Stories that engage the audience: An investigation of popular breast cancer narratives on social media

Narratives play a critical role in health communication and promotion on social media. This study aimed to identify the features of popular social media narratives that generate emotional support and engage users in cancer communication. We conducted a content analysis of popular breast cancer narratives (N = 410) by five influential breast cancer non-profit organizations on Facebook. Based on a theoretical framework grounded in narrative communication research, we analyzed these narratives in the following dimensions: narrative content (e.g., character attributes, events, and mood), narrative form (e.g., perspective and length), literary techniques (e.g., imperatives, metaphors, and celebrity appeals), and visual elements (e.g., the color pink, events, and vividness). Negative binomial and linear regressions were conducted to examine the relationships between narrative characteristics and three types of social media engagement: affective, cognitive, and behavioral engagement. Results showed that cancer stories that were longer, less emotionally intensive, told from the cancer survivor's perspective, with gender identity-related information, describing the act of providing social support, explicitly requesting engagement and/or donation, and using more vivid forms of visuals such as linked images tended to be more engaging. However, different narrative features were associated with the three engagement outcomes differently. This study provides a framework for understanding how health communicators can leverage social media to share cancer narratives to reach and engage the intended audience.