Cancer on screen: comparing the effects of films on audiences based on their companionship level with cancer and their lifestyle changes
Article information
Abstract
This article analyzes the short-term effects of cancer-themed films on viewers’ access to information, screening/consultation intentions, and low-threshold lifestyle steps, within the context of personal/family proximity to cancer. Two separate groups were formed for the films Ordinary Love and Our Family; each film group consisted of five adults with experience of cancer (A) and five without (B), totaling twenty adults. Semi-structured interviews were conducted with participants before the film, immediately after the screening, and on the tenth day; data were analyzed comparatively along the axes of time (before/after/follow-up) and group (A/B, film). The findings reveal an increase in information-seeking and screening/consultation intentions for both films, as well as the emergence of actionable steps, including taking short walks, simplifying one’s diet, and reducing smoking/alcohol consumption. These effects are more rapid and concrete in action in group A, while in group B, they are more focused on the planning level. The results show that realistic and everyday narratives can be used as a tool to strengthen the immediate determinants of cancer awareness. Although the small and purposeful sample, short (10-day) follow-up, and self-selection bias due to voluntary participation limit the generalizability of the findings, the study shows that realistic and applicable cinematic narratives are a valuable tool for strengthening the immediate determinants of cancer awareness and that the level of proximity to cancer shapes these effects.
Introduction
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.
Method
Study Design
This study employed a comparative qualitative design, utilizing in-depth interviews. In-depth interviews are suitable for revealing the meanings participants attribute to their experiences and their feelings and evaluations regarding sensitive issues (Kvale & Brinkmann, 2009; Rubin & Rubin, 2012). Semi-structured data were collected from each participant at three time points (prescreening, post-screening, and ten days after screening); thus, the aim was to monitor short-term intra-time changes and between-group differences (those with/without cancer experience). The repeated interview approach effectively tracks changes in perceptions and intentions related to a specific event (Seidman, 2019). Two separate focus groups were shown different cancer-themed films; within each group, all participants watched the same film, ensuring that the observed effects stemmed from proximity level and time factors rather than content diversity. The sample was purposefully selected and comprised two subgroups. Purposive sampling enables the researcher to systematically select participants who can provide the most relevant information for the study’s objectives (Patton, 2015). This approach is methodologically sufficient when conducting in-depth interviews (Kirsti et al., 2015). Furthermore, findings that thematic saturation in qualitative interview studies can often be achieved with a limited number of interviews support this choice (Guest et al., 2006). The interview form was structured around awareness, emotional response, narrative engagement/identification, intention, and lifestyle changes, in line with the study’s objectives.
Two separate discussion groups, each consisting of ten people, were shown different films; all participants in each group watched only the film assigned to their group together. There are three main reasons for this choice: First, the film directly addresses the research questions by representing the diagnosis-treatment journey, the continuation of daily life, the burden of caring for a spouse/partner, and the balance between hope and realism in a balanced manner. Second, the narrative language, which avoids excessive melodrama, allows for healthy assessments of perceived realism and identification. Third, the use of a single, standard stimulus in a small sample increases internal validity, allowing for a more transparent comparison of group differences (those with/without a close connection to cancer) and changes over time (before the film, immediately after, 10 days after). In addition, participants were warned about the intense emotional scenes in the film (e.g., hair loss, post-surgical period). They were given the right to stop or end viewing if they felt uncomfortable.
Furthermore, two feature-length cancer-themed films were used as stimuli in the study: Ordinary Love (UK/Ireland) and Our Family (Bokutachi no kazoku) (Japan). Both films realistically depict family and relationship-focused daily life; however, one focuses more on the stages of the treatment process, while the other highlights the progression of the disease and the palliative care experience. The films also differ in terms of cultural context; one represents the Western experience, while the other represents the Eastern experience, and they exhibit meaningful differences in narrative tone and style. To maintain consistency in provocative content within each group, each film was shown to a separate group of participants under standard conditions. This setup enabled a more precise assessment of the relationship between the observed effects and the level of proximity to cancer, as well as the time dimension, rather than elements specific to the film content, while also providing the opportunity to test the robustness of the findings through cross-film comparisons.
Participants
Participants were selected through purposive sampling. Individuals suitable for the study were identified through oncologists; those who met the criteria were selected from voluntary applications and included in the sample. To participate in the study, individuals were required to be 18 years of age or older, able to complete a three-stage interview process, and provide written consent. Individuals who were understood to be experiencing an intense grieving process or who were observed to have a serious psychiatric problem during the interview were not included in the study. The diversity of participants in terms of age, gender, and type of relationship enhances the study’s informative power and supports the representativeness of the themes obtained. The cancer experience in group A was diversified by including different types of patients (parent, sibling, grandfather, uncle, etc.) and caregiving roles across different age groups.
Participants consisted of a total of N = 20 adults (≥18 years old) selected through purposive sampling. Two independent discussion groups were formed for the two films, with n = 10 participants in each group; each participant was included in only one film. Within each discussion group, subgroups were balanced: those with personal/family experience of cancer (Group A, n = 5) and those without such experience (Group B, n = 5). The sample was designed to ensure diversity in terms of age, gender, and educational background. Accordingly, the distribution of participants included in the discussions is shown in Table 1.
Procedure
The interviews were conducted in two separate interview groups for each of the two films, at three different time points: before the film (prescreening), immediately after the film (post-screening), and ten days after the film (ten days after the screening). Each participant watched only one film under standard conditions. The screenings were conducted in the original language with appropriate subtitles, minimizing distractions. Content warnings were shared at the beginning of the session; participants were reminded of their right to pause or end the viewing or discussion at any time, and a brief debrief was conducted. All interviews were audio-recorded and supported by the researcher’s field notes.
Pre-screening
Personal or familial proximity to cancer, current knowledge and access to healthcare networks, initial perceptions, and expectations were assessed. A matched core set of questions was used for both films, creating a comparable baseline profile on family communication, caregiving roles, and contact with the healthcare system.
Post-screening
Emotional impact, engagement with the narrative, identification, perceived realism, and potential counterarguments were explored immediately. Near-term intention indicators were compiled. Parallel follow-up questions targeting the same themes were used for both films, and family decision-making processes, caregiving labor, communication with healthcare professionals, experiences navigating the healthcare system, and perceptions of narrative tone and style were systematically addressed. This framework enabled a comparative examination of cultural context and narrative differences between Ordinary Love and Our Family.
Ten days after the screening, participants discussed whether their expressed intentions had translated into concrete actions, the facilitators and barriers they encountered, and changes in their self-efficacy and outcome expectations. Participants shared examples of memorable scenes and reflected on their family roles, care arrangements, and experiences with the healthcare system. The observation of the same thematic axes in both film groups enabled analytical cross-film and cross-cultural comparison. This framework allowed the comparison to be structured along two axes: groups A and B in terms of proximity to cancer, and the Ordinary Love and Our Family groups in terms of film and cultural dimensions.
Coding Process and Data Analysis
The semi-structured question guide, prepared before the interviews, was based on conceptual areas frequently emphasized in the literature, including access to information, emotional response, and lifestyle adjustments. These areas functioned as sensitizing concepts that guided data collection; however, rather than forming preconceptions in determining the final themes, they were reshaped in interaction with the data. This approach was designed as a data-sensitive and iterative process, consistent with the understanding of reflexive thematic analysis (Braun & Clarke, 2006, 2019, 2021).
The coding and theme development process was conducted in accordance with Braun and Clarke’s six-step framework: (1) In the process of becoming familiar with the data, the interview transcripts were read repeatedly, and initial notes were taken. (2) Initial codes were created based on meaningful statements. (3) Candidate themes were developed by searching for patterns among the codes. (4) These themes were reviewed by returning to the data set, and their meaning boundaries were reevaluated. (5) Themes were defined, named, and structured around unique centers of meaning. (6) In the reporting phase, themes were structured to form a meaningful whole and supported by representative quotations.
In this process, thematic saturation was assessed based on the absence of new first-level codes in the later stages of the interviews and the intensification of repetitions overlapping with previous codes. By the twelfth interview, a decrease in the production of new meaningful content was observed, and saturation was considered to have been achieved at this point. This decision was based not only on code repetition but also on the level of contribution of the diversity within the sample to the themes. The information power approach was employed throughout the analysis process, assuming that a small but contextually rich group of participants provided sufficient insight for the study’s purposes (Malterud et al., 2016).
The author conducted all interviews, and detailed field notes were taken during this process. Coding was performed after the interviews. To ensure that the data was not limited to the perspective of a single interpreter during the coding process, a second independent coder was included in the process. The second coder listened to the audio recordings from start to finish and performed independent coding based on the original transcripts. Where coders disagreed, consensus was reached through mutual discussion, and final coding decisions were made jointly.
Data were transcribed verbatim from audio recordings, anonymized by removing personally identifiable information, and coded using identifiers such as OL-A1 through OL-A5 and OF-B1 through OF-B5. The analysis was conducted using a framework matrix structured along the axes of time (pre-screening, post-screening, ten days after the screening) and group (A/B); changes at the participant level and group differences were reported comparatively. Notes were taken, and an audit trail was created throughout the coding process to ensure the traceability of analytical decisions.
The researcher’s professional background in health communication and sensitivity to illness narratives necessitated the conscious consideration of subjective influences that could be reflected in the analysis process. These influences were evaluated with a reflexive attitude, and care was taken to balance interpretations with multiple perspectives.
Ethics
Ethical committee approval has been obtained for this research. Consent forms were obtained from all participants included in the study. To ensure the confidentiality and anonymity of participants, identifying information was not included in the coding forms, and participant identities were protected in the reporting using anonymous codes (A1–A5/B1–B5).
Results
Access to Information and Frequency Pre-screening
For both films, Group A (those with family experience with cancer) exhibited a more systematic and consistent information-seeking pattern compared to Group B. No significant difference was observed between Group A in Ordinary Love and Our Family; participants in both groups had already acquired basic cancer knowledge due to their previous diagnosis and treatment processes. These participants mostly access information through specialist doctors and follow-up appointments, occasionally through oncology nurses, family doctors, and written materials provided to them; they turn to online sources more for additional verification or to learn details. In Group B (those without cancer experience), a similar and more need-based pattern was observed in both film groups. Information searches are typically triggered by a specific symptom, a topic raised within the family, or a warning encountered in the media; the first point of contact is usually general internet searches, followed by consultations with family physicians. However, these searches are irregular and not tied to a specific follow-up plan. Therefore, the intention to access information in the prescreening phase is moderate to high in Group A and more moderate in Group B; the two Group A participants are similar within their group, and the two Group B participants are similar to each other.
Completed COREQ Checklist (Tong et al., 2007) with Page Mappings
Post-screening
The intention to seek information increased in all participants after both films. Group A, who watched Ordinary Love, clearly expressed their desire to meet with a specialist again in the short term to cope with uncertainty. They also focused on concrete planning, such as when to go for a follow-up checkup. The B group, watching the same film, converted their information search into an intention to seek advice for the first time, stating that they needed clarity, especially regarding age-specific recommendations. The A group watching Our Family showed an increase in consulting within the family, rather than seeking medical advice, sharing experiences related to the care process, and reviewing their support network. Group B, on the other hand, acknowledged their own lack of information, particularly when comparing it to the system in Japan, and emphasized the need for guidance on issues such as who to contact and when. At this stage, the intention to access information reached a high level in Group A and a medium-high level in Group B for both films.
Ten days after the screening, the convergence between intention and behavior became clear. Group A, who watched Ordinary Love, took steps such as seeking expert consultation, rescheduling appointments, or solidifying examination plans. Group B, on the other hand, received health counseling or made concrete plans in this direction. The A group, who watched Our Family, on the other hand, focused particularly on sharing their awareness of caregiving with their family, reassessing responsibilities, and seeking emotional support. Tendencies toward family restructuring rather than medical consultation were prominent. In Group B, the first step of accessing information was largely completed, but the transition to regular monitoring habits varied between the two films. In this final segment, Ordinary Love viewers emphasized individual consultation and medical steps, while Our Family viewers adopted an approach centered around caregiving relationships and social support. In Group A, the differences between the films were clearly observed, while in Group B, the similarities remained more pronounced.
Early Diagnosis/Screening Knowledge and Intent
Pre-screening
Participants in both film groups are familiar with the concept of screening at a basic level; however, the main difference in knowledge level is seen between groups A and B, with no significant difference observed between participants in groups A of Ordinary Love and Our Family. In the A groups, the level of knowledge about the types of cancer involved in the relationship is relatively higher; it is evident that they are aware of practices such as mammography, colonoscopy, or regular check-ups due to experiences in their family or personal history. However, details such as the screening interval, age threshold, which unit to contact, and how screening differs from routine check-ups are not entirely clear in either A group. In the B groups (those without cancer experience), familiarity with the concept of screening is more superficial, with most participants confusing screening with general check-ups or tests performed when complaints arise. At this stage, no significant difference was observed between the two B groups. Therefore, before the screening, there was a distinction not so much between the film groups but somewhat between the A and B groups: thanks to their current experience and contact with the healthcare system, the A groups exhibited a relatively more structured profile of knowledge and intention regarding screening, while the B groups exhibited a more fragmented profile, acting only when the need arose.
Post-screening
Intent to undergo screening increased after both films. In the A group that watched Ordinary Love, the decisive role of early diagnosis was particularly emphasized; the desire to undergo screening at the appropriate time and to consult a doctor in the short term was a prominent concern. The level of intent remained high in this group. In Group A, who watched Our Family, the factor triggering the intention to undergo screening was concern about the progression of the disease; in this group, the transformation of emotional impact into behavioral intention was observed to be stronger. Although an increase in intention was also reported in Group B, participants in the Ordinary Love group were seen to have developed a more determined and systematic attitude towards planning the first consultation step.
Ten days after the screening
In the tenth-day interviews, most participants in the Ordinary Love-viewing A group had applied for screening or scheduled an appointment. The group’s determination throughout the process and its tendency to schedule screenings regularly became apparent. Although a tendency to take action was also observed in Group A, who watched Our Family, some participants still evaluated the process within an emotional framework, which could therefore delay the decision-making process. In Group B, it was observed that concrete steps were more frequently seen among those who watched Ordinary Love. In contrast, the transition to action was more limited and variable among those who watched Our Family. Overall, while Group A stands out in the screening decision, when viewed on a film basis, the Ordinary Love group exhibits a more precise and more consistent pattern of action.
Facilitators and Barriers Influencing the Decision
Pre-screening
Participants reported both facilitating and hindering factors that influenced their decision-making process. In Group A, ongoing treatment relationships, established communication with specialist physicians, and familiarity with the healthcare system emerged as key facilitators of care. Family/partner support played a particularly significant role in accompanying and joint decision-making. In Group B, while the informative role of the family physician and environmental guidance were prominent, the decision-making process was primarily based on individual initiative. In all groups, time constraints, work-life balance, privacy concerns, and fear of facing a poor outcome were cited as hindering factors in the decision-making process.
Post-screening
In the post-screening period, the visibility of facilitating factors increased, while the impact of some barriers weakened. In Group A, which watched Ordinary Love, it was stated that early action reduced uncertainty and clarified the plan for a short-term consultation with a specialist. Partner support and the tendency to share planning stood out. In Group A, which watched Our Family, the themes of caregiving and facing illness in particular created awareness among family members about sharing responsibility. This awareness was encouraging for some participants and emotionally burdensome for others. In both B groups, the desire to seek information increased after watching both films; however, while the expectation of guidance was more clearly defined in the Ordinary Love group, signs of indecision continued to appear intermittently in the Our Family group. At this stage, time pressure and privacy concerns persisted in some individuals.
Ten days after the screening
By the tenth day, facilitating factors had taken shape within a more action-oriented framework. In Group A, which watched Ordinary Love, contact with the healthcare system was maintained, with some participants scheduling appointments or taking the first step toward seeking care. It was reported that a division of labor had been established within the family, and that accompanying and supportive attitudes had increased determination. In Group A, who watched Our Family, awareness and responsibility regarding the process increased; however, it was reported that emotional intensity slowed down the decision-making process for some participants. In Group B, examples of taking action were more common among those who watched Ordinary Love. In the Our Family group, the consultation plan became clearer, but time pressure and shyness delayed some decisions. In both films, family support, information sharing, and appropriate timing were among the key factors that facilitated the decision-making process.
Lifestyle adaptations
Pre-screening
Lifestyle changes reported by participants generally remain irregular and limited. In both film groups, participants in Group A reported engaging in behaviors more frequently, such as participating in low-threshold physical activities like walking, reducing their intake of processed foods, simplifying meal patterns, and limiting their consumption of tobacco and alcohol. Sleep patterns were irregular in both the Ordinary Love and Our Family groups. In Group B, lifestyle adjustments mainly remained at the level of intention; although various initial ideas were expressed regarding physical activity and nutrition, these did not translate into regular practice.
Post-screening
In the post-film period, plans related to lifestyle in both film groups centered around small and achievable steps. In the A group that watched Ordinary Love, plans for short walks became concrete, and simple reduction strategies (e.g., limiting refined sugar) were implemented as part of the home nutrition routine. In Group A, which watched Our Family, themes of caregiving burden and family responsibilities led to a review of meal planning and rest times. A desire for improved sleep patterns was expressed, but the scope of change varied among participants. In Group B, there was an increased intention to integrate walking into daily life and reduce consumption of prepared foods. While these plans were clearer and more short-term in the B group that watched Ordinary Love, some uncertainties persisted in the Our Family group due to emotional intensity and the increased mental load of household responsibilities. Both B groups expressed intentions to reduce smoking and alcohol consumption; however, the rate of behavioral change remained limited.
Ten days after the screening
By the tenth day, it was observed that the small changes initiated by the film experience in the A groups had become more established. In the A group that watched Ordinary Love, the walking habit became more consistent, and simple dietary changes (e.g., reducing the frequency of ordering takeout) were maintained. In the A group that watched Our Family, the need to balance emotional impact increased the focus on rest and personal time planning; it was reported that some individuals continued with topics such as reducing smoking/alcohol consumption. In the B groups, the sustainability of the trials that were started varied. While steps such as taking short walks and reducing snacking were maintained more consistently in the Ordinary Love group, it was noted that behaviors were interrupted in the Our Family group due to heavy household responsibilities and difficulties with time planning. In both films, participants in Group B indicated that they were more inclined to adopt low-threshold changes that were compatible with their routines; however, they struggled to maintain these changes due to external factors.
Emotional State and Persuasion Dynamics
Pre-screening
Participants’ initial emotional state is generally one of cautious calm. In Group A, which watched Ordinary Love, strategies such as being mindful of emotional triggers related to past experiences, taking breaks if necessary, or distancing themselves during viewing were mentioned. In Group A, which watched Our Family, expectations regarding the slow progression of the disease and the responsibilities placed on family members created a sense of emotional preparation in some participants beforehand. In both Groups B, emotional expectations were low before watching either film; curiosity and uncertainty were emphasized among those who watched Ordinary Love, while curiosity about cultural differences in the story was emphasized among those who watched Our Family. In both film groups, it was noted that artificial emotionality and a didactic tone created resistance to persuasion, whereas realistic and measured narration increased clarity and effectiveness.
Post-screening
The emotional impact and level of persuasion became apparent in the post-film period. In Group A, who watched Ordinary Love, empathy towards caregivers, spousal support, and shared responsibility for the process left a strong impression. In Group A, who watched Our Family, the progression of the disease and the distant communication structure created emotional intensity in some participants, with an emphasis on shared responsibility between siblings. This was considered motivating by some participants and emotionally exhausting by others. In Group B, those who watched Ordinary Love connected more easily on an emotional level with the smooth transitions in the narrative; those who watched Our Family found the story culturally more distant but noted its realism was compelling. In both films, the natural flow and personal relationship scenes were identified as elements that increased the persuasive power.
Ten days after the screening
On the tenth day, traces of the emotional impact lingered around scenes more related to everyday life. In Group A, who watched Ordinary Love, scenes depicting collaborative problem-solving and the practice of living with illness were remembered; the impact of these scenes on planning and responsibility sharing persisted. In Group A, who watched Our Family, the theme of strained family relationships due to the increasing burden of illness was particularly memorable; this led some participants to reevaluate family communication and support networks. In Group B, those who watched Ordinary Love reported a more balanced emotional impact, while those who watched Our Family experienced a slight increase in viewer-film distance; however, some participants indicated that they still found certain scenes thought-provoking. It was noted that scenes that were realistic, free of exaggeration, and directly related to life were still remembered ten days later in both films; overly dramatic narratives, on the other hand, could create a sense of distance.
Findings Related to the Film Experience Expectations from the film (pre-screening)
Before screening, expectations showed similar trends in both film groups. Participants in Group A stated that a realistic and straightforward narrative would be more meaningful to them. Group A, who watched Ordinary Love, expected the film to focus on the spouse/partner relationship and show the daily realities of living with illness. In Group A, who watched Our Family, attention was drawn to scenes that showed the effect of the illness process on other family members and reflected how the responsibility of care was shared. In Group B, a narrative language that was neither overly emotional nor overly formal, providing direct information and touching on everyday life, was preferred for both films. In both film groups, it was predicted that a didactic tone, dramatic exaggeration, and clichéd messages could increase resistance to persuasion.
The film’s impact on thoughts and awareness about cancer (post-screening)
An increase in participants’ thoughts and awareness about cancer was observed after both films. In Group A, which watched Ordinary Love, identification with themes such as caregiving, appointment and follow-up planning, and early referral became apparent, facilitating clarity in short-term health decisions. In Group A, which watched Our Family, themes such as the progression of the disease, roles within the family, and the burden of care heightened the emotional impact. While some participants gained motivation to take action due to this intensity, others found the process required more reflection. In Group B, both films showed that a neutral or distant initial attitude evolved into a more engaged and attentive position. In Group B, which watched Ordinary Love, the question of where to start was expressed more directly and in a more planning-oriented manner. In contrast, in Group B, which watched Our Family, this need was expressed in a more intuitive and emotional tone. For both films, when the narrative language was realistic and measured, the persuasion process was supported; conversely, an overly emotional or generalizing style created resistance in some participants.
Newly learned aspects / Misconception awareness (post-screening and ten days after the screening)
Post-screening, it was observed that the information acquired in Group A was more related to practical steps. Group A, which watched Ordinary Love, described a more decisive framework for concretizing the journey through the healthcare system (e.g., appointment scheduling, follow-up frequency) and initiating lifestyle changes in small steps. Similar content was emphasized in the A group that watched Our Family, but the burden of caregiving and the sharing of responsibilities within the family were more prominent. This awareness sometimes accelerated action and sometimes led to an emotional processing period. In Group B, it was understood that uncertainties regarding issues such as the scope of screening, the initial point of contact, and timing decreased, and the basic information framework was more clearly defined. In the tenth-day interviews, the rate of continuing and implementing what was learned was higher in Group A, which watched Ordinary Love, compared to Group A, which watched Our Family. The way emotional effects shaped the decision-making process showed more individual differences in Group A, which watched Our Family. In Group B, both films were effective in initiating consultation or creating a short-term plan; however, whether the plan turned into a regular follow-up schedule varied according to the participant’s living conditions and motivation. In terms of misconception awareness, it was reported that implicit assumptions such as “there is no need to seek counseling if there are no symptoms” or “one counseling session is sufficient” weakened in both films, while awareness that counseling is a continuous process strengthened.
Discussion
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.
Limitations
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.
Conclusion
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.
Notes
Data Availability Statement
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Funding Information
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conflict of Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article.