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5 reasons why media is key to driving patient engagement

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Chief Cognitive Scientist @ Affective Health

Humans are complex creatures. Our brains are capable of incredible things. Sometimes though, it can be hard to learn new topics or change deep-seated behaviors. It also doesn’t help that in the digital age we are highly distracted and bombarded with content constantly. Here we’ll show you 5 reasons why media so important to successful patient engagement and adherence.

1. We learn by association

In the psychology of learning and memory, context-dependent learning refers to learning that depends to some degree on the learning environment itself, including both physical and psycho-social aspects (Smith, Glenberg, & Bjork, 1978; Smith, 1982; Smith & Vela, 2001).

The dominant theory behind this effect is that of the associations that connect the concepts and features of concepts that make up our semantic memory system (Raaijmaakers & Shiffrin, 1981; Hintzmann, 1988). We most easily learn by associating new concepts with bits of pre-existing knowledge, and in retrieval concepts that have more associations are (on the whole) more easily brought to mind. In the case of context-dependent learning, the aspects of the context that were encoded along with the learning material act as retrieval cues to the associated information. In novel contexts these cues are not available, thus recall suffers.

2. Media creates a feeling of coherence.

In this example, media can be used in two ways: to facilitate recall or cue participants to a change in context and mental set.

For example, simply including the same image, sound, or video before certain experiences can facilitate recall of similar past sessions, creating a feeling of coherence, as well as potentially boosting learning and retention. On the flipside, novel media can be used to cue participants to a change in context and mental set.

There is a great deal of research on context-dependent learning, which includes work on the conditions under which context-dependent learning is not found (Macken, 2002; Smith, 1982), or is dis-advantageous (for example, too much context-dependence can impede transfer to new situations). However, the effect has been consistent across dozens of studies (Smith & Vela, 2011), and is a useful psychological tool for program designers.

3. Media cues prime the participant.

In other areas of cognitive psychology, we speak of related concepts as being able to prime one another (Masson, 1995; Neely, 1977). This can be interpreted as media setting a participant up to understand and get in the correct mindset.

For example, “cat.” Now that you’ve read that word, you’ll be slightly quicker to name “mouse” in your head than had you read “map” (You’ll just have to trust me). Priming works similarly to context-dependent learning, in that the activation of one concept in your semantic memory (“cat”) leads to some level of activation of related concepts (“mouse,” “pet,” “fuzzy,” “Garfield,” etc).

Again, experiences and programs can be crafted to take advantage of these semantic connections. Using pictures, songs, words, and videos can “call up” related knowledge in the minds of users, taking them on mental “trips” from meaning space to meaning space in their memory. Although the example I’ve been using are toys, priming effects have been found in a broad range of overt behaviors, from conversations (Pickering & Ferreira, 2008*), to physical posture (Klatsky & Creswell, 2014). If you aren't sure how a piece of media will be interpreted by a group of people, there are many tools available that can give you a good idea

4. Create cue reactivity in your participant based on your content and end goals.

One last area in which there is a great deal of evidence for the influence of “artificial” laboratory cues is in clinical work on addictive behaviors, such as cigarette smoking and alcohol abuse (Carter & Tiffany, 1999; Drummond, 2000). In these cue-reactivity studies, typically pictorial or video cues are displayed to participants to “simulate” the psycho-social situations that have been encoded and stored along with drug-use and their effects (Hardy et al., 2017; Noori, Linan, Spanagel, 2016; Shiffman et al., 2013).

That simple pictures and videos are able to elicit similarly powerful behavioral, emotional, physiological, and neural responses as actual drug-taking scenarios speaks to the potent role that cues can play.

5. Bolster your storytelling and enhance simple engagement.

Don’t let your participants get bored! A video can immerse a user differently than straight, consistent text. An image within a text-base frame can re-engage and redirect a participant.

Final thoughts

To summarize,’s media frames can be used in a number of ways. However, these frames are very useful for pulling on the psychological levers of learning and memory. This is the case with context-dependent learning, where a media cue can transport a participant back to the doctor’s office where they first received instruction on managing their chronic condition. This is also the case in the use of media cues as primes to test for associated knowledge. What do people associate with their new CPAP machine? Priming can provide information that simple surveys cannot. Finally, a richer set of media can be used to create highly reactive scenarios, allowing for the mental simulation of even relatively intense diagnoses.

References in this article

  • Carter, B. L., & Tiffany, S. T. (1999). Meta‐analysis of cue‐reactivity in addiction research. Addiction, 94(3), 327-340.
  • Drummond, D. C. (2000). What does cue‐reactivity have to offer clinical research?. Addiction, 95(8s2), 129-144.
  • Hardy, L., Mitchell, C., Seabrooke, T., & Hogarth, L. (2017). Drug cue reactivity involves hierarchical instrumental learning: evidence from a biconditional Pavlovian to instrumental transfer task. Psychopharmacology, 234(13), 1977-1984.
  • Hintzman, D. L. (1988). Judgments of frequency and recognition memory in a multiple-trace memory model. Psychological review, 95(4), 528-551.
  • Klatzky, R. L., & Creswell, J. D. (2014). An intersensory interaction account of priming effects—and their absence. Perspectives on Psychological Science, 9(1), 49-58.
  • Macken, W. J. (2002). Environmental context and recognition: The role of recollection and familiarity. Journal of Experimental Psychology: Learning, Memory, and Cognition, 28(1), 153-161.
  • Masson, M. E. (1995). A distributed memory model of semantic priming. Journal of Experimental Psychology: Learning, Memory, and Cognition, 21(1), 3-23.
  • Neely, J. H. (1977). Semantic priming and retrieval from lexical memory: Roles of inhibitionless spreading activation and limited-capacity attention. Journal of experimental psychology: general, 106(3), 226-254.
  • Noori, H. R., Linan, A. C., & Spanagel, R. (2016). Largely overlapping neuronal substrates of reactivity to drug, gambling, food and sexual cues: A comprehensive meta-analysis. European Neuropsychopharmacology, 26(9), 1419-1430.
  • Raaijmakers, J. G., & Shiffrin, R. M. (1981). Search of associative memory. Psychological review, 88(2), 93-134.
  • Shiffman, S., Dunbar, M., Kirchner, T., Li, X., Tindle, H., Anderson, S., & Scholl, S. (2013). Smoker reactivity to cues: Effects on craving and on smoking behavior. Journal of abnormal psychology, 122(1), 264-280.
  • Smith, S. M. (1982). Enhancement of recall using multiple environmental contexts during learning. Memory & Cognition, 10(5), 405-412.
  • Smith, S. M., Glenberg, A., & Bjork, R. A. (1978). Environmental context and human memory. Memory & Cognition, 6(4), 342-353.
  • Smith, S. M., & Vela, E. (2001). Environmental context-dependent memory: A review and meta-analysis. Psychonomic bulletin & review, 8(2), 203-22

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