University of Otago The Use of Regional Accent in Audio Health Communications Rachel Leeson A thesis submitted in partial fulfilment of the requirements for the degree of Master of Science Communication Centre for Science Communication, University of Otago, Dunedin, New Zealand 28 June 2019 Abstract Cancer is a large and complex family of diseases with a variety of causes and risk factors. The health communication strategy needed to combat cancer may also need to be a large and complex family of communications. Podcasts are an easily made, readily accessible form of audio communication. However, little research has been done about the use of podcasts for health communications. Drawing on the body of literature that supports the efficacy of tailored and targeted health communications, this project looks at the use of audio cancer prevention communications tailored with three regional accents, the American Midwestern accent, the Southern Texan accent, or the Tejano (Texan Mexican American) accent, focusing on a cancer prevention message in two cohorts, Americans (excluding Texans) and Texans. After listening to any of the three audio communications, both cohorts had a strong comprehension of the message and intended to exercise more. The American population reported liking the Southern-accented narrator less and viewing the message as less valid compared to the other narrators, but this did not impact either comprehension or intention to exercise. The Texan population had no significant difference in response to any of the three accents. However, in both the Texan and American population, there was a difference in the response to accents between men and women. Additionally, Americans who had been affected by cancer rated the only Midwestern-accented message higher in validity than those who hadn’t been affected, while Texans who had been affected by cancer rated only the Southern-accented message as higher in validity than those who hadn’t. This study found that audio health messages were well comprehended by listeners regardless of regional accent. It also found that regional accent may interact with other axes of identification, such as gender or association with disease, to create a significant increase in perception of validity of the health communication. Given the increasing popularity of podcasts and the need for health communications targeted towards specific populations, this study is an important addition to the health communications field, with implications for future research. i Table of Contents Abstract ................................................................................................................................. i Table of Figures .................................................................................................................. v Table of Tables .................................................................................................................... v Acknowledgements ............................................................................................................ vii Chapter 1: Introduction ...................................................................................................... 1 Structure of the thesis ................................................................................................................ 1 Notes on Terminology and Spelling Used in the Thesis ........................................................................ 2 Chapter 2 Literature Review ............................................................................................... 4 Introduction ............................................................................................................................... 4 Overview ..................................................................................................................................... 4 Health Communication ............................................................................................................. 4 Health Literacy ....................................................................................................................................... 5 The Internet and Health Communications.............................................................................................. 6 Cancer ......................................................................................................................................... 7 Preventative Cancer Behaviours ............................................................................................................ 8 Health Communications Projects: Scaling up ........................................................................................ 8 Narrowcasting in Health Communications ............................................................................. 9 Targeting Health Communications ...................................................................................................... 10 Narrowcasting on the Internet .............................................................................................................. 15 Targeted Health Communications Campaigns ..................................................................................... 16 Audio Health Campaigns ..................................................................................................................... 17 Podcasts as a Form of Communication ................................................................................................ 18 Podcasts and Science Communications ............................................................................................... 19 Podcasts and Health Communications ................................................................................................. 20 Podcasts and Audio Narrowcasting ...................................................................................................... 22 Regional accent .................................................................................................................................... 23 Accent as Identifier .................................................................................................................. 23 Regional Accents: In-groups and Outgroups ....................................................................................... 24 American Midwest Accent ................................................................................................................... 26 American Southern Accent .................................................................................................................. 26 American Tejano Accent...................................................................................................................... 30 ii Chapter 3 Methods ............................................................................................................ 35 Research Problem .................................................................................................................... 35 Research Design ....................................................................................................................... 35 Methods Overview ............................................................................................................................... 35 Accent Selection .................................................................................................................................. 35 Audio Recording .................................................................................................................................. 37 Audio Health Message ......................................................................................................................... 37 Survey .................................................................................................................................................. 38 Sampling and Recruitment ..................................................................................................... 40 Georestriction ....................................................................................................................................... 40 Recruitment .......................................................................................................................................... 40 Cleaning the Data ................................................................................................................................. 41 Data Analysis and Instrument Validation ............................................................................. 42 Comprehension of the Message ........................................................................................................... 42 Scales testing validity and relevance of the message ........................................................................... 44 Analysis of Scales ................................................................................................................................ 45 Analysis of Items ................................................................................................................................. 45 Pre/Post Intervention Exercise Questions ............................................................................................ 45 Conversational Element ....................................................................................................................... 46 Chapter 4 Results and Discussion ...................................................................................