Persuasive health communication research changed health promotional practice and increased Hong Kong’s organ donation registrants

1. Summary of the impact

Dr. Fung’s research changed health promotional practice and increased Hong Kong’s organ donation registrants. His research on persuasive health communication guided the message design of an animated video (Say Your Wish, Save a Life) for organ donation promotion. In 2016, the government incorporated the video into its citywide organ donation campaign. Since then, a total of five government agencies and advocacy groups adopted the video’s narrative-based persuasive strategy into their health promotions, and the number of registrants increased from 200,400 in 2016 to 293,000 in 2018 [5.5].

The impact is on practitioners and professional services and health and welfare impact.

2. Underpinning research

Background

To increase organ donation rate, encouraging people to discuss with family about their donation wish is essential because family, particularly deceased patients’ next-of-kin, plays a decisive role in organ donation procedure. The opting-in system for donation in Hong Kong requires family consent prior to extracting the deceased’s organs, regardless of the individual’s donation card indication. Exposition, which relies on information and argument for persuasion, has been Hong Kong’s common persuasive appeal for health promotion. However, to promote family discussion on organ donation, the expository strategy is inadequate because it potentially induces audience resistance. Therefore, to promote family discussion on organ donation, Dr. Fung’s research addressed the ineffective persuasive messages.

Research Program on Persuasive Health Communication

The findings from the three areas below of Dr. Fung’s award-winning research on persuasive health communication were applied to use the narrative-based strategy, a form of persuasion based on storytelling, for creating the animated video (Say Your Wish, Save a Life) in 2016.

(1) Formative Research – the Prelude to Deciding the Persuasive Appeal

When formulating persuasive messages, formative research can first identify the communication approach that motivates audience. For example, to design a health treatment adherence promotion, Dr. Fung’s 2014 studies [3.1–3.2] identified patients’ perceived barriers and facilitators. Built on his 2014 research, he conducted in-depth interviews in 2015 to explore the reasons why people avoid telling their families about their donation wish [3.3]. A key finding revealed that after the audience learned others’ successful experience, they could imitate how to share their donation wish with their family. This finding inspired storytelling for persuasive messages.

(2) Counterfactual Thinking-based Storytelling

Stories have been recognized as an effective form of communication for attitudinal and behavioral change in health promotion, but how story features and their underlying processes enable their persuasiveness remains less understood. Dr. Fung received a grant in 2015 to study how the counterfactual thinking process (a mode of thought about what might have been), as a story feature, enhances the story’s persuasiveness [3.6]. This award-winning study [3.4] showed that stories with counterfactual thinking could trigger greater anticipated regret and mental simulation, and, in turn, change the audience’s attitude and behavioral intention. As a result, to prompt the audience to imagine, if they had not expressed their donation wish, how frustrated and stressed family members might be during the decision-making process, Dr. Fung designed the animated story with the feature of counterfactual thinking.

(3) Attitude and Behavioral Change

Understanding the factors that motivate people to change their attitude and behavior is essential to develop the story content. Dr. Fung’s 2015 award-winning research examined the factors that led people to change their risky behavior [3.5]. A key finding indicated that emotional responses, such as uncertainty and worry, toward the health issue played an important role in the process. Therefore, in the animated video story, Dr. Fung highlighted how families deciding whether or not to donate their deceased’s organs might experience feelings of uncertainty and worry when they do not know the deceased’s donation wish.

3. References to the research

[3.1] Fung, Timothy K. F., Lee, Kelvin, K. W., & Lam M. F. (2016). A formative research as the groundwork for designing evidence-based adherence promotion campaigns for patients on peritoneal dialysis. Journal of Communication in Healthcare, 9(2), 98–108.

[3.2] Fung, Timothy K. F., Ng, Y. L., Lam, M. F., & Lee, Kelvin, K. W. (2017). Psychosocial factors predict nonadherence to PD treatment: A Hong Kong survey. Peritoneal Dialysis International, 37(3), 331-337. doi:/10.3747/pdi.2016.00094.

[3.3] Fung, Timothy K. F., Ng, Isabella, Lam, M. F., & Lee, K. W. K., Deciding to discuss organ donation with parents: An in-depth interview study with Chinese young adults. Poster presented at the 26^th International Congress of the Transplantation Society, Hong Kong, August 18–23, 2016.

[3.4] Fung, Timothy K. F. (2019). The role of counterfactual thinking in narrative persuasion: Its impact on patients’ adherence to treatment regimen. Health Communication, 34(12), 1482-1493. doi:10.1080/10410236.2018.1500432.

(An earlier version of the paper was presented at the annual conference of the Association for Education in Journalism and Mass Communication, Washington, D.C., August 6–9, 2018, and the paper received the Top Faulty Paper Award)

[3.5] Fung, Timothy K. F., Griffin, R., & Dunwoody, S. (2018). Testing Links Among Uncertainty, Affect, and Attitude Toward a Health Behavior. Science Communication, 40(1), 33-62. doi:10.1177/1075547017748947

(An earlier version of this paper was presented at the annual conference of Association for Education in Journalism and Mass Communication, San Francisco, CA., August 6–9, 2015, and it was awarded one of the Top Three Faculty Papers)

[3.6] Fung, Timothy K. F., Lee, Kelvin, K. W., & Lam M. F. General Research Fund (GRF) (HK$144,570), University Grant Council (UGC), Hong Kong (Grant no.: RGC12600115) October 1, 2015–June 30, 2016.

Project Title: The effects of different types of counterfactual thinking in narrative persuasion: A case study of using animated narratives to persuade peritoneal dialysis patients to adhere to antiseptic regimens.

4. Details of the impact

To promote family discussion about organ donation, Dr. Fung’s research program on persuasive health communication provided empirical evidence and a theoretical framework to guide the development of the animated video, Say Your Wish, Save a Life, which impacts the form of persuasion in health promotion and the attraction of more organ donor registrants.

(1) Changing Persuasive Message Design Practice in Health Promotion

Dr. Fung’s research directly impacts health promotion practitioners to use his research program’s empirical evidence rather than to rely on their intuition and experience for designing persuasive message. To persuade the target audience to share their organ donation wish with their family, the practitioners changed the form of persuasion from arguments and instructions (expository strategy) to stories containing counterfactual thinking and emotional response features about health issues (i.e., counterfactual thinking-based narrative persuasion). The Hong Kong Transplant Sport Association's (HKTSA) testimonial letter is evidence that Dr. Fung's research impacted them to change their persuasive strategy: to use evidence-based and communication theory-driven animated videos to promote family discussion about organ donation [5.1].

The success of the organ donation animated video inspired the Department of Health, to advocate for the family doctor healthcare model in Hong Kong society, by contracting Dr. Fung to produce two live-action promotional videos using storytelling as the persuasive appeal [5.2].

Besides influencing HKTSA’s organ donation promotion, Renal Companion Association (RCA), an end-stage renal patients’ support group, collaborated with Dr. Fung to design an animated video with counterfactual thinking-based narrative persuasion for promoting treatment adherence among patients undergoing peritoneal dialysis. This video was produced into DVDs and distributed to more than 500 patients [5.3].

A total of five government agencies and advocacy groups adopted the narrative-based strategy in their health promotions: the Food and Health Bureau, the Department of Health, the Hong Kong Transplant Sport Association, the Renal Companion Association, and the Hong Kong Broadband.

Dr. Fung also extended the research impact to the international level by showcasing his promotional message design practice and research at the 2016 International Congress of the Transplantation Society [5.4 and 5.9].

(2) The Centralized Organ Donation Register (CODR) Increased Its Number of Registrants

Employing the Say Your Wish, Save a Life video increased the number of registrants in the centralized organ donation registry. The Hong Kong government officially included the Say Your Wish, Save a Life video into the citywide “Say Yes to Organ Donation” promotional campaign [5.5], which resulted in increasing the number of registrants in the CODR from 200,400 in late June 2016 to 293,000 as of November 10, 2018 [5.6].

Numerous Campaign Venues Employed The Video In Different Capacities:

(A) An abridged version of the video was first screened at the kick-off ceremony on October 15, 2016 and subsequently broadcast on municipal promotional channels from October 16, 2016 to December 31, 2017 [5.5]:

• TV kiosks in 97 public markets and cooked food markets of the Food and Environmental Hygiene Department;
• TV kiosks in 66 Community Halls of the Home Affairs Department;
• TV kiosks in 11 District Social Welfare Offices of the Social Welfare Department;
• TV kiosks in 38 public clinics of the Department of Health;
• TV walls at Victoria Park and the Urban Council Centenary Garden, both of the Leisure and Cultural Services Department;
• the Food and Health Bureau website;
• the Information Department Facebook page website and youtube channel; and
• the Department of Health Facebook page website.

(B) The full version of the video was broadcast on municipal promotional channels:

• ongoing since October 16, 2016 at the Center of Health Protection youtube channel;
• May 6–8, 2017 at the organ donation exhibition in the Kowloon Mass Transit Railway station [5.7]; and
• From 2016 to 2018, the municipal Organ Donation Promotion Vehicle visited 18 districts across Hong Kong;

(C) The Hong Kong Broadband Network sponsored to screen the video (full version) in over 80 McDonald’s restaurants in the city from January to February 2017 [5.8].

(D) The Hong Kong Society of Transplantation adopted the video (full version) in 2016 for its donation talks in secondary schools [5.9].

(E) To organize a series of promotional activities for the community, Hong Kong Baptist University (HKBU) signed the Organ Donation Promotion Charter and adopted Dr. Fung’s full version animated video for their donation promotion [5.10]. On November 10, 2018, the government awarded HKBU the Certificate of Commendation for its organ donation promotional effort in which the video was part of the promotional initiative [5.10].

5. Sources to corroborate the impact

[5.1] A testimonial letter from Hong Kong Transplant Sport Association (HKTSA). This letter indicated that Dr. Fung’s research has changed HKTSA’s promotional practice based on narrative persuasion theory and communication research.

[5.2] Evidence indicated that Dr. Fung obtained a HK$450,000 grant from the Department of Health to produce two live-action promotional videos using storytelling as the persuasive appeal. The video is available at https://www.youtube.com/watch?v=qpfO235Dgtw&t=5s&pbjreload=10 (Editor Edition) and https://www.youtube.com/watch?v=8bGFSd0UI8Y&pbjreload=10 (Editor Edition)

[5.3] A testimonial letter from the Renal Companion Association (RCA) and the photo of a DVD copy. The letter showed RCA’s collaboration with Dr. Fung to design an animated video with counterfactual thinking-based narrative persuasion for promoting treatment adherence among patients undergoing peritoneal dialysis

[5.4] Presentations of persuasive message design for health promotion and research on persuasive health communication at the 26^th International Congress of the Transplantation Society, Hong Kong, August 18–23, 2016. Dr. Fung shared his research and persuasive message design practice for health promotion with international scholars and health promoters and educators.

[5.5] Testimonial letters from the Secretary for Food and Health in Hong Kong and from the Director of Health, Hong Kong Special Administrative Region Government. The letters indicated that the animated video first screened at the kick-off ceremony of the “Say Yes to Organ Donation” Campaign in October 2016, and subsequently broadcast in municipal promotional channels

[5.6] Letters from the Director of Health in Hong Kong about the number of registrants in the Centralized Organ Donation Register (CODR) from 2016 to 2018. The letters indicated that, since the citywide organ donation campaign has launched in 2016, the number of registrants increased from 200,400 in 2016 to 293,000 in 2018.

[5.7] Email exchanges showed that the Department of Health requested for screening Dr. Fung’s animated video at the organ donation exhibition in the Kowloon Mass Transit Railway station in May 2017 and at the Organ Donation Day in November 2017.

[5.8] Email exchanges showed that Hong Kong Broadband Network Limited invited Dr. Fung to screen his animated video at around 80 McDonald’s restaurants in Hong Kong to promote organ donation from January to February 2017; over 120 TVs broadcasting 24-hour a day.

[5.9] A testimonial letter from the Hong Kong Society of Transplantation (HKST). The letter indicated that HKST used Dr. Fung’s animated video for its donation talks in secondary schools.

[5.10] Testimonial letter from the Vice-President (Administration) & Secretary, Hong Kong Baptist University (HKBU), and the Certificate of Commendation awarded to HKBU’s organ donation campaign. The letter indicated that the animated video was incorporated in the HKBU’s organ donation campaign. HKBU’s campaign received the Certificate of Commendation from the Hong Kong Special Administrative Region Government