Learning through the power of story

Cognotion operates on the premise that there is narrative inherent in any teachable subject. We locate this narrative and craft it into an immersive storyline. The learner progresses through the story by drawing upon existing resources and synthesizing new knowledge. Emotional proximity is characterized as the “empathy and identification the learner feels for the characters in a program” and is established by developing characters with strengths and weaknesses, who change and grow as the program moves forward. 

Learners recognize their own desires and concerns in the prototypical heroes, people with traits similar to their own, and people who learn to draw upon their own reserves of strengths (assets) for the greater good. This approach, grounded in research, is a good foundation for a sound program; but there are other tools we add to our pedagogical design to maximize likelihood of impact.

Cognotion conducts research and development with various academic institutions to deepen our understanding of behavioral change models. Below is one case study of a program co-developed with NYU Meyers College of Nursing and Penn State University. 

PROJECT DESCRIPTION

Using MOST to optimize an HIV care continuum intervention for vulnerable populations; 07/01/2016-04/30/2021. Funded by the National Institute on Drug Abuse (NIDA), at the National Institutes of Health (NIH), R01DA040480

Field name: Heart to Heart2 Project

NYU Meyers College of Nursing, Penn State University

Marya Gwadz, PhD. and Linda M. Collins, Ph.D., Co-Principal Investigators

Mg2890@nyu.edu

 

The Heart to Heart 2 project will enroll African American/Black and Hispanic persons living with HIV in New York City who are not taking HIV antiretroviral therapy (ART) or engaging in HIV primary care at recommended levels (N=512), beginning in 2017.

Guided by a multi-level social cognitive theory, the study will evaluate five distinct intervention components (i.e., culturally salient counseling sessions using motivational interviewing, pre-adherence preparation, focused support groups, peer mentorship, and patient navigation), each designed to address a specific barrier to HIV care and ART initiation.  The components will be tested in an efficient, engineering-inspiring factorial design. (See Gwadz et al. 2017 for a description of the study protocol and components.)

Component A - Culturally salient counseling sessions using motivational interviewing (60-90 minutes each, 4 sessions).

Sessions will be conducted with participants individually and made up of discrete exercises. Session 1 addresses barriers to HIV care. Sessions 2 and 3 target barriers to ART (S2: evoking barriers, fostering readiness; S3: decisions, plans). Session 4 addresses adherence, individual barriers and their solutions in depth, and finalizing care/ART plans. This component’s primary theoretical targets are health beliefs (e.g., outcome expectancies, self-efficacy, medical distrust), and emotions (e.g., concerns/fears of ART).

Each session includes 1-2 culturally salient video narrative segments to highlight key issues and foster discussion. Each video is followed by a discussion of issues and themes that arise for the participant. The videos, professionally produced by Cognotion, Inc., use realistic narratives to highlight the specific barriers to HIV care and ART experienced by the target population. The videos are meant to engage emotions, and foster a discussion of the deep and complex reasons that persons living with HIV of color have difficulties engaging in, and barriers to engaging in, HIV care and taking ART.  These barriers include fear of ART and of side effects. The importance of fear as a barrier cannot be over-stated. Barriers also include distrust of HIV care settings and ART, based in part of past abuses of populations of color in medical research and medical settings, which resonates with present day structural racism.  In past research we have found that these issues do not necessarily arise spontaneously during sessions, but that participants are eager to discuss them when signaled that it is acceptable to do so.  Indeed, they are the “elephant in the room” for many participants.  Discussion of barriers such as fear and distrust are a unique aspect of the Heart to Heart 2 intervention, and participants note they have few opportunities in their lives to discuss these critical barriers. 

 

Quotes from research participants, our “end users” about the utility of the videos. Download case study to read more. 

The videos made me feel like, that’s me.”

“They had a lot of videos where people were asking similar questions to what I might have had in my mind, but never really asked or didn’t know who to ask.”

“The intervention sessions gave me a lot of insight. It gave me a chance to express my feelings about the reason I got the virus or how I think I got the virus. And I was seein’ some video in regards to some, the actors. Well, I don’t think they were actors, I think they was the real deal. And I began getting some feelings from behind seeing the movies.