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By Jessa Engelberg (Ph.D.)

& Moshe Engelberg (Ph.D., MPH)

Part One: What is Entertainment-Education?

Edutainment, or more formally Entertainment-education (EE), comprises “prosocial messages that are embedded into popular entertainment media content” (Moyer-Guse, 2008, p. 408). In other words, EE is the use of entertainment messages for promoting health. Though sometimes storylines are created for the purpose of influencing behavior, at other times they are included for reasons like dramatic effect or humor. Regardless of the intent, the messages in entertainment media all fall within EE when they “…share the feature of promoting healthy and/or prosocial behaviors and/or negatively portraying ‘risky behaviors’’’ (Moyer-Guse, 2008, p. 409).​

Part Two: EE and the Four Types of Mass Communication

​Mass communication can be categorized into four functional types, each serving a particular and important function in society, as summarized in the table below. Generally, News (at least if it’s from credible sources) helps us stay up to date with what is happening in our environment, which in turns helps people know what action to take. For example, news tells us what is going on in the global and local community, including events, politics, sports, weather, etc.  Advertising and PR generally comprise straightforward messages to persuade us to buy certain products, services, or ideas---and select certain health and social behaviors. Information campaigns aim to provide us with essential knowledge in order to promote awareness and behavior change for particular health and social issues, though the form will vary based on region and audience. Entertainment, the type of mass communication most relevant to this discussion, is about providing enjoyment, and often an escape from reality. Entertainment can take many forms, including books, movies, music, theater, video games and apps.

Let's examine how each of these 4 types of mass communication communicate realities of structural racism against Black people in American history, from the Civil War onward.

There is often substantial overlap among these 4 types of mass communication. For example, hybrid programs, such as The Daily Show, offer news in an entertainment format. It is considered an entertainment news show because it is designed to entertain viewers and provide a source of news. Additional subcategories further blur the distinction between types of mass communication. For example, video games (entertain) may portray positive health behaviors (promote health). Popular music may (occasionally) contain lyrics that promote health. In both of these cases, while the intended effect may simply be to entertain, an unintended effect or byproduct can be promoting health.

Health promotion and health communication professionals can use shows, movies, or celebrities to share a health message. These channels can often have great reach and the message is delivered from a source the target audience already trusts.

In Hollywood, there are numerous advocacy groups and several universities that try to influence content within popular entertainment. For example, Health, Hollywood, and Society is a program based at the USC Annenberg Norman Lear Center that endeavors to provide entertainment industry professionals with accurate and timely health information that can be woven into their storylines. With multiple public and private funders, Hollywood, Health, and Society recognizes the profound impact that entertainment media have on individual knowledge and behavior. In partnership with their funding agencies, they offer the industry practical resources, including fact sheets, consultations with health experts, case examples, and panel discussions on a broad range of issues, such as influenza, cancer, autism, motor vehicle crashes, obesity, and more. 

​Nevertheless, engaging celebrities and producers and directors of popular shows and movies can be prohibitively expensive for most health promotion programs. Given that challenge, one thing that health promotion and health communication professionals can do is to direct the target audience towards an already existing entertaining piece that would still educate the audience.

Analysis Activity 1

​​Categorize which type of communication program you think the following example demonstrates to us and explain why (relate your reasoning to what you perceive the function of the communication piece to be).

Within EE, there is a spectrum that all health-related communication pieces fall within. The spectrum is anchored with “low entertainment, high education” and “high entertainment, low education” on either side. The primary intent of those in the “low entertainment, high education” category is to educate. In the documentary Supersize Me, the audience was entertained and it held their attention, but the intent was to teach the audience about the dangers of fast food. In contrast, the primary intent of those that fall into the “high entertainment, low education” category is to entertain the audience. For example, in the movie Juno, the intent was to entertain the audience and make them laugh; however, there were scenes that also taught about the risks of unplanned pregnancies, as happens with adults too of course (see Knocked Up). The middle of the spectrum represents communication pieces that intend to both educate and entertain the audience, in a more equal mix. For example, in the reality TV show The Biggest Loser, overweight and obese participants compete to lose weight through diet and exercise (not without prompting concern, as the ‘entertainment’ contains a strong element of fat-shaming as well).

Part Three: How EE Works; Communication Contracts

​The notion of a “communication contract” is based on the premise that people’s behaviors around communication are governed by implicit contracts (Anderson, 2012; Kreps, 1990). These contracts are between receivers (i.e., audience) and senders (i.e., sources and intent of the sources), and communicate the way each person is ‘expected’ to behave. Two contracts we will discuss here are the persuasion and entertainment contracts. The context for each type of contract is that each has a receiver, a sender, and then a contract (i.e., unspoken expectation between the receiver and the sender).

  1. Persuasion context

    • Receiver: defensive, evaluative, on-guard, judgmental

    • Sender: sales pitch (goal to persuade/sell)

    • Contract: “Convince me”

  2. Entertainment context

    • Receiver: suspend disbelief

      • Usually through empathy, where the viewer aligns him or herself with the characters and become empathetic

    • Sender: stories, and good/fun feelings (goal to entertain you)

    • Contract: “Make it enjoyable"

Analysis Activity 2

Which type of contract do you think would be best to get people to change their behaviors and live healthy lifestyles? Think of a recent time where you experienced both types of contracts (in a book, show or movie), and use those experiences to explain why you think one contract may be more effective than the other. Clarify the context of the behavior and lifestyle to which the contracts you discuss could apply.

Part Four: Persuasion vs. Entertainment and EE

If we try to persuade people, we need them to take the ‘central route’ and be rational and pay attention to the communication piece (i.e., message), to the degree that they are able to cognitively process what they are seeing and/or hearing. One can think of going to a car dealership as an example of a persuasion contract, because one typically expects the car salesman to try to take advantage of the customer.

But health communication does not need to rely only on persuasion, because entertainment can both entertain and persuade! The receiver’s psychological guard is lowered because the receiver feels personal connections to the story and characters. Thus, we can 'sneak in' through the peripheral route, by embedding issue-related information (like in the Knocked Up clip above). Additionally, the relevance of the health issue is heightened because it is part of the story. It can function to stimulate interest in wanting to know more, generate openness to the more traditional information sources, and serve as behavioral modeling via observational learning and vicarious reinforcement. BUT, it is critical to not violate the contract and cross into lecturing, because the audience will become evaluative and may even feel that they were 'tricked.'

Some great EE examples are available through Johns Hopkins Center for Communication Programs (CCP). Example 1, the brief BBC video about its spread helped combat the spread of Ebola. Newman Street is a weekly TV series in Nigeria that incorporates health messages, like family planning and malaria.

The format or channels of EE is dependent on the intent behind the health piece or issue. Channel selection depends on what your goal is and what you are trying to do or communicate:

  1. Sell stuff (e.g., marketing/advertising through commercials)

  2. Inform (e.g., news in print, online or TV)

  3. Change behavior (e.g., health promotion campaigns/PSA’s) 

  4. Entertain (e.g., TV shows/movies/radio)

What are the destinations or intended effects of EE? The destinations can include advising (e.g., increasing awareness of key health issues), activation (i.e., motivating behavior change), and advocacy (e.g., promoting social justice and providing information about environmental changes to the audience), as well as entertaining, of course. Though it can be used for all these destinations, typically EE is best for these three contexts: 1) increasing the salience and personal relevance of the health topic, 2) stimulating interpersonal communication related to the health topic, and 3) modeling behaviors and consequences.

Research Activity 1

Find a health communication piece for each of the 4 goals of EE (i.e., sell, inform, change behavior, and entertain). Explain the following in full: 1) why you believe that is the goal of the piece, 2) what you think the destination is, and 3) the channel and whether you think it matched the intent of the piece well.

Part Five: Theory Behind EE

Let’s review the theories and models from the behavioral and social sciences that are relevant to EE, perhaps most directly being the “Two path to persuasion” frameworks, like the Elaboration Likelihood Model of Persuasion (ELM) by Petty and Cacioppo. As a reminder, ELM posits that there are two routes to persuasion (e.g., the desired behavior or action): the central route and the peripheral route​​.​

The central route (i.e., high issue involvement) is effective when someone already cares about the topic and is able to pay attention to and process information about it, i.e., when they are ‘highly involved’ with the topic. It is a highly cognitive and conscious state targeting people who are already invested in the health issue, so there is ‘high elaboration likelihood.’ The term “elaboration” refers to the extent to which an individual carefully thinks about the message presented through persuasive communication and, hopefully, leads to the desired destination.

​The peripheral route (i.e., low issue involvement) can be effective when someone does not already care about the topic and/or is unable to pay or not paying attention to information about it, i.e., when they have ‘low involvement’ with the topic. The utility of the peripheral route is in getting people to become aware of the health issue without requiring them to think deeply about it. However, using the peripheral route to encourage behavior change is more difficult, because it is not a proactive cognitive process. Given its peripherality, people are not very involved in the argument being presented (i.e., they have low involvement). Thus, there is ‘low elaboration likelihood’ because it is largely relying on people’s heuristic cues to make quick decisions. Peripheral route processing is less likely to result in behavior change.

Using entertainment to move people from low involvement (the peripheral route) to high involvement (the central route) is sometimes referred to as “issue involvement conversion.”

ELM is related to the Communication Contracts discussed above, because if we go through persuasion, we want the audience to be highly involved. If we want high involvement, the audience will have to consciously think about the information and make a rational decision. This usually requires the issue or topic to be important or relevant to the receiver and/or a high need for cognition (i.e., think through ideas, even if it is not personally relevant). However, many people often do not have high receiver involvement or high need for cognition, especially related to public health messages. Therefore, it is possible to go through the entertainment route, where the audience can initially have low-involvement with the topic. Then the topic or issue is subsequently subtly woven in while audience members are being entertained and thus are less likely to be actively guarding against a direct pitch.

Another way to think about messaging to those with high issue involvement is by envisioning a message going through the front door. These are messages that the audience finds personally relevant. In contrast, messages sent through the back door target those with low issue involvement. The goal here is simply to engage the audience, at least minimally. Not everyone agrees that messaging through the back door is the 'right reason' for promoting health, as it can encourage people to become interested in the health or pro-social information or behavior because of a superficial reason not directly tied to that behavior change (e.g., wanting to exercise to "look good in a bathing suit" rather than in order to boost cardiovascular health). Just as with channels, the back door message approach is about meeting people where they are and not operating off of the assumption that everybody should care about something simply because health professionals care about it. 

Television and sports have led the American culture (ever so slowly) into a greater sense of our diversity and its value. See an episode or two of Will and Grace, The Good Place, and/or Abbott Elementary. Are these primarily comedy shows with back door social messages? To the extent that they convey the latter, what are the subtle messages presented?

Analysis Activity 3

Discuss whether of the following this teen pregnancy/birth control ads use a front or back door approach. Are they using the central or peripheral route?

Part Six: Research on the Effects of EE

The power of entertainment to influence substance use and abuse has long been recognized.  There has been a lot of recent media attention on celebrities who have overdosed on prescription drugs, heroin, and other drugs. DMX, Michael K. Williams, Demi Lovato, Heath Ledger, Amy Winehouse, Prince, and Philip Seymour Hoffman are all examples, but there countless others as well (including numerous rock and pop stars from decades past, such as Janis Joplin, Jim Morrison, and Jimi Hendrix, among others). This parallels the current opioid and heroin + fentanyl abuse crisis in the US, and the government is taking notice and trying to implement effective policies.

As early as 1983, just after John Belushi died of a drug overdose and Richard Pryor set himself on fire freebasing cocaine, the Entertainment Industries Council (EIC) was formed to tackle drug abuse via entertainment. The mission statement of the EIC is to bring "the Power and Influence of the Entertainment Industry and News Media to Better Communicate about Health and Social Issues.” An example of early success was the Harvard Alcohol Project launched in 1988; it broke new ground by getting all major Hollywood studios to insert drunk driving prevention messages and references to designated drivers into popular TV shows, like Cheers, LA Law, and The Cosby Show. By 1991, the term “designated driver” was a household phrase even appearing in Webster’s College Dictionary. Until 2013, annual fatalities dropped by 65% since 1982. There had been a growing body of evidence demonstrating the effectiveness of EE to promote both awareness and action on topics ranging from drunk driving to birth control to STDs (summarized in Beck, 2004).

The key finding was that EE had a modest impact on health knowledge, attitudes and intention, and adaptive health behaviors. Multiple exposures appeared to be especially effective in EE programs (Shen & Han, 2014, p. 613). The findings were promising because they demonstrated that EE is as (or more) effective compared to other more traditional methods of persuasion. For example, field studies that examined repeated exposures to an EE program showed that this repetition was much more effective than single exposure, but the channel or format (e.g., TV, movie, radio) did not make a difference in the effectiveness of EE. Moyer-Gusé (2008) argued that EE and the use of narrative persuasion was more effective than traditional methods; however, it is likely that certain behaviors and subgroups will respond best to EE. That said, the more recent fentanyl epidemic, even among users of other drugs who have no idea fentanyl is contained in them, may set back these hard fought victories.

Part Seven: Conclusion

​Ultimately, entertainment-education is a useful and important tool in reaching and influencing your target audience to improve health and change behaviors. When using EE, it’s critical to be make decisions about what type of message you are trying to convey and which path to persuasion you will use (i.e., central or peripheral). Additionally, you need to test any pieces you develop with your target audience to make sure you are not violating the entertainment contract (if you are trying to utilize that approach). Don’t forget: it can be very helpful to use existing EE pieces, whether it is a celebrity candidly discussing a health problem or an existing Buzzfeed article or a documentary highlighting health risks or disparities.


Anderson, J. A. (Ed.). (2012). Communication yearbook 14 (No. 14). Routledge.

Beck, V. (2004). Working with daytime and prime-time television shows in the United States to promote health. Entertainment-education and social change: History, research, and practice, 207-224.

Kreps, G. L. (1990). Organizational communication: Theory and practice. Longman Publishing Group.

Moyer‐Gusé, E. (2008). Toward a theory of entertainment persuasion: Explaining the persuasive effects of entertainment‐education messages. Communication Theory, 18(3), 407-425.

Shen, F., & Han, J. (2014). Effectiveness of entertainment education in communicating health information: A systematic review. Asian Journal of Communication, 24(6), 605-616. 

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