Entertainment-Education and Recruitment of Cornea Donors: The Role of Emotion and Issue Involvement

"In Korea, roughly 20,000 people are waiting for donor cornea tissues, but only 1% of that figure receives cornea transplant surgery each year..."

In this 17-page article, published in the Journal of Health Communication (Volume 13, Issue 1), Hyuhn-Suhck Bae shares the results of research conducted in Korea that was designed to move beyond an emphasis on the effect that the entertainment-education (E-E) strategy has on viewers of a television segment that encouraged viewers to sign cornea donor cards; the focus, instead, is on how and why the effects are observed. In short, Bae examines - from a theoretical perspective - the thinking behind the use of E-E to promote an altruistic behaviour.

Specifically, Nunl Dduhyo! (Open Your Eyes!) was a segment that was included for a 1-year period (December 2004 through December 2005) of the E-E reality TV show titled Nggimpyo (Exclamation Mark). The segment was designed to raise awareness about people with poor visual function and to shift social norms regarding organ and tissue donations. Each episode began with the main host (who has been described as a very popular male comedian) and 4 co-hosts (reportedly "top male vocal group members") visiting a person with poor eyesight; the goal was to provoke sympathy or empathy toward the characters. Organisers say that "the increasing rate of signed cornea donor cards is dramatic when data are compared before and after the E-E program broadcast - from 1,239 in November, 2004 to 13,733 in March of 2005, respectively."

Following this introductory presentation, Bae describes (and explores the viewers' levels of) "issue involvement", which he characterises as the extent to which an individual believes that an issue is of intrinsic importance or has significant consequences for his or her own life - and the application of this concept to Nunl Dduhyo! as a tool for predicting intention to register for cornea donation. Bae contextualises this inquiry by, first, outlining the differences between the constructs of sympathy and empathy that viewers of E-E programmes such as Nunl Dduhyo! may display. He then describes the Elaboration Likelihood Model (ELM), which centres on the idea that "issues involvement" (defined above) has a significant influence on how much relevant thought a particular message is likely to generate. Also explored here is the Theory of Planned Behavior (TPB), according to which behavioural intention is assumed to be the immediate determinant of human behaviour.

The methodology used in assessing these effects, which involved a web-based survey, is outlined in detail beginning on page 6 of the document. In short, researchers found that "[e]licitation of sympathetic and empathic sentiment by an organ donation message is an effective cue for expressing helping behavior; sympathy and empathy arousal cues are effective in provoking heightened concern about donation, which then fuels the high-involvement decision to sign an organ donor card....This also suggests that adding emotion and involvement in the TPB enhances the explanatory power of the theory in predicting intentions, which indicate the possibility of combining the ELM and the TPB in the prediction of human behaviors....The direct effect of empathy on involvement was stronger than that of sympathy....[W]hile perceived behavioral control exhibited a large positive impact on intentions, and subjective norms also showed a moderate impact on intentions, the impact of attitudes on intentions was not statistically significant. This result reflects the fact that the public's positive views about organ donation do not necessarily lead to subsequent behavioral commitment in the form of signed donor cards..."

Based on these findings, Bae concludes with several recommendations:

• "E-E interventions should consider the cultural variables of the host country. For example...Confucian thoughts commonly are considered as a reason of Koreans' low rate of organ donation....The most basic and crucial concept of Confucianism is that a person's duty is to maintain the body in the same condition in which it was received from his or her parents....Therefore, educational efforts through entertainment, in particular, are urgently needed to change the Korean's deep-rooted Confucian thoughts as well as to increase the public's awareness and responsiveness to serious donor organ shortage.
• Second, a reality show E-E format could be adapted for the more common dramatic formats such as telenovelas by enhancing its ability to generate sympathy and empathy and issue involvement for audiences and thus stimulate behavior change...
• Third, ...[r]egistering for cornea donation...requires much more self-sacrifice than any other behaviors solicited by E-E interventions. Despite such possible difference, this study already has suggested some solution: Generate empathy and issue involvement."

In short, Bae's research indicates that sympathetic and empathic feelings generated by organ donation messages through edutainment can be an effective strategy for stimulating altruistic behaviour (i.e., signing an organ donation card). Also, "[t]he findings of this study suggest that adding emotion and involvement in the...TPB...enhances the explanatory power of the theory in predicting intentions, which indicates the possibility of combining the...ELM...and the TPB in the prediction of human behaviors."