The Role of Counterfactual Thinking in Narrative Persuasion: Its Impact on Patients’ Adherence to Treatment Regimen

Timothy K F Fung*

*Corresponding author for this work

Research output: Contribution to journalJournal articlepeer-review

3 Citations (Scopus)
27 Downloads (Pure)


The purpose of this study is twofold: (1) to explicate the underlying process of how narratives, accompanied with counterfactual thinking, exert cognitive and affective influence on audiences and (2) to examine how counterfactual thinking and regulatory focus, as story characteristics, enhance the persuasiveness of the narrative. Participants in the experiment were exposed to animated narratives in which the protagonist described her nonadherence to the peritoneal dialysis treatment regimen that resulted in her hospitalization. One hundred thirty-six patients undergoing peritoneal dialysis participated in a 2 (Goal failure framing: promotion-framed failure versus prevention-framed failure) by 2 (Counterfactual thinking: additive counterfactuals versus subtractive counterfactuals) between-subject factorial experiment. The analyses showed that narratives with additive counterfactuals, as opposed to those with subtractive counterfactuals, elicited greater anticipated regret and mental simulation, and, in turn, influenced the audience’s attitude toward and intention of adherence. More important, promotion-/prevention-framed failure and additive/subtractive counterfactuals jointly influenced the audience’s anticipated regret and mental simulation. Specifically, in the prevention-framed goal failure condition, narratives with additive counterfactuals elicited greater anticipated regret and mental simulation; however, in the promotion-framed goal failure condition, there was no significant difference on anticipated regret and mental simulation between narratives with subtractive counterfactuals and those with additive counterfactuals. The theoretical and practical implications were discussed.

Original languageEnglish
Pages (from-to)1482-1493
Number of pages12
JournalHealth Communication
Issue number12
Early online date30 Jul 2018
Publication statusPublished - 15 Oct 2019

Scopus Subject Areas

  • Health(social science)
  • Communication


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