Annenberg School of Communication, University of Southern California

This case study analyses a particular communication strategy: the integration of educational messages into television dramas in an effort to raise awareness about a particular public health crisis. The authors look at an intervention implemented in the United States that used the entertainment-education (E-E) strategy to heighten public awareness about the shortage of organs and donors, and to shift their attitudes about and behaviour toward organ donation. Specifically, this case study critically analyses an organ donation transplant storyline that aired on the primetime drama "Numb3rs", a procedural crime drama. This example is used to illustrate the process by which Hollywood, Health & Society (HH&S) worked with writers to help them tell a more accurate story about the topic, and a story that might motivate viewers to become organ donors. The authors hope to highlight how the strategy of providing writers with accurate information and maintaining an open dialogue can inspire them to tell a more positive story about what they characterise as "a widely misunderstood topic".

As detailed here, as part of his research for this storyline, J. David Harden, a writer for Numb3rs, read a news story about the black market trade of human organs in the developing world. This article inspired a concept for an episode; Harden contacted HH&S to learn more specific information about the organ donation process for further storyline development. In response to Harden, HH&S sent electronic Web resources on organ donation and transplants and then facilitated a telephone consultation between the writer and a transplant surgeon with knowledge about organ donation trends in the United States. The expert explained to the writer that no black market exists in the United States, and suggested that the episode instead emphasise the high demand for organ donations, since vulnerable populations in the United States may be susceptible to myths and inaccurate portrayals associated with organ transplants in television media. In addition to providing statistical facts about the issue, the expert conveyed the gravity of the problem by providing case examples; this was thought to be a meaningful way to communicate how accurate health communication could be inserted dramatically into storylines.

The resulting storyline, "Harvest", aired on January 27 2006; 13.36 million people tuned in. As the writer originally planned, the storyline focused on a black market for organ donations. However, the episode also provided what the authors of this report describe as "considerable accurate information" about the number of people on the transplant waiting list and the computer system for organ matching. In addition, the storyline concludes with an extensive discussion about the importance of organ donation. The authors indicate that, "[t]hrough a warm and comedic scene, four of the characters who are already donors themselves convince a fifth character that he too should sign up to become an organ donor....In the scene, the main character showed off the organ donation sticker on his driver's license, and talked about the importance of signing up to become an organ donor....This segment was the direct result of the writer's conversations with experts...[T]he characters were modeling the desired behavior of how to become an organ donor."

To evaluate the impact on knowledge, attitudes, and beliefs among viewers who saw the episode, HH&S partnered with researchers at the University of Southern California and Purdue University to conduct viewer surveys. Six primetime storylines for 4 shows were investigated ("House" storyline 1 and 2, "Grey's" Anatomy storyline 1 and 2, "CSI: NY", and "Numb3rs"). Online surveys were posted on the 4 shows' websites, online chat rooms, and fan sites. One finding outlined in this report is that viewers of a particular storyline are more likely to agree with a statement about the plot than viewers of other storylines. For example, due to a concern about perpetuated myths about organ donation through the media, evaluators looked at the episode of "Numb3rs", which was the only storyline about a black market for organs which benefited rich patients in need of a transplant. On a scale from 1 to 5, where 1 was "strongly disagree" and 5 was "strongly agree," viewers of Numb3rs were the most likely to agree with the survey statement that there is a black market for organs (M = 4.26), compared to viewers of "CSI: NY" (M = 3.93, p < .001), "House" (M = 3.87, p < .001), and "Grey's Anatomy" (M= 3.65, p < .001).

The survey also measured the effects of episodes on donation-related behaviours, finding that the willingness of non-donors to become potential donors varied according to the content of viewed episodes. Findings indicated that viewers who saw an episode in which the main characters discuss the importance of organ donation were more likely to express willingness to become potential donors, versus viewers of episodes that did not include these dialogues. The "Numb3rs" episode was the only show which explicitly encouraged donation and modeled signing up to be an organ donor. Non-donor viewers of "Numb3rs" were most likely to become a potential donor (10.3%), c2 (5) = 49.40, p < .001, compared to viewers of "CSI: NY" (9.8%), "House" storyline 1 (8.1%), "House" storyline 2 (3.8%), and "Grey's Anatomy" (3.8%). Based on survey results, viewers of Numb3rs were also most likely to agree that the storyline "made [them] think about the importance of organ donation" and "empowered others to sign up as donors". The survey also measured viewers' emotional involvement in storylines and found that it was significantly related to outcomes. For example, those who urged someone to become a donor after watching the storyline rated significantly higher emotional involvement (M = 4.32) than those who did not (M = 3.66, t (4471) = 7.88, p < .001). A research director at "Grey's Anatomy" quoted here said, "[i]f we want as many people to donate organs, we create a character that's sympathetic and tell the story in a very dramatic way, somewhat hyperbolic way. Whereas the organ procurement centers give statistics and they deal in factual evidence, our first agenda is always entertainment..."

The authors conclude that, "health information included in primetime dramas with emotional features, and with the broadest reach, can be an ideal channel for dissemination....A mutually beneficial relationship can exist between public health advocates and television writers. The case study of Hollywood, Health & Society's efforts with the "Numb3rs"' writer provides a successful example of such a relationship."

Cases in Public Health Communication & Marketing [8], The George Washington University School of Public Health and Health Services, Volume 1 - June 2007; and email from Lauren B. Movius to The Communication Initiative on April 16 2008.