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 helps us keep 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 are intended to persuade us to buy certain products, services, or ideas. 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.
It’s important to note that there is often substantial overlap among the 4 types of mass communication; these are not always mutually exclusive. For example, hybrid programs, such as The Daily Show, offer news in an entertainment format (see example 1). It is considered an entertainment news show because it is designed to entertain viewers and provide a source of news. There are additional subcategories that further blur the distinction between types of mass communication. For example, video games (entertain) may portray positive health behaviors (promote health). Rap music may (occasionally) contain lyrics that promote health. However in both these cases, the intended effect may simply be to entertain, but an unintended effect or byproduct can be promoting health.
EE is by definition a hybrid form of communication that includes some aspect of entertainment plus some aspect of health information or persuasion. The channel used to deliver EE can vary greatly, from a feature film in the US that depicts obesity as part of a broader story, to a soap opera on literacy in Mexico to live drama in Africa with an HIV prevention storyline.
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, Health, Hollywood, 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.
Research Activity 1
Categorize which communication type you think the following two examples are and explain why (relate your reasoning to what you perceive the function of the communication piece as).
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 that fall into the “low entertainment, high education” category is to educate. In the documentary Supersize Me (example 1), 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 Knocked Up, the intent was to entertain the audience and make them laugh, however there were scenes that also taught about the risks of unprotected sex, like in the scene where they argue about if they used a condom (example 2). 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 as seen in example 3.
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 (audience) and senders (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 (i.e., audience), a sender (i.e., source and intent of the source) and then a contract (i.e., unspoken expectation between the receiver and the sender).
Receiver: defensive, evaluative, on-guard, judgmental
Sender: sales pitch (goal to persuade/sell)
Contract: “convince me”
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
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, 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 that the contracts you discuss could apply to.
Part Four: Persuasion vs. Entertainment and EE
If we try to persuade people, we need them to be rational and pay attention to the communication piece (e.g., message), to the degree that they 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 with the story and characters. Thus, we can “sneak in” or embed 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. 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 song “Ebola is Real” was created by local Liberian musicians to help combat the spread of Ebola. Newman Street, example 2 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 ranges, but can include advising (increasing awareness of key health issues), activation (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 three primary reasons: 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.
Find a health communication piece for each of the 4 goals of EE (i.e., sell, inform, change behavior or entertain). Explain the following in full: 1) why you believe that is the goal of the piece, 2) explain what you think the destination is, and 3) identify the channel and discuss if you think it matched the intent of the piece well.
Part Five: Theory Behind EE
Several theories and models from the behavioral and social sciences 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 shown here and here and. ELM posits that there are two routes to persuasion (e.g., the desired behavior or action)—the central route and the peripheral route
(See also the Messages module).
The central route (i.e., high-involvement) is effective when someone already cares about the topic and is paying attention to 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” is referring 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-involvement) can be effective when someone does not already care about the topic and is not paying attention to information about it, i.e. when they have “low involvement” with the topic. The peripheral route is good for 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 conscious, cognitive process. Given it is more unconscious, 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.
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 (i.e., receiver involvement) 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 they are being entertained and they are less likely to be actively guarding against a direct pitch.
Part Six: The "Front Door" vs. "Back Door" Approach
First "Frontdoor"=high-involvement with the issue: to communicate messages that the audience finds personally relevant, one could discuss topics like morbidity and mortality rates. This would work best for the central route.
In contrast, Backdoor=low-involvement with the issue: the goal is simply to get people to engage at all, which is more similar to the peripheral route. Sometimes the backdoor approach is called “wrong reason” health promotion, because it encourages people to become interested in the health information or behavior because of a superficial reason that is not directly related to being healthier (e.g., exercise to “look good naked” or seek preventive care to save money). The backdoor approach is about meeting people where they are,
(see Channels module), and not operating off the assumption that everybody should care about something simply because we (in the field of public health) care about it.
Arguably, our default assumption should be that generally people won’t care about what we in health promotion are trying to teach them. Remember that people will notice things once their attention has been drawn towards those things (e.g., once someone is thinking about buying a certain kind of car, he/she will see that car everywhere). An example is getting people to eat healthy and exercise to lose weight because they are motivated to look better. This is using the backdoor approach because they may already care about how they physically look and could adopt those behaviors, but they could still not care about the numerous other long-term benefits of the healthy behaviors. The NYT recently published an article about exercise as the closest thing to a “wonder drug” because of evidence of numerous benefits (see example 1); this is a clear example of the frontdoor approach. In contrast, The e-card in (example 2) and an actress who exercised to lose weight (example 3) both demonstrate the backdoor approach.
Discuss which of the following teen pregnancy/birth control ads use frontdoor or backdoor approaches. For each, discuss in terms of ELM and if they are using the central or peripheral route.
Part Seven: Research on the Effects of EE
The power of entertainment to influence substance use and abuse has been long recognized. There has been a lot of recent media attention on celebrities who have been overdosing on prescription drugs and heroin. Heath Ledger, Prince and Philip Seymour Hoffman are all examples but there are more as well (see example 1). This parallels the current opioid and heroin abuse crisis in the US, and the government is taking notice (example 2) and trying to implement policies (see example 3).
However, 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: “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. By 2013, annual fatalities dropped by 65% since 1982. There is 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). A recent meta-analysis of the EE’s effects on health outcomes found a small, but significant, effect (example 1).
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 are promising because they demonstrate that EE is as (or more) effective as other more traditional methods of persuasion. Additionally, the findings from the extra moderator analysis can help inform educators who will use EE what leads to bigger effect sizes when creating designing EE programs. For example, field studies that examined repeated exposures to the 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
Part Eight: Conclusion
Ultimately, entertainment-education is a useful and important tool that can be used to reach and influence 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 the health risks or disparities.
Go to sojust.net and select 2 songs with similar topics or messages, and then compare and contrast them. Discuss the following: what is the primary goal of the song in terms of what message is being communicated, which route of persuasion is used, if they are ‘violating a contract’, and how effective the song is.
Moyer‐Gusé, E. (2008). Toward a theory of entertainment persuasion: Explaining the persuasive effects of entertainment‐education messages. Communication Theory, 18(3), 407-425.
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.
Shen, F., & Han, J. (2014). Effectiveness of entertainment education in communicating health information: A systematic review. Asian Journal of Communication, 24(6), 605-616. Available at http://www.tandfonline.com/doi/abs/10.1080/01292986.2014.927895
Kreps, G. L. (1990). Organizational communication: Theory and practice. Longman Publishing Group.
Anderson, J. A. (Ed.). (2012). Communication yearbook 14 (No. 14). Routledge.
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