Health communication is a multi-layered field that aims to improve knowledge, attitudes, and behaviors at the individual and societal levels; it encompasses dimensions such as message design, targeting, channel selection, and intensity. In mass communication, the reach, repetition, credibility, and target-specific adaptation of the message are seen as decisive factors in its impact; well-designed campaigns have been shown to produce minor to moderate but meaningful behavioral effects across different health topics (Noar, 2006; Snyder et al., 2004; Wakefield et al., 2010). However, impact can be explained not only by the number of people reached, but also by how the audience relates to the message and the extent to which they are emotionally and cognitively engaged.

At this point, the entertainment-education approach (Sabido, 2004, 2021) and persuasion theories provide a fundamental framework for understanding the place of popular narratives in health communication. The entertainment-education literature emphasizes that story-based content not only conveys information but also influences attitudes and behaviors by drawing the audience into the story, fostering identification with characters, and leveraging perceived realism (Hinyard & Kreuter, 2007; Moyer-Gusé, 2008). Models such as ELM (Elaboration Likelihood Model) (Allen & Reynolds, 1993; Ott et al., 2020; Petty et al., 1993) and E-ELM (Extended Elaboration Likelihood Model) (Carpenter, 2020; Slater & Rouner, 2006) suggest that such narratives can strengthen persuasion by reducing counter-argument production and weakening defensive responses; Social Cognitive Theory posits that modeling through observational learning, self-efficacy, and outcome expectations, along with relatable characters, play a central role in behavioral change. This theoretical line explains why popular visual narrative media such as cinema and television are considered powerful tools for conveying and processing health representations (Cohen, 2001, 2006; Dixon & Clarke, 2012; Hoffner & Cohen, 2015).

Three processes are particularly prominent within the narrative-based approach: narrative transportation, identification with characters, and perceived realism/authenticity (Cohen, 2001; Green & Brock, 2000). Narrative transportation is defined as the state of directing the viewer’s attention and imagination toward the story, temporarily distancing themselves from their everyday reality and immersing themselves in the story world; identification involves the processes of internalizing the characters’ emotions and perspectives. Perceived realism, on the other hand, is based on the credibility of the narrative and the viewer’s sense that it could happen to them (Busselle & Bilandzic, 2008, 2009). E-ELM and entertainment-education models suggest that these three processes, working together, can reduce counterargument production and allow health messages to be processed in a less didactic, more experiential manner (Moyer-Gusé, 2008; Moyer-Gusé & Nabi, 2010; Slater & Rouner, 2006).

Previous empirical findings suggest that narrative formats may be associated with meaningful increases in knowledge, attitude, and intention indicators across various health topics. Hinyard and Kreuter (2007) and Shen et al. (2015) have shown that narrative-based content can offer advantages over direct persuasion messages that encounter resistance, particularly on complex or sensitive topics; as viewers become immersed in the narrative and identify with the characters, the message is perceived as less threatening and more actionable. Studies presenting peer-to-peer information in narrative film format, in the context of cervical cancer, reported more potent effects on knowledge, attitudes, and screening intentions compared to non-narrative formats. This effect was shown to have the potential to reduce inequalities across different ethnic groups (Murphy et al., 2013, 2015). Similarly, narrative interventions targeting black women living with HIV have produced promising results in terms of reducing internalized stigma, increasing intentions to share their status with partners, and increasing intentions to adhere to medical treatment (Bryant et al., 2023). These findings suggest that health-themed popular narratives, when effectively designed, can yield small to moderate yet meaningful improvements not only in awareness but also in intention and behavioral indicators (Snyder et al., 2004; Wakefield et al., 2010).

Early diagnosis and screening processes have a significant life-saving impact, particularly in the case of cancer. The World Health Organization emphasizes that early diagnosis improves outcomes by reducing delays in diagnosis and treatment, and recommends regular screening for many types of cancer (American Cancer Society, 2023; WHO, 2025). In this context, guidance provided through cinema and television can serve as a critical bridge in translating abstract awareness into concrete behavior. Representations of cancer in cinema are primarily shaped around the burden of caregiving as a patient’s relative, the treatment process, death, and the swing between hope and despair; examples are common in films where, regardless of the type of cancer, recovery is depicted as rare and death as a frequent outcome (Benjamin et al., 2024b). Pain and pain management are frequently presented as solely medication (opioid)-centered; the multidimensional nature of holistic care practices, psychosocial support, and palliative care remains in the background (Mukhida et al., 2022). As the roles of patients and their relatives in providing care and labor at home become more prominent (Morel & Miyose, 2022), dark narratives in some national cinemas may fuel cancer fear (carcinophobia) (Domaradzki, 2022). These representations sometimes do not correspond to clinical reality; they may portray survival rates, treatment options, and pain management as more pessimistic or one-dimensional than they actually are (Benjamin et al., 2024a, 2024b; Clark, 1999; Johnson & Quinlan, 2018).

Although the impact of popular narratives on knowledge, attitudes, and behaviors in the context of health communication has been demonstrated, how this impact is shaped by perceived realism, source credibility, and, most importantly, the intersection with the viewer’s life experience is still not fully understood (Shen et al., 2015). Particularly in a highly emotionally charged topic such as cancer, the viewer’s personal/family proximity to cancer can be considered a moderator that either strengthens or complicates the processes of narrative engagement, identification, and risk perception. For viewers with a personal connection to cancer, film scenes may evoke past experiences, thereby providing a context that involves more intense self-reference and emotional processing; for viewers without such experience, the narrative may serve more as an abstract possibility or a schematic description of where to take the first step. Nevertheless, qualitative, comparative studies examining how viewers’ personal proximity to cancer influences their engagement with the narrative, identification, perceived realism, access to information, screening/consultation intent, and low-threshold steps related to daily life practices within a short timeframe (from pre-film to immediately after to a short follow-up) are limited. Furthermore, it is not sufficiently known how cancer-themed films produced in different cultural contexts trigger these processes and whether they produce similar or differential patterns of impact.

This gap necessitates a study of how cinema-based health communication affects cancer awareness and the transition from awareness to action, considering the viewer’s personal proximity to cancer and film narratives in different cultural contexts. This study aims to fill this gap by analyzing health communication conducted through cancer-themed films set in two different cultural contexts, focusing on how it influences viewers’ information-seeking, screening/consultation intentions, and low-threshold lifestyle steps. Examines, through a qualitative, comparative design, how health communication conducted via cancer-themed films set in two different cultural contexts affects viewers’ information seeking, screening/consultation intentions, and low-threshold lifestyle steps, and how these effects differ between viewers who have (A) and who do not have (B) personal/family experience with cancer. The aim is to compare short-term changes in awareness, attitude, and intention indicators between groups A and B after the experience of watching cancer-themed films, as well as between films representing two different cultural contexts, and to interpret these patterns by relating them to the processes of narrative immersion, identification, and perceived realism. In summary, this study’s theoretical model assumes that cancer-themed film narratives will influence information seeking, screening/consultation intention, and low-threshold lifestyle steps through (1) narrative immersion, (2) identification with characters, and (3) perceived realism processes; and that the intensity of these relationships will be moderated by the level of personal/family proximity to cancer. Within this framework, interviews conducted at three time points with five participants who have had personal or family experience with cancer and five who do not, for each film, aim to reveal in detail both the narrative processes and how proximity to cancer moderates these processes.

The comparative qualitative design used in this study is based on showing two different feature-length films with cancer themes (Ordinary Love and Our Family) to separate groups of participants and conducting face-to-face interviews with each participant at three points in time (prescreening, post-screening, and ten days after the screening). Unlike studies focusing on one-time, momentary affect, this design enables the tracking of participants’ meaning-making processes over time. Thus, the intense emotional reactions immediately following the film can be distinguished from the relatively cooled-down, more grounded assessments in daily life on the tenth day. The design also enabled the tracking of observed changes in two key aspects: the level of personal/family proximity to cancer (groups A and B) and the film or narrative genre and cultural context (United Kingdom/Ireland and Japan). This multi-layered construction allowed the impact to be read not only as a scattered picture dependent on film preference or content diversity, but also through the interactions between proximity to cancer, narrative style, representations of the healthcare system, and the passage of time.

Following the cancer-themed film viewing experience, short-term increases were observed in both films in terms of information seeking, screening/consultation intent, and low-threshold lifestyle steps. A significant proportion of participants indicated that within ten days, they planned to consult at least one healthcare professional, see their family doctor, or reschedule a previously postponed screening/check-up appointment. While this basic pattern was familiar to individuals with and without cancer experience, there were meaningful differences in the speed, concreteness, and persistence of change. In Group A, which had proximity to cancer, concrete actions such as rescheduling an appointment with a specialist, bringing forward an appointment, or applying for screening were reported more frequently, especially after watching Ordinary Love, as of the tenth day. In the Our Family viewer Group A, steps toward reorganizing caregiving and family responsibilities, as well as reviewing support networks, were more prominent than medical applications. In Group B (those without experience), both films increased the intention to seek counseling/screening. Still, Ordinary Love triggered more systematic and short-term plans. At the same time, Our Family initiated more awareness and emotional thinking processes, resulting in a more limited and variable pattern in terms of transitioning to action.

From a cinematic perspective, the impact of Ordinary Love on viewers is primarily shaped by themes of early diagnosis, regular check-ups, and navigating the healthcare system. By integrating the clinical stages of a year (biopsy, surgery, chemotherapy/radiotherapy, and side effects) into everyday routines, the film’s restrained and measured style, free from melodrama, has made it easier for participants to make concrete plans regarding appointment scheduling, check-up intervals, and who to contact and when. The film’s depiction of open communication with the healthcare team and strategies for managing uncertainty provided viewers with a repertoire of model behaviors they could adapt to their own lives. In contrast, for Our Family viewers, the progression of the disease, palliative care, and the sharing of caregiving labor among siblings/children emerged as more dominant themes; particularly in Group A, it triggered intense reflection on family communication, responsibility sharing, and emotional burden. This difference resulted in a more consistent pattern of action in favor of Ordinary Love, particularly in terms of screening and early referral intentions. At the same time, Our Family created an effect centered around the caregiving relationship and social support, indirectly linked to medical steps. In other words, while Ordinary Love primarily addressed the question of how to engage with the healthcare system, Our Family centered on the question of how families living with illness manage their circumstances.

Personal/family proximity to cancer appears to be a significant moderator in this process. As identification with and perceived similarity to the caregiver-patient figures in the film increase in Group A, narrative transportation and self-referential processes intensify, bringing information seeking and screening intentions closer to faster and more lasting action. Participants who were able to bridge their own story with the story in the film experienced the film not only as something that happened to others, but as an extension of their own past or possible future. In group B, the film experience often generated low-threshold action plans (short walks, consulting a family doctor, simple dietary adjustments); however, the transformation of these intentions into a regular follow-up schedule appeared to be more sensitive to interpersonal support, time constraints, and living conditions. Participants who reported heavy workloads or economic hardship, in particular, emphasized that while they valued the motivation generated by the films, structural barriers were decisive in translating this motivation into action. This pattern is consistent with findings highlighted in narrative persuasion and entertainment-education literature, which show that high levels of narrative engagement and identification with characters reduce counterarguments, creating minor to medium but meaningful effects on intentions and behavior (Busselle & Bilandzic, 2008, 2009; Braddock & Dillard, 2016; Hinyard & Kreuter, 2007; Moyer-Gusé, 2008; Snyder et al., 2004).

In terms of narrative processes, the intimate micro-scenes and daily rituals seen in both films suggest two main mechanisms that explain the increase in intention. In Ordinary Love, scenes such as haircuts, interactions in the clinic waiting room, and walks along the shore; in Our Family, scenes depicting the division of household labor and conversations about responsibilities between siblings amid the increasing burden of illness, conveyed through everyday details, serve as examples of scenes that deepen the viewer’s immersion in the narrative and identification with the characters. Participant narratives show that these scenes are remembered not as major dramatic turning points, but as small yet intensely emotional moments within daily life. These micro-moments, as predicted by E-ELM and entertainment-education models, produce cues that enhance perceived realism, thereby reducing counter-argument production and lowering persuasion resistance (Green & Brock, 2000; Moyer-Gusé & Nabi, 2010; Slater & Rouner, 2006). The study’s findings show that messages containing concrete behavioral cues at the micro level, which are understated and have practical relevance, facilitate acceptance in both groups A and B. In contrast, a judgmental, condescending, or overly emotional tone generates distance and resistance, particularly in group B. This suggests that dramatic intensity alone is not sufficient for persuasion; rather, the visibility of small steps that maintain feelings of hope, control, and self-efficacy is critical, as it increases the viewer’s perception that they can do it themselves.

Emotional patterns and persuasion dynamics have revealed qualitative differences between the two films. In Ordinary Love, the preservation of hope, open communication with the healthcare team, partner support, and visible coping cues such as manageable daily practices have created a structure that balances emotional intensity and facilitates acceptance. While the film generates anxiety and fear, it shows practical coping strategies without taking these emotions to a paralyzing point. In Our Family, the narrative tone, where the burden of illness and loss is more visible, sometimes generated a strong motivation to take action in Group A, while at other times it led to a prolonged emotional processing period and delayed decisions. The fact that scenes remembered even on the tenth day primarily revolve around daily adaptation, small plans, and relationship negotiations, while overly dramatic emphasis produced distance and defensiveness in some participants, suggests that the balance between emotional intensity and self-efficacy cues is critical in terms of persuasion.

Another contribution of the study is that it provides qualitative insights into how cancer narratives are processed within a cultural context and through representations of the healthcare system. While participants found both films realistic, they compared their own experiences with the Japanese healthcare system and family structure, particularly in the context of Our Family; this comparison created awareness of systemic differences within these contexts. When it came to Ordinary Love, participants tended to translate the screening and follow-up routines seen in the film more directly to their own healthcare networks; they rethought their relationships with their family doctor, public hospital, or private healthcare institutions through the scenes in the film. This finding is consistent with the literature, which highlights the decisive role of cultural adaptation and proximity to local languages and symbols in health communication outcomes (Kreuter & McClure, 2004; Ochoa et al., 2020). It also shows that films from different cultures can serve as a mirror, enabling viewers to examine their own health systems from an outside perspective.

In conclusion, this qualitative comparative study demonstrates that cancer-themed cinematic narratives can produce short-term but meaningful improvements in information seeking, screening/consultation intent, and low-threshold lifestyle steps, based on two films from different cultural contexts and viewers with varying levels of proximity to cancer. The realism of the narrative, its provision of micro-level behavioral cues, and an emotional balance that maintains feelings of hope and competence while avoiding excessive dramatization emerge as the primary mechanisms reinforcing this effect. Furthermore, interactions between the level of proximity to cancer, cultural context, and representations of the healthcare system emerge as critical dimensions for understanding the impact of cinema-based narratives on cancer awareness and early referral behaviors. This provides a conceptual framework for future film-based studies to be designed.

These findings should be interpreted within the context of several significant limitations. First, the study sample is small and was selected through purposive sampling from a single urban setting. This limits the generalizability to communities with different sociodemographic characteristics, healthcare system structures, and media consumption habits. Although findings from qualitative interview studies suggest that high information power can be achieved with a limited number of participants, findings need to be validated with larger and more diverse samples (Guest et al., 2006; Kirsti et al., 2015).

Another limitation is that only two feature-length cancer-themed films (Ordinary Love and Our Family) were used as stimuli in the study. While this design partially mitigates the single-stimulus limitation, given that film representations are vibrant and multidimensional, the results still carry the risk of being content-specific. The films are centered around specific cancer types (e.g., breast, liver) and specific family configurations (middle-aged heterosexual couple, nuclear family structure). Comparisons with films that feature diverse narrative styles, character representations, LGBT+ portrayals, narratives of children and young adult patients, or different socioeconomic contexts will provide broader external validity in terms of both proximity to cancer and cultural context (Judd et al., 2012; Westfall et al., 2014).

Additionally, the results are primarily based on self-reports and intention indicators. Although concrete actions taken by the tenth day were reported, this study was not designed to produce predictive results regarding long-term behavioral change (adherence to a regular screening schedule, permanent lifestyle changes). Self-report-based data also carries the risks of social desirability bias and common method bias; participants’ tendency to use statements close to the “correct” answer suggested by health professionals may inflate reports of intention and behavior (Krumpal, 2013; Podsakoff et al., 2003).

Finally, the study participants consisted of individuals who volunteered to watch a cancer-themed film and participate in three follow-up interviews about their experience. This voluntary participation structure increases the risk of self-selection bias and limits generalizability to less interested or less media-literate viewers. Individuals who avoid cancer-related content or exhibit intense anxiety or avoidance responses are not represented in this sample. Therefore, the findings should be considered more valid for viewers who are at least minimally open to cancer narratives in mental and emotional terms. Future studies incorporating designs that include viewer groups with different levels of sensitivity could reveal in greater detail the kinds of risks and opportunities cinema-based narratives carry for various audiences.

The increase in information seeking, screening/consultation intent, and low-threshold lifestyle steps observed after exposure to Ordinary Love and Our Family can be explained through the films’ aesthetics, which lean on everyday life, avoid relative melodrama, and contain micro-level actionable tips; can be explained through the viewer’s processes of becoming absorbed in the story, identifying with the characters, and referencing the narrative to their own lives. The revitalization and intimacy cues provided by everyday micro-moments, such as intimate scenes, waiting room interactions, family negotiations, and coastal walks, facilitate acceptance by reducing counterargument production; these scenes remain memorable even on the tenth day.

The effects manifest more rapidly and persistently in those with personal/family ties to cancer, indicating a strengthening of similarity and self-reference processes; in those without such experience, the film’s daily rituals offer action-oriented schemas regarding where to take the first step. Ordinary Love produced a more precise and consistent pattern of action, particularly in terms of early diagnosis and screening behavior. Our Family, on the other hand, revealed a pattern of awareness and selective behavioral intent centered around care work, family responsibilities, and emotional support networks. The overall pattern is consistent with meta-analytic findings that narratives produce minor to moderate but meaningful effects, as well as the knowledge/attitude/intention/behavior gains demonstrated in film-based trials (Braddock & Dillard, 2016; Murphy et al., 2015; Shen et al., 2015; Snyder et al., 2004).

These results indicate that cinema-based narratives—particularly when they are perceived as highly realistic, free from exaggeration, and strongly actionable—can serve as a viable tool for enhancing key determinants of cancer awareness (access to information, screening/consultation intent, low-threshold lifestyle steps). Films representing different cultural contexts can provide a productive framework for audiences to rethink their own healthcare systems, family roles, and care arrangements; however, maximizing the impact of this framework depends on supporting it with adaptations that are sensitive to local language, symbols, and healthcare realities. Future studies could further explore these findings by examining the long-term impact of cinema-based interventions on behavioral change within broader narrative universes that encompass various cancer types, life stages, and forms of representation.