Abstract
Policy Points Community organizers addressing health issues use narrative strategy to shift public attitudes, build support for health-affirming policies, and motivate collective action. Through a mixed methods research partnership with a power-building organization, we evaluate how narrative power is leveraged to disrupt dominant ideas about the health care system-testing the impact of counter-narratives grounded in the lived experiences of people most harmed by structural failures. Findings demonstrate that strategic messaging from community organizers about health policy issues has the potential to shift policy-relevant beliefs, particularly those related to attributions of blame and intent to take collective action.
Building narrative power, a foundational strategy used in community organizing, involves dismantling dominant narratives that uphold inequity and constructing counternarratives that advance health equity and racial justice by reshaping how people make sense of the world. Yet, the mechanisms through which narrative power can influence public opinion and subsequent policy are seldom evaluated with research.
In partnership with a power-building organization, we developed and tested two counternarratives that challenge dominant framings of the US health care system. In this three-phase study, we (1) conducted interviews with community organizers to explore their motivations and health care experiences, (2) iteratively developed two counternarratives reflecting the system's complexity and unaffordability, and (3) tested the counternarratives in a randomized experiment (N = 1,587), against a constructed dominant narrative and a no-message control. Following exposure to an assigned narrative, participants completed a posttest questionnaire measuring the primary (policy perceptions and intentions to participate in civic actions to improve health care) and secondary (perceptions of causal attributions and blame) outcomes.
Our results indicate the dominant narrative effectively individualizes blame for poor health and dampens motivation for civic engagement. Meanwhile, counternarratives rooted in the lived experiences and language of those most harmed by the system have potential to shift public beliefs, increase attribution for poor health to external factors vs. internal factors, and motivate some types of collective action.
Our findings show the dominant narrative about health care does what health justice organizers argue it is designed to do: perpetuate harmful myths of individual blame for structural problems, shifting blame for health challenges away from powerful institutions. However, there is potential for counternarratives to reframe public perception and motivate collective action. Our study underscores the value of research partnerships between grassroots organizers and academic researchers in developing narrative power strategies.