Date of Award

Spring 2026

Document Type

Open Access Dissertation

Department

School of Journalism and Mass Communications

First Advisor

Jungmi Jun

Abstract

Despite extensive intervention efforts, breast cancer remains the most common cancer among women in the United States and the second leading cause of cancer-related deaths in women. Prior research in breast cancer communication has largely focused on older women, yet early-onset breast cancer among younger women (ages 18-39) has increased in recent years. This trend highlights an urgent need for tailored communication strategies to improve young women’s understanding of breast cancer risk factors, prevention, detection, treatment, and survivorship. The present study developed and tested a digital narrative game based on the Health Belief Model, as a potential tool to enhance young women’s perceptions of breast cancer risk and strengthen their efficacy in prevention and detection practices. Using a one-group pretest-posttest design (N = 101 young women in the United States), this study examined whether gameplay influenced key HBM constructs, including perceived susceptibility, severity, benefits, barriers, and self-efficacy. Two theoretical frameworks guide this research: the Health Belief Model (HBM) and Transportation Theory. While the narrative game content was structured around HBM constructs, Transportation theory was used to explain transportation as a potential explanatory mechanism linking interactive narrative exposure to post-intervention health belief change. Findings revealed that the HBM-based narrative game significantly increased young women’s perceptions about their susceptibility to breast cancer, severity of breast cancer and benefits of early detection, while reducing perceived barriers and strengthening self-efficacy. These effects reflect belief-level changes rather than directly measured behavioral outcomes. Participants reported moderately high levels of transportation during gameplay and transportation significantly explained variance in pretest-posttest changes in HBM constructs except perceived severity. These findings reinforce the importance of the HBM and cognitively scaffolded HBM content in breast cancer communication, while highlighting the utility of transportation theory in narrative health communication. The study contributes methodologically by integrating established health behavior theories such as the HBM and persuasion constructs such as transportation theory in one single analytical framework, and practically by demonstrating the feasibility of theory-driven narrative game design, offering guidelines for developing youth-targeted breast cancer communication interventions. Implications for future randomized controlled trials and behavioral outcome measurement are discussed.

Rights

© 2026, Adetutu Oluwaseyi Wande-Kayode

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