Preferences for Statements and Narratives about Fish Consumption among Women of Childbearing Age: Minnesota Focus Group Results

Transcription

1 Preferences fr Statements and Narratives abut Fish Cnsumptin amng Wmen f Childbearing Age: Minnesta Fcus Grup Results Rebecca Rbbins Bruce Lauber Jeff Niederdeppe Crnell University - 1 -

2 Table f Cntents Table f Cntents... 2 Intrductin... 3 Results... 4 Statement Preferences... 5 Preferences fr Statements in Set Preferences fr Statements in Set Preferences fr Statements in Set Preferences fr Statements in Set Summary f Respnses t Statements Narrative Analysis Narrative 1: Analysis Favrable Reactins t the Stry Unfavrable Reactins t the Stry Narrative 2: Analysis Favrable Reactins t the Stry Unfavrable Reactins t the Stry Narrative 3: Analysis Favrable Reactins t the Stry Unfavrable Reactins t the Stry Summary f Narrative Analysis

3 Intrductin Five fcus grups were cnducted in Minnesta in September 2014 with wmen between the ages f 18 and 50 wh ate fish at least ccasinally. The purpse f the fcus grups was t determine hw wmen f childbearing age in nrthern Minnesta respnd t fish cnsumptin materials. The grups were cnducted in Duluth (residents within city limits), Duluth-Rural (residents f area surrunding city), Ely, Hibbing, and Tw Harbrs. The number f wmen participating in each grup ranged between 4 and 11. The fcus grups had tw primary cmpnents: (1) Wmen were presented with a list f 18 statements (rganized int 4 grups) describing either reasns t eat fish r reasns t fllw Minnesta s fish cnsumptin guidelines. They were asked t rganize each grup f statements frm thse that they thught were mst likely t encurage them t eat fish r fllw the guidelines t thse that they thught were least likely t encurage them t eat fish r fllw the guidelines. Each participant was asked t explain the reasns fr her mst preferred statement and her least preferred statement; althugh participants may have had psitive r negative reactins t multiple statements, nly the mst and least preferred were discussed. The specific questins used t elicit respnses in the fcus grups were: Which statements wuld make it mst likely fr yu t cntinue t eat fish/fllw the guidelines? What is it abut the statements that wuld make it mre likely fr yu t cntinue t eat fish/fllw the guidelines? Which statements wuld make it least likely fr yu t cntinue t eat fish/fllw the guidelines? What is it abut the statements that wuld make it less likely fr yu t cntinue t eat fish/fllw the guidelines? - 3 -

4 (3) Fcus grup leaders distributed three narratives (stries abut individuals designed t cmmunicate fish cnsumptin advice) t the participants and asked them a series f questins t understand their psitive and negative reactins t each stry. The specific questins asked were: What came t yur mind as yu read this stry? What d yu think abut the main character in this stry? Des this stry sund familiar t yu? Why r why nt? OR Have yu ever had feelings r thughts similar t thse described in the stry? Tell me abut that. Discussins were recrded and transcribed. The fcus grup data in the transcripts were separated by questin. Next, respnses frm each questin were jined acrss all five fcus grups in a single wrksheet t be cded. The cding prcedure tk place in three stages. In the first stage, the transcripts were simply read in entirety. In the secnd stage, initial cdes were assigned t the cmments wmen made t explain their reactins t statements r narratives. Each cde reflected the reasns wmen prvided fr either liking statements r narratives, r disliking statements r narratives. The final stage f cding invlved refining the cding system by clarifying the cdes and ensuring that all excerpts assigned the same cde were cnceptually related. The final prduct f the cding prcedure was a set f chesive cdes, which was used t categrize all relevant data frm the fcus grups. fllws. Results The results f the analysis f statement preferences is presented first. The analysis f narrative preferences - 4 -

5 Statement preferences. The results f the statement preference analysis are rganized accrding t each f the fur sets f statements abut which wmen were asked. The tw mst preferred statements and tw least preferred statements are presented fr each set f statements abut which wmen were asked. In the statement sets that cntained nly 3 statements (statements 7 9 and statements 16 18), nly the single mst and least preferred statements and assciated justificatins are ffered. Narrative analysis. Reactins t the narratives are analyzed and reprted in 3 sectins crrespnding t the 3 narratives.we discuss bth favrable and unfavrable reactins t narratives. We discuss the primary reasns fr these reactins and present representative fcus grup excerpts t illustrate them. Statement Preferences Statements were presented t fcus grup participants in fur sets: Statement Set #1: Statement 1: Eating fish is the best way t get healthy mega-3 fats. Statement 2: Eating fish that has mega-3 fats while pregnant may help during fetal brain and eye develpment. Statement 3: Eating fish that has mega-3 fats may lwer the risk f heart disease in adults. Statement 4: Fish are generally lw in saturated fats. Statement 5: Benefits utweigh risks if wmen eat fish lw in mercury and ther cntaminants. Statement 6: Children f wmen wh eat lwer mercury fish every week when they are pregnant have been fund t d better develpmentally. Statement Set #2 Statement 7: Our bdies can t make EPA and DHA and they are generally nt fund in ther fds. Statement 8: DHA is a building blck f the brain and eyes. Statement 9: Pregnant mms and breastfeeding mms can eat fish t give DHA t their babies. Statement Set #3 Statement 10: Wmen wh fllw the guidelines get the health benefits f fish with very little risk t themselves r their children. Statement 11: Wmen wh fllw the guidelines get the health benefits f fish with few risks

6 Statement 12: Wmen wh fllw the guidelines are less expsed t cntaminants fund in sme fish. Statement 13: Wmen wh fllw the guidelines avid eating fish high in cntaminants. Statement 14: Wmen wh fllw the guidelines knw which fish are lw in cntaminants. Statement 15: Our bdies eliminate mercury ver time. Wmen wh fllw the guidelines will keep mercury in fish frm building up t harmful levels in their bdies. Statement Set #4 Statement 16: Wmen wh fllw the guidelines reduce their risk f being expsed t cntaminants fund in sme fish. Statement 17: Wmen wh fllw the guidelines knw hw t make healthier chices abut which fish t eat. Statement 18: Wmen wh fllw the guidelines are able t eat fish safely. Preferences fr Statements in Set 1 Statements 1 thrugh 6 ffered reasns fr eating fish. The tw mst preferred statements were 1 and 3, while the least preferred statements were 5 and Statement Set 1: Mst and Least Preferred Statements 0 Statement 1 Statement 2 Statement 3 Statement 4 Statement 5 Statement 6 Number Listing as Mst Preferred Number Listing as Least Preferred - 6 -

7 Mst Preferred Statements Statement 1: Eating fish is the best way t get healthy mega-3 fats. The cde mst cmmnly used t classify the reasns wmen ffered justifying their selectin f this statement as mst preferred was infrmatin n health/nutrients. Infrmatin n health/nutrients: This cde was assigned in the majrity f cases t explain preference fr statement 1. This cde was assigned when wmen explained their interest in receiving infrmatin abut either ways fish cnsumptin culd enhance their health r imprtant nutrients like mega-3s that are fund in fish. Representative cmments include: Well, I guess that wuld be mst imprtant fr me right nw. I'm nt pregnant either, s it's what is healthiest fr me at this pint in my life. A wman frm Hibbing, MN I knw that eating fish is the best way t get healthy megas, but I d take a liquid fish il supplement every day, t. CuzI dn't eat a whle lt f fish and s I knw that's imprtant. A wman frm Duluth, MN Statement 3: Eating fish that has mega-3 fats may lwer the risk f heart disease in adults. The vast majrity f wmen wh selected statement 3 as their mst preferred explained their selectin was in large measure due t persnal experience with heart disease. We used the cde infrmatin n aviding chrnic health cnditins t classify these reasns. Infrmatin n aviding chrnic health cnditins: This cde was applied t statements that linked imprtant nutrients fund in fish with lwer risk f health cnditins. In many cases, wmen referred t persnal experience with heart cnditins. #3 because my dad died f a heart attack s there's sme heart disease in my family. And just wmen in general tend t have a higher risk f heart disease s that's imprtant t me. A wman frm Duluth, MN Rural - 7 -

8 I have heart disease in the family s that ne resnates. And like she said, it's very specific and that jumped ut at me the mst. A wman frm Ely, MN Least Preferred Statements Statement 5: Benefits utweigh risks if wmen eat fish lw in mercury and ther cntaminants. Cdes used t classify cmments frm wmen justifying their selectin f this statement as least preferred included infrmatin abut cntaminants and vague r cnfusing message. Infrmatin abut cntaminants: In this categry f respnses, wmen explained that they simply were nt cncerned abut cntaminants, r the risks frm cnsuming cntaminants were nt large enugh t warrant cncern. Mercury pisning it's a lw risk. If yu're eating fish nly a cuple times a week, it's nt a big deal. Prbably eat mre tefln than yu d mercury, yu knw? Yu knw hw it is n the bttm f yur pan there. A wman frm Tw Harbrs, MN I'm nt as cncerned with cntaminants, I guess. I feel like it's mre hype, a lt f hype, I guess. A wman frm Hibbing, MN Vague r cnfusing message: In this case, wmen explained they were cnfused by the message cntent r wrding. And #5 I put last just because it seemed kind f vague, like didn't really have any effect n whether r nt I'm ging t eat fish. A wman frm Duluth, MN Statement 4: Fish are generally lw in saturated fats. Mst participant explanatins fr their lw ranking f this statement were classified with infrmatin abut saturated fats

9 Infrmatin abut saturated fats: Wmen explained that they did nt have t wrry abut saturated fats r that their diet was healthy and saturated fats were nt a cncern fr them. Then #4 is fish are generally lw in saturated fats. That's really nt that imprtant t me. A wman frm Duluth, MN Rural And #4 because I dn't usually have fried fish. I usually d baked. I just try t ck it in a healthier way. A wman frm Duluth, MN Preferences fr Statements in Set 2 Statements 7 thrugh 9 als described reasns fr eating fish. This series f statements had t d with specific nutrients fund in fish, like EPA and DHA. With nly three statements in this set, nly the single mst preferred and the least preferred statements are reprted. The mst preferred statement was 8, while the least preferred statement was Statement Set 2: Mst and Least Preferred Statements Statement 7 Statement 8 Statement 9 Number Listing as Mst Preferred Number Listing as Least Preferred - 9 -

10 Mst Preferred Statement Statement 8: DHA is a building blck f the brain and eyes. The cdes mst cmmnly used t classify the reasns wmen ffered t justify their selectin f this statement as their mst preferred in the questin set included Infrmatin n brain and eye benefits and Infrmatin n health/nutrients. Infrmatin n brain and eye benefits: This type f ratinale was mst cmmn, cited the majrity f the time by thse wh preferred statement 8. This cde was assigned when wmen mentined their appreciatin f the infrmatin n brain and eye benefits in the message. Interestingly, the message was interpreted by sme wmen as describing the benefits pssible fr their baby during pregnancy r early childhd develpment, while ther wmen interpreted the message as describing brain and eye develpment benefits that the wmen themselves stand t receive. #8 mst imprtant cuz it is a very gd prmter fr brain and eye develpment which are imprtant. Wman frm Duluth, MN Rural #8 being the first ne. I put it up there because I knw DHA is imprtant fr yur brain, specifically. Wman frm Hibbing, MN Infrmatin n health/nutrients: In several cases, this cde was assigned when wmen explained their preference fr receiving infrmatin abut ways fish cnsumptin culd enhance their health mre generally: Thse amin acids are imprtant fr keeping ur health f ur eyes and ur brain and they actually help with depressin and things like that, suppsedly, t. There's a whle bunch t that. Wman frm Tw Harbrs, MN

11 Least Preferred Statement Statement 9: Pregnant mms and breastfeeding mms can eat fish t give DHA t their babies. The cdes that were mst cmmnly during the analysis t explain wmen s selectin f this statement as least preferred included Lacked relevance, and Lacked evidence fr claims. Lacked relevance: This cde was assigned when wmen argued that the infrmatin in the statement was less relevant t them fr ne reasn r anther. This type f justificatin was bserved apprximately 20 times in the fcus grup data. I picked #9 last because when I was pregnant and breastfeeding, I didn't change the amunt f fish that I ate. I just kinda ate the same amunt as I d nrmally which wasn't very much. S then, I just tk a DHA supplement anyways guess it wasn't t relevant cuz being pregnant r nt desn't change the amunt f fish I eat. Wman frm Duluth, MN Again, it desn't affect me persnally r a whle lt f peple I knw, if I'm lking at verall health fr myself and my family, it's just nt really relevant. Wman frm Ely, MN Lacked evidence fr claims: This cde was assigned when wmen supprted their selectin f a statement as least preferred with the lack f evidence fr the facts stated in the message. I feel like it's chrnlgical s if yu said, yu knw, great I can give DHA t my baby, why des that matter? Like I feel like yu need this infrmatin first befre yu culd draw that cnclusin. If yu have the eight and seven first, then it makes nine imprtant, but nine withut that ther infrmatin is kind f irrelevant. Nt irrelevant, that's nt a gd wrd, but it desn't it's nt as imprtant. Wman frm Duluth, MN Preferences fr Statements in Set 3 Unlike statements 1 thrugh 9, which described reasns fr eating fish, statements 10 thrugh 15 described reasns fr fllwing fish cnsumptin guidelines. This set f statements mentins utcmes f fllwing the

12 guidelines. Interestingly, statement 15 was the mst preferred chice but als the least preferred chice. The tw mst preferred statements were 15 and 11, while the tw least preferred were 15 and Statement Set 3: Mst and Least Preferred Statements 0 Statement 10 Statement 11 Statement 12 Statement 13 Statement 14 Statement 15 Number Listing as Mst Preferred Number Listing as Least Preferred Mst Preferred Statements Statement 15: Our bdies eliminate mercury ver time. Wmen wh fllw the guidelines will keep mercury in fish frm building up t harmful levels in their bdies. There were tw general explanatins wmen gave as t why they chse this statement, including Infrmatin n bdy remving cntaminants and Clear/straightfrward infrmatin. Infrmatin n bdy remving cntaminants: This was the mst cmmn respnse frm wmen wh selected statement 15 first. In their justificatin, wmen explained their interest in the infrmatin abut the bdy s ability t remve cntaminants. Sample qutes are ffered belw: #15 because, yeah, it was clear and said that even if yu get the mercury, it's ging t leave yur bdy if yu dn't get t much. Wman frm Ely, MN

13 Um, it's gd that ur bdies eliminate it ver time It's gd that it can yu can eliminate it frm yur bdy. Tw Harbrs, MN Clear, straightfrward infrmatin: Cmments that were assigned this cde explained the selectin f first chice fr statement 15 due t the clear, straightfrward nature f the infrmatin. A sample qute is ffered belw: It was the easiest fr me t understand. All f 'em kinda gt cnfusing. A wman frm Ely, MN Statement 11: Wmen wh fllw the guidelines get the health benefits f fish with few risks. This statement explains that wmen wh fllw the guidelines will receive benefits with lw risks. Amng the explanatins wmen ffered fr their preference fr this statement, wmen explained interest in such factrs as Infrmatin abut benefits f fish, Infrmatin n fllwing guidelines, and 3 A psitive message. Infrmatin abut benefits f fish: This type f respnse was the mst cmmn frm wmen wh selected statement 11 first. Qutes were assigned t this categry when wmen explained their preference fr infrmatin that emphasized what they std t receive frm fish cnsumptin versus what they std t lse. Sample qutes are ffered belw: My thught was similar. They're all kinda ne and the same. I put #11 first because I lve the taste f fish but mst f the reasn I eat it is because f the health benefits. S I want thse benefits with few risks. Duluth, MN And #11 just because it gets the health benefits with the few risks. Wman frm Duluth, MN- Rural Infrmatin n fllwing the guidelines: This cde was applied when participants mentined liking the cnnectin made in the statement between fllwing the guidelines, and their likelihd f receiving benefits r aviding risks

14 #11 just kind f seems like a natural chice fr me. I can't really say specifically, but it s just like if yu're fllwing the guidelines and yu knw the health benefits f fish and yu're educated, yu're ging t have fewer risks. A wman frm Duluth, MN Psitive message: This cde was assigned in tw cases where wmen mentined liking the psitive emphasis in statement I chse #11 cuz #11-14 all sunded pretty similar but #11 seemed the mst psitive ut f thse five. A wman frm Duluth, MN-Rural Least Preferred Statements Statement 15: Our bdies eliminate mercury ver time. Wmen wh fllw the guidelines will keep mercury in fish frm building up t harmful levels in their bdies. The cmments explaining dislike fr this statement were assigned the cdes Infrmatin n bdy remving cntaminants r Infrmatin abut cntaminants. Infrmatin n bdy remving cntaminants: This cde was assigned t the majrity f cmments frm wmen in fcus grups abut their reasn fr selecting this statement last. Wmen expressed skepticism abut the bdy s efficacy in remving cntaminants, r general distrust f the message. Sample qutes are ffered belw: And then #15, I dn't think that I thught that mercury didn't really g get ut f yur bdy ver time. I'm nt really sure abut that, but I thught nt, s I'm kind f skeptical f that statement. Wman frm Hibbing, MN And then fr the least ne, I didn't like #15 because I dn't think that's true. I dn't think ur bdy des eliminate mercury ver time. I think it's ne f thse that stays with yu. Where if it des, it's ver a lng perid f time frm what I've read and where I've caught fish. A wman frm Duluth, MN

15 Infrmatin abut cntaminants: In this categry f respnses, wmen explained that they simply were nt cncerned abut cntaminants, r the risks frm cnsuming cntaminants were nt large enugh t warrant cncern. A sample qute is ffered belw: And then I picked #15. I just dn't like t hear abut mercury, I dn't knw, it just sunds I dn't knw, the fact that yur bdy is trying t eliminate it all the time, it just sunds like I'd rather nt think abut it, I guess. A wman frm Duluth, MN-Rural Statement 14: Wmen wh fllw the guidelines knw which fish are lw in cntaminants. Tw categries f justificatin fr selecting this statement were classified as Infrmatin n fllwing the guidelines and Infrmatin abut cntaminants. Infrmatin n fllwing the guidelines: This cde was applied where participants mentined the uncertainty abut what the guidelines were. This was the mst cmmnly bserved cde in the justificatins fr statement 14 being least preferred. And then the rest are really similar but again, I think the guidelines are s nebulus that I dn't knw whse guidelines? What guidelines? That manufacturers guidelines? Or the gvernment guidelines? Like guidelines dn't mean, I dn't trust any guidelines. I just d what I feel I am mre educated t d, based n what I read because I dn't trust anybdy's guidelines but my wn fr my wn family s guidelines dn't mean anything t me, persnally, n anything. A wman frm Duluth, MN #14 was my least and, um, basically just that guidelines thing, really, I dn't knw anything abut the guidelines s it didn't it wuldn't stick ut t me, I wuldn't care abut any f thse ther statements cuz it desn't tell me anything. A wman frm Ely, MN Infrmatin abut cntaminants: In this categry f respnses, wmen explained that they simply were nt cnfident in infrmatin abut cntaminants

16 # 14, I wasn't real sure. Still nt really knwing which fish, exactly, are high in mercury, hw d we knw fr sure? A wman frm Duluth, MN-Rural Preferences fr Statements in Set 4 Statements 16 thrugh 18 als described reasns fr fllwing fish cnsumptin guidelines. This set f statements included text that mentins the imprtance f fllwing guidelines t either avid risk, r t btain a certain benefit. Wmen ften nted the similarity in f these statements and described the difficulty f chsing amng the ptins due t the similarity. With nly three statements in this set, nly the mst and least preferred are reprted. The mst preferred was statement 17 while the least preferred was statement Statement Set 4: Mst and Least Preferred Statements Statement 16 Statement 17 Statement 18 Number Listing as Mst Preferred Number Listing as Least Preferred Mst Preferred Statement Statement 17: Wmen wh fllw the guidelines knw hw t make healthier chices abut which fish t eat. The cmments frm wmen justifying their chice f statement 17 as mst preferred were categrized as shwing interest in Infrmatin n healthy chices and Infrmatin n fllwing the guidelines

17 Infrmatin n health/nutrients: This cde was assigned in the majrity f cases t explain preference fr statement 17. This cde was assigned when wmen explained their preference fr receiving infrmatin abut ways fish cnsumptin culd be mst healthy. I chse #17 first because I think if I knew the healthier chices, persnally, that wuld make me want t eat fish mre and I guess I never really think abut it, yu knw. I just eat what I want t eat. A wman frm Tw Harbrs, MN I chse #17 because the reasn I eat fish is fr the benefit, s I want t knw hw t make thse healthier chices. A wman frm Duluth, MN Least Preferred Statement Statement 16: Wmen wh fllw the guidelines reduce their risk f being expsed t cntaminants fund in sme fish. Tw primary types f justificatins fr selecting this statement last were identified: Infrmatin abut cntaminants and Infrmatin abut fllwing guidelines. Infrmatin abut cntaminants: In this categry f respnses, wmen explained that they simply were nt particularly cncerned abut cntaminants. This type f cmment was bserved mst frequently amng respnses t selecting statement 16 last. Sample qutes are ffered belw: #16 I put last. I guess I'm nt as wrried abut the risks, and it was wrded a little bit ambiguusly being expsed t cntaminants fund in sme fish. S are the cntaminants nly in sme fish? Or yu'd nly knw hw t reduce risk with certain types f fish? I dn't knw. A wman frm Duluth, MN And #16 because, hnestly, that's expsed t cntaminants thing is really getting annying. A wman frm Tw Harbrs, MN Infrmatin abut fllwing the guidelines: This cde was applied in instances where wmen mentined cnfusin abut the guidelines, which guidelines the message was referencing, and what they

18 suggested as far as fish cnsumptin. This was bserved amng several wmen explaining their lw preference fr this statement. Several sample qutes are ffered belw: And then #16, wmen wh fllw the guidelines reduce their risk f being expsed t cntaminants fund in sme fish. It ges back t my guidelines; I dn't knw whse guidelines. I dn't believe that's true r nt true. It depends n what guidelines yu fllw. I think a lt f the manufacturer guidelines yu wuld nt be reducing yur risk t cntaminatin fund in fish s this just gets hung up n the guidelines. A wman frm Duluth, MN Summary f Respnses t Statements Given that messages were presented t fcus grup participants in sets, we are unable t evaluate which f the 18 statements were mst and least preferred verall. Hwever, certain types f ratinales fr liking r disliking particularly messages emerged repeatedly and are wrth nting: Wmen ften respnded favrably t mre psitive messages that emphasized particular benefits. Respnses t messages were influence by persnal experience and the perceived relevancy f messages. Fr example, wmen wh had family histries f heart disease were mre likely t respnd favrably t messages abut heart disease. Wmen wh did nt perceive fats r cntaminants as a cncern t them, were less likely t respnd favrably t messages abut fats r cntaminants. Messages that were perceived as mre clear and straightfrward were mre favrably perceived. Sme wmen respnded favrably t infrmatin that was new and nvel t them. Hwever, thers distrusted new and nvel infrmatin specifically because it was incnsistent with what they already believed

19 Narrative Analysis Narrative 1: Melanie, frm Duluth, Minnesta, was very excited t becme pregnant with their first child. Since she and her husband Jhn had been trying t get pregnant, she had made a strng effrt t ck healthy meals fr her family. While she and Jhn have always lved fishing, Melanie stpped eating any fish when she became pregnant because she had heard that mercury and ther fish cntaminants can hurt a baby s develpment. One Saturday early in her pregnancy, Melanie ran int her neighbr Julie, wh was visibly pregnant with her secnd child. Julie mentined that she was cking walleye fr her family that evening. Melanie was surprised she lved walleye but had stpped eating it since she became pregnant. Julie respnded that she had dne sme research and learned that fish are a great surce f mega-3 fatty acids, which are very imprtant fr a baby s develpment. She said that while sme types f fish d cntain cntaminants like mercury, Minnesta s Safe Eating Guidelines prvided infrmatin abut which fish t eat and hw ften. Melanie went hme and checked it ut herself - she and Jhn were excited t learn that they culd eat many f the fish that they lved and ffer benefits t the baby! Eight mnths later, Melanie gave birth t a healthy baby girl, and while it seems like almst everything in their life has changed, they can cntinue t enjy eating fish tgether. Analysis This stry descries a wman s hesitatin t eat fish during her pregnancy until she encunters her neighbr wh tells her abut the evidence that fish is healthy fr pregnant wmen. Amng the wmen in the fcus grups, slightly mre than half made favrable remarks abut the narrative (54%), with the remainder unfavrable cmments (46%)

20 Reactins t Narrative 1 Unfavrable reactins 46% Favrable reactins 54% Favrable Reactins t the Stry There were several different types f favrable reactins frm fcus grup participants. Favrable reactins received three primary cdes, including 1) agreement with the stry, 2) admirable character qualities, and 3) persnally relevant stryline. Cdes and supplementary qutes are ffered belw: Agreement/liking: This cde was assigned t participants wh indicated agreement with the plt f the stry r character actins, r simply restated events in the stry t explain why they liked the stry. Sample qutes are ffered belw: I feel like it shws that the mre educated, in this case Melanie, but the mre educated we are, the healthier chices we can make fr urselves and ur family A wman frm Duluth, MN (Rural) She was given infrmatin that fish aren't healthy fr her and then she was prvided with the real infrmatin s she prbably lked it up n-line and gt misinfrmatin A wman frm Tw Harbrs, MN Admirable character qualities: This cde was assigned t cmments that described likeable qualities in the character. Sme f the adjectives used by participants included smart and cautius. Anther

21 reasn cmments were cded in this manner was if the participant mentined appreciating that the character was fcused n prtecting her family. Sample qutes are ffered belw: Well, it's smart enugh t d yur wn research instead f just taking smebdy else's wrd fr it a wman frm Hibbing, MN Well, Melanie, yu knw, had heard ne stry and that's what she was sticking with until she learned smething frm smebdy else and went and researched it herself and fund she didn't have t be as wrried as she was. S that was gd fr her and her family A wman frm Duluth, MN (Rural) Persnally relevant stryline: This cde was assigned when wmen explained the stry was smehw familiar t them, r they explained added meaning frm the stry due t their persnal experience. Sample qutes are ffered belw: Yeah, I hear it, yu knw, with friends and everything else, t. I mean the stry is very familiar because that's what peple d that happened a lt and even wrking in clinics where peple cme in because they heard this r they heard that s it's a very familiar stry A wman frm Duluth, MN I feel like I kind f relate t Melanie. I've had tw kids. The first ne was in Nebraska and the dctr there was mre n dn't eat fish while yu're pregnant. We didn't have a lt f lcal cd, great fish there A wman frm Duluth, MN (Rural) Unfavrable Reactins t the Stry Mst unfavrable reactins were cded as either 1) relying n wrd f muth/failure t d research r 2) unrealistic characters actins. Cdes and supplementary qutes are ffered belw: Character relied n wrd f muth: This cde was assigned when fcus grup participants viced dislike fr hw the character relied n the wrd f muth frm her neighbr as t hw t behave, and als the failure t d research and be prepared befre her child arrived. Sample qutes are ffered belw:

22 I wuld definitely d sme research then, but I'm nt ging t just stp eating it altgether based n what smebdy else has t say. I guess, I dn't knw, if I was t d the research and, yu knw, it pretty much clearly explained why it was bad r why yu shuldn't eat it, then I might recnsider like, h, k, instead f having it nce a week, maybe nce a mnth r nce every tw mnths while I'm pregnant. But I wuldn't just stp eating it altgether A wman frm Ely, MN It just seemed dd she made this healthy effrt t ck healthy meals but didn't d this research and gt it frm her neighbr and then did sme research. Kind f cnflicting A wman frm Duluth, MN Unrealistic character actins: This cde was assigned when participants indicated that actins were unrealistic, and specifically, in respnse t this narrative, represented irratinal fear abut fish cnsumptin. A sample qutes is ffered belw: In mderatin. If yu're eating sme type f fish like every meal f every day, then yu might have a prblem just in general. Um, yeah, and I think that Melanie is a little paranid A wman frm Duluth, MN Narrative 2: Sarah and her husband Nick gt married fur years ag and live in Tw Harbrs, Minnesta. Recently they decided that they wanted t start a family, and after a few mnths Sarah learned she was pregnant! Nick wrks flexible hurs and lves t ck fish he catches, but he stpped bringing fish hme after Sarah gt pregnant because he was cncerned abut mercury and the baby s health. One night, when Sarah and Nick were watching the news, they saw a stry abut guidelines fr healthy fish cnsumptin amng wmen f childbearing age, issued by the Minnesta Department f Health. The stry described the health benefits f including fish as part f a balanced diet during pregnancy. Nick was relieved that he culd ck their favrite fish like perch. Eight mnths

23 later, after a safe, and relatively easy pregnancy, Nick and Sara are s glad they have a healthy, happy baby and grateful that they heard the fish cnsumptin guidelines when they did. Analysis This stry descries a husband, respnsible fr preparing meals fr his pregnant wife, learns fish is nt healthy fr wmen, then stps bringing back fish he catches like he nce did. The cuple refrains frm eating fish until they learn f the healthiness f fish fr pregnant wmen n the televisin. Amng the wmen in the fcus grups, slightly mre than ne third made favrable remarks abut the narrative (37%), with the remainder tw thirds unfavrable cmments (63%). Reactins t Narrative 2 Favrable Reactins 37% Unfavrable Reactins 63% Favrable Reactins t the Stry There were tw cdes that were bserved mst cmmnly, including 1) admirable character qualities, and 2) persnally relevant infrmatin. Cdes and supplementary qutes are ffered belw: Admirable character qualities: This cde was assigned t cmments that described likeable qualities in the character. Sme f the adjectives used by participants included smart and cautius. Anther reasn cmments were cded in this manner was if the participant mentined appreciating that the character was fcused n prtecting her family. Sample qutes are ffered belw:

24 I think that it was cute that Nick gt cncerned fr Sarah and the baby's health and stpped bringing fish hme. It was kind f his fatherly instincts, yu knw A wman frm Hibbing, MN They are cnscientius. I mean, they want what's best fr their kids A wman frm Duluth, MN (Rural) Persnally relevant stryline: This cde was assigned t nearly tw thirds f the psitive cmments. This cde was assigned when wmen explained the stry was smehw familiar t them, r they explained added meaning frm the stry due t their persnal experience. Sample qutes are ffered belw: I guess that was me when I was yunger but nt like s much recently. I guess when I was yunger A wman frm Tw Harbrs, MN Yeah, abslutely, I think it's just part f having children is that yu d want t d what's best fr them and research everything and if yu find ne anecdtal thing, it kind f tends t be magnified smetimes in yur brain because f hrmnal changes in yur bdy and then it might spin ut f cntrl smetimes fr peple and they think, h, I can't d this. I can't safely d this r I can't safely d that A wman frm Duluth, MN (Rural) Unfavrable Reactins t the Stry There were three primary unfavrable reactins frm participants. The mst cmmnly bserved unfavrable reactin t the narratives were cded as 1) unrealistic character actins, 2) cntent that was nt persnally relevant, and 3) unclear cause and effect. Cdes and supplementary qutes are ffered belw: Unrealistic character actins: This cde was assigned when participants indicated that actins were unrealistic. A number f cmments cded as unrealistic in respnse t Narrative 2 centered n the rle f the husband in this stry. Sample qutes are ffered belw: All the men in ur family, in my family, wuldn't really care. They wuldn't really knw enugh, they'd leave it up t the wman f the huse t make all the health and diet decisins s fr me, it didn't like hit hme r anything because my husband is kind f clueless when it cmes t during

25 the whle pregnancy and whatever. He wasn't ne f thse wrriers A wman frm Tw Harbrs, MN And I think the thing that stuck ut fr me was like they weren't necessarily n the same page. Like neither f them had really dne sme research like he had heard that it wasn't gd but neither f them really lked int it r talked t their OB abut it. Like yu just cut ut this, yu knw, this ut f yur diet withut even really understanding. And, yeah, the research says different things, but yu need t figure ut what's best fr yu and what yu're cmfrtable with instead f just like stpping, nt really knwing all the facts A wman frm Duluth, MN Cntent was nt persnally relevant: This cde was assigned when fcus grup participants explained the stry was nt smething they had persnally experienced r events that might be relevant t their persnal experience. Sample qutes are ffered belw. It seems it has a lt t d with being pregnant. That's kind f the whle thing. Fr me, I've never been pregnant, s A wman frm Duluth, MN (Rural) I just knw where I'm getting my fd, I guess, s like, I feel like that's nt an issue because I'm nt getting my fd frm shipped frm wh knws where where they dump sewage in the ceans and stuff like that. I dn't have t wrry abut that, but I guess I never have researched the levels f mercury in Minnesta lakes either A wman frm Hibbing, MN Unclear cause and effect: This cde was assigned when wmen indicated the stry jumped t cnclusins abut fish cnsumptin being imprtant during pregnancy yet failed t prvide sufficient causal evidence. Sample qutes are ffered belw: I dn't get the cause and effect either. I mean, yur baby culd be healthy if yu ate fish everyday, I dn't knw. Did it have anything t d with it? A wman frm Duluth, MN It just makes me think, what if they didn't have a healthy baby? Wuld they have thught maybe the fish wasn't healthy t eat? A wman frm Duluth, MN (Rural)

26 Narrative 3: Kristy and her husband Nathan recently mved back t their hmetwn f Virginia, Minnesta. Nw married fr several years, the cuple was excited t try t have a baby. A baby is a big change, s Kristy began ding her hmewrk n healthy exercise and nutritin fr wmen hping t cnceive. Kristy came acrss an article n the internet abut fish cnsumptin guidelines fr wmen f childbearing age. The article explained that, althugh many wmen avid fish during pregnancy, there is strng evidence that eating fish during pregnancy is imprtant fr her baby s develpment. Skeptical, Kristy explred several fish cnsumptin guidelines, like the Minnesta Department f Health and fund this reprt t be well supprted. In truth, Kristy was relieved; crappie is ne f her favrite fds! The next mnth, Kristy discvered she was pregnant. Kristy and Nathan decided they wuld try t eat a variety f lw-mercury fish during her pregnancy. The cuple was grateful, and happy t have fund the helpful guidelines. Analysis This stry descries a wman and her husband wh carefully plan t have a baby, and incrprate fish int their diet after ding their research n healthy fish cnsumptin during pregnancy. There were verwhelmingly favrable reactins t this narrative, with nearly all cmments being cded as favrable (95%), while nly several negative (5%)

27 Reactins t Narrative 3 Unfavrable reactins 5% Favrable reactins 95% Favrable Reactins t the Stry There were tw primary cdes bserved amng the data, including 1) practive character, and 2) persnally relevant stry. Cdes and supplementary qutes are ffered belw: Admirable character qualities Practive character: This cde was assigned t nearly tw thirds f favrable cmments. The cde was assigned t cmments that described likeable qualities in the character. The specific quality that came up again and again in respnse t this stry was that fcus grup participants appreciated that the character did her research and was prepared fr her pregnancy, as ppsed t having t receive infrmatin abut fish cnsumptin frm a neighbr. Sample qutes are ffered belw: She seemed much mre smart abut it. She researched it n her wn, she didn't just, yu knw, she might have heard ne thing but she did her wn research n it and went t a lt f different surces. A wman frm Duluth, MN (Rural) Um, I liked this ne prbably the mst s far. Yeah, I liked that she des research, it's kind f my thing, t, and I like that they decided they wuld well, I like that she learned that there's

28 bviusly a variety f lwer mercury fish ut there s she learned that and -- A wman frm Hibbing, MN Persnally relevant stryline: This cde was assigned t apprximately ne third f the psitive reactins t Narrative 3. This cde was assigned when wmen explained the stry was smehw familiar t them, r they explained added meaning frm the stry due t their persnal experience. Sample qutes are ffered belw: When I was pregnant, that's kind f what when I was handed that brchure at my dctr's ffice, I kind f lked at it, lked at the guidelines, and realized that I wuld never eat that much fish t push me ver, yu knw, say yu culd have tw tuna sandwiches a day and if I ate three I wasn't gnna freak ut, yu knw, I mean I just knew I was never gnna get that much fish but I did, yu knw, get the infrmatin, I lked at it, did my wn research and realized then the rest f the time I didn't really wrry abut what I was eating cuz I knew I wasn't gnna eat fish every meal, every day t get t the pint where I wuld have t be wrried abut anything if there were ever any wrries A wman frm Duluth, MN I guess it kinda seems like hw like my husband and I wuld prbably wrk tgether, I'd say like, h, my gsh, I heard this and we wuld prbably, yu knw, be like little, yu knw, Ggle and smething like that and figure ut, h, yu saw this but I saw this that said this and I dn't knw, it just seems like I culd prbably relate t this stry cuz that's prbably hw I wuld g abut it mre likely than the first tw A wman frm Duluth, MN (Rural) Unfavrable Reactins t the Stry There were tw cmments cded as unfavrable and unrealistic. Sample qutes are utlined belw: Unrealistic stry: Bth unfavrable cdes were assigned this categry, fr citing that the events seemed unrealistic. The tw qutes are utlined belw:

29 I just, I mean, I kinda feel like, yu knw, they d mentin the Minnesta Department f Health Guidelines in here, and I almst feel like, t me, I almst feel like they're creating an unnecessary wrry and stress fr pregnant wmen when they're already wrried and stressed. S fr wmen t have t be wrried abut where they eat their fish, where it was caught, where it, yu knw, I just, I dn't knw, t me, um, yu knw, the clinic I wrked at, we ended up just we stpped handing ut thse brchures because it was creating t much. We were getting phne calls abut, h, my gsh, like I said, I had three tuna sandwiches this week and I was nly suppsed t eat tw, am I gnna be k? It's like, I dn't knw, I just feel that these guidelines are just kinda putting false fear int peple A wman frm Duluth, MN I just can't imagine the majrity f the peple eating this much fish. I mean, I think all f us being highly intelligent wmen and being familiar with fish and eating fish, we're gnna think abut it mre than like the average peple s I guess in my mind I think abut ur yunger generatin and the amunt f prcessed fds they eat, thinking that it's k t drink Mnster drinks and, yu knw, Red Bull when yu're pregnant A wman frm Duluth, MN Summary f Narrative Analysis Althugh all three narratives elicited sme psitive and negative reactins, the respnse t narrative 3 was verwhelmingly psitive. The respnses t the ther tw narratives were mixed with narrative 1 perceived mre favrably than narrative