"You are Telling the Story Yourself": Defining and Developing Narrative Pictorial Warning Labels

Pictorial warning labels (PWLs) featuring narrative content are promising strategies for communicating health risks and motivating behavior change. The objectives of this study were to (1) identify what intrinsic features a PWL must have to be constructed as a narrative and (2) uncover in what ways narrative PWLs are perceived as being (in)effective. Seven online focus groups were conducted via Zoom with moderate and heavy drinkers (n = 30). Participants discussed a series of mockup PWLs designed to communicate the cancer risk of alcohol. The discussion revealed that a static image must include character, causality, and setting to help individuals construct the story. Specifically, the character should be discernible and believable so that individuals can infer risk information. Moreover, the connection between the image and text should imply a causal relationship between alcohol drinking and cancer risks. Lastly, there should be sufficient relevant background or context information. When discussing the label effectiveness, most participants thought narrative PWLs were more effective than graphic, non-narrative PWLs at informing consumers about the cancer risk of alcohol. Their reasoning included narrative PWLs (1) being easy to understand, (2) evoking curiosity and imagination, (3) eliciting sympathy for the character, (4) not causing aversion, and (5) increasing risk perceptions. This study contributes to the narrative persuasion research and offers practical implications for designing image-based narratives.