), and E-E is considered the most
effective type of narrative persuasion (Bilandzic & Busselle, 2012). Connecting media effects
and persuasion theories, E-E stories are based on social learning principles (Bandura, 1977,
2001, 2004), so audience members may feel positive or negative reinforcement of behaviors and
feel more capable of performing a new behavior through vicarious experience (Slater, 2002).
This dissertation focuses on one of the VaccinateLA E-E films, Team Player, written and
directed by Alejandro Marquez Vela, which was produced to address COVID-19 parental
vaccine hesitancy and will be discussed further in the next chapter.

13
Source Credibility and COVID-19 Parental Vaccine Hesitancy
When selecting the appropriate source for health promotion messages, it is important to
account for perceived attractiveness and perceived credibility (Kareklas et al., 2015; Petty &
Cacioppo, 1986; Tseng & Fogg, 1999). There is strong evidence that people like to affiliate and
form groups with similar others (Lazarsfeld & Merton, 1954; McPherson et al., 2001), and a
previous section in Chapter 1 reviewed how people learn information and mimic behavior of
important social connections (see: Diffusion of Innovation and Normative Beliefs). Thus,
perceived source attractiveness is comprised of the extent to which an audience likes and
perceives similarity and/or familiarity with the source. Perceived source credibility is comprised
of perceived expertise and trustworthiness (Hovland & Weiss, 1951; Wathen & Burkell, 2002).
Expertise is the extent to which an audience perceives the source as capable of providing
accurate information or recommendations (Pornpitakpan, 2004). Health authorities may
emphasize professional experience and academic credentials to demonstrate credibility, and as
previously discussed, some parents rely on perceptions of self-expertise in terms of health
decisions. Trustworthiness is the extent to which an audience perceives the source as being
truthful and interested in the benefit of the audience (Pornpitakpan, 2004). Some scholars
suggest that sources can project trustworthiness by communicating similarity with the audience
(Rogers & Bhowmik, 1970), further supporting the notion that parental peers may be more
influential sources for vaccine promotion than health authorities. This should be particularly
evident in the context of COVID-19 vaccination, because research has demonstrated that lowcredibility assessments of the source discounts the persuasive effect of a message (Haase et al.,
2015) and perceived credibility of health authorities was particularly low during the COVID-19
pandemic (e.g., Chou & Budenz, 2020).

14
In the early summer of 2020, the American public was trying to understand evolving
information about who was at risk for SARS-CoV-2 infection, how it was transmitted, and which
behaviors should be adopted to prevent COVID-19 illness. Early media emphasized the
importance of disinfecting and avoiding contact with surfaces, but research ultimately revealed
that surfaces were not a major vector of transmission (CDC Media Relations, 2020). Efforts to
communicate updated pandemic-related knowledge to the public were complicated by mixed or
even contradictory messages. For example, former President Trump incorrectly stated on several
occasions that children were immune to or not at risk for COVID-19 despite hundreds of
thousands of confirmed cases and nearly 100 pediatric deaths by July 2020 (American Academy
of Pediatrics & Children’s Hospital Association, 2020). Adding to the complexity was the
localized nature of pandemic-related restrictions. California, for example, had some of the
strictest mitigation policies nationwide, including closing schools and most businesses,
dramatically impacting the lives of parents with young children. Further, the availability of
public resources to entertain children in California varied by county. Playgrounds and beaches
were closed in Los Angeles County but remained open in adjacent Orange County. Such
seemingly arbitrary rules could easily muddle the understanding of what behavior is unsafe, as
well as undermine the perceived credibility of health authorities. Studies have shown that prior
beliefs impact our assessment of truth, so misinformed beliefs about risk and prevention
measures may remain stable even in the face of new evidence (Lewandowsky et al., 2012). This
may be particularly true when faced with an identity threat (Nyhan & Reifler, 2019) suggesting
that past or current behaviors may not have been the optimal strategies for keeping one’s child
and family safe. Thus, parental vaccine hesitancy toward COVID-19 is both understandable and
calls for an empathetic approach to health promotion.

15
Introducing Initial Hypotheses
Since parental vaccine hesitancy is conceptualized as a behavior, the parent is assumed to
have already completed an innovation-decision process that resulted in their child not being
vaccinated against COVID-19. Therefore, a health promotion message to influence parental
vaccine hesitancy should aim to initiate a new innovation-decision process by modeling that one
can consider information and change one’s mind about vaccinating their child. Should that
happen, conversations with a trustworthy source would hopefully persuade vaccine acceptance.
Further, theory and previous research support testing whether messages that leverage normative
beliefs – beliefs about how others behave and how others want one to behave – can influence
vaccine hesitant parents (Brewer et al., 2017) rather than rely solely on expert sources
communicating risk. Such messages would communicate that it is socially acceptable—in fact,
encouraged—to change beliefs and modify behavior. This dissertation tests these claims using a
narrative message produced to influence parents who were hesitant about COVID-19 vaccination
for children as part of the VaccinateLA campaign. The first three hypotheses are articulated
below, with H1 and H2 serving to provide support for the proposed model in H3. The remaining
hypotheses will be articulated in Chapter 2.
H1: The narrative message will have a greater effect on (a) descriptive normative beliefs and (b)
injunctive normative beliefs than the nonnarrative control message.
H2: The narrative message will have a greater effect on intent to seek information than the
nonnarrative control message.
H3: The effect of the narrative message on intent to vaccinate one’s child will be mediated by (a)
normative beliefs and (b) intent to seek information.

16
Figure 1. Hypothesis 3, Serial Mediation Model

17
CHAPTER 2:
Understanding Entertainment-Education and the Development of COVID-19 Vaccine
Promotion Messages, Team Player and Ask a Doctor
The purpose of a health promotion message is to influence a specific audience regarding
a specific behavior. To successfully promote behavior change, the message must be designed in
such a way that the receiver has reason to believe that the recommended behavior will lead to an
important outcome. In other words, the receiver needs to “buy” what is being “sold” by the
source. This is why many health promotion practitioners employ the strategic use of commercial
marketing practices when designing campaigns (Wakefield et al., 2010), conceptualizing the
desired benefit or health outcome as the product that is being sold and what must be done to get
the benefit as the price. Behavior change is the price, not the product. Messages that are
thoughtfully tailored for the intended audience are more likely to successfully cue behavior
change because the price/behavior seems reasonable given the perceived value of the
product/outcome (Wakefield et al., 2010). As discussed in Chapter 1, vaccine promotion
messages often present the product as sustaining health or avoiding serious illness or death and
the price as accepting vaccination. As will be explained in this chapter, the narrative message
studied for this dissertation presents social approval as a product and reconsidering vaccination
as the associated price.
There are several theory-based content strategies to consider when designing a health
promotion message to communicate the price and product. This dissertation argues that messages
to address parental vaccine hesitancy should be designed using the theories and principles of
entertainment-education, which is a specific type of narrative persuasion. The entertainment-

18
education approach encompasses many message content strategies, including framing and
priming, and is based on the social learning principles that this dissertation posits are relevant for
influencing parental vaccine hesitancy. The following sections briefly review other message
content strategies to introduce how they apply to entertainment-education and parental vaccine
hesitancy. This chapter will then review scholarly literature regarding narrative persuasion and
entertainment-education. It will proceed with a detailed description of the vaccine promotion
messages studied in this dissertation – Team Player and Ask a Doctor (direct links for each
message are included in Chapter 3) – and end by articulating the remaining hypotheses.
Message Content Strategies – Framing, Priming, and Persuasion
Framing refers to a strategy for indirectly influencing how people think about an issue by
presenting the information in such a way that it affects interpretation (Cacciatore et al., 2016).
More specifically, “to frame is to select some aspects of a perceived reality and make them more
salient in a communicating text, in such a way as to promote a particular problem definition,
causal interpretation, moral evaluation, and/or treatment recommendation” (Entman, 1993, p.
52). The theoretical argument is that different frames may stimulate different conceptual links
and, as a result, influence understanding of the message and attitudes or beliefs (Cacciatore et al.,
2016). Within the field of communication, the application of a framing strategy can be
differentiated between the psychological perspective and the sociological perspective
(Cacciatore et al., 2016). Among scholars who utilize this system of classification, the
psychological perspective calls for presenting information either emphasizing potential gains or
losses to motivate action in terms of a goal (Tversky & Kahneman, 1974). As discussed in
Chapter 1, vaccine promotion messages often employ goal-framing, relying on individual
cognition of risks to motivate vaccine acceptance (Penţa & Băban, 2018). The sociological

19
perspective of framing calls for organizing information in such a way that helps construct
meaning and thus aids the audience with sensemaking around a decision or behavior (Cacciatore
et al., 2016; Goffman, 1974). Meaning may be communicated by situating an issue as it relates to
a broader context – called thematic framing – or deliberately isolating the issue from context –
called episodic framing (Cacciatore et al., 2016; Iyengar, 2005). Narrative messages facilitate the
use of multiple framing strategies; goal-framed messages can be included in dialogue and the
plot of the story provides a thematic frame. It is this latter point that makes narrative appeals
useful for health promotion. If a plot/thematic frame relates to something the audience values, it
could shape the perceived desirability of behavioral consequences (O’Keefe, 2016). As will be
discussed later in this chapter, storytelling should be a particularly effective promotion strategy
for influencing vaccine hesitant parents because it can frame vaccination as not only socially
acceptable but normative and desired.
Priming refers to a strategy for indirectly influencing how people think about an issue by
making certain beliefs salient so they are likely to be used in sensemaking or judgement about
the message (Bargh, 1989). Of particular relevance to health promotion is the stereotype priming
model (Pechmann, 2001), which suggests that people may be motivated to change behavior if
existing beliefs about social identities or groups are activated (Kelly, 1955; Pechmann, 2001). In
this model, associating positive social traits with the promoted behavior and/or associating
negative social traits with existing (undesirable) behavior would hopefully produce change
toward the promoted behavior. In the case of parental vaccine hesitancy, this might mean
priming being a good parent as an important social identity (Hogg & Reid, 2006) and then
associating it with certain behaviors. As will be further explained, the entertainment-education

20
structure employs this message strategy by using character and plot tropes to communicate
desirable and undesirable behavior.
Persuasion refers to attempts to directly influence how people think about an issue by
changing existing beliefs and presenting what to think (O’Keefe, 2016). There are different types
of persuasive appeals and effective persuasive messages employ a message content strategy that
matches the intended audience and desired goal (Dillard & Shen, 2012). Persuasive messages
can be categorized as informational, argumentative/logical, or emotional/affective appeals based
on the style and tone (Dillard & Shen, 2012). Models of health behavior and health behavior
change have not generally accounted for the influence of emotions or affective states (Ferrer &
Mendes, 2018), instead assuming rational actors (Fishbein & Ajzen, 2010) who might be
persuaded by informational or logical appeals. However, research demonstrates the influence of
emotions on health decisions and health behaviors (Ferrer & Mendes, 2018), so even messages
that are not conceptualized as an affective appeal may have an emotional response. Further,
research from the field of consumer marketing demonstrates the greater effect of
emotional/affective appeals compared to other types (Dunlop et al., 2008). Therefore, messages
aiming to change health behavior should account for the influence of emotions.
Emotions can be conceptualized as a system of processing information and providing
“signals” about actions to take (Dillard & Peck, 2000; Nabi, 1999), so persuasive appeals can be
constructed to elicit emotions that match the persuasive goal. For example, guilt might signal that
someone has done something wrong and therefore motivate behavior change toward the correct
behavior (Dillard & Peck, 2000). Fear might signal danger and therefore the need to take
protective action (Dillard & Peck, 2000). While these may seem like productive signals, appeals
that activate negative emotions may have the unintended effect of causing reactance, meaning

21
feeling angry, annoyed, irritated or aggravated (Dillard & Shen, 2005; Shen, 2010), which might
signal rejection or dismissal (Dillard & Peck, 2000). If the audience feels anger or annoyance at
the message and/or source instead of processing the promoted behavior, it would undermine the
persuasive intent of the message (Dillard & Shen, 2005; Shen, 2010).
It is more common for public health messages to prioritize negative emotions and attach
them to the potential negative outcomes of behavior (Dunlop et al., 2008), but it is worth
exploring positive emotional appeals in the context of parental vaccine hesitancy. Prior research
has found that happiness can increase acceptance of the message (Dillard & Peck, 2000) and
empathy can mitigate reactance to persuasive messages (Shen, 2010). Stories can elicit emotions
that might be distinct from the topic or health issue (Nabi, 1999), which might facilitate the
commercial marketing strategy of associating positive feelings with the product and price
(Dillard & Peck, 2000). After reviewing the theory and evidence related to narrative persuasion
and entertainment-education, this chapter will hypothesize about emotional reactions to the
tested messages and influence on beliefs and behavioral intent.
Narrative Persuasion
Narrative persuasion refers to a persuasive strategy where personal stories, exemplars,
testimonials, or fictional entertainment are intentionally used to influence attitudes, beliefs, and
behaviors (Murphy & Phelps, 2022). Narrative persuasion appeals include elements that are not
associated with other forms of persuasion, including a character and a plot, sequence of events,
or story (Murphy & Phelps, 2022; Shen et al., 2015). Research has provided at least two
arguments for using storytelling for the purpose of persuasion: mitigating reactance and
modeling behavior. Since people are motivated to behave “correctly” (Cialdini & Trost, 1998), a
message to do or believe something different implies that one has previously been incorrect, and

22
that may result in defensive mechanisms that impede the persuasive process, such as reactance
(Brehm, 1966; Brehm & Brehm, 1981). As mentioned above, reactance can be an emotional
response of feeling angry, annoyed, irritated, or aggravated (Dillard & Shen, 2005). Reactance
may also be experienced more cognitively, such as the audience perceiving the message as
attempting to control thoughts (Dillard & Shen, 2005). Storytelling may mitigate the reactance
response (Moyer-Gusé, 2008) through engagement with the story and/or characters, sometimes
called being transported or character identification (Cohen, 2001; Green & Brock, 2000), and
emotional response to the narrative (Murphy et al., 2011). This is because being cognitively and
affectively invested in the story is thought to prevent the audience from resisting or even noticing
the persuasive message (Moyer-Gusé, 2008; Slater & Rouner, 2002). The second argument for
using storytelling for persuasion is that a story can model the change of interest (Bandura, 2001).
Bandura (2001) argues that mass storytelling should be a powerful form of persuasive
communication because people already rely on observation of others to learn values and
behaviors. Therefore, stories can leverage theories of social influence by portraying a social
environment that communicates attitudes, norms, and beliefs, and demonstrates how to engage in
a behavior, including the behavior of changing an attitude or belief (Moyer-Gusé, 2008),
particularly if the audience feels affinity with characters.
Narrative persuasion has grown in its use and importance in the field of communication
in recent decades (Walter et al., 2018). The popularity of narrative persuasion as an approach to
health promotion can be explained by the observed effects (Braddock & Dillard, 2016; Shen et
al., 2015; Zebregs et al., 2015), but research has revealed important message factors to support
these effects. Narrative health promotion messages are predicted to have greater influence when
delivered via audio or video (Shen et al., 2015) and when messages are deliberate about eliciting

23
an emotional response (Zebregs et al., 2015). Previous studies have tested narrative messages for
vaccine promotion, and a systematic review found that narrative messages about vaccination
were more effective than statistical messages in changing attitudes, but the effect on behavioral
intent was only found in three of seven studies (Perrier & Ginis, 2018). Many previous vaccine
studies that tested narratives used first-person testimonials and were meant to elicit negative
emotions, such as fear or anticipated regret, in order to influence behavior (e.g. Fadda et al.,
2018; Hopfer, 2012; Kim et al., 2020; Kim et al., 2019; Lee & Su, 2020; Liu et al., 2019; Nan et
al., 2015; Nyhan et al., 2014; Okuhara et al., 2018). However, at least one previous study tested a
vaccination narrative with a positive tone. Chan and colleagues (2015) developed and tested a
fotonovela that depicted friends talking about sex and risk of infection to educate young adults
about HPV and the HPV vaccine (Chan et al., 2015). They found that being entertained by the
humorous story predicted changes in complacency beliefs and intent to vaccinate (Chan et al.,
2015). Thus, narratives with a positive tone should be further explored in the context of parental
vaccine hesitancy.
Entertainment-Education
Entertainment-education refers to a specific type of persuasive story format developed by
Miguel Sabido. He developed this storytelling format using several social science and dramatic
theories (Sabido, 2021). Entertainment-education (E-E) messages build from a moral framework
and include character and plot tropes to communicate the persuasive message (Sabido, 2021).
Characters are developed around stereotypes recognizable to the audience so they can represent
positive or negative role models (Sabido, 2021). Storytellers attempt to build audience selfefficacy around behavior change by including transitional characters, meaning characters who
depict the change from undesirable to desirable behavior (Sabido, 2021). Scholars suggest that

24
E-E is likely more effective than other forms of narrative persuasion because the persuasive
message is part of the plot rather than a digression or something mentioned during a story
(Green, 2021). In fact, E-E stories include at least two plots, one that communicates the explicit
message and the other that conveys an implicit message (Sabido, 2021). The implicit message is
meant to communicate the moral framework through which the explicit message should be
understood and accepted. An E-E message is most effective when it leverages the power of
audio-visual storytelling to convey the appropriate tone for the persuasive goal, which is
achieved through non-verbal communication by the characters and production elements such as
sound and music (Sabido, 2021). The following section briefly summarizes the E-E message
studied in this dissertation, Team Player. This chapter will then summarize the nonnarrative
control message, Ask a Doctor, and describe specific choices made when constructing that
message. Finally, this chapter will review the principles of E-E and mechanisms of narrative
persuasion as they apply to Team Player.
Introducing the Entertainment-Education Message, Team Player
Team Player is set at a youth soccer game. It opens with a swell of up-tempo music that
reflects the excitement of the scene: kids are warming up, parents are setting up chairs, and
everyone is smiling. Most of the team is excited to welcome Charlie back to the field. Charlie’s
mom, who is pregnant, expresses relief to her friends, Alexa’s mom and Henry’s mom. Charlie is
finally vaccinated against COVID-19, so now his mom feels comfortable letting him return to
school and sports. Charlie was kept home to keep his grandmother, little sister, and himself safe
from infection. As the mothers are talking, Ricky’s dad pulls attention when he bets the coach –
Charlie’s dad – that his own child’s soccer team will lose because “they suck.” Alexa’s mom,
who is later called “Doc,” says she will take the bet if Ricky and his dad get vaccinated against

25
COVID-19 when the team wins. Ricky’s dad does not want to get vaccinated because he believes
it will cause erectile dysfunction. Christina’s dad explains that he looked up information about
the vaccine in a medical journal and learned that COVID-19 infection, not the vaccine, can have
this negative consequence. Ricky’s dad seems intrigued and accepts the bet.
Meanwhile, Ricky calls Charlie a “dweeb” and shares misinformation about the COVID19 vaccine that he learned on social media. Alexa cautions the other kids against believing
information from unknown sources and Christina calls Ricky “crazy.” Henry shares, with
embarrassment, that he is not vaccinated because his mom worries the vaccine was developed
too quickly. The scene transitions to the parents and Alexa’s mom empathizes with Henry’s
mom for having worries and tries to assure her that the vaccine is safe. The scene transitions
back to the kids and Charlie uses the metaphor of videogame system development to explain
how the vaccine was safely, albeit quickly, developed. The scene goes back to the parents and
Alexa’s mom invites Henry’s mom to visit the clinic so they can talk more about the vaccine.
The soccer game begins, and a montage depicts the highs and lows of youth soccer.
Finally, it all comes down to a penalty kick. Ricky will need to block the goal for the team to
win. Before the referee blows the whistle, Charlie runs across the field to offer Ricky words of
encouragement. Ricky apologizes for being mean and Charlie assures him it is okay because they
are on the same team. Charlie leads his teammates in a chant of support. The parents start to join
in, and Alexa’s mom asks Ricky’s dad, “Are you going to be a team player and root for your
team? Or are you going to root against your own son just so you can win?” Ricky’s dad decides
to join the cheering. Ricky makes the save and everyone celebrates.

26
Introducing the Nonnarrative Control Message, Ask a Doctor
The nonnarrative control message, Ask a Doctor, combines nine public service
announcements (PSAs) produced by the U.S. Department of Health and Human Services and
incorporates the same key points as Team Player, which will be explained in the next section
(see: Explicit Message – Key Points). The format of eight of the PSAs was question-response,
where a question was written on a title card and a health expert answered. The remaining PSA
began with a statement, not question, on the title card. Five of the PSAs were seemingly scripted
and four were seemingly unscripted. The health experts in the PSAs were introduced as either
practicing physicians or public health officials, and their names and professional titles appeared
on-screen. The order of the nine PSAs was established to convey a logical argument in support
of vaccination.
The two main goals when constructing the control message were covering the same
educational points (discussed below under “Explicit Message”) and controlling for elements that
might confound hypotheses regarding identification with/liking the persuasive sources and
emotional response to the messages. As will be discussed below, identifying with or liking a
source may be due to various factors, one of which is perceived similarity in visual
characteristics (Lazarsfeld & Merton, 1954; McPherson et al., 2001). One of the parameters set
by Drs. Kipke, Baezconde-Garbanati, and Murphy for Team Player was that characters include
women and men from different races and ethnicities. Thus, the nine PSAs included in Ask a
Doctor were chosen among available resources because the health experts were both women and
men who may identify as different races and ethnicities. Therefore, any differences in measured
identification with persuasive sources might be attributed to the intended difference of status as
peer (Team Player) or non-peer expert (Ask a Doctor). Regarding emotional response to the

27
message, both Team Player and Ask a Doctor include up-tempo music that may influence the
affective response to the messages (Levitin, 2006). By including up-tempo music in both
messages, any differences in measured emotional response might be attributed to the intended
difference in implicit messages, which will also be discussed further in this chapter.
There are narrative elements in some of the PSAs in Ask a Doctor. Four of the PSAs
include visual representations of people interacting with health professionals or getting
vaccinated while the health expert communicates the persuasive message as a voiceover, and one
PSA includes the health expert re-enacting a conversation he had with a patient. However, none
of these narrative elements amount to a complete story, thus, the main factor to be a nonnarrative
control message in this context stands. The following table provides additional details about each
PSA.
Table 1. Details of Nonnarrative Control Message – Ask a Doctor
Segment Start Time Prompt/Title Card Health Expert Summary of Segment
Message
00:00 Card 1: Ask A Doctor
Card 2: Why do young,
healthy people need a
COVID-19 vaccine?
Kristamarie Collman,
MD
Family Medicine
Physician, Orlando, FL
COVID-19 infection
can result in long-term
health effects in
previously healthy
people.
00:39 COVID Vaccines for
Kids 5-11
Amy Edwards, MD
Pediatric Infectious
Diseases, University
Hospital, Rainbow
Babies and Children’s
Hospital
It is not possible to
predict which child will
suffer serious outcomes
from COVID-19
infection, and
vaccination is a safe
tool to protect children
from serious outcomes.
01:25 Why should eligible
children get a COVID
vaccine?
Amy Edwards, MD
Pediatric Infectious
Diseases, University
Hospital, Rainbow
Babies and Children’s
Hospital
COVID-19 is the worst
respiratory virus
doctors have seen in
children in a very long
time. Children can
contribute to the spread
of the virus and the
vaccine can reduce risk
of spreading.

28
NOTE: Different
camera angle than
previous segment
Segment Start Time Prompt/Title Card Health Expert Summary of Segment
Message
02:17 Card 1: Ask the
Surgeon General
Card 2: How do we
know COVID vaccines
are safe for children?
Vivek Murthy, MD
Surgeon General,
United States
Department of Health
and Human Services
The vaccine has been
thoroughly tested for
safety in children and
all vaccines are
carefully monitored in
the United States.
02:54 Card 1: Ask An Expert
Card 2: Do the COVID
vaccines cause longterm health problems?
Peter Marks, M.D.,
Ph.D.
Director, Center for
Biologics Evaluation
and Research, United
States Food and Drug
Administration
Serious health effects
are very rare for any
vaccine and very
unlikely in the case of
COVID-19 vaccines.
There is no evidence
that COVID-19
vaccines cause
infertility or cancer.
Mild or moderate side
effects from
vaccination are
possible. The disease
COVID-19 carries risk
of serious health
complications.
03:48 How do we know the
COVID-19 vaccines
are safe during
pregnancy?
Rochelle P. Walensky,
MD, MPH
Director, Centers for
Disease Control and
Prevention
There have been no
safety concerns about
the COVID-19 vaccine
for pregnant people
following animal
studies and human
vaccination. The
vaccine is a safe tool to
prevent tragic outcomes
that have been
documented among
pregnant women and
fetuses after COVID-19
illness.
04:38 Card 1: Ask A Doctor
Card 2: Why is it
important to get a
COVID vaccine
booster?
Jamie Fergie, MD
Director of Pediatric
Infectious Diseases,
Driscoll Children’s
Hospital, Texas
Boosters maintain
immunity longer and
provide protection
against new variants.
05:08 Card 1: Ask A Doctor
Card 2: If I have natural
immunity because I’ve
already had COVID,
Gerald Harmon, MD
President, American
Medical Association;
Previous illness (i.e.,
natural immunity) is
not enough to protect
against future COVID-

29
why do I need a
vaccine?
Family Medicine,
Tidelands Health
19 infection and
variants.
Segment Start Time Prompt/Title Card Health Expert Summary of Segment
Message
06:00 What would you tell
parents who are
hesitant to vaccinate
their children against
COVID?
Moira Szilagyi, MD
President, American
Academy of Pediatric;
Professor of Pediatrics,
University of
California, Los Angeles
Vaccination represents
another of the many
choices that parents
make to protect their
children from unlikely
but devastating
consequences. Like
using a seatbelt, getting
vaccinated is what is
best for children.
Explicit Message – Key Points
Persuasive messages include both explicit and implicit information that is meant to
influence the innovation-decision or behavior change process (Bilandzic & Busselle, 2012). The
explicit message is what the audience should understand based on what is said in the dialogue or
message (Bilandzic & Busselle, 2012). The explicit, overarching message was the same for both
Team Player and Ask a Doctor, which was that parents should get their children vaccinated
against COVID-19. Team Player was written to communicate eight specific educational points to
convey this explicit message. These educational points were prioritized based on scholarly
literature about parental vaccine hesitancy, specifically related to confidence and complacency
beliefs, and formative research about myths circulating about COVID-19 vaccination. The
following table details how the educational points were communicated in Team Player and Ask a
Doctor, and how they were measured in the experimental study (discussed further in Chapter 3).
The first column lists the key points provided to Mr. Marquez Vela and Mr. Kagan to initiate
script development. The second column lists the time stamp and dialogue or description of how
each educational point was communicated in Team Player. The third column lists the time stamp

30
and monologue or description of how each educational point was communicated in Ask a
Doctor. The fourth column lists how each educational point was measured in the experiment.
Table 2. Key Points by Messages and Measurements
Key Point
Experimental
Condition: Team
Player
Control Condition:
Ask a Doctor
Measurement on
Survey
The vaccines are safe
and were not
developed too quickly.
05:07
Henry’s Mom
I mean, I’m
vaccinated. And his
dad had COVID, so
he has immunity.
But, with the kids, I
just feel like the
vaccine happened
really quickly and
I’m still scared.
Alexa’s Mom
As you should be.
We all care about our
children’s health and
what they put in their
body. We hear these
concerns all the time
from parents at the
hospital. And I
explain to them that
the vaccine was not
created overnight.
The first vaccine
ever was created in
1796, that’s over 200
years ago!
*****
05:42
Charlie uses the
analogy of the
evolution of gaming
systems to explain
that the vaccine was
01:19
Dr. Amy Edwards
We have this
amazing, safe tool to
protect our children.
We should be using
it.
****
02:35
Dr. Vivek Murthy
The vaccine has been
tested in this age
group in clinical
trials and is given in
a smaller dose that’s
tailored for young
children. All COVID
vaccines in the
United States are
monitored under
stringent safety
standards.
Variable: Harm
Item:
“I worry that the
COVID-19 vaccine
was developed too
quickly to be safe for
my child.” 1
(completely
disagree) to 10
(completely agree)

31
not developed too
quickly.
Key Point
Experimental
Condition: Team
Player
Control Condition:
Ask a Doctor
Measurement on
Survey1
The vaccine does not
affect puberty or
fertility.
06:24
Henry’s Mom
Okay, but what about
infertility and all
those things people
talk about?
Charlie’s Mom
Not only did the
vaccine not affect my
fertility, but my
doctor says that my
baby will also be
born with some
immunity, right Doc?
Alexa’s Mom
That’s right!
03:06
Dr. Peter Marks
Serious health effects
from vaccines are
very rare. It’s very
unlikely that
COVID-19 vaccines
will cause long-term
health problems.
Also, there’s no
evidence at all that
they will cause
infertility or cancer.
Variable: Knowledge
Item:
According to the
film, vaccination
against COVID-19
makes a person…
A. Less fertile
B. More fertile
C. Has no impact on
fertility*
There are more side
effects from COVID19 than from the
vaccine.
Alexa’s Mom offered
a bet where the
stakes were $20 or
getting vaccinated.
03:00
Ricky’s Dad
I’m not gonna risk
my manhood for a
couple of bucks.
Christina’s Dad
You know…The
vaccine doesn’t
cause impotence.
Ricky’s Dad
Oh yeah? And what
about that guy,
00:19
Dr. Kristamarie
Collman
It is much safer to
take a vaccine that is
highly effective at
preventing COVID
related
hospitalizations or
death then it is to risk
getting a disease that
could leave you with
a serious health
condition for the rest
of your life.
****
03:15
Dr. Peter Marks
Variable:
Knowledge
Item:
According to the
film, side effects
from COVID-19 are
much worse than any
side effects some
might experience
from a vaccine.
A. True*
B. False
ALSO
Variable: Harm
Item:
1 For items measuring Knowledge, which means retention of the explicit message, the correct answers are noted
with *.

32
what’s his name?
From accounting?
Christina’s Dad
Oh, he wasn’t
vaccinated. His
erectile disfunction is
a side effect from
actually getting
COVID.
Ricky’s Dad
What? Nah!
Christina’s Dad
I’m telling you, man,
it’s true. Side effects
from COVID are
way worse than the
possible side effects
from the vaccine. A
New England Journal
of Medicine study
found that the
vaccine has no effect
on erectile
disfunction.
However, a mild
COVID infection
could…You know.
(bends his straw
from his soda down)
Ricky’s Dad
How do you know all
this?
Christina’s Dad
I did my research,
man. I’m all vaxed
up!
(allows straw to
bounce back)
It is true that some
people experience
mild or moderate
side effects from the
COVID-19 vaccines,
such as a sore arm,
fever, or fatigue, and
those can interfere
with your normal
activities. But these
side effects usually
last only a couple of
days. Your risk for
serious health
problems is much
lower from the
vaccine than your
risk if you’re
unvaccinated and get
COVID-19.
“I worry about sideeffects that my child
may experience from
the COVID-19
vaccine.”
1 (completely
disagree) to 10
(completely agree)

33
Key Point
Experimental
Condition: Team
Player
Control Condition:
Ask a Doctor
Measurement on
Survey2
Everyone who can get
vaccinated should to
help protect those who
cannot (such as really
young children, or
people for whom the
vaccine is less
effective because of
age of being
immunocompromised).
01:36
Henry’s Mom
But why did you wait
so long to let him out
of the house? The
kids don’t need to be
vaccinated to go to
school.
Charlie’s Mom
I know, but my mom,
you know, with her
cancer…
Henry’s Mom
What does cancer
have to do with
COVID? They can’t
get vaccinated?
Alexa’s Mom
Oh yes, people with
cancer can get the
vaccine.
Charlie’s Mom
Yeah, and my mom
is vaccinated.
Alexa’s Mom
It is just that people
with immune
disorders, like
cancer, are still
vulnerable.
Charlie’s Mom
That’s why Charly,
Coach and I got
01:55
Dr. Amy Edwards
Especially with some
of the older age
groups, teenagers
especially, you
know, they are
contributing in a very
real way to the
spread of the virus.
And we know that
the vaccine—there’s
lots of data coming
out right now that
shows that the
vaccine can reduce
your risk of
spreading COVID-19
to other people.
Variable: Knowledge
Item:
The people in the
film encourage
everyone who is
eligible to get
vaccinated in order
to protect…
A. Yourself
B. Other people
around who may not
be vaccine eligible
C. All of the above*
ALSO
Variable: Efficacy
Item:
“If my child gets the
COVID vaccine, I
believe that will help
protect my family
and friends.”
1 (completely
disagree) to 10
(completely agree)
2 For items measuring Knowledge, which means retention of the explicit message, the correct answers are noted
with *.

34
vaccinated; not only
to protect ourselves,
but also my mom and
my little one, Ana.
She’s still too young
to get the vaccine.
Key Point
Experimental
Condition: Team
Player
Control Condition:
Ask a Doctor
Measurement on
Survey3
Even people who had
COVID-19 need to get
vaccinated because of
new variants.
06:16
Alexa’s Mom
And as far as your
husband…Even if he
had COVID, he still
needs the vaccine
and boosters to
protect him against
new variants.
04:45
Dr. Gerald Harmon
And I’ll say, listen, I
can understand that
but the data shows
and the science
shows that natural
immunity – having
had the disease – is
still not enough. You
don’t know how sick
you were at the time.
You told me yourself
you were barely sick.
So you might not
have enough viral
load to stimulate
enough memory cells
in your immune
system to produce
enough antibody in
case you get
challenged again
with the virus.
Variable: Knowledge
Item:
According to the
film, even people
who already had
COVID-19 need to
be vaccinated…
A. To protect them
against new
variants*
B. In case they did
not really have
COVID-19
C. These people do
not need to be
vaccinated
ALSO
Variable:
Complacency
Item:
“I do not think that
people who have
already had COVID19 need the vaccine.”
1 (completely
disagree) to 10
(completely agree)
3 For items measuring Knowledge, which means retention of the explicit message, the correct answers are noted
with *.

35
Key Point
Experimental
Condition: Team
Player
Control Condition:
Ask a Doctor
Measurement on
Survey4
It is important to get
vaccinated as often as
recommended (there
may be more doses
needed in the future to
maintain immunity).
06:16
Alexa’s Mom
And as far as your
husband…Even if he
had COVID, he still
needs the vaccine
and boosters to
protect him against
new variants.
****
07:20
Alexa’s Mom
Of course! Bring
your husband and
your son, and I’ll
answer all the
questions you have.
And, at the end, we
can give them their
first shot. We have
both the adult and
kid doses at the
clinic. And maybe a
booster for you while
we’re at it.
04:45
Dr. Jaime Fergie
Boosters are an extra
layer of protection
against the COVID
virus. They keep
vaccines effective
longer and help
protect against new
variants that may be
more contagious or
make you sicker.
Variable: Knowledge
Item:
According to the
film, booster doses
of the COVID-19
vaccine are
important because
A. Vaccines always
require booster doses
B. Booster doses
keep people immune
longer and protect
against new
variants*
C. Some people may
have forgotten they
are vaccinated
It is very important for
pregnant people to get
vaccinated to save
themselves and the
baby.
06:41
Alexa’s Mom
We’ve had pregnant
women who were not
vaccinated die from
COVID at the
hospital, and it’s
heartbreaking to see
families shattered
like that over
something that could
have been so easily
prevented.
03:53
Dr. Rochelle
Walensky
Data show that
pregnancy increases
the risk of severe
COVID disease and,
sadly, COVID-19
infection during
pregnancy can also
increase the risk for
preterm birth and
other adverse
Variable: Knowledge
Item:
According to the
film, it is
recommended that
pregnant people…
A. Get the COVID19 vaccine*
B. Do not get the
COVID-19 vaccine
4 For items measuring Knowledge, which means retention of the explicit message, the correct answers are noted
with *.

36
pregnancy outcomes
that have impact on
the baby.
The vaccines for kids
are easily accessible in
your community.
End card
To find the vaccine
nearby anywhere in
the U.S.
Text your Zip Code
to GETVAX
(438829)
Or
Go to Vaccines.gov
Or
Call 1-800-232-0233
End card
To find the vaccine
nearby anywhere in
the U.S.
Text your Zip Code
to GETVAX
(438829)
Or
Go to Vaccines.gov
Or
Call 1-800-232-0233
No question/not
measured
Implicit Message
Both Team Player and Ask a Doctor were meant to communicate that asking questions
about vaccination is a positive behavior. This implicit message is conveyed in Ask a Doctor with
the question-response format and in Team Player by portraying friends asking questions and
being met with empathy. While both messages include explicit information about risk, Ask a
Doctor also implicitly communicates that the potential consequences of COVID-19 risk should
motivate behavior change to a greater extent that Team Player. In fact, this dissertation argues
that the important implicit message of Team Player is unrelated to a cognitive appraisal of
disease risk. With entertainment-education messages, the implicit message is the meaning
created by the plot (Bilandzic & Busselle, 2012). For Team Player, the implicit message is there
is a team in our community and COVID-19 is our opponent; everyone is welcome to join our
team when they are ready. Thus, behavior change would be a result of social influence. For this
to occur, scholars argue that audiences need to be engaged in the story, identify with characters,
and experience an emotional response.

37
Transportation or Engagement with the Message
Scholars of narrative persuasion describe transportation or engagement with a message
as the experience of being so immersed in a story that the audience is not bothered by the
persuasive message (Green, 2021). Being transported into a narrative world may also generate
mental images or conceptual ideas that can be linked with beliefs and result in change over time
(Green & Brock, 2000). Stimulating this level of engagement necessitates a coherent story that
the audience perceives as consistent, plausible, and complete (Green, 2021). Therefore, the story
context or plot should be familiar and accessible by concentrating on values that are important to
the audience (McGuire, 1984). As previously mentioned, entertainment-education messages are
developed around a moral framework so that the promoted behavior change can be understood
within cultural values, even if the behavior is not yet normative itself (Sabido, 2021). The
cultural context or thematic frame of Team Player is a youth soccer game. To be more specific, it
appears to be a recreation league soccer game, as opposed to a competitive league.5
It is outside
the scope of this dissertation to consider all possible motivations for a parent to enroll a child in
recreational soccer, but two reasonable assumptions would include to encourage exercise and to
develop social skills.6 Team-based sports facilitate teaching children how to work hard and work
together. Children can learn how to be gracious in both victory and defeat, and how to support
each other as they learn and grow. In other words, parents might want their children to play
youth soccer to learn how to be a team player.7
5 A competitive league would not allow boys and girls to be on the same team, and it would be very rare for a parent
to serve as the coach.
6 Families move on to competitive leagues if children want a higher level of exercise or aspire for university
scholarships.
7 This dissertation author makes these claims based on prior (childhood) and current (parental) lived experience.

38
These values are portrayed in Team Player in story arcs of Ricky and his dad. Ricky is a
mean and “mouthy” kid. He makes fun of a teammate and promotes conspiracy theories. The
other kids seem practiced at dismissing and ignoring Ricky, but the object of his insults, Charlie,
shows forgiveness and embraces a team spirit. Ricky’s dad is also mouthy, going out of his way
to criticize the soccer skills of children. The parents could dismiss and ignore Ricky’s dad or
even angrily confront this behavior. Christina’s dad and Alexa’s mom, instead, show patience
and invite him to be part of the team or community opposing COVID-19. Being transported,
meaning having sustained attention and engagement with the story, could help audience
members understand the implicit message and connect those values to the explicit message. This
dissertation argues that moving from understanding of the explicit message to acceptance of
behavioral change is facilitated by social influence, which in the case of entertainment-education,
means how connected the audience feels with the characters.
Character Identification
There are two ways that scholars have conceptualized how characters in a narrative may
influence the persuasive process. The first suggests that an audience member may take on a
character’s perspective (Cohen, 2001; Tal-Or & Cohen, 2010). This “imaginary process” is
thought to facilitate vicarious experience, which may make the persuasive message seem more
relevant and acceptable (Cohen, 2001; Tal-Or & Cohen, 2010). The other conceptualization is
related to familiarity and liking (Moyer-Gusé, 2008). Based on the principles of social influence,
the audience should like the character who models and/or promotes the attitude, belief, and
behavior because people are more willing to listen to and trust those they like (Moyer-Gusé,
2008). Therefore, characters should reflect similarity in values and priorities with the audience to
be persuasive sources (Green, 2021). As previously mentioned, entertainment-education

39
messages employ stereotyped role models to depict behavior change and reinforce the persuasive
message. Negative role models reflect behaviors contrary to cultural values and experience
negative consequences for their behavior (Sabido, 2021). Positive role models reflect ideal
behavior that matches cultural values (Sabido, 2021) and could be perceived by the audience as
trusted sources of information. Transitional characters are those who model the promoted
behavior change of the E-E message (Sabido, 2021) and thus become positive role models.
Audience understanding of whether a character is a negative or positive role model requires
priming relevant social traits (Kelly, 1955; Pechmann, 2001; Sabido, 2021).
Team Player includes four parent characters relevant to the persuasive appeal. Alexa’s
mom and Christina’s dad are the parent characters who persuade behavior change and this
dissertation argues they are both positive role models. Both characters depict positive personality
traits and positive social behavior. Alexa’s mom is bold and friendly, and she balances her social
roles of being a doctor and a peer. She is not judgmental or annoyed by the hesitant parents but
demonstrates empathy and validates Henry’s mom’s fears. Christina’s dad is charming and wellinformed. He uses humor when he corrects a misinformed belief. Both characters also model
trusting in science, and they demonstrate trustworthiness. Henry’s mom and Ricky’s dad are the
transitional characters who model behavior change. Both were hesitant about vaccination based
on harm beliefs, but they model willingness to learn information and consider change. Audience
members who perceive transitional characters as realistic, familiar, and likable may be more
willing to reconsider vaccination for their own children. This dissertation argues that such
perceptions would be influenced by the emotional response to the message.

40
Emotional Response to the Message
By the time vaccination against COVID-19 became available, families had been
experiencing persistent negative feelings related to the pandemic for over a year (Chou &
Budenz, 2020). Scholars theorize that people will prioritize reducing negative emotions over
changing behavior to mitigate threats during uncertain times, such as a pandemic (Chou &
Budenz, 2020). For this reason, the general tone of Team Player and Ask a Doctor is meant to be
upbeat, hopeful, or positive. However, the plot of Team Player and the portrayal of peer support
rather than advice from unknown health experts should result in greater feelings of happiness,
hope, and enjoyment than the nonnarrative control message. Persuasive messages that arouse
emotions have been found to be better recalled (Dunlop et al., 2008) and experiencing happiness
has been found to increase acceptance of the message (Dillard & Peck, 2000). For entertainmenteducation messages, audience emotions may be directed at features of the message and the story
may stimulate self-referent feelings and thoughts (Dunlop et al., 2008). In fact, Dunlop and
colleagues (2008) conceptualize the persuasive effect of a narrative message as a process that
begins with a message-referent emotional response – meaning the immediate response to the
message itself – that leads to self-referencing. Team Player begins with up-tempo music and
ends with a crowd cheering for their children’s victory. To the extent that an audience becomes
transported into the story, a positive emotional response should result in a persuasive effect
because the audience would attach the positive feelings of social support and victory (from the
message) to the promoted behavior change, which is reconsidering vaccination for one’s child.
Articulating Remaining Hypotheses
As reviewed in Chapters 1 and 2, parents want to behave correctly to protect their
children, particularly in the face of uncertainty. Negative feelings in the context of COVID-19

41
might impact their willingness to trust health experts as persuasive sources of information.
However, research has shown the influence of normative beliefs – beliefs about how others
behave and how others want one to behave – on vaccine behavior. The narrative message studied
in this dissertation used peer sources who were meant to demonstrate trustworthiness because
they are empathetic and caring. Further, the narrative message portrayed two parents willing to
change their mind about COVID-19 vaccination for their child – representing the transitional
characters in the E-E structure – which is the persuasive goal of both messages. Engagement or
transportation into a narrative should facilitate the intended (positive) emotional response to the
message and character identification, making the modeled behavior easier to understand and
perceived as relevant and appropriate. This dissertation proposes that character identification
would result in a persuasive effect as a mechanism of social influence, and a positive emotional
response to the message would result in a persuasive effect as a mechanism of self-referencing.
The remaining hypotheses tested in this dissertation are articulated below. Hypothesis 4
represents the first stage of the innovation-decision process and is a manipulation check that the
E-E message was more effective in sustaining attention. Hypotheses 5, 6, and 7 serve to provide
support for the proposed models in H8, H9, H10, H11, H12, H13, and H14.
H4: The narrative message will have a greater effect on retention of the explicit knowledgebased messages than the nonnarrative control message.
H5: The narrative message will have a greater effect on feelings of (a) enjoyment, (b) happiness,
and (c) hope than the nonnarrative control message.
H6: The narrative message will have a greater effect on sense of transportation than the
nonnarrative control message.

42
H7: The narrative message will have a greater effect on sense of identification with the (a)
female and (b) male persuasive sources than the nonnarrative control message.
H8: The effect of transportation on intent to vaccinate one’s child will be mediated by (a)
identification with the female persuasive source, (b) harm beliefs, and (c) intent to seek
information.
Figure 2. Hypothesis 8, Serial Mediation Model
H9: The effect of transportation on intent to vaccinate one’s child will be mediated by (a)
identification with the male persuasive source, (b) harm beliefs, and (c) intent to seek
information.
Figure 3. Hypothesis 9, Serial Mediation Model

43
H10: The effect of transportation on intent to vaccinate one’s child will be mediated by (a)
identification with the mother transitional character and (b) intent to seek information.
Figure 4. Hypothesis 10, Serial Mediation Model
H11: The effect of transportation on intent to vaccinate one’s child will be mediated by (a)
identification with the father transitional character and (b) intent to seek information.
Figure 5. Hypothesis 11, Serial Mediation Model
H12: The effect of transportation on intent to vaccinate one’s child will be mediated by (a)
feelings of enjoyment and (b) intent to seek information.

44
Figure 6. Hypothesis 12, Serial Mediation Model
H13: The effect of transportation on intent to vaccinate one’s child will be mediated by (a)
feelings of happiness and (b) intent to seek information.
Figure 7. Hypothesis 13, Serial Mediation Model
H14: The effect of transportation on intent to vaccinate one’s child will be mediated by (a)
feelings of hope and (b) intent to seek information.

45
Figure 8. Hypothesis 14, Serial Mediation Model

46
CHAPTER 3:
METHODS
Design
This study was a web-based pretest-posttest experiment hosted on the USC-Qualtrics
platform between June 16, 2022 and July 15, 2022. Participants who consented to participate
were screened for eligibility, which is defined below (see: Sample). After collecting baseline
beliefs, behavior, and behavioral intent (see: Measures), participants were randomized to view
either the experimental condition message, Team Player, or the control condition message, Ask a
Doctor. Participants who failed an attention check after viewing their assigned message were
required to watch the message again. A second failure to pass the attention check resulted in
dismissal from the study. Details about the attention check are described in Appendix A. The
remaining participants completed a series of questions to assess their response to their assigned
message (see: Measures), retention of educational information embedded in the message, and
repeated measures of beliefs and behavioral intent. Additional demographic information was
collected at the end of the survey instrument. The study protocol was reviewed by the
Institutional Review Board at Children’s Hospital of Los Angeles (CHLA-21-00152).
Materials
Both the experimental message, Team Player, and the control message, Ask a Doctor,
were hosted on this author’s Vimeo account and embedded in the Qualtrics survey instrument to
improve the viewing experience for participants. As previously mentioned, Team Player was
commissioned by Drs. Michele Kipke and Lourdes Baezconde-Garbanati for their VaccinateLA
campaign (more information about the campaign can be found at https://vaccinatela.info). Team
Player was written and directed by Alejandro Marquez Vela, working under Executive Producer

47
Jeremy Kagan. Mr. Marquez Vela developed his story based on guidance this author provided,
under the supervision of Dr. Sheila Murphy, about message tone and educational points. The end
credits were excluded from the experiment (see: Appendix B). The experimental message had a
run time of 9 minutes and 45 seconds and can be viewed at this link. The control message, Ask a
Doctor, was constructed using publicly available public service announcements produced by the
U.S. Department of Health and Human Services (more information about the original videos can
be found under “Shareable Resources” at https://wecandothis.hhs.gov). The run time for the
control message was 7 minutes and 08 seconds and can be viewed at this link. Additional
information about both the experimental and control messages were detailed in Chapter 2.
Sample
Participants were recruited online by Soapbox Sample, a subsidiary of Interviewing
Services of America. The company’s recruitment method is proprietary, so specific details are
not available for this dissertation, but the contract stipulated participant eligibility criteria. The
eligibility criteria were the following: (a) English-speaking adult (18 years or older), (b) living in
the United States, who was (c) unvaccinated or partially vaccinated against COVID-19 (i.e. not
boosted) and (d) has at least one child between the ages of 5 and 12 years old who was not
vaccinated against COVID-19. This study took place over seven (7) months after COVID-19
vaccination became available for children in this age range, so participants were deemed vaccine
hesitant.
The Principal Investigators of VaccinateLA and Dr. Sheila Murphy allowed this author to
conduct this dissertation study as a component of their evaluation of the narrative message, Team
Player. A quota-method of recruitment was used to balance enrollment of women and men for
the purpose of the film’s evaluation, thus, gender was tested as an analytic factor. The initial

48
convenience sample consisted of 587 responses. After performing a data quality assessment and
reviewing for eligibility, the analytic sample consisted of 548 unique participants. Appendix A
provides specific details regarding the sample review process.
Measures
The two behavioral intent measures were intent to seek information and intent to
vaccinate child. Four types of beliefs were measured, two related to tested hypotheses (harm and
normative) and two to ensure randomization of participants was effective (complacency and
efficacy). The mechanisms of narrative persuasion were measured in several ways: knowledge or
retention of the explicit message; emotional response or enjoyment, happiness, and hope;
transportation or engagement with the message; and identification with both persuasive sources
and transitional characters. Each measure is detailed below.
Intent to seek information. Intent to seek information about vaccination was calculated
as the difference in mean scores of four items collected at pretest (Cronbach’s alpha = .94) and
posttest (Cronbach’s alpha = .96): “Before the end of 2022, how likely are you to seek additional
information about the COVID-19 vaccine by…talking to your health care provider?...talking to
your CHILD’s health care provider?...looking for information online?...talking to a loved one?”
Participants indicated their likelihood for each separate item on a scale ranging from “not at all
likely” (0) to “extremely likely” (100). Thus, higher scores indicate greater intent to seek
information, and the goal of a vaccine promotion message would be to increase the score. The
sample mean at pretest was M = 36.51 (SD=33.24) and at posttest was M = 39.84 (SD=34.98),
and the sample mean change or difference between posttest and pretest was M = 3.32 (SD =
15.64).

49
Intent to vaccinate child. Intent to vaccinate one’s child was calculated as the difference
in mean scores of a single item collected at pretest and posttest: “How likely are you to get your
YOUNGEST CHILD between the ages of 5 and 12 years old the COVID-19 vaccine before the
end of 2022?” Participants indicated their likelihood on a scale ranging from “not at all likely”
(0) to “extremely likely” (100). Thus, higher scores indicate greater intent to vaccinate, and the
goal of a vaccine promotion message would be to increase the score. The sample mean at pretest
was M = 21.74 (SD=29.18) and at posttest was M = 31.69 (SD=34.70), and the sample mean
change or difference between posttest and pretest was M = 9.95 (SD = 20.13).
Harm Beliefs. Harm beliefs were calculated as the difference in mean scores of two
items collected at pretest (Cronbach’s alpha = .72) and posttest (Cronbach’s alpha = .83): “I
worry that the COVID-19 vaccine was developed too quickly to be safe for my child” and “I
worry about side-effects that my child may experience from the COVID-19 vaccine.” Participants
were asked to rate the extent to which they agreed with these separate statements on a scale
ranging from “completely disagree” (1) to “completely agree” (10). Thus, higher scores indicate
higher harm beliefs, and the goal of a vaccine promotion message would be to decrease the
score. The sample mean at pretest was M = 8.05 (SD=2.11) and at posttest was M = 7.25
(SD=2.56), and the sample mean change or difference between posttest and pretest was M = -
0.80 (SD = 2.29).
Descriptive Normative Belief. Descriptive normative belief was calculated as a mean
score of a single item collected at posttest: “Out of 100 people like you, how many do you think
will get the COVID-19 vaccine for their child or children between the ages of 5 and 12 years
old?” Participants were asked to select a number between 0 and 100. Thus, higher scores
indicate that vaccinating children against COVID-19 is more normative behavior, and the goal of

50
a vaccine promotion message would be to increase the score. The sample mean was M=39.87
(SD=28.10).
Injunctive Normative Belief. Injunctive normative belief was calculated as the
difference in mean scores of a single item collected at pretest and posttest: “If other people get
their children a COVID vaccine, I will feel encouraged to get my child vaccinated too.”
Participants were asked to rate the extent to which they agreed with this statement on a scale
ranging from “completely disagree” (1) to “completely agree” (10). Thus, higher scores indicate
a stronger influence of normative behavior on vaccination decisions, and the goal of a vaccine
promotion message would be to increase the score. The sample mean at pretest was M = 4.05
(SD=2.90) and at posttest was M = 4.32 (SD=3.04), and the sample mean change or difference
between posttest and pretest was M = -0.27 (SD = 2.00).
Complacency. Complacency beliefs were calculated as a mean score of two items
collected at pretest (Cronbach’s alpha = .71):“I do not think that people who have already had
COVID-19 need the vaccine” and “I do not think it is necessary for my child to get the COVID19 vaccine.” Participants were asked to rate the extent to which they agreed with these separate
statements on a scale ranging from “completely disagree” (1) to “completely agree” (10). Thus,
higher scores indicate higher complacency beliefs and the sample mean at pretest was M = 6.36
(SD=2.64).
Efficacy. Efficacy beliefs were calculated as a mean score of two items collected at
pretest (Cronbach’s alpha = .92): “I believe the COVID vaccine could protect my child against
COVID” and “If my child gets the COVID vaccine, I believe that will help protect my family and
friends.” Participants were asked to rate the extent to which they agreed with these separate
statements on a scale ranging from “completely disagree” (1) to “completely agree” (10). Thus,

51
higher scores indicate higher efficacy beliefs and the sample mean at pretest was M = 4.40
(SD=2.72).
Knowledge. Retention of the explicit message was measured as a calculated mean score
of correct answers to six items collected at posttest. The survey items are listed in Table 2 in
Chapter 2. Scores could range from 0 to 6. The sample mean was M=5.15 (SD=1.09).
Emotional response. Emotional response to the message was measured as three separate
variables: enjoyment, happiness, and hope. Enjoyment was calculated as a mean score of two
items from previous research (Tal-Or & Cohen, 2010) collected at posttest: “I liked this film”
and “I would watch this film again.” Participants were asked to rate the extent to which they
agreed with these separate statements on a scale ranging from “not at all” (1) to “a great deal”
(10). Enjoyment had high reliability (Cronbach’s alpha = .90) and the sample mean was M=5.09
(SD=3.08). Both happiness and hope were calculated mean scores based on single items
collected at posttest: “Please indicate the level to which you felt each of the following emotions
while watching the film, with 1 being ‘not at all’ and 10 being ‘a great deal.’” The sample mean
for happiness was M=5.04 (SD=2.98) and for hope was M=5.48 (SD=3.01).
Transportation. Transportation or engagement with the message was calculated as a
mean score of a three-item scale from previous research (Green & Brock, 2000; Tal-Or &
Cohen, 2010) collected at posttest: “I could imagine myself in the scenes I was watching,” “I
was mentally involved in the scenes I was watching,” and “The scenes affected me emotionally.”
Participants were asked to rate the extent to which they agreed with these separate statements on
a scale ranging from “not at all” (1) to “a great deal” (10). Transportation had high scale
reliability (Cronbach’s alpha = .84) and a sample mean of M=4.81 (SD=2.56).

52
Identification with persuasive sources. Identification with persuasive sources was
calculated as a mean score of four items based on previous research (Moyer-Gusé, 2008)
collected at posttest: “The following questions are about this [mom/dad or woman/man and the
instrument showed a still photo from the message]. When thinking about [her/him]…How much
do you like [her/him]? How similar are you to [her/him]? How much would you like to be like
[her/him]? How much do you feel like you know [her/him]?” Participants were asked to rate
their response on a scale ranging from “not at all” (1) to “a great deal” (10). For the experimental
message, the female persuasive source was Alexa’s mom (Cronbach’s alpha=.92) and the male
persuasive source was Christina’s dad (Cronbach’s alpha=.90). For the control message, the
female persuasive source was Dr. Kristamarie Collman (Cronbach’s alpha=.90) and the male
persuasive source was Dr. Peter Marks (Cronbach’s alpha=.93).
Identification with transitional characters. Identification with transitional characters,
Henry’s mom (Cronbach’s alpha=.91) and Ricky’s dad (Cronbach’s alpha=.88), was calculated
as a mean score of four items based on previous research (Moyer-Gusé, 2008) collected at
posttest: “The following questions are about this [mom/dad and the instrument showed a still
photo from the message]. When thinking about [her/him]…How much do you like [her/him]?
How similar are you to [her/him]? How much would you like to be like [her/him]? How much do
you feel like you know [her/him]?” Participants were asked to rate their response on a scale
ranging from “not at all” (1) to “a great deal” (10).
Analysis

53
Hypotheses were subjected to one-way analyses of variance (ANOVA) with two levels of
study condition (experimental and control), two-way analyses of variance (ANOVA) with two
levels of study condition and two levels of gender (women and men), and/or independent
samples t-tests with a 0.05 alpha level for statistical significance. Regression analysis was based
on Hayes’s serial mediation models (Hayes, 2018). Analyses were conducted using IBM SPSS
(Version 29) with the PROCESS macro.

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CHAPTER 4:
RESULTS
Confirming Effective Randomization
A total of 548 participants were included in the analytic sample, with 266 randomized to
the experimental condition and 282 randomized to the control condition. Using study condition
as the independent variable, analysis of variance (ANOVA for age and Pearson’s chi-square for
categorical variables) showed no significant between group differences for participant
sociodemographic characteristics, including age, gender, race/ethnicity, level of education,
household income, and political affiliation. These sociodemographic characteristics are
summarized in Table 3.
Table 3. Sociodemographic Characteristics of Participants by Condition
Characteristic Experimental
Condition
Control
Condition
Full Sample
Age, years (mean, SD) 37.2 (5.8) 36.8 (5.9) 37.0 (5.8)
Gender (n, %)
Woman 133 (50%) 144 (51%) 277 (51%)
Man 133 (50%) 138 (49%) 271 (49%)
Race/Ethnicity (n, %)
American Indian or Alaska Native 5 (1.9%) 6 (2.1%) 11 (2.0%)
Asian or Asian American 2 (0.8%) 7 (2.5%) 9 (1.6%)
Black or African American 28 (10.5%) 28 (9.9%) 56 (10.2%)
Hispanic, Latina/o, or Spanish Origin 24 (9%) 19 (6.7%) 43 (7.8%)
Middle Eastern or North African 2 (0.8%) 1 (0.4%) 3 (0.5%)
Native Hawaiian or Other Pacific Islander 1 (0.4%) 1 (0.4%) 2 (0.4%)
White 198 (74.4%) 216 (76.6%) 414 (75.5%)
Other, Not Specified 6 (2.3%) 4 (1.4%) 10 (1.8%)
Education, Highest Completed (n, %)
High School/GED or less 102 (38.3%) 103 (36.5%) 205 (37.4%)
Associate’s Degree or Trade/Technical/Vocational 64 (24.1%) 75 (26.6%) 139 (25.4%)
Bachelor’s Degree or more 100 (37.6%) 104 (36.9%) 204 (37.2%)
Household Income (n, %)
$49,999 or less 117 (44.0%) 112 (39.7%) 229 (41.8%)
$50,000 to $99,999 104 (39.1%) 112 (39.7%) 216 (39.4%)
$100,000 or more 45 (16.9%) 58 (20.6%) 103 (18.8%)
Political Affiliation (n, %)
Republican 96 (36.0%) 99 (35.1%) 195 (35.6%)
Independent 82 (30.8%) 85 (30.1%) 167 (30.5%)

55
Democrat 59 (22.2%) 67 (23.8%) 126 (23.0%)
Not specified 29 (10.9%) 31 (11.0%) 60 (10.9%)
Analysis was also conducted on pretest COVID-19 experience, beliefs and behavior to
test whether randomization was effective. Using study condition as the independent variable,
analysis of variance (Pearson’s chi-square) showed no significant between group differences for
participant vaccination status and history of infection. Finally, using study condition as the
independent variable, analysis of variance (ANOVA) showed no significant between group
differences for pretest beliefs or behavioral intent. These results are summarized in Table 4.
Therefore, randomization to study condition was effective.
Table 4. Pretest COVID-19 Experience, Beliefs, and Behavior by Condition
Characteristic Experimental
Condition
Control
Condition
Full Sample
COVID-19 Vaccination Status, Self (n, %)
Not vaccinated 149 (56.0%) 166 (59%) 315 (57%)
Partially vaccinated 117 (44.0%) 116 (41%) 233 (43%)
History of COVID-19 Infection, Self (n, %)
No 126 (47%) 115 (41%) 241 (44%)
Yes 121 (45%) 140 (50%) 261 (48%)
Unsure 19 (7%) 27 (10%) 46 (8%)
History of COVID-19 Infection, Child (n, %)
No 176 (66%) 172 (61%) 348 (64%)
Yes 69 (26%) 86 (30%) 155 (38%)
Unsure 21 (8%) 24 (9%) 45 (8%)
Complacency beliefs, pretest (mean, SD) 6.44 (2.69) 6.27 (2.59) 6.36 (2.64)
Efficacy beliefs, pretest (mean, SD) 4.45 (2.70) 4.34 (2.75) 4.40 (2.72)
Harm beliefs, pretest (mean, SD) 8.10 (2.10) 8.00 (2.13) 8.05 (2.11)
Injunctive norm belief, pretest (mean, SD) 4.12 (2.90) 3.98 (2.90) 4.05 (2.90)
Intent to seek information, pretest (mean, SD) 38.80 (33.32) 34.36 (33.07) 36.51 (33.24)
Intent to vaccinate child, pretest (mean, SD) 21.79 (28.40) 21.69 (29.95) 21.74 (29.18)
Consideration of Gender as Analytic Factor
As discussed in Chapter 3, a quota method of purposive sampling was employed to
ensure balanced inclusion of participants who identified as women and men. Prior to testing
hypotheses, analysis was conducted to determine whether gender should be included as an

56
analytic factor by testing whether there was an observed difference between women and men in
pretest measurements of harm beliefs, injunctive norm beliefs, intention to seek information, and
intention to vaccinate one’s child. Findings of this analysis is summarized in Table 5. Using
study condition and gender as factors, analysis of variance (ANOVA) revealed a main effect of
gender for pretest harm beliefs (F(1, 547) = 5.90, p<0.05, partial eta squared = 0.01), pretest
injunctive norm beliefs (F(1, 547) = 16.71, p<0.001, partial eta squared = 0.03), pretest
intention to seek information (F(1, 547) = 18.47, p<0.001, partial eta squared = 0.03), and
pretest intention to vaccinate their child (F(1, 547) = 22.05, p<0.001, partial eta squared =
0.04). As summarized in Table 5, women appeared to be more vaccine hesitant than men with
higher pretest harm beliefs and lower pretest injunctive norm beliefs, intent to seek information,
and intent to vaccinate their child. Since this analysis did not reveal any interaction effect of
condition and gender, these findings confirmed effective randomization. However, since the
measures used to test hypotheses included change scores – meaning calculated differences
between posttest and pretest measurement – mothers (women) and fathers (men) were
treated as separate samples to control for differences in pretest beliefs and intentions that
may affect interpretation of the remaining statistical tests.
Table 5. Analysis of Variance of Pretest Measurement of Dependent Variables, by Gender
Variable Women
Mean (SD)
Men
Mean (SD)
Effect of
Condition
Effect of
Gender
Interaction
Effect
Harm beliefs, pretest 8.27 (2.01) 7.83 (2.19) Not significant Significant Not significant
Injunctive norm belief,
pretest
3.55 (2.71) 4.56 (3.02) Not significant Significant Not significant
Intent to seek
information, pretest
30.54
(31.93)
42.62
(33.49)
Not significant Significant Not significant
Intent to vaccinate child,
pretest
24.88
(31.60)
38.65
(36.38)
Not significant Significant Not significant

57
Hypothesis 1a
Hypothesis 1a was there would be an effect of message condition on descriptive
normative beliefs, or perception of how many other parents intend to vaccinate their children
against COVID-19. The effect of message condition on descriptive norms was tested using an
independent samples t-test. There was no effect of condition on descriptive normative beliefs for
women, t(275)=-1.16, p>0.05, nor men, t(269)=-1.34, p>0.05. The difference in perception of
others’ intent to vaccinate one’s child between women in the narrative condition (M=41.83,
SD=26.85) and women in the control condition (M=38.10, SD=26.47) was not statistically
significant. Similarly, the difference in perception of others’ intent to vaccinate one’s child
between men in the narrative condition (M=42.29, SD=28.99) and men in the control condition
(M=37.49, SD=29.99) was not statistically significant. Hypothesis 1a was not supported.
Hypothesis 1b
Hypothesis 1b was there would be an effect of message condition on injunctive
normative beliefs, or perception of whether others want the parent to vaccinate their children
against COVID-19. The effect of message condition on injunctive normative beliefs was tested
using an independent samples t-test. There was a significant effect of message condition on
injunctive normative beliefs among women, t(275)=-2.24, p<0.05, Cohen’s d=0.27. Women in
the narrative condition had a significantly greater increase in perception of how others want them
to behave (M=0.46, SD=1.95) than women in the nonnarrative control condition (M=-0.09,
SD=2.12). See Figure 9.

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Figure 9. Change in Injunctive Normative Beliefs by Condition for Women
Note: Results that do not share alphabetic letter are statistically significantly different, p<0.05
However, there was no effect of message condition on injunctive normative beliefs among men,
t(269)=-1.31, p>0.05. The difference in the change in perceptions of how parents should behave
between men in the narrative condition (M=0.53, SD=1.83) and men in the nonnarrative control
condition (M=0.25, SD=2.03) was not statistically significant. Hypothesis 1b was supported for
women but not supported for men.
Hypothesis 2
The second hypothesis was there would be an effect of message condition on intention to
seek information, which was measured at both pretest and posttest. The effect of message
condition on intention to seek information was tested using an independent samples t-test. There
was a significant effect of message condition on intention to seek information about the COVID19 vaccine for women, t(275)=-1.58, p=0.05, Cohen’s d=0.19. Women in the narrative condition

59
had a significantly higher increase in intent to seek information (M=5.03, SD=19.10) than
women in the nonnarrative control condition (M=1.72, SD=15.64). See Figure 10.
Figure 10. Change in Intent to Seek Information by Condition for Women
Note: Results that do not share alphabetic letter are statistically significantly different, p=0.05
However, there was no effect of message condition on intention to seek information among men,
t(269)=-1.54, p>0.05. The difference in the change in intention to seek information between men
in the narrative condition (M=4.63, SD=10.93) and men in the nonnarrative control condition
(M=2.09, SD=15.67) was not statistically significant. Hypothesis 2 was supported for women but
not supported for men.
Hypothesis 3
The third hypothesis was that the effect of the message on intention to vaccinate one’s
child would be mediated by normative beliefs and intent to seek information. This hypothesis
was tested using a serial mediation model, specifically Hayes’s (2018) Process Model 6 with two

60
mediators. Within this model, injunctive normative belief was included as the first mediator
since previous analysis revealed an effect of message condition for women, and there was no
effect for descriptive norms for women or men (see Hypothesis 1a and 1b).
For women, regression analysis revealed that the total effect of this model was
significant. The total effect of message condition on intent to vaccinate one’s child, mediated by
injunctive normative beliefs and intention to seek information, was 4.98 units (SE=2.34), p<0.05,
r-squared = 0.02. Figure 11 includes the significant path coefficients and standard errors.
Figure 11. Significant Paths, Serial Mediation Model, H3 for Women
There was a significant relationship between message condition and injunctive normative beliefs
such that women in the narrative condition differ in normative beliefs by 0.55 units from women
in the nonnarrative control (see also results for Hypothesis 2). There was also a significant
relationship between perception of how others want one to behave (injunctive norms) and intent
to vaccinate one’s child, such that women who differ by one unit in normative beliefs differ by
1.87 units in intent to vaccinate one’s child. There was a significant relationship between
normative beliefs and intent to seek information, such that women who differ by one unit in

61
normative beliefs differ by 2.46 units in intent to seek information. There was a significant
relationship between intent to seek information and intent to vaccinate one’s child, such that
women who differ by one unit in intent to seek information differ by 0.45 units in intent to
vaccinate one’s child. Hypothesis 3a was supported and hypothesis 3b was partially supported
for women.
For men, regression analysis revealed that the total effect of this model on intent to
vaccinate one’s child was not significant. However, there was a statistically significant
association between intent to seek information and intent to vaccinate one’s child, such that men
who differ by one unit in intent to seek information differ by 0.58 units (se=0.09) in intent to
vaccinate one’s child (p<0.001). Hypothesis 3a was not supported and hypothesis 3b was
partially supported for men.
Hypothesis 4
The fourth hypothesis was there would be an effect of message condition on retention of
explicit information or knowledge. The effect of message condition on knowledge was tested
using an independent samples t-test. There was a significant effect of message condition on
knowledge among women, t(275)=-3.88, p<0.001, Cohen’s d=0.43, such that women in the
narrative condition had a significantly higher knowledge score (M=5.53, SD=0.87) than women
in the nonnarrative control condition (M=5.08, SD=1.06). See Figure 12.

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Figure 12. Knowledge Score by Condition for Women
Note: Results that do not share alphabetic letter are statistically significantly different, p<0.001
For men, there was no effect of message condition on retention of explicit information or
knowledge. The difference in knowledge scores between men in the narrative condition
(M=5.10, SD=1.14) was not statistically different from men in the nonnarrative control condition
(M=4.90, SD=1.17), t(269)=-1.41, p>0.05. Hypothesis 4 was supported for women but not
supported for men.
Hypothesis 5a
Hypothesis 5a was there would be an effect of message condition on feelings of
enjoyment. The effect of message condition on enjoyment was tested using an independent
samples t-test. There was a significant effect of message condition on enjoyment for both
women, t(275)=-2.95, p<0.01, Cohen’s d=0.36, and men, t(269)=-2.48, p<0.01, Cohen’s d=0.30.
Women in the narrative condition had significantly higher feelings of enjoyment (M=5.18,
SD=2.97) than women in the nonnarrative control condition (M=4.17, SD=2.75). Similarly, men

63
in the narrative condition had significantly higher feelings of enjoyment (M=6.03, SD=3.20) than
men in the nonnarrative control condition (M=5.07, SD=3.15). Hypothesis 5a was supported for
women and men.
Hypothesis 5b
Hypothesis 5b was there would be an effect of message condition on feelings of
happiness. The effect of message condition on happiness was tested using an independent
samples t-test. There was a significant effect of message condition on happiness for both women,
t(275)=-4.04, p<0.001, Cohen’s d=0.49, and men, t(269)=-3.05, p=0.001, Cohen’s d=0.37.
Women in the narrative condition had significantly higher feelings of happiness (M=5.29,
SD=2.83) than women in the nonnarrative control condition (M=3.94, SD=2.73). Similarly, men
in the narrative condition had significantly higher feelings of happiness (M=6.07, SD=3.01) than
men in the nonnarrative control condition (M=4.96, SD=2.99). Hypothesis 5b was supported for
women and men.
Hypothesis 5c
Hypothesis 5c was there would be an effect of message condition on feelings of hope.
The effect of message condition on hope was tested using an independent samples t-test. There
was a significant effect of message condition on hope for women, t(275)=-1.96, p<0.05, Cohen’s
d=0.24. Women in the narrative condition had significantly higher feelings of hope (M=5.45,
SD=2.92) than women in the nonnarrative control condition (M=4.75, SD=3.03). For men, there
was no effect of message condition on feelings of hope, t(269)=-0.76, p>0.05. The observed
feelings of hope among men in the narrative condition (M=6.02, SD=2.87) was not statistically
different from men in the nonnarrative control condition (M=5.75, SD=3.09). Hypothesis 5c was
supported for women but not supported for men.

64
Hypothesis 6
The sixth hypothesis was there would be an effect of message condition on sense of
transportation into the message. The effect of message condition on transportation was tested
using an independent samples t-test. There was a significant effect of message condition on
transportation for women, t(275)=-4.17, p<0.001, Cohen’s d=0.50. Women in the narrative
condition had significantly higher sense of transportation (M=5.07, SD=2.47) than women in the
nonnarrative control condition (M=3.89, SD=2.24). See Figure 13.
Figure 13. Transportation by Condition for Women
Note: Results that do not share alphabetic letter are statistically significantly different, p<0.001
There was also an effect of message condition on transportation for men, t(269)=-2.06, p<0.05,
Cohen’s d=0.25. Men in the narrative condition had significantly higher sense of transportation
(M=5.51, SD=2.58) than men in the nonnarrative control condition (M=4.85, SD=2.70). See
Figure 14. Hypothesis 6 was supported for women and men.

65
Figure 14. Transportation by Condition for Men
Note: Results that do not share alphabetic letter are statistically significantly different, p<0.05
Hypothesis 7a
Hypothesis 7a was there would be an effect of message condition on identification with
the female persuasive source, who was Alexa’s mom in Team Player and Dr. Kristmarie
Collman in Ask a Doctor. The effect of message condition on identification with the female
persuasive source was tested using an independent samples t-test. There was a significant effect
of message condition on identification with the female persuasive source for women, t(275)=-
4.11, p<0.001, Cohen’s d=0.50. Women in the narrative condition had significantly higher sense
of identification with Alexa’s mom (M=5.02, SD=2.50) than women in the nonnarrative control
condition had with Dr. Collman (M=3.87, SD=2.18). See Figure 15.

66
Figure 15. Identification with Female Persuasive Source by Condition for Women
Note: Results that do not share alphabetic letter are statistically significantly different, p<0.001
The effect of message condition on identification with the female persuasive sources was not
significant for men, t(268)=-1.60, p>0.05. Men in the narrative condition did not significantly
differ in their sense of identification with Alexa’s mom (M=5.22, SD=2.73) than men in the
nonnarrative control condition identified with Dr. Collman (M=4.70, SD=2.71). Hypothesis 7a
was supported for women but not for men.
Hypothesis 7b
Hypothesis 7b was there would be an effect of message condition on identification with
the male persuasive source, who was Christina’s dad in Team Player and Dr. Peter Marks in Ask
a Doctor. The effect of message condition on identification with the male persuasive source was
tested using an independent samples t-test. There was a significant effect of message condition
on identification with the male persuasive source for both women, t(274)=-7.10, p<0.001,
Cohen’s d=0.86, and for men, t(268)=-4.77, p<0.001, Cohen’s d=0.58. Women in the narrative

67
condition had significantly higher sense of identification with Christina’s dad (M=4.91,
SD=2.25) than women in the nonnarrative control condition had with Dr. Marks (M=3.00,
SD=2.21). Similarly, men in the narrative condition had significantly higher sense of
identification with Christina’s dad (M=5.35, SD=2.54) than men in the nonnarrative control
condition had with Dr. Marks (M=3.83, SD=2.69). See Figure 16. Hypothesis 7b was supported
for women and men.
Figure 16. Identification with Male Persuasive Sources by Condition for Women and Men
Note: Results that do not share alphabetic letter are statistically significantly different, p<0.001. Difference between
women and men samples not tested.
Hypothesis 8
The eighth hypothesis was that the effect of the transportation on intention to vaccinate
one’s child would be mediated by identification with the female persuasive source, harm beliefs,
and intent to seek information. This hypothesis was tested using Hayes’s (2018) Process Model 6
Serial Mediation Model with three mediators.

68
For women, regression analysis revealed that the total effect of this model was
significant. The total effect of transportation on intent to vaccinate one’s child, accounting for
identification with a female persuasive source, harm beliefs, and intention to seek information,
was 3.53 units (SE=0.44), p<0.001, r-squared = 0.19. Figure 17 includes the significant path
coefficients and standard errors.
Figure 17. Significant Paths, Serial Mediation Model, H8 for Women
There was a direct effect of transportation on change in intent to vaccinate one’s child for
women, such that a one unit increase in transportation resulted in a 2.42 units increase in intent
to vaccinate. There was a positive association between transportation and identification with the
female persuasive source, such that one unit increase in sense of transportation resulted in 0.71
units increase in liking the persuasive source. Neither identification with the female persuasive
source nor change in intent to seek additional information directly mediated the effect of
transportation on intent to vaccinate one’s child, but they were part of a serial mediation model.
Thus, hypotheses H8a and H8c are partially supported for women. A one unit increase in sense

69
of transportation resulted in lower harm beliefs (b = -0.17, se=0.08), which had a negative
association with intent to vaccinate one’s child. Hypothesis 8b is supported for women.
For men, regression analysis revealed that the total effect of this model was significant.
The total effect of transportation on intent to vaccinate one’s child, accounting for identification
with a female persuasive source, harm beliefs, and intention to seek information, was 2.96 units
(SE=0.44), p<0.001, r-squared = 0.15. Figure 18 includes the significant path coefficients and
standard errors.
Figure 18. Significant Paths, Serial Mediation Model, H8 for Men
There was a direct effect of transportation on change in intent to vaccinate one’s child for men,
such that a one unit increase in transportation resulted in a 1.71 units increase in intention to
vaccinate one’s child. There was a positive association between transportation and identification
with a female persuasive source, however, identification with the female persuasive source was
not associated with change in intent to vaccinate one’s child through any path. Hypothesis 8a
was partially supported for men. A one unit increase in harm beliefs results in lower intentions to

70
vaccinate one’s child (b=-1.93, se=0.46), but it did not mediate the associate between
transportation and change in intent to vaccinate one’s child. Hypothesis 8b was partially
supported for men. Finally, change in intentions to seek information did mediate the association
between transportation and increase in intentions to vaccinate one’s child. Hypothesis 8c is
supported for men.
Hypothesis 9
The ninth hypothesis was that the effect of the transportation on intention to vaccinate
one’s child would be mediated by identification with the male persuasive source, harm beliefs,
and intent to seek information. This hypothesis was tested using Hayes’s (2018) Process Model 6
Serial Mediation Model with three mediators.
For women, regression analysis revealed that the total effect of this model was
significant. The total effect of transportation on intent to vaccinate one’s child, accounting for
identification with a male persuasive source, harm beliefs, and intention to seek information, was
3.54 units (SE=0.44), p<0.001, r-squared = 0.19. Figure 19 includes the significant path
coefficients and standard errors.
Figure 19. Significant Paths, Serial Mediation Model, H9 for Women

71
There was a direct effect of transportation on change in intent to vaccinate one’s child for
women, such that a one unit increase in transportation resulted in a 2.53 units increase in intent
to vaccinate. There was a positive association between transportation and identification with the
male persuasive source, such that one unit increase in sense of transportation resulted in 0.68
units increase in liking the male persuasive source. Identification with the male persuasive source
was not associated with change in intent to vaccinate one’s child, so hypothesis 9a is partially
supported for women. Both lower harm beliefs and change in intent to seek information directly
mediated the relationship between transportation and change in intent to vaccinate one’s child for
women. Thus, hypotheses Hb and Hc are supported for women.
For men, regression analysis revealed that the total effect of this model was significant.
The total effect of transportation on intent to vaccinate one’s child, accounting for identification
with a male persuasive source, harm beliefs, and intention to seek information, was 2.97 units
(SE=0.44), p<0.001, r-squared = 0.15. Figure 20 includes the significant path coefficients and
standard errors.
Figure 20. Significant Paths, Serial Mediation Model, H9 for Men

72
There was a direct effect of transportation on change in intent to vaccinate one’s child for men,
such that a one unit increase in transportation resulted in a 1.79 units increase in intention to
vaccinate one’s child. There was a positive association between transportation and identification
with a male persuasive source, however, identification with the male persuasive source was not
associated with change in intent to vaccinate one’s child through any path. Hypothesis 9a was
partially supported for men. A one unit increase in harm beliefs results in lower intentions to
vaccinate one’s child (b=-1.91, se=0.46), but it did not mediate the associate between
transportation and change in intent to vaccinate one’s child. Hypothesis 9b was partially
supported for men. Finally, change in intentions to seek information did mediate the association
between transportation and increase in intentions to vaccinate one’s child. Hypothesis 9c is
supported for men.
Hypothesis 10
The tenth hypothesis was that the effect of transportation on intent to vaccinate one’s
child would be mediated by identification with the mother transitional character, Henry’s mom,
and intent to seek information. This hypothesis was tested as Hayes’s Model 6 Serial Mediation
Model with two mediators. For both women and men, the total effect model was significant. For
women, the total effect of transportation on intent to vaccinate one’s child, accounting for
identification with Henry’s mom and intent to seek information, was 4.51 units (SE=0.68),
p<0.001, r-squared=0.25. Figure 21 includes significant path coefficients and standard errors.
There was a positive association between transportation and identification with Henry’s mom
(b=0.49, se=0.07), but identification with this character was not associated with intention to
vaccinate one’s child through any path. Hypothesis 10a was partially supported for women.
There was a positive association between transportation and intention to seek information

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(b=2.47, se=0.75), and intention to vaccinate one’s child (b=3.35, se=0.76). There was also a
positive association between intention to seek information and intention to vaccinate one’s child
(b=0.44, se=0.09). Hypothesis 10b was supported for women.
Figure 21. Significant Paths, Serial Mediation Model, H10 for Women
For men, the total effect of transportation on intent to vaccinate one’s child, accounting for
identification with Henry’s mom and intent to seek information, was 3.10 units (SE=0.60),
p<0.01, r-squared=0.17. Figure 22 includes significant path coefficients and standard errors.
There was a positive association between transportation and identification with Henry’s mom
(b=0.61, se=0.07), but identification with this character was not associated with intention to
vaccinate one’s child. Hypothesis 10a was partially supported for men. There was a positive
association between transportation and intention to seek information (b=1.29, se=0.45), and
intention to vaccinate one’s child (b=2.17, se=0.74). There was also a positive association
between intention to seek information and intention to vaccinate one’s child (b=0.65, se=0.14).
Hypothesis 10b was supported for men.

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Figure 22. Significant Paths, Serial Mediation Model, H10 for Men
Hypothesis 11
The eleventh hypothesis was that the effect of transportation on intent to vaccinate one’s
child would be mediated by identification with the father transitional character, Ricky’s dad, and
intent to seek information. This hypothesis was tested as Hayes’s Model 6 Serial Mediation
Model with two mediators. For both women and men, the total effect model was significant. For
women, the total effect of transportation on intent to vaccinate one’s child, accounting for
identification with Ricky’s dad and intent to seek information, was 4.51 units (SE=0.68),
p<0.001, r-squared=0.25. Figure 23 includes significant path coefficients and standard errors.
There was a positive association between transportation and identification with Ricky’s dad
(b=0.26, se=0.07), but identification with this character was not associated with intention to
vaccinate one’s child. Hypothesis 11a was partially supported for women. There was a positive
association between transportation and intention to seek information (b=3.03, se=0.67), and
intention to vaccinate one’s child (b=3.81, se=0.70). There was also a positive association

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between intention to seek information and intention to vaccinate one’s child (b=0.41, se=0.09).
Hypothesis 11b was supported for women.
Figure 23. Significant Paths, Serial Mediation Model, H11 for Women
For men, the total effect of transportation on intent to vaccinate one’s child, accounting for
identification with Ricky’s dad and intent to seek information, was 3.10 units (SE=0.60), p<0.01,
r-squared=0.17. Figure 24 includes significant path coefficients and standard errors. There was a
positive association between transportation and identification with Ricky’s dad (b=0.19,
se=0.08), but identification with this character was not associated with intention to vaccinate
one's child. Hypothesis 11a was partially supported for men. There was a positive association
between transportation and intention to seek information (b=1.41, se=0.36), and intention to
vaccinate one’s child (b=2.43, se=0.60). There was also a positive association between intention
to seek information and intention to vaccinate one’s child (b=0.61, se=0.14). Hypothesis 11b was
supported for men.

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Figure 24. Significant Paths, Serial Mediation Model, H11 for Men
Hypothesis 12
The twelfth hypothesis was that the effect of transportation on intent to vaccinate one’s
child would be mediated by feelings of enjoyment and intent to seek information. This
hypothesis was tested as Hayes’s Model 6 Serial Mediation Model with two mediators. For both
women and men, the total effect model was significant. For women, the total effect of
transportation on intent to vaccinate one’s child, mediated by feelings of enjoyment and intent to
seek information, was 3.53 units (SE=0.44), p<0.001, r-squared=0.19. Figure 25 includes
significant path coefficients and standard errors. There was a positive association between
transportation and enjoyment (b=1.39, se=0.56). There was a positive association between
enjoyment and intention to seek information (b=1.39, se=0.56) and intention to vaccinate one’s
child (b=1.86, se=0.55). There was also a positive association between intention to seek
information and intention to vaccinate one’s child (b=0.39, se=0.06). Hypothesis 12a is
supported and hypothesis 12b is partially supported for women.

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Figure 25. Significant Paths, Serial Mediation Model, H12 for Women
For men, the total effect of transportation on intent to vaccinate one’s child, mediated by feelings
of enjoyment and intent to seek information, was 2.99 units (SE=0.44), p<0.001, r-squared=0.15.
Figure 26 includes significant path coefficients and standard errors. There was a positive
association between transportation and feelings of enjoyment (b=1.03, se=0.04). There was a
positive association between feelings of enjoyment and intention to seek information (b=1.13,
se=0.47) and intention to vaccinate one’s child (b=1.58, se=0.56). There was also a positive
association between intention to seek information and intention to vaccinate one’s child (b=0.43,
se=0.08). Hypothesis 12a was supported and hypothesis 12b was partially supported for men.

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Figure 26. Significant Paths, Serial Mediation Model, H12 for Men
Hypothesis 13
The thirteenth hypothesis was that the effect of transportation on intent to vaccinate one’s
child would be mediated by feelings of happiness and intent to seek information. This hypothesis
was tested as Hayes’s Model 6 Serial Mediation Model with two mediators. For both women and
men, the total effect model was significant. For women, the total effect of transportation on
intent to vaccinate one’s child, mediated by feelings of happiness and intent to seek information,
was 3.53 units (SE=0.44), p<0.001, r-squared=0.19. Figure 27 includes significant path
coefficients and standard errors. There was a positive association between transportation and
happiness (b=0.76, se=0.05), intent to seek information (b=1.18, se=0.53), and intent to
vaccinate one’s child (b=2.13, se=0.53). There was a positive association between happiness and
intention to seek information (b=1.23, se=0.45). There was also a positive association between
intention to seek information and intention to vaccinate one’s child (b=0.40, se=0.06).
Hypothesis 13a was partially supported and hypothesis 13b was supported for women.

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Figure 27. Significant Paths, Serial Mediation Model, H13 for Women
For men, the total effect of transportation on intent to vaccinate one’s child, accounting for
feelings of happiness and intent to seek information, was 2.99 units (SE=0.44), p<0.001, rsquared=0.15. Figure 28 includes significant path coefficients and standard errors. There was a
positive association between transportation and feelings of happiness (b=0.87, se=0.05) and
intent to vaccinate one’s child (b=1.47, se=0.64). There was a positive association between
feelings of happiness and intention to vaccinate one’s child (b=1.16, se=0.55). There was also a
positive association between intention to seek information and intention to vaccinate one’s child
(b=0.45, se=0.08). Hypothesis 13a was supported and hypothesis 13b was partially supported for
men.

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Figure 28. Significant Paths, Serial Mediation Model, H13 for Men
Hypothesis 14
The fourteenth hypothesis was that the effect of transportation on intent to vaccinate
one’s child would be mediated by feelings of hope and intent to seek information. This
hypothesis was tested as Hayes’s Model 6 Serial Mediation Model with two mediators. For both
women and men, the total effect model was significant. For women, the total effect of
transportation on intent to vaccinate one’s child, mediated by feelings of hope and intent to seek
information, was 3.53 units (SE=0.44), p<0.001, r-squared=0.19. Figure 29 includes significant
path coefficients and standard errors. There was a positive association between transportation
and hope (b=0.81, se=0.06), intent to seek information (b=1.25, se=0.54), and intent to vaccinate
one’s child (b=2.10, se=0.54). There was a positive association between hope and intention to
seek information (b=1.01, se=0.44). There was also a positive association between intention to
seek information and intention to vaccinate one’s child (b=0.40, se=0.06). Hypothesis 14a is
partially supported and hypothesis 14b is supported for women.

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Figure 29. Significant Paths, Serial Mediation Model, H14 for Women
For men, the total effect of transportation on intent to vaccinate one’s child, accounting for
feelings of hope and intent to seek information, was 2.99 units (SE=0.43), p<0.001, rsquared=0.15. Figure 30 includes significant path coefficients and standard errors. There was a
positive association between transportation and feelings of hope (b=0.85, se=0.04), intention to
seek information (b=1.15, se=0.47), and intent to vaccinate one’s child (b=2.05, se=0.64). There
was also a positive association between intention to seek information and intention to vaccinate
one’s child (b=0.46, se=0.08). Hypothesis 14a was partially supported and hypothesis 14b was
supported for men.

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Figure 30. Significant Paths, Serial Mediation Model, H14 for Men
Summary of Findings
Table 6 summarizes the findings of tested hypotheses. These findings will be discussed in
the next chapter.
Table 6. Summary of Hypotheses and Statistical Findings
Hypothesis Findings for Women Findings for Men
H1a: The narrative message will have a greater effect
on descriptive normative beliefs than the nonnarrative
control message.
Not supported Not supported
H1b: The narrative message will have a greater effect
on injunctive normative beliefs than the nonnarrative
control message.
Supported Not supported
H2: The narrative message will have a greater effect
on intent to seek information than the nonnarrative
control message.
Supported Not supported

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Hypothesis Findings for Women Findings for Men
H3a: The effect of the narrative message on intent to
vaccinate one’s child will be mediated by normative
beliefs. Serial Mediation Model
Supported Not supported
H3b: The effect of the narrative message on intent to
vaccinate one’s child will be mediated by intent to
seek information. Serial Mediation Model
Partially supported
Indirect path
Partially supported
Association between
intent to seek
information and
intent to vaccinate
H4: The narrative message will have a greater effect
on retention of the explicit knowledge-based messages
than the nonnarrative control message.
Supported Not supported
H5a: The narrative message will have a greater effect
on feelings of enjoyment than the nonnarrative control
message.
Supported Supported
H5b: The narrative message will have a greater effect
on feelings of happiness than the nonnarrative control
message.
Supported Supported
H5c: The narrative message will have a greater effect
on feelings of hope than the nonnarrative control
message.
Supported Not supported
H6: The narrative message will have a greater effect
on sense of transportation than the nonnarrative
control message.
Supported Supported
H7a: The narrative message will have a greater effect
on sense of identification with the female persuasive
source than the nonnarrative control message.
Supported Not supported
H7b: The narrative message will have a greater effect
on sense of identification with the male persuasive
source than the nonnarrative control message.
Supported Supported
H8a: The effect of transportation on intent to vaccinate
one’s child will be mediated by identification with a
female persuasive source. Serial Mediation Model
Partially supported
Indirect path
Partially supported
Association between
transportation
and identification
H8b: The effect of transportation on intent to vaccinate
one’s child will be mediated by harm beliefs. Serial
Mediation Model
Supported Partially supported
Association between
harm beliefs and
intent to vaccinate
H8c: The effect of transportation on intent to vaccinate
one’s child will be mediated by intent to seek
information. Serial Mediation Model
Partially supported
Indirect path
Supported
H9a: The effect of transportation on intent to vaccinate
one’s child will be mediated by identification with the
male persuasive source. Serial Mediation Model
Partially supported
Association between
transportation
and identification
Partially supported
Association between
transportation
and identification
H9b: The effect of transportation on intent to vaccinate
one’s child will be mediated by harm beliefs. Serial
Mediation Model
Supported Partially supported
Association between
harm beliefs
and intent to
vaccinate

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Hypothesis Findings for Women Findings for Men
H9c: The effect of transportation on intent to vaccinate
one’s child will be mediated by intent to seek
information. Serial Mediation Model
Supported Supported
H10a: The effect of transportation on intent to
vaccinate one’s child will be mediated by
identification with the mother transitional character.
Serial Mediation Model
Partially supported
Association between
transportation
and identification
Partially supported
Association between
transportation
and identification
H10b: The effect of transportation on intent to
vaccinate one’s child will be mediated by intent to
seek information. Serial Mediation Model
Supported Supported
H11a: The effect of transportation on intent to
vaccinate one’s child will be mediated by
identification with the father transitional character.
Serial Mediation Model
Partially supported
Association between
transportation
and identification
Partially supported
Association between
transportation
and identification
H11b: The effect of transportation on intent to
vaccinate one’s child will be mediated by intent to
seek information. Serial Mediation Model
Supported Supported
H12a: The effect of transportation on intent to
vaccinate one’s child will be mediated by feelings of
enjoyment. Serial Mediation Model
Supported Supported
H12b: The effect of transportation on intent to
vaccinate one’s child will be mediated by intent to
seek information. Serial Mediation Model
Partially supported
Indirect path
Partially supported
Indirect path
H13a: The effect of transportation on intent to
vaccinate one’s child will be mediated by feelings of
happiness. Serial Mediation Model
Partially supported
Indirect path
Supported
H13b: The effect of transportation on intent to
vaccinate one’s child will be mediated by intent to
seek information. Serial Mediation Model
Supported Partially supported
Association between
intent to seek
information and
intent to vaccinate
H14a: The effect of transportation on intent to
vaccinate one’s child will be mediated by feelings of
hope. Serial Mediation Model
Partially supported
Indirect path
Partially supported
Association between
transportation
and hope
H14b: The effect of transportation on intent to
vaccinate one’s child will be mediated by intent to
seek information. Serial Mediation Model
Supported Supported

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CHAPTER 5:
DISCUSSION
This study empirically tested the relative effectiveness of a narrative message and a
nonnarrative control message on beliefs and intentions among vaccine hesitant parents in the
context of COVID-19. Conceptualizing vaccine hesitancy as a behavior, this dissertation argues
that promotion messages that leverage theories of social influence and narrative persuasion are
more likely to initiate behavior change with this audience than messages that rely on risk
communication from health authorities. As detailed in Chapter 3, this claim was tested in a series
of hypotheses using a web-based pretest-posttest experiment. After observing statistically
significant differences in pretest beliefs and behavioral intentions by gender, hypotheses were
tested by treating women and men as separate samples to control for pretest variance that may
make observing change at the individual level difficult. Separating the samples by gender
clarified results for both mothers and fathers and revealed potential future research questions to
be discussed in this chapter and Chapter 6.
This chapter will summarize and discuss the findings reported in Chapter 4 by applying
the Diffusion of Innovation theory’s innovation-decision process (Rogers, 2003) as a conceptual
model for behavior change. As discussed in Chapter 1 (see: Diffusion of Innovation and
Normative Beliefs), the innovation-decision process proposes five stages in the behavior change
process (Rogers, 2003). This chapter will discuss how hypotheses represent the early stages of
the innovation-decision process – knowledge, persuasion, and behavioral intent – and movement
between stages. Since the later stages of the innovation-decision process were not measured in
this study, opportunities for future studies related to those stages will be discussed in Chapter 6.
This chapter concludes by proposing additional aspects of Team Player to study.

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Knowledge Stage
The first stage of the innovation-decision process is knowledge or awareness of the
promoted behavior change (Rogers, 2003). Parents who are vaccine hesitant are deliberately
delaying or refusing vaccination for their child. The explicit message of both Team Player and
Ask a Doctor was that parents should be willing to learn more information and change their mind
toward intent to vaccinate their children against COVID-19. For this study, attention to and
understanding of the explicit message was measured using six survey items related to correcting
myths that undermined COVID vaccine acceptance, such as that vaccination was still beneficial
after previous illness and that the vaccine would not impact fertility.
For women, participants who viewed Team Player had a statistically significantly higher
mean score of knowledge, or retention of the explicit message, than those who viewed Ask a
Doctor (see findings of Hypothesis 4). This suggests that the narrative promotion message might
be more effective at initiating the proposed behavior change process than the nonnarrative
control because mothers in the narrative condition retained more information meant to correct
myths that could undermine vaccine acceptance. Interestingly, there was no effect of message
condition on knowledge among men (see findings of Hypothesis 4). Since men were less vaccine
hesitant than women at pretest, it is possible that there was a “ceiling effect” on men’s
knowledge scores leaving not enough variance to find statistical difference and that knowledge
scores in both conditions reflect at least some amount of prior knowledge. Future studies should
explore this potential association, which would require measurement of knowledge facts at both
pretest and posttest.

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Moving from Knowledge to Persuasion Stage
This dissertation argues that continuing movement through the innovation-decision
process after the knowledge/awareness stage requires the belief that the message is relevant and
valuable. Since prior research suggests that vaccine hesitant parents view themselves as experts
in making decisions for their child’s wellbeing (Reich, 2016; Romijnders et al., 2019; Wang et
al., 2015) and some scholars propose that parents engage in complicated risk appraisals when
making vaccine decisions (Brewer et al., 2017), it might be possible for a vaccine hesitant parent
to retain information from a vaccine promotion message and then dismiss it because they have
already made their decision to delay or reject the vaccine. However, being perceived as a
competent parent is an important social value (Collett, 2005; Reich, 2016; Song et al., 2012), so
communicating social instructions – either by influencing perceptions of what others do
(descriptive norms) or perceptions of what others encourage (injunctive norms) – may make the
audience judge a message to be relevant and valuable. The first hypothesis predicted the
narrative message would have a greater impact on normative beliefs than the control message
that contained the same key information, and it was partially supported. There was no effect of
the narrative message on descriptive normative beliefs, as measured in estimates of the number
of people like them out of 100 who would have their child vaccinated, for women or men. This
may suggest that a single exposure to Team Player and/or the depiction of events in the message
was not sufficient for influencing perceptions of how others behave. As discussed in Chapter 2,
this narrative message depicted the innovation-decision process of willingness to discuss
COVID-19 vaccination and consider changing one’s mind based on new information. It is
implied that Ricky’s dad and Henry’s mom intend to accept vaccination for their children, but
enactment of that intention is not part of the message. It is possible that influencing descriptive

88
norms about vaccination necessitates depicting acceptance, such as showing parents and children
arriving at a health clinic.
Importantly, what was depicted in Team Player influenced related normative beliefs.
Team Player depicted friends encouraging others (injunctive norms) to vaccinate their children.
For women, participants who viewed Team Player had a significantly greater increase in
injunctive normative beliefs related to vaccinating children against COVID-19 than those who
viewed Ask a Doctor (see findings of Hypothesis 1b). This suggests mothers would feel more
encouraged to vaccinate their children if peers communicated positively about vaccine decisions.
Mothers who watched Team Player also had significantly greater intention to seek information
than women in the nonnarrative control (see findings of Hypothesis 2), and the effect of the
narrative message on increasing intention to vaccinate one’s child was mediated by positive
associations with change in injunctive norm beliefs and change in intentions to seek additional
information about the COVID-19 vaccine (see findings of Hypothesis 3). These positive findings
may represent movement from the first to second stage of the innovation-decision process.
However, for men, there was no effect of message condition on change in injunctive
norm beliefs (see findings of Hypothesis 1b) or change in intentions to seek information (see
findings of Hypothesis 2). Future research should explore whether these finding relate to
elements of Team Player, or whether they point to the need to explore a potential association
between parental health decision-making authority and persuasive efforts. If a father is not “in
charge” of vaccine decisions, it is reasonable that he would not experience a change in beliefs or
behavioral intentions. Therefore, future studies should measure the extent to which a parent
holds authority or influence regarding familial vaccine decisions to better understand the effect
of a persuasive message.

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Persuasion Stage
The second stage of the innovation-decision process is persuasion, where one changes
beliefs and attitudes toward the promoted behavior (Rogers, 2003). As discussed in Chapter 2
(see: Message Content Strategies – Framing, Priming, and Persuasion), persuasive appeals
should be carefully tailored for the intended audience, both in terms of selecting the persuasive
source and designing the message. This dissertation argues that in the case of parental vaccine
hesitancy, peers or perceived peers are more likely to be influential sources to motivate change
than health experts because of the effect of normative beliefs on behavior. Prior research
concludes that for narrative persuasion to occur, the audience must experience identification with
or liking of the persuasive sources. Identification with the persuasive sources were examined by
gender of the source and gender of the participate. Women who viewed Team Player had
significantly higher levels of identification with both Alexa’s mom (female persuasive source)
and Christina’s dad (male persuasive source) than women who viewed Ask a Doctor had with
their counterparts (see findings of Hypothesis 7a and 7b). Men who viewed Team Player had
significantly higher levels of identification with Christina’s dad (male persuasive source) than
men who viewed Ask a Doctor had with Dr. Peter Marks (see findings of Hypothesis 7b), but
there was no between-group difference in identification with female persuasive sources (see
findings of Hypothesis 7a). Future research should explore if these findings relate to the
difference in tone between the characters, since Christina’s dad used humor and Alexa’s mom
did not.
Moving from Persuasion to Behavioral Intent
As discussed in Chapter 2 (see Transportation or Engagement with the Message), the
experience of being engaged with or transported into the narrative world is theorized to be an

90
important mechanism of narrative persuasion. For both women and men, participants who
viewed Team Player were significantly more transported than those who viewed Ask a Doctor
(see findings of Hypothesis 6). Transportation should predict both character identification and
story-consistent emotional response. As theorized by Dunlop and colleagues (2008), the
persuasive effect of character identification may be a mechanism of social influence and the
persuasive effect of positive emotional response may be a mechanism of self-referencing. Thus,
the proposed hypotheses tested whether character identification and emotional response mediated
the effect of transportation on behavioral intentions. These results are discussed below.
Effect of Character Identification. As previously mentioned, there was some effect of
message condition on identification with persuasive sources (see findings of Hypothesis 7). For
women, the effect of transportation on intent to vaccinate one’s child was mediated by
identification with Alexa’s mom and intention to seek additional information about the vaccine
(see findings of hypotheses 8a and 8c). For women, there was also a positive association between
transportation and identification with Christina’s dad, but identification with this male persuasive
source was not associated with behavioral outcomes (see findings of hypothesis 9a). It is
important to note that Alexa’s mom directly encourages others to seek information and consider
vaccination, while Christina’s dad only mentions his own effort to correct myths he had heard.
These findings may suggest the importance of dialogue in communicating social instructions.
Among men, there was a positive association between transportation and identification with both
Alexa’s mom and Christina’s dad, but identification with a persuasive source was not associated
with behavioral outcomes (see findings of 8a and 9a). Future research should explore whether
aspects of these characters help explain these findings.

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Interestingly, identifying with a persuasive source was not found to influence harm
beliefs in the serial mediation model. For women, identifying with a persuasive source was not
associated with harm beliefs, but changes in harm beliefs did mediate the effect of transportation
and intent to vaccinate one’s child (see findings of hypotheses 8b and 9b). For men, there was a
negative association between changes in harm beliefs and intent to vaccinate one’s child, but
there was no association between transportation and harm beliefs for men (see findings of 8b and
9b). Future research should explore whether other constructs, such as emotional response, help
explain this observed role of changes in harm beliefs.
The tenth and eleventh hypotheses predicted that identification with the transitional
characters – Henry’s mom and Ricky’s dad – would mediate the relationship between
transportation and change in intention to vaccinate one’s child. Although there was a positive
association between transportation and identification with Henry’s mom and Ricky’s dad for
both women and men, this identification did not mediate the relationship between transportation
and increase in intention to seek information or vaccinate one’s child (see findings of Hypotheses
10 and 11). Future research should explore whether aspects of these characters or the plot help
explain these findings. As will be discussed in Chapter 6, additional research is needed to
determine if these characters are perceived as positive role models by the end of the story, which
would be necessary to support adopting modeled behavior.
Effect of Emotional Response. Previous research suggests that a positive emotional
response can increase acceptance of a persuasive message. The fifth hypothesis predicted there
would be an effect of message condition on feelings of (a) enjoyment, (b) happiness, and (c)
hope. Both H5a and H5b were supported for women and men. In other words, both mothers and
fathers of unvaccinated children who viewed Team Player had significantly higher experiences

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of enjoyment and happiness than those who viewed Ask a Doctor. There was also an effect of
message condition on feelings of hope for women, but not for men. It was theorized that the
story about an underdog youth soccer game could inspire hope, which might be transferred to an
association with vaccine decisions. It is also possible that the women who viewed Team Player
did not experience hope because of the soccer team, but because of the depiction of life returning
to pre-pandemic conditions, where one’s child could play soccer. Given the potential unbalanced
parental burden due to pandemic stay-at-home measures, it is possible that the women were more
influenced by the emotional resonance of the message. Further research is needed to understand
the emotional resonance of Team Player, which will be discussed further in Chapter 6.
The findings of Hypotheses 12, 13, and 14 revealed an interesting pattern of effects of
positive emotions that should be studied further. For both women and men, experiencing
enjoyment from the message mediated the relationship between transportation and change in
intention to vaccinate one’s child, both directly and as a path in the serial mediation model.
Notably, this model did not include a direct effect of transportation on intention to vaccinate (see
findings of Hypothesis 12), which was observed in other models (see findings of Hypotheses 8,
9, 10, 11, 13 and 14). Future research should explore which message features enhanced
enjoyment.
Experiencing happiness while viewing the message had different effects for women and
men. For women, happiness only mediated the relationship between transportation and change in
intention to vaccinate one’s child as part of the serial mediation model that included change in
intent to seek information, which also directly mediated the independent and dependent variables
(see findings of Hypothesis 13a). For men, however, happiness mediated the relationship
between transportation and change in intent to vaccinate one’s child but did not predict change in

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intention to seek information. Future research should explore which message features enhanced
happiness and whether there are other factors that explain how this emotion may motivate
different behavioral intentions between women and men.
Finally, experiencing hope followed the same pattern of effects for women as
experiencing happiness. Hope mediated the relationship between transportation and change in
intention to vaccinate children as part of the serial mediation model, but there was no direct
effect of hope on intention to vaccinate. For men, transportation was positively association with
feelings of hope, but hope did not mediate any relationships. This follows the findings of H5c for
men, and calls for research to better understand if hope is a motivating emotion and whether
message features can spark hope.
Behavioral Intent Stage
The third stage of the innovation-decision process is decision or behavioral intent
(Rogers, 2003). As discussed in Chapter 1, conceptualizing parental vaccine hesitancy as a
behavior suggests that a previous innovation-decision process was completed that resulted in
delaying or refusing COVID-19 vaccination. Therefore, both Team Player and Ask a Doctor
promoted seeking additional information in order to persuade willingness to change one’s beliefs
and behavior to then accept vaccination. As previously discussed, mothers (but not fathers) who
viewed Team Player were significantly more likely to seek information about COVID-19
vaccination at posttest than those who viewed Ask a Doctor (see findings of Hypothesis 2).
Previously discussed study findings support this conceptualization of intention to seek
information as a proximal variable to intention to vaccinate one’s child. In all tested models for
both women and men, change in intent to seek information had a significant and positive
association with intent to vaccinate one’s child (see findings of Hypotheses 3, 8, 9, 10, 11, 12,

94
13, and 14). These findings further suggest that the narrative message was more effective at
initiating behavior change than the nonnarrative control.
Additional Future Research
There are at least two additional aspects of this study that call for further research.
Although randomization to study conditions was confirmed to be effective, there were
statistically significant differences in pretest harm beliefs, normative beliefs, and behavioral
intentions between men and women overall, such that women would be deemed more vaccinehesitant than men. This finding should be studied further and include measurement of other
relevant constructs, such as health-related locus of control and health decision-making authority.
The other aspect of Team Player that calls for further study is related to the child characters,
particularly Charlie. He shows forgiveness and embraces team spirit, even though it might be
reasonable to ignore or lash out at Ricky. He also uses the metaphor of videogaming systems to
help explain vaccine development. A future study should test whether any of the child characters
affect the persuasive message.

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CHAPTER 6:
CONCLUSION
Telling a story, particularly when using the entertainment-education format, means one
can include several message strategies in hopes something initiates behavioral change. While
certainly beneficial, it also might be difficult to isolate effects. This study tested the application
of theoretical concepts. Future experiments with additional message conditions might isolate
each construct to support the claims made in this dissertation, such as peer sources versus health
authorities and positive tone versus risk. Additionally, there are three limitations to this study to
review. First, emotions are included as an important element for the persuasive process,
however, this study only measured integral emotions (Ferrer & Mendes, 2018), and more
specifically, plot-referent emotions, meaning emotions thought to be experienced as a result of a
specific stimulus (Dunlop et al., 2008). Incidental emotions, meaning those experienced while
viewing the message but elicited by some other stimuli (Ferrer & Mendes, 2018), were not
measured and may have confounded findings and/or impacted elaboration of the message. Future
studies should measure incidental emotions and develop measurement of complex integral
emotions (Nabi, 2015) to better understand effects.
The second limitation is that all claims about the implicit message and tone come from
this author. Future focus group studies are needed to reveal how the audience perceives and
understands the meaning of Team Player to learn whether the cultural symbols and experiences
communicate the intended message. Focus groups could also provide insight into perceptions of
transitional characters and persuasive sources as role models, and audience response to the use of
metaphor (videogaming systems), innuendo (the straw), and the subplot focused on the children.
The third limitation is that this study measured identification with persuasive sources – meaning

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familiarity and liking – as an operationalization of source influence. This study did not directly
measure credibility – perceived expertise and trustworthiness – so future studies would be useful
for understanding effects and designing promotion messages. Further, it is possible that peer
influence was more effective in the context of COVID-19 because other research found evidence
of low perception of credibility for health authorities among the public as a result of early
response to the pandemic (e.g., Chou & Budenz, 2020). Therefore, the effect of source identity –
peer or authority – should be studied in other vaccine contexts. Despite these limitations, study
findings support the following recommendations for entertainment-education scholars and health
promotion practitioners.
Future Agenda for Entertainment-Education Scholars
Vaccine beliefs are formed by information learned and considered in a social context, and
individuals will seek information to decrease uncertainty about expected outcomes, as well as
seek social reinforcement during the implementation and confirmation stages of the innovationdecision process (Rogers, 2003). As discussed in Chapter 1, the Diffusion of Innovations model
recognizes the role of interpersonal influence in changing behavior. Individuals in a social
network may be sources of new information, role models performing new behaviors, and provide
reinforcement for sustaining a behavior once it is adopted (Rogers, 2003). The Diffusion of
Innovation model also assumes that mass-media health promotion campaigns will generate
interpersonal communication that influences the change process (Rogers, 2002, 2003). Scholars
have theorized that E-E results in this multi-step flow process, where storylines lead to
interpersonal discussions, which aid in the progression from knowledge to changes in beliefs to
behavioral intent over time (Slater, 2002). This has been supported by previous research, which

97
found that the type and amount of interpersonal communication about an E-E message
influenced the persuasive impact (Valente et al., 1996). Valente, Poppe, and Merritt (1996)
propose that E-E interventions should be evaluated using models that integrate both message
effects and interpersonal influences (Valente & Pitts, 2017). Beyond measuring perceived norms
about the behavior of interest, scholars might collect data to situate a person within adopter
categories broadly and within a specific social group (Valente, 1996). Of specific interest would
be measuring any interpersonal influences who might reject the innovation and undermine the
effect of the E-E intervention, as well as earlier adopters who might reinforce the media
message. For example, messages like Team Player could function as a social script and train
vaccine-accepting parents how to positively influence others, like the promotoras model and
community health educators used in other health contexts. Since it is expected that E-E messages
will be consumed and discussed together(Valente & Fosados, 2006), scholars could measure
with whom it was consumed and/or discussed, how often it was discussed, and how favorably it
was discussed. Consistently measuring interpersonal and social factors will provide important
insight and allow for the development of better E-E interventions to address important health
issues such as parental vaccine hesitancy.
In terms of type of entertainment-education, musicals are an underexplored form of
persuasive entertainment that this author predicts would be effective in initiating change in
complicated beliefs, such as vaccination for one’s child. In book musicals, songs are fully
integrated into the narrative and serve a dramatic purpose, drawing audience attention to points
of significance. Thus, the reflection of values is enhanced by the emotional response stimulated
by music. Heide and colleagues (2012) wrote an original musical to measure emotional
involvement as it related to changes in attitudes about hunting. They found that participants who

98
had complex emotional reactions to the show — for example, reporting feeling both happy and
sad — reported more emotional engagement, which was found to be related to a change in
attitude about hunting (Heide et al., 2012). The authors acknowledged that the emotional
resonance of the piece may be due to the overlay of narrative to music, which has been shown to
increase attention and memory of events (Bandura, 2004; Coffman et al., 1995; Heide et al.,
2012; Purnell-Webb & Speelman, 2008). Since this form of entertainment lends to both
character identification and emotional response through music, it is worth exploring the potential
effect within the rich cultural history of vaccine beliefs and myths.
Future Agenda for Health Promotion Practitioners
Myths spread through personal experience narratives, legends, and rumors (Kitta &
Goldberg, 2017). According to Shelby and Ernst (2013), anti-vaccine messages take story form –
generally as personal accounts or anecdotes – because it is a way to make meaning of
complicated and often tragic events. So, why aren’t we telling more stories to promote
vaccination? Stories spread and they are remembered. Recognizing that producing a musical may
seem a lofty goal, there are more accessible ways that health promotion practitioners can
leverage narrative elements to influence vaccine hesitant parents. This dissertation argues that
the observed effects of Team Player were a result of the persuasive sources talking like friends.
In addition to the network intervention mentioned in the previous section, health promotion
practitioners could consider another space where parents look for friendly advice. For mothers,
online public diaries — called blogs — are important spaces for sharing personal experiences,
information, advice, and social support (Abidin, 2017; Hunter, 2016; Morrison, 2010, 2011;
Wright et al., 2019). One study found that “mommy bloggers” were effective at disseminating

99
health risk information that affected attitudes about prevention behavior (Wright et al., 2019).
Wright and colleagues (2019) attributed this finding to readers’ perceived similarity with the
blogger, noting that such similarity predicts acceptance, sharing, and adoption of the behavior
described in the blog. Similar to character identification, followers may form a parasocial
relationship with mommy bloggers because they connect over shared experience and values.
There is an important distinction between mommy blogger and mommy influencers, with the
former generally perceived as sources of important information with a shared social experience
(Morrison, 2011) and the latter generally perceived as selling products for personal gain (Hunter,
2016). Health promotion practitioners should consider partnering with mommy bloggers,
particularly those who are health professionals themselves.
Overall, rather than overemphasizing risk of disease, messages for parents who have
already decided to delay or reject vaccines should convey empathy and understanding. Alexa’s
mom and Christina’s dad demonstrated trustworthiness because they approached their peers with
empathy and a little humor. For parents, our real friends are the people we trust with our
children, to help teach them and protect them. We are willing to consider new or different ideas
from our friends because we feel safe if we feel like we are in it together. If messages sound like
they are coming from a friend, hesitant parents might be more receptive and willing to trust new
information that can change harm beliefs and support decisions to improve the health of their
children and community. As health promotion practitioners aim to sound like friends, public
health and communication scholarship should aim to act like friends by expanding the scope of
interventions beyond individual behavior change to address the social and structural factors that
drive health outcomes (Hull et al., 2020). As noted by Drs. Hull, Stevens, and Cobb (2020) in the
early months of the pandemic, health promotion practitioners and health communications

100
scholars could play an important role in cultivating and/or repairing public trust in health
authorities. Such work is essential in our recovery from this pandemic and our preparations for
what comes next.

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APPENDIX A:
DETAILS ABOUT ATTENTION CHECK AND SAMPLE SELECTION
Attention Check
As previously mentioned, participants were required to complete an attention check after
viewing their assigned message. For the experimental condition, participants were asked, “Which
character in the story was NOT vaccinated?” The answer options were images of the characters,
as shown below, with the correct answer being the second option (the White man named Robert,
who is Ricky’s dad). For the control condition, the attention check question was, “In the film,
what color was the text that asked the questions (for example, ‘why do young, healthy people
need a COVID-19 vaccine’)?” The response options were green, blue, pink, and all different
colors; the correct answer was the second option (blue).
Which character in the story was NOT vaccinated?
•
•
•
•

113
In the experimental condition, a total of 66 participants failed to correctly answer the
attention check question (identify the character Robert/Ricky’s dad), so the Qualtrics instrument
directed them to rewatch the message and respond to the same attention check prompt. At the
second attention check, 28 participants correctly identified Robert/Ricky’s dad, completed the
study, and were included in the analytic sample. The remaining 38 participants, who failed the
attention check twice, were dismissed from the study immediately.
In the control condition, a total of 94 participants failed to correctly answer the attention
check question and were required to watch the control message a second time. At the second
attention check, 79 participants correctly selected “blue,” completed the study, and were
included in the analytic sample. The remaining 15 participants, who failed the attention check
twice, were dismissed from the study.
Sample Selection
Ensuring data quality is a necessary step for any study. When collecting data online, it is
important to screen for potential scammers, defined here as responses from people who
manipulated the system to get compensation and may not represent eligible participants. Also,
while online platforms like USC-Qualtrics can be programmed to screen out participants based
on eligibility criteria, sometimes systems do not work as expected. Therefore, the data quality
check for this dissertation study consisted of two steps: (1) identify and remove suspicious
entries, and (2) re-check eligibility criteria.
A total of 587 participants completed the study, meaning they passed the attention checks
and completed the survey instrument. To screen for potential scammers, this author generated a
frequency table for the variable IPAddress,8 which is embedded data collected when using a
8 Per the Oxford Dictionary, an IP Address is “a unique string of characters that identifies each computer using the
Internet Protocol to communicate over a network.”

114
USC-Qualtrics instrument. A total of 9 unique IP Addresses had duplicate entries, representing
19 unique participant entries. These 19 suspicious participant entries were removed from the
sample. The remaining 568 entries were screened to confirm eligibility criteria. For year of birth,
one participant entered “Dayton,” which may suggest lack of English proficiency – which was
part of the inclusion criteria – or lack of attention. Regardless, since it could not be used to
validate age eligibility (being 18 years or older), this participant response was removed from the
sample. All remaining participants reported either being unvaccinated or partially vaccinated and
having at least one child between the ages of 5 and 12 years old. However, 19 participants
reported that their child was at least partially vaccinated against COVID-19 (8 reported 1 dose
and 11 reported 2 doses), so these responses were removed from the sample. The remaining 548
participants were included in the analytic sample.
Figure 31. Data Quality Screen and Sample Selection
Screen for scammers
(N=587)
Screen for eligibility
criteria (N=568)
Analytic sample (N=548)
Removed potential
scammers (n=19)
Removed ineligible
participants (n=20)

115
APPENDIX B:
FILM CREDITS FOR TEAM PLAYER
A Change Making Media Center
presentation
www.tcmmc.org
Written and Directed by
Alejandro Márquez Vela
Executive Producer
Jeremy Kagan
Produced by
Annika Dawson
Producer
Sheila Murphy
Co-Producer
Irina Slepneva
Co-Producer
Ashley Phelps
Director of Photography
John Veleta
Casting by
Jamie Ember, CSA
CAST
Charlie
Eli Kaplan
Ricky
Toby Grey
Henry

116
Richard Aaron Anderson
Alexa
Isabella Bennett
Christina
Alysia Juniel
Charlie’s Mom
Elizabeth Pun
Coach/Charlie’s Dad
Levi Petree
Ricky’s Dad
Tim Trobec
Henry’s Mom
Kate Krieger
Alexa’s Mom
Samantha Alvarado
Christina’s Dad
Jeremy S. Walker
CREW
1
st Assistant Director
Sarah Gross
2
nd Assistant Director
Ferran Molina
Production Coordinator
Jenn Beliard
Key Production Assistant
Benjamin Champagne
Production Assistants

117
Enoc Mendez
Hatuey Rodriguez
Jacqueline Elyse Rosenthal
Angel Falcon
Brannan Shepherd
Script Supervisor
Eddie Vigil
“B” Cam Operator
Lauren Gadd
1
st Assistant Camera “A” Cam
Lorenzo Porras
1
st Assistant Camera “B” Cam
Santiago Garcia
2
nd Assistant Camera
Fred Porras
DIT/Media Manager
Jocelyn Koo
Gaffer
Marshall Victory
Best Boy Electric
Greg Unger
Key Grip
Brendan “Snake” Cahill
Best Boy Grip
Han Whitesides
Production Designer
Sunday Smith
Art Director

118
Sofija Elena Alekna
Set Dresser
Tia Cestaro
Wardrobe Supervisor
Paige Draney
Sound Mixer
Alex Bologna
Studio Teacher
Tom Porter
Catering
IT Catering
Covid Compliance Officer
Ashley Phelps
Set Medic
Becky Rossiter-Moon
Paul Uhl
SAG AFTRA Rep
Gabe Diamond
Background Kids
Lexie Hsieh
Leo Horowitz
Sophia Rodriguez
Jeremy George Whitehead
Emma Sofia Otero
Victoria E. Phelps
Simon Sigal
Background Adults
Jennifer Beatty
Aden Ajayi
Monica Marquez

119
Soccer Coach Consultant
Kate Oddo
Ben Phelps
Editor
Alejandro Márquez Vela
Colorist
Olha Korczynska
Post Sound Supervisor
Alvaro Arce
Sound Producer
Lili Guadalajara
Sound Design
Caleb Sevilla
Background and SFX
Martin Arellano
Foley Artists
Arantxa Belem Oliver
Sound Mix
Iván Ledesma
Co-Producers
Lourdes Baezconde-Garbanati
Michele Kipke
Special Thanks
Education Consultant – USC Center EDGE
Annenberg School for Communication and Journalism at USC
Center for Health Equity in the Americas
CTSA (SC Clinical and Translation Science Institute)
Los Angeles County Department of Public Health

120
Keck Family Foundation
Keck Medicine of USC
Keck School of Medicine of USC
Stay Connected LA
USC School of Cinematic Arts
USC University Relations, Office of Local and Government Relations
Vaccinate LA
Wondros
Department of Preventive Medicine, Coronavirus Pandemic Research Center at USC
City of Torrance
Los Angeles, CA 2022

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Asset Metadata

Creator Phelps, Ashley (author)

Core Title The effects of a COVID-19 narrative message on beliefs and intentions among vaccine hesitant parents

School Annenberg School for Communication

Degree Doctor of Philosophy

Degree Program Communication

Degree Conferral Date 2024-05

Publication Date 06/03/2024

Defense Date 05/22/2024

Publisher Los Angeles, California (original), University of Southern California (original), University of Southern California. Libraries (digital)

Tag COVID-19,entertainment-education,OAI-PMH Harvest,parental vaccine hesitancy

Format theses (aat)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Murphy, Sheila (committee chair), Stevens, Robin (committee member), Valente, Thomas (committee member), Young, Lindsay (committee member)

Creator Email alphelps@usc.edu,ashley.luth@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC113987444

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