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The narrative immersion model (Shaffer & Zikmund-Fisher, 2013) extends narrative theory into health communication specifically. It proposes five broad purposes served by narratives: to persuade (e.g., alter behavioral intentions), to influence (alter behaviors), to inform (increase knowledge or decrease uncertainty), to comfort (reduce anxiety) or to engage (transport, immerse, entertain, etc.). These purposes are sought by three types of health-related narrative types: outcome narratives (i.e., the mental or physical health outcomes or effects associated with a health-related factor such as a disease or a treatment), experiential narratives (i.e., the phenomenological symptoms, progression, and senses resulting from a disease or treatment), and process narratives that explain how a person makes decisions relevant to the disease or treatment (Shaffer & Zikmund-Fisher, 2013). The model predicts different effects with different narratives, which would also suggest ways in which narratives could be manipulated to be most relevant at various stages of a disease progression or pandemic history. The model proposes that narrative realism, source credibility (ethos), and entertainment value will influence the extent of a person’s immersion in a given narrative (Shaffer et al., 2018).

Among the antecedents and consequences of such misinformation is a general distrust of institutions and information sources. In one survey of US adults regarding the 2020 COVID-19 pandemic, 38% believe that government has handled the pandemic issue “badly,” 34% are not confident in the health authorities’ ability to respond, and 41% report not having enough information on how to respond (Nguyen, 2020). Of over 27,000 readers responding to a Pharmaceutical Technology poll, over half (55%) lacked confidence that the World Health Organization or national healthcare institutions could effectively manage the outbreak (Nawrat, 2020). A Pew survey (Mitchell & Oliphant, 2020) of almost 10,000 US adults in early June 2020 indicated that only two-thirds believed that the Centers for Disease Control and Prevention (CDC) and similar health organizations got their facts about COVID-19 correct “almost all” or “most” of the time, whereas a majority distrusted President Trump and his administration for such information, believing they got such information right only “some of the time” (29%) or “hardly ever” (36%). Trust in government, public authorities, and information sources; worry, fear, and knowledge about the disease; and amount of media exposure and information-seeking behaviors tend to promote compliance with public health recommended infection prevention behaviors (Lin et al., 2014), whereas distrust in government is predictive of belief in conspiracy theories (Freeman et al., 2020a; Imhoff & Lamberty, 2018), which in turn decrease the likelihood of engaging in valid health protective behaviors (Patev et al., 2019). “In polarized, low-trust environments political actors more frequently act as sources of online disinformation. In these countries, political actors seem to fuel polarized debates by attacking political enemies” (Humprecht, 2019, p. 1984).