Grey’s Anatomy Viewing and Organ Donation Attitude Formation

Abstract

This study tests a comprehensive model linking Grey’s Anatomy viewing and perceived realism of this program with organ donation knowledge, barriers—including medical mistrust, disgust, bodily integrity, and superstition—and subsequent organ donation attitudes. In addition to testing the hypothesized structural model, ethnic differences were examined by way of (a) the multigroup method to test for differences in path coefficients, (b) multivariate analysis of variance to examine differences among the study variables, and (c) χ² tests to assess differences in organ donation registrations among African Americans (n = 200), Caucasians (n = 200), and Latinos (n = 200). Support for the overall structural model was found and various differences emerged among the African American, Caucasian, and Latino sample across study variables. The results from this research are discussed with an emphasis on the theoretical and practical implications.

Keywords

organ donation ethnicity media effects

Approximately 18 people die each day in the United States waiting for an organ transplant and the number of people waiting for a transplant continues to rise at a staggering rate [United Network for Organ Sharing (UNOS), 2012]. Not surprisingly, given the need for more registered organ donors, numerous campaigns have been launched to raise awareness about the need for more organ donors, the registration process, and to debunk misperceptions about organ donation. Despite these efforts, organ donation practitioners face unique challenges as individuals regularly receive competing anti-donation messages from the entertainment media (see Moloney & Walker, 2002; Morgan, Harrison, Chewning, Davis, & DiCorcia, 2007; Morgan, King, Smith, & Ivic, 2010). With numerous storylines reifying common myths about organ donation, Harrison, Morgan, and Chewning (2008) referred to such media representations as a “counter campaign” (p. 34). Of the medical dramas examined for depicting organ donation myths, perhaps no program features as many inaccuracies as Grey’s Anatomy (see Morgan et al., 2007; Morgan et al., 2010; Morgan, Movius, & Cody, 2009; Quick, 2009). Unfortunately, the impact of these inaccurate media portrayals results in misguided societal beliefs about organ donation (Morgan et al., 2010) and often surface as reasons for declining to register to be organ donors (Morgan et al., 2005).

Although previous research shows that individuals’ reasons for not joining an organ donation registry are frequently grounded in the myths presented on television (Morgan et al., 2005), to date, we know very little about the underlying process connecting these inaccurate media representations and organ donor attitudes among African Americans, Caucasians, and Latinos (Morgan, Movius, et al., 2009). Understanding the underlying process linking television viewing with organ donation attitudes among African Americans and Latinos is particularly important as research shows these ethnic groups maintain greater mistrust of the medical establishment than Caucasians (see Arriola, Robinson, Thompson, & Perryman, 2010; Boulware et al., 2002). Moreover, it is important to reference that African Americans and Latinos consent to donation at rates almost half of Caucasians in the USA (UNOS, 2012). We do know, however, that among university students, staff, faculty, and administrators, medical mistrust accounts for more variance in donor status than knowledge about organ donation (Morgan, Stephenson, Harrison, Afifi, & Long, 2008). Given the frequent presentation of organ donation myths on Grey’s Anatomy and the research showing the relationship between medical mistrust and organ donation attitudes, the current study seeks to more fully understand how viewing Grey’s Anatomy influences African Americans’, Caucasians’, and Latinos’ understanding of organ donation and, subsequently, their organ donation attitudes.

At the time of data collection for this project, Grey’s Anatomy was the third most popular television show in America according to Nielsen Media Research (2009) and remains a popular medical drama today, particularly among the young adults sampled in this investigation. Grey’s Anatomy offers viewers with a behind-the-scenes look, albeit an unrealistic portrayal, into the day-to-day decisions that come with being a medical doctor at a teaching hospital. In the quest for maximizing entertainment value, the fidelity of medical procedures is often compromised in Grey’s Anatomy, and their depictions of the organ donation process are no exception (Morgan et al., 2007; Morgan et al., 2010). We begin with a brief overview of the storylines featuring organ donation throughout the first eight seasons of Grey’s Anatomy.

Grey’s Anatomy

Research documents that medical dramas often portray doctors in an unfavorable light when the storyline involves organ donation (Morgan et al., 2007; Quick, 2009) and that exposure to these misrepresentations often result in distorted perceptions of the organ donation process among viewers (Morgan et al., 2010). A review of the 172 episodes of Grey’s Anatomy produced revealed that organ donation is a reoccurring theme throughout the program as 18% of the episodes mention deceased donor organ donation as a major storyline. Some of the positives associated with organ donation are depicted on Grey’s Anatomy such as occasionally portraying organ donors as heroes and portraying a demographically diverse pool of organ recipients. However, the majority of organ donation coverage presented plays on the barriers standing in the way of individuals registering as organ donors. Specifically, the majority of organ donation coverage on this program depicts doctors as vultures, eager to transplant organs from their patients. In addition, plots often highlight doctors crossing ethical lines by privileging patients that are their friends as well as affluent patients with organ transplantation over less familiar and affluent individuals. Each of these fallacious portrayals is elaborated on below with excerpts from the program.

Portraying doctors as vultures, eager to declare a patient brain dead rather than try to save patients’ lives is commonly presented in Grey’s Anatomy. For instance, in an episode entitled “All by Myself” (Season 5), a young woman was pronounced brain dead after her car crash. Viewers’ watch as Dr. Dixon comments on how fortunate it is that such a young healthy woman is brain dead because she will make an excellent donor. Similarly, in “Stairway to Heaven” (Season 5), the Chief found a man whose family has decided to take him off of life support. Despite being emotionally distraught about the loss of her husband, the Chief repeatedly pushed the wife to donate her husband’s organs to a little boy. Following considerable pushing, reluctantly, the wife agreed to donate her husband’s organs. Storylines depicting doctors as vultures eager to transplant organs can create and reinforce mistrust among viewers that doctors will not try to save a registered donor’s life.

Another common theme presented in Grey’s Anatomy revolved around the personal connections between medical doctors and organ recipients. The most obvious illustration of this theme is the story of Denny Duquette (Seasons 2 and 3), which spanned more than 10 episodes of Grey’s Anatomy, as he waited for a heart transplant. As his health condition deteriorated, viewers watched as Dr. Izzy Stevens, his fiancé, took matters into her own hands by cutting his LVAD wire, and as a result, manipulated the organ allocation system by artificially deteriorating his health and thus moving him up the waiting list. In an earlier episode entitled “Winning the Battle, Losing the War” (Season 1), a man was effectively brain dead, and was given 6 hours to either show signs of life or be officially pronounced. The doctors of Seattle Grace made it their mission to find his family to get permission to transplant his organs. In one particular scene, while watching the doctors gather for an organ transplant, Izzie turns to Christina and states that she is disgusted by all the “vultures” just waiting to pick the carcass clean.” After using his power as the Chief to pull strings, the man ends up dying and his liver gets donated to the Chief’s friend. Plots such as the ones mentioned above can reinforce the belief among viewers that doctors are eager to transplant organs and that they can use their authority to influence who receives organ transplants. Unfortunately, portrayals such as these neglect to demonstrate the checks and balances built into the organ allocation system established to ensure ethical actions on the part of the medical personnel.

Other Grey’s Anatomy plots highlight undeserving recipients. For example, in “Almost Grown” (Season 7), a man in his 50s desperately needed a lung transplant. However, the decision to issue him a transplant was complicated for the doctors at Seattle Grace because he was a difficult patient with no friends or family. During the transplant hearing, April and other doctors began listing all the reasons why he was an undeserving organ recipient; however, after much hesitation, Christina disagreed and stated that he should receive a lung because it would save his life and he wanted to live. The theme of undeserving recipients resurfaced again in “Not Responsible” (Season 7) when a man with cystic fibrosis needed a double lung transplant. Although cystic fibrosis is not contagious to the general population, it is highly contagious between two people with the disease. So when Teddy found out that the man’s girlfriend also had cystic fibrosis, the team of doctors became reluctant to perform the surgery. Despite their hesitation, the doctors decided to move forward with the transplant despite the couple’s decision to continue seeing each other, which prompted the doctor to state, “If he wastes them, I swear to God I will kill him.” Emphasizing that undeserving individuals often receive organ transplants could dissuade individuals from registering to be an organ donor, as the rewards may not outweigh the costs of such a sacrifice.

Unfortunately, exposure to the abovementioned misrepresentations on Grey’s Anatomy leaves viewers with a distorted view of the organ donation process (for an extensive review, see Morgan et al., 2007; Quick, 2009). Compounding this problem, extant research cites the mass media as the primary source of organ donation information (Conesa et al., 2004; Feeley & Servoss, 2005). For all of these reasons, the current study seeks to examine the underlying process bridging Grey’s Anatomy viewing with organ donor attitudes. That is, the proposed model offers an explanation for how media exposure can impact beliefs, barriers, and attitudes. We seek to move this literature forward by bringing it into the context of organ donation by identifying the constructs connecting Grey’s Anatomy viewing with organ donation attitudes among African American, Caucasian, and Latino adults. In doing so, we seek to better understand ethnic differences among these groups by examining path coefficient and mean differences among the study variables as well as by exploring differences in organ donation registration frequency among African American, Caucasian, and Latino participants. As noted above, African Americans and Latinos are considerably less likely to be registered as an organ donor compared to Caucasians. Therefore, gaining a deeper understanding of how Grey’s Anatomy influences various ethnic groups is warranted.

For the present study, we assume that exposure to organ donation depictions on Grey’s Anatomy can shape viewers’ perceptions about organ donation. Similar theorizing in previous studies examining newspaper content (Feeley & Vincent, 2007), television news programs (Quick, Kim, & Meyer, 2009), and entertainment program portrayals of organ donation (Morgan et al., 2007; Morgan et al., 2010) exists in the literature. Unlike print (Feeley & Vincent, 2007) and television (Quick et al., 2009) news coverage of organ donation, which is limited but largely positive, research suggests that entertainment programming emphasizes negative aspects of organ donation by repeatedly reinforcing myths and other gross fallacies about the organ donation process in hopes of generating greater viewership and galvanizing conversations with friends and colleagues about program content (Morgan et al., 2007). Following exposure to these destructive portrayals of organ donation on shows such as Grey’s Anatomy, viewers’ beliefs are created, reinforced, or changed (Morgan et al., 2010; Quick, 2009), family conversations are distorted (Morgan et al., 2005), and organ donation attitudes are adversely influenced by these inaccurate portrayals (Morgan et al., 2010).

Arguably, making these fallacious organ donation portrayals more influential is research suggesting that television influences viewers’ perceptions at a much stronger clip when viewers have limited real world experience with the television content (Busselle & Shrum, 2003; Quick, 2009). Specifically, Busselle and Shrum (2003) discovered that media examples were more quickly retrieved from memory for events portrayed often on television, yet rarely experienced personally. For young adults, experience with organ donation is rare and, thus, exposure to portrayals of the organ donation process, such as those depicted on Grey’s Anatomy, is likely novel and consequently perceived as more realistic than exposure to more familiar topics. In fact, for most individuals, their only experience with organ donation is through television exposure (Conesa et al., 2004; Feeley & Servoss, 2005). Therefore, it is hypothesized that frequent viewers will perceive depictions of organ donation on this program as more realistic than infrequent viewers.

Hypothesis 1 (H1): As time spent viewing Grey’s Anatomy increases, the perceived realism of the program will also increase.

Research shows that realistic images influence social judgments (Busselle, 2001; Busselle & Greenberg, 2000). Specifically, Busselle and colleagues found that as perceived realism increases, so does the likelihood of program content creating, modifying, or changing beliefs among viewers. Following this line of reasoning, viewers perceiving Grey’s Anatomy portrayals to be realistic will likely adopt beliefs congruent with those presented in these storylines (Morgan et al., 2010), thus resulting in stronger barriers such as medical mistrust, superstitions, disgust, and bodily integrity due to these fabrications portrayed with regularity (Morgan et al., 2008). In short, medical mistrust refers to distrust in the medical system to act in the patient’s best interest (Morgan et al., 2008). Bodily integrity concerns afterlife consequences that follow organ removal (Stephenson et al., 2008). Disgust refers to the squeamish feelings that accompany the thought of having one’s organs removed and placed into another person (Parisi & Katz, 1986). Finally, superstition pertains to the anxiety that if one declares intentions to donate, his or her life will be cut short as a result (Morgan et al., 2008; Wittig, 2001). Medical mistrust (Salim et al., 2010; Siminoff, Burant, & Ibrahim, 2006) and bodily integrity (McNamara et al., 1999; Stephenson et al., 2008) are commonly cited as barriers preventing individuals from registering as organ donors (Morgan et al., 2008). Evidence abounds with respect to the inaccuracies routinely presented in Grey’s Anatomy following recent content analyses (e.g., Morgan et al., 2007) as well as our brief review of Grey’s Anatomy’s portrayal of organ donation. For this reason, we hypothesize that as the perceived realism associated with Grey’s Anatomy increases, knowledge about organ donation will decrease whereas beliefs regarding medical mistrust, superstitions, disgust, and bodily integrity will increase.

Hypothesis 2 (H2): Grey’s Anatomy perceived realism will be negatively associated with organ donation knowledge.

Hypothesis 3 (H3): Grey’s Anatomy perceived realism will be positively associated with medical mistrust, superstitions, disgust, and bodily integrity beliefs.

Although inherently distinct entities, it is expected that organ donation knowledge and medical mistrust, superstitions, disgust, and bodily integrity will be inversely related. For decades, organ donation practitioners have sought to enhance public perceptions of how organs are allocated to diminish mistrust of the system (e.g., Alvaro, Jones, Robles, & Siegel, 2006; Feeley et al., 2009; Harrison, Morgan, King, & Williams, 2011; Morgan, Miller, Arasaratnam, 2003). The idea behind such efforts is that as knowledge increases, beliefs in these barriers will be mitigated. Therefore,

Hypothesis 4 (H4): Organ donation knowledge will be negatively associated with medical mistrust, superstitions, disgust, and bodily integrity beliefs.

Compared to knowledge, relatively little research examines the aforementioned barriers with organ donation attitudes (Morgan et al., 2008). That is, historically, research identifying antecedents to organ donation attitudes examined knowledge with modest attention devoted to medical mistrust, and substantially less consideration to superstition, disgust, and bodily integrity. A change in foci emerged a few years ago when Morgan and colleagues (2008) examined knowledge along with medical mistrust, superstition, disgust, and bodily integrity significantly predicted organ donation attitudes. From this research we learn that organ donation attitudes may not necessarily be the result of knowledge when we consider these barriers. Due to the inconsistent findings, we posit a research question to determine the extent to which knowledge serves as an antecedent to organ donation attitudes.

Research question 1 (RQ1): Is organ donation knowledge positively associated with favorable organ donation attitudes?

Unlike the relationship between knowledge and attitudes, Morgan et al. (2008) demonstrated an inverse relationship between medical mistrust, superstition, disgust, and bodily integrity with organ donation attitudes. Surprisingly, since their landmark study, few studies have sought to move this literature forward by examining differences among these barriers (O’Carroll, Foster, McGeechan, Sandford, & Ferguson, 2011) and we are aware of no study that closely assesses differences with an ethnically diverse pool of potential organ donors. Therefore, in line with recent work by Morgan and colleagues (2008), we hypothesize that the abovementioned barriers will be negatively associated with organ donation attitudes.

Hypothesis 5 (H5): Medical mistrust, superstition, disgust, and bodily integrity beliefs will be negatively associated with favorable organ donation attitudes.

H1 through H5 and RQ1 are visually depicted in Figure 1. Two overarching goals serve as the impetus for the project. First, the present study examines the role of knowledge and beliefs regarding bodily integrity, disgust, superstition, and medical mistrust as each relates to organ donation attitudes. The second goal of this study is to evaluate the applicability of a theoretical model grounded in previous organ donation research for African Americans, Caucasians, and Latinos. African Americans and Latinos are already more mistrustful for a variety of reasons (see Alvaro et al., 2006; Arriola et al., 2010; Boulware et al., 2002), so these television depictions encouraging greater mistrust will be particularly impactful as such representations may resonate with these individuals following their knowledge of previous tragedies such as the Tuskegee Syphilis Study. Thus, it is important to test the proposed model separately for each group to see if there is a differential impact among these ethnic groups. The existing literature on organ donation willingness has not determined whether the hypothesized relationships are generalizable across various ethnicities and particularly among those with low organ donation rates—African Americans and Latinos. To our knowledge, no study to date has examined the role of Grey’s Anatomy viewing, organ donor attitudes, and the mediating variables that connect the two with a heterogeneous sample consisting of African Americans, Caucasians, and Latinos. In addition to evaluating the proposed model across these three ethnic groups, the present study examines differences in Grey’s Anatomy viewing, perceived realism, organ donation knowledge, barriers, attitudes, and registration status among African Americans, Caucasians, and Latinos. In this spirit,

Research question 2 (RQ2): Do African Americans, Caucasians, and Latinos differ in Grey’s Anatomy viewing and perceived realism of the program?

Hypothesis 6 (H6): Caucasians will exhibit greater knowledge, less barriers, more favorable attitudes toward organ donation, and will be more likely to be registered organ donors than African Americans and Latinos.

Research question 3 (RQ3): Do African Americans and Latinos differ in their organ donation knowledge, barriers, attitudes, and organ donor status?

Figure 1.

Hypothesized structural model.

Method

Participants and Procedures

Illinois residents (N = 600) participated in a stratified random telephone survey about organ donation. The sample was evenly distributed among African Americans (n = 200), Caucasians (n = 200), and Latinos (n = 200). Of those surveyed, the majority were female (n = 367) between the ages of 18 and 24 (M = 21.01, SD = 2.14). Additionally, the sample was well represented with respect to parent income with no more than 10% of the sample falling into any income category, which ranged from under US$10,000 to greater than US$100,000 with US$10,000 increments separating each category. However, it should be noted that lower income earners were overrepresented among African American and Latino participants whereas higher income earners were overrepresented among Caucasian participants. 51.2% of participants were registered organ donors.

Phone lists were purchased with these age and ethnicity qualifications in mind. After the phone lists were purchased, random-digit dialing was performed until 200 surveys were completed for each ethnic group. If an individual was not reached at first, five additional callbacks followed at various times throughout weekdays and weekends. Of the African Americans, Caucasians, and Latinos reached that met the ethnic and age qualifications to participate in the study, 89%, 92%, and 95% completed the phone survey, respectively. Participants received a US$25 gift card to Wal-Mart for their participation in the 15-minute survey. All of the phone surveys were completed within a 1-month period.

Measures

Attitude

Attitude toward joining the organ donation registry was measured with two items on a 1 = strongly disagree to 7 = strongly agree scale adapted from Fishbein and Ajzen (1975) [e.g., Joining the organ donation registry is a good thing for you to do (α = .76)] The means and standard deviations for all measured variables are presented in Table 1, 2, 3, and 4.

Table 1.

Correlation Matrix for Overall Model.

	1	2	3	4	5	6	7	8	9
1. Grey’s Anatomy	1.0
2. Perceived realism	0.26***	1.0
3. Knowledge	−0.09*	−0.16***	1.0
4. Medical mistrust	−0.03	−0.11**	−0.24***	1.0
5. Bodily integrity	0.01	0.13***	−0.32***	0.17***	1.0
6. Disgust	0.02	0.15***	−0.32***	0.23***	0.51***	1.0
7. Superstition	0.01	0.17***	−0.34***	0.22***	0.57***	0.57***	1.0
8. Attitude	0.05	0.04	0.24**	−0.35***	−0.40***	−0.34***	−0.32***	1.0
9. Donor status	0.03	0.04	0.06	−0.06	−0.20***	−0.14***	−0.14 ***	0.32***	1.0
M	3.75	3.97	5.90	2.51	2.25	2.02	1.81	6.03	0.49
SD	1.27	1.69	1.57	1.43	1.49	1.40	1.22	1.32	0.50

Note: *p < .05. **p < .01. ***p < .001.

Table 2.

Correlation Matrix for African American Model.

	1	2	3	4	5	6	7	8	9
1. Grey’s Anatomy	1.0
2. Perceived realism	0.25***	1.0
3. Knowledge	0.03	0.00	1.0
4. Medical mistrust	−0.02	−0.16*	−0.19*	1.0
5. Bodily integrity	−0.07	−0.05	−0.29***	0.03	1.0
6. Disgust	0.02	−0.01	−0.28***	0.14	0.52***	1.0
7. Superstition	−0.01	0.04	−0.33***	0.14	0.50***	0.55***	1.0
8. Attitude	0.07	0.08	0.24**	−0.27***	−0.37***	−0.30***	−0.26***	1.0
9. Donor status	0.10	0.19**	−0.00	−0.01	−0.25***	−0.18**	−0.17**	0.23***	1.0
M	3.57	4.71	5.48	2.71	2.62	2.24	2.01	5.78	0.43
SD	1.30	1.56	1.55	1.58	1.69	1.53	1.38	1.46	0.50

Note: *p < .05. **p < .01. ***p < .001.

Table 3.

Correlation Matrix for Caucasian Model.

	1	2	3	4	5	6	7	8	9
1. Grey’s Anatomy	1.0
2. Perceived realism	0.14*	1.0
3. Knowledge	−0.11	−0.19**	1.0
4. Medical mistrust	0.03	0.04	−0.34***	1.0
5. Bodily integrity	0.05	0.21**	−0.33***	0.36***	1.0
6. Disgust	0.15*	0.27***	−0.36***	0.38***	0.62***	1.0
7. Superstition	0.17*	0.18**	−0.31***	0.45***	0.66***	0.59***	1.0
8. Attitude	−0.07	−0.04	0.19**	−0.36***	−0.44***	−0.45***	−0.47***	1.0
9. Donor status	−0.13	−0.01	0.10	−0.06	−0.19**	−0.12	−0.07	0.33***	1.0
M	3.84	3.08	6.45	2.40	1.69	1.82	1.49	6.20	0.57
SD	1.24	1.35	1.37	1.21	1.03	1.25	0.84	1.22	0.50

Note: *p < .05. **p < .01. ***p < .001.

Table 4.

Correlation Matrix for Latino Model.

	1	2	3	4	5	6	7	8	9
1. Grey’s Anatomy	1.0
2. Perceived realism	0.31***	1.0
3. Knowledge	−0.16*	−0.15*	1.0
4. Medical mistrust	−0.12	−0.26***	−0.20**	1.0
5. Bodily integrity	0.03	0.17**	−0.29***	0.18**	1.0
6. Disgust	−0.11	0.14*	−0.29***	0.19**	0.42***	1.0
7. Superstition	−0.09	0.22**	−0.34***	0.18**	0.59***	0.56***	1.0
8. Attitude	0.17*	0.19*	0.24**	−0.41***	−0.37***	−0.27***	−0.26***	1.0
9. Donor status	0.13	0.01	0.04	−0.09	−0.13	−0.08	−0.13	0.39***	1.0
M	3.85	4.12	5.75	2.41	2.44	1.99	1.93	6.13	0.47
SD	1.26	1.74	1.62	1.46	1.51	1.39	1.32	1.25	0.50

Note: *p < .05. **p < .01. ***p < .001.

Bodily integrity

Bodily integrity was measured on a 7-point scale with 1 = strongly disagree to 7 = strongly agree (Morgan et al., 2008). Four items were used to comprise the bodily integrity scale [e.g., The body should be kept whole for burial (α = .83)].

Disgust

Disgust was measured using Morgan et al.’s (2008) three-item scale, which was measured on a 7-point scale with endpoints 1 = strongly disagree to 7 = strongly agree [e.g., The idea of organ donation is somewhat disgusting (α = .73)].

Donor status

An individual answered yes or no to the following item: “Have you joined the Illinois organ donor registry?”

Grey’s Anatomy viewing

Grey’s Anatomy viewing was measured with a single item (Morgan, Movius, et al., 2009). Specifically, participants indicated on a 1 = I never watch the show, 2 = I have seen the show but rarely watch it, 3 = I watch the show occasionally, 4 = I often watch the show, and 5 = I always try to watch every episode.

Knowledge

Knowledge was measured using eight items taken from previous work (e.g., A brain dead organ donor might feel pain when his or her organs are removed) (Feeley, 2007; Morgan et al., 2008). The number of items answered correctly was summed to represent knowledge of organ donation with a range from zero to eight.

Medical mistrust

Morgan et al.’s (2008) scale was used to measure medical mistrust with two items assessed on a 1 = strongly disagree to 7 = strongly agree scale (Morgan et al., 2008) [e.g., You don’t feel like you can trust doctors (α = .60).

Perceived realism

The perceived realism of Grey’s Anatomy was measured with four items on a 1 = strongly disagree to 7 = strongly agree scale (Busselle, 2001) [e.g., You can learn a lot about the real world by watching medical shows like Grey’s Anatomy (α = .85).

Superstition

Superstition was measured using a four-item scale (Morgan et al., 2008), which was measured on a 1 = strongly disagree to 7 = strongly agree scale [e.g., Joining the organ donor registry might make death happen more quickly (α = .79)].

Results

To test H1 through H5 and RQ1, four structural models were run. Specifically, a model containing data from the entire sample, as well as separate models featuring data from the African American, Caucasian, and Latino subsamples were run. Each model was tested using covariance-based structural equation modeling with latent variables using full-information maximum likelihood estimators in EQS 6.1 for Windows. For the overall model, ethnicity, sex, and income were controlled for by regressing these covariates onto the model variables and then using the unstandardized residuals to estimate model fit. For the ethnicity specific models, only sex and income were controlled for in the analyses. The multivariate distributions were marginally nonnormal with a Mardia’s normalized estimate of 27.24 for the entire sample, 10.48 for the African American model, 18.87 for the Caucasian model, and 10.05 for the Latino model. Because the multivariate distributions were moderately nonnormal, maximum likelihood with robust estimators were employed to estimate the hypothesized models. Tables 1, 2, 3, and 4 provide a correlation matrix for the measured variables for each model. Of the variables appearing in the model, Grey’s Anatomy viewing and organ donation knowledge were modeled as single-item observed variables. Perceived realism and organ donation attitudes were treated as latent composite variables by setting the error terms to (1-α) * variance (see Stephenson & Holbert, 2003). Finally, consistent with previous work (Morgan et al., 2008), medical mistrust, superstition, disgust, and bodily integrity beliefs were modeled as a second-order factor.

The omnibus model fit was evaluated using the Satorra-Bentler Chi square-distributed goodness of fit test (S-Bχ²), comparative fit index (CFI), and the standardized root mean squared residual (SRMR). According to Bentler (2007), a nonsignificant χ², a CFI above .90, and values close to or below .09 for SRMR represent a good fitting model (also, see Holbert & Stephenson, 2002). We followed Anderson and Gerbing’s (1988) two-step approach by evaluating the measurement model and the structural model in two separate steps. The measurement model for the entire sample achieved acceptable fit, CFI = .99, SRMR = .06, S-Bχ² (19, N = 600) = 82.69, p < .001, as did the structural model, CFI = .99, SRMR = .06, S-Bχ² (18, N = 600) = 74.34, p < .001. For the African American sample, the measurement, CFI = .99, SRMR = .06, S-Bχ² (19, N = 200) = 26.37, p = .12, and structural models, CFI = .99, SRMR = .06, S-Bχ² (18, N = 200) = 25.96, p = .10, achieved good fit. For the Caucasian sample, the measurement, CFI = 1.0, SRMR = .07, S-Bχ² (19, N = 200) = 36.47, p < .01, and structural models, CFI = 1.0, SRMR = .05, S-Bχ² (18, N = 200) = 28.86, p = .05, obtained adequate fit. For the Latino sample, the measurement, CFI = .98, SRMR = .10, S-Bχ² (19, N = 200) = 72.04, p < .001, and structural, CFI = .97, SRMR = .11, S-Bχ² (18, N = 200) = 74.69, p < .001, models adequately fit the data. The standardized path coefficients along with effect sizes for each model are depicted in Figure 2 through 5.

Figure 2.

Overerall structural model.

Figure 3.

African American structural model.

Figure 4.

Caucasian structural model.

Figure 5.

Latino structural model.

In addition to testing for main effects, a multigroup modeling approach was used to examine if the hypothesized paths were moderated by participant ethnicity. Following Cohen and Cohen (1983), testing for moderation involved the use of unstandardized path coefficients and their respective standard errors to compute a z statistic to determine if differences emerged between path coefficients among the African American, Caucasian, and Latino models. Z scores were calculated by taking the difference between path coefficients and then dividing the difference by the square root of the squared standard errors total.

To address RQ2, RQ3, and H6, a multivariate analysis of variance was used to determine differences between the study variables between African American, Caucasian, and Latino participants. In addition, to address differences with respect to organ registration status, a χ² was computed.

Hypothesis 1 (H1): Grey’s Anatomy viewing and perceived realism

The first hypothesis predicted that as Grey’s Anatomy viewing increased, perceived show realism would also increase. For the overall sample, Grey’s Anatomy viewing was positively associated with perceived realism (path coefficient = .29, p < .001). A similar trend was observed for African Americans (path coefficient = .28, p < .001, Caucasians (path coefficient = .16, p < .05), and Latinos (path coefficient = .33, p < .001), respectively. H1 was fully supported. With respect to differences in path coefficients between African Americans, Caucasians, and Latinos, the results revealed that Latinos demonstrated a stronger association between Grey’s Anatomy viewing and perceived realism compared to Caucasians (z = −2.09, p < .05). No other differences were observed.

Hypothesis 2 (H2): Grey’s Anatomy perceived realism and organ donation knowledge

Consistent with previous research demonstrating the inaccurate portrayals of organ donation on television, it was predicted that as perceived realism increased, organ donation knowledge would decrease. Overall, as perceived realism increased, organ donation knowledge decreased (path coefficient = −.19, p < .001). For Caucasians (path coefficient = −.24, p < .01) and Latinos (path coefficient = −.21, p < .01) perceived realism was negatively associated with knowledge. However, for African Americans, the relationship between perceived realism and knowledge was not present (path coefficient = .00, p > .05). Thus, H2 received mixed support. With respect to differences among African Americans, Caucasians, and Latinos, results revealed that Caucasians had a stronger association between perceived realism and knowledge than African Americans (z = −2.26, p < .05). No other differences were found.

Hypothesis 3 (H3): Perceived realism, medical mistrust, superstition, disgust, and bodily integrity

H3 predicted that as perceived realism increased, beliefs regarding medical mistrust, superstition, disgust, and bodily integrity would increase. The third hypothesis was supported in the overall model (path coefficient = .09, p < .05). For Caucasians, perceived show realism was positively associated with these beliefs (path coefficient = .17, p < .05) as well. However, the hypothesized association was nonsignificant for African Americans (path coefficient = −.03, p > .05) and Latinos (path coefficient = .12, p > .05). In all, H3 received partial support. No difference in relationship emerged between perceived show realism and barriers among African Americans, Caucasians, and Latinos.

Hypothesis 4 (H4): Organ donation knowledge, medical mistrust, superstition, disgust, and bodily integrity

An inverse association was predicted between organ donation knowledge and barriers. Taking the entire sample into account, as expected, knowledge was negatively associated with these barriers (path coefficient = −.46, p < .001). A similar trend emerged for African Americans (path coefficient = −.44, p < .001), Caucasians (path coefficient = −.42, p < .001), and Latinos (path coefficient = −.44, p < .001). Thus, H4 was fully supported. Like H3, no differences were found among the path coefficient bridging knowledge with medical mistrust, superstition, disgust, and bodily integrity barriers between African Americans, Caucasians, and Latinos.

Research Question 1 (RQ1): Organ donation knowledge and organ donation attitudes

The first research question examined the association between organ donation knowledge and attitudes toward joining the organ donation registry. For the entire sample, this association was not significant (path coefficient = .06, p > .05). A similar nonsignificant trend emerged among African Americans (path coefficient = .09, p > .05), Caucasians (path coefficient = −.08, p > .05), and Latinos (path coefficient = .14, p > .05). Again, no statistical differences were found between African Americans, Caucasians, and Latinos with respect to the knowledge–attitude relationship.

Hypothesis 5 (H5): Medical mistrust, superstition, disgust, bodily integrity, and organ donation attitudes

Research shows that medical mistrust, superstition, disgust, and bodily integrity beliefs can serve as obstacles to supporting organ donation. Thus, the fifth hypothesis predicted a negative association between these barriers and attitudes toward joining the registry. For the entire sample, medical mistrust, superstition, disgust, and bodily integrity beliefs were negatively associated with organ donation attitudes (path coefficient = −.53, p < .001). This hypothesized association was robust for African Americans (path coefficient = −.49, p < .001), Caucasians (path coefficient = −.67, p < .001), and Latinos (path coefficient = −.39, p < .001), thus demonstrating support for H5. Z-tests revealed no statistical differences in the path coefficient connecting organ donation barriers with attitudes among for African Americans, Caucasians, and Latinos.

Research Question 2 (RQ2): Ethnic differences in Grey’s Anatomy viewing and perceived realism

RQ2 tested for differences in Grey’s Anatomy viewing and perceived realism of the program among African Americans, Caucasians, and Latinos. To test for potential differences, a multivariate analysis of variance was performed and revealed overall differences among these study variables, Wilks’ λ = .74, F (16, 994) = 10.33, p < .001, η² = .27. In order to reduce the likelihood of committing a Type I error, the conventional α level was divided by the number of pairwise comparisons (.05/3) resulting in the new α level of .0167. With respect to Grey’s Anatomy viewing, univariate tests revealed differences among the three ethnic groups, F (2,504) = 3.21, p < .05, η² = .01. Viewing differences between African Americans approached significance between Caucasians and Latinos with p = .027 and .031, respectively.

For perceived realism of Grey’s Anatomy, univariate tests demonstrated differences among the three ethnic groups, F (2,504) = 54.34, p < .001, η² = .17. Specifically, African Americans perceived the program to be significantly more realistic than Caucasians and Latinos. Additional differences emerged between Caucasians and Latinos at p < .001.

Hypothesis 6 (H6): Caucasians maintain greater knowledge, less barriers, more favorable attitudes, and more likely to be registered organ donors than African Americans and Latinos

Research Question 3 (RQ3): Do African Americans and Latinos differ in their organ donation knowledge, barriers, attitudes, and organ donor status?

H6 predicted that Caucasians would exhibit more knowledge, less barriers, more favorable attitudes, and would be more likely to be a registered organ donor compared to African Americans and Latinos whereas RQ3 addressed differences among these variables between African Americans and Latinos. A multivariate analysis of variance yielded differences among knowledge, barriers, and attitudes, Wilks’ lambda = .74, F (16, 994) = 10.33, p < .001, η² = .27. With respect to knowledge, F (2,504) = 18.23, p < .001, η² = .07, Caucasians displayed greater knowledge than African Americans and Latinos at p < .0167. With respect to RQ3, no differences in knowledge emerged between African Americans and Latinos.

Barriers were treated as four distinct entities when testing H6 and the final research question to enhance interpretation clarity. For medical mistrust, no differences emerged among African Americans, Caucasians, and Latinos, F (2,504) = 2.41, p = .09. For bodily integrity, differences emerged among the ethnic groups, F (2,504) = 22.42, p < .001, η² = .07. As predicted in H6, Caucasians displayed fewer concerns over bodily integrity than African Americans and Latinos. With respect to RQ3, no differences emerged between African American and Latino participants. For disgust, differences emerged among the ethnic groups, F (2,504) = 5.62, p < .01, η² = .02. H6 was partially supported in that Caucasians expressed less disgust compared to African Americans, but not Latinos. Per RQ3, no differences emerged between African Americans and Latinos (p = .02). For superstition, significant differences emerged among the ethnic groups, F (2,504) = 11.59, p < .001, η² = .04. As hypothesized in H6, Caucasians revealed less superstition than African Americans and Latinos. Again, no differences emerged between African American and Latino participants (RQ3).

With respect to organ donation attitudes, differences were present among the ethnic groups, F (2,504) = 4.76, p < .001, η² = .02. H6 received partial support with Caucasians maintaining more favorable attitudes than African Americans; however, no differences emerged between Caucasians and Latinos. For RQ3, differences between African Americans and Latinos approached significance at p = .03.

Finally, in determining differences in organ donation registration rates among African American, Caucasian, and Latino participants, a χ² was employed. Results revealed that the number of registered Caucasians (n = 113, 57%) was greater than the number of African American (n = 85, 43%) and Latino (n = 95, 48%) registered organ donors, χ² (2, N = 600) = 4.12, p < .05.

Discussion

The present findings extend Morgan et al.’s (2008) results, which demonstrate that medical mistrust, superstition, disgust, and bodily integrity beliefs are better at predicting organ donor attitudes toward registering to be an organ donor compared to knowledge, by identifying key mediators connecting Grey’s Anatomy viewing with organ donor attitudes. To date, we are unaware of any published research utilizing perceived realism (Busselle, 2001; Busselle & Shrum, 2003) to better understand the influence of medical dramas such as Grey’s Anatomy. Moreover, the study moves previous organ donation work forward by recruiting an ethnically heterogenous sample to heighten the generalizability of the tested associations and differences among the African American, Caucasian, and Latino sample. The present study revealed that when the aforementioned barriers are included in the model, knowledge does not predict attitudes toward registering as an organ donor among African Americans, Caucasians, and Latinos. To the contrary, beliefs regarding medical mistrust, superstition, disgust, and bodily integrity account for a sizable amount of variance in organ donation attitudes across all four models. Below the results are discussed with an emphasis on the theoretical and practical implications.

Theoretical Implications

A number of theoretical frameworks have been advanced to explain media influence on viewers’ perceptions of the real world. Social cognitive theory assumes that individuals learn by way of behavioral, environmental, and personal determinants (Bandura, 1986). With respect to these three determinants, the current study was interested in the influence of Grey’s Anatomy on cognitions and feelings with respect to organ donation and how each relates to organ donation attitudes. A considerable amount of research supports the claim that individuals learn from what they watch on television. As recently observed by Bandura (2009), repeated exposure to television content can make these images appear more realistic. The current study provides additional support for Bandura’s (1986) framework in that as the perceived realism of Grey’s Anatomy increased, organ donation knowledge decreased whereas barriers to donation (e.g., bodily integrity, disgust, medical mistrust, and superstition) increased. As documented earlier in the manuscript, the majority of coverage pertaining to organ donation on Grey’s Anatomy is inaccurate and plays into the reasons nonregistered donors give when asked about their decision to register as an organ donor (see Morgan et al., 2005; Morgan et al., 2010). Together, findings from the current study as well as extant research add credibility to Bandura’s framework suggesting that viewers vicariously learn about organ donation via Grey’s Anatomy portrayals.

Similar to social cognitive theory, cultivation theory assumes that viewers learn about the world around them from their television viewing. A key difference between cultivation theory and the former rests in the amount of exposure. Whereas Bandura’s framework takes into account short- and long-term viewing, cultivation theory places an emphasis on overall television viewing over an extended period of time. Essentially, the theory predicts that heavy television viewers begin to blur TV reality with their reality over an extended period of time (see Morgan, Shanahan, & Signorielli, 2009). That is, overall television exposure continuously alters our thoughts about the world but these shifts in beliefs are not noticeable immediately. To date, cultivation research continues to thrive as researchers have begun to extend the precision of the cultivation hypothesis to genre-specific programming (Wilson, Martins, & Marske, 2005) as well as to specific programs such as Grey’s Anatomy over an extended period of time (Quick, 2009) (for a review, see Morgan & Shanahan, 2010). In the current study, and in accordance with cultivation theory, heavy viewers of Grey’s Anatomy were more likely to subscribe to the barriers portrayed in this program, as mediated by way of perceived realism of the program, which is consistent with Gerbner and colleagues’ theorizing. Although the current study is limited to one program, albeit over eight seasons, our results show additional support for applying cultivation theory within the context of a single program over several seasons.

Unlike cultivation, which has a drip effect, an alternative explanation for our findings is found in the drench hypothesis, which advances that media viewers may not be influenced as much by frequent exposure over time but immediately following exposure to some significant, intense, or particular exposure to media imagery (Greenberg, 1988). As an individual show, Grey’s Anatomy has proven extremely popular and maintains a large viewership (Nielsen Media Research, 2009). It is possible that the high intensity impact of this particular show, especially on those who watch it regularly, could be responsible for a drench effect on viewers’ perceptions of perceived realism and organ donation, as the topic is portrayed with regularity throughout the seasons thus far. At a topical level, media genres, in general, have increasingly featured organ donation in their storylines, with increased exposure pertaining to organ donation in legal dramas such as Law and Order, medical dramas such as House (see Morgan et al., 2007; Morgan et al., 2010), and even entire movies, such as John Q (Burg & Cassavetes, 2002) and Repo Men (Stuber & Sapochnik, 2010). At any of these levels, this high impact exposure could contribute to a drench effect. The intensity of exposure, at least in part, could be responsible for the perceived realism and, ultimately, the corresponding medical mistrust, disgust, bodily integrity, and superstition beliefs and attitudinal outcomes associated with organ donation. Although Greenberg’s hypothesis was advanced to explain positive changes in racial stereotyping among media viewers, it stands to reason that the drench hypothesis could also explain the relationships observed in the current study.

Clearly these results, coupled with the results from earlier studies (Morgan et al., 2008), speak of the importance of mitigating medical mistrust, disgust, bodily integrity, and superstition concerns pertaining to organ donation as opposed to simply informing individuals about the registration process when promoting organ donation. Given the relationships among these four barriers, it is difficult to look at each independently in our models although we view such an examination as desirable. However, we were able to examine differences by way of a multivariate analysis of variance test, which revealed that African Americans reported greater bodily integrity, disgust, and superstition compared to Caucasians. Per RQ3, no differences emerged between African Americans and Latinos although differences approached significance for disgust (p = .02). Despite no differences between Latinos and Caucasians with respect to medical mistrust and disgust, Latinos displayed stronger superstitions and bodily integrity concerns than Caucasians.

Interestingly, no significant differences emerged in medical mistrust among the three ethnic groups. Medical mistrust was somewhat germane among African Americans, Caucasians, and Latinos. Specifically, medical mistrust might be addressed through specific education about the organ allocation system and the checks and balances in the procurement/transplant process. However, addressing bodily integrity, disgust, and superstitions with respect to organ donation might be more difficult but could be done through clever campaign messages and extensive formative research.

Additionally, our results are the first to pinpoint differences in how media consumption influences these organ donation barriers and subsequent outcomes such as attitudes toward registering to be an organ donor between various ethnic groups by modeling the underlying processes at work such as perceived realism, knowledge acquisition, and concerns with respect to medical mistrust, disgust, bodily integrity, and superstitions (Busselle, 2001). Following much research examining the relationship between media coverage and relevant beliefs, the current study showed full or partial support for the hypothesized relationships. Overall, as exposure to Grey’s Anatomy increased, the perceived realism of this show increased. In turn, perceived realism was negatively associated with knowledge and positively associated with beliefs with respect to medical mistrust, disgust, bodily integrity, and superstitions as expected. Given the significant associations between realism and the aforementioned beliefs, future research should continue to utilize perceived realism when bridging media exposure with outcomes of interest. In turn, these barriers were inversely associated with favorable attitudes toward registering to be an organ donor whereas knowledge was not associated with organ donation attitudes.

Perceived realism was positively associated with Grey’s Anatomy viewing among African Americans, Caucasians, and Latino participants. Hence, the more viewers watched this program the more realistic they perceived its content. This relationship was particularly robust for Latino viewers as they demonstrated a stronger viewing-perceived realism relationship than Caucasians. In addition to this difference, the association between perceived realism with knowledge and organ donation barriers varied considerably. Specifically, for African Americans, no association emerged between perceived realism and knowledge or the previously mentioned barriers. For Latinos, a negative association was found between perceived realism and knowledge, but no association was found between perceived realism and organ donation barriers. In all, the results revealed that Caucasians are more susceptible to be influenced by Grey’s Anatomy programming than African Americans. That is, Caucasians reported a stronger negative association between perceived realism and knowledge as well as a stronger positive association between realism and organ donation barriers when compared to African Americans.

Ethnic differences were ascertained by using additional analytic approaches in the present study. Specifically, in addition to testing for interactions using the multigroup method, differences among African Americans, Caucasians, and Latinos were also assessed using multivariate analysis and χ² tests. Multivariate tests revealed that African Americans watched less Grey’s Anatomy than Caucasian (p = .03) and Latino (p = .03) participants. Interestingly, African Americans were more likely to perceive Grey’s Anatomy to be realistic compared to Caucasian and Latino participants and Latino participants displayed greater show realism than Caucasians. We know from previous research that individuals do not necessarily need to view programs such as Grey’s Anatomy to be influenced by their storylines (e.g., Morgan et al., 2005; Morgan et al., 2010). Clearly, the fact that African Americans and Latinos are more likely to perceive Grey’s Anatomy as credible is troubling and needs to be addressed in future work. Not surprisingly, then, multivariate tests revealed that Caucasian participants possessed more favorable attitudes toward registering to be an organ donor compared to African Americans. Differences in attitudes approached significance with Latino participants expressing more favorable attitudes than African American participants (p = .03). Adding further evidence for organ donation disparities among African Americans, Caucasians, and Latinos, a χ² test revealed differences in organ donation registrations among these ethnic groups with Caucasians being the most likely to have registered followed by Latinos, and African Americans.

Together, these findings may come as a surprise to readers given the extensive research documenting medical mistrust among African Americans. However, this medical mistrust may leak into mistrust of Grey’s Anatomy as well. Caucasians and Latinos appear to be more influenced by the perpetuation of organ donation myths depicted on Grey’s Anatomy compared to African Americans. This could be a direct result of greater exposure to this program (RQ2). Alternatively, this finding could be because African Americans have direct (and indirect) experiences that shape their mistrust of the medical system that are more powerful than television portrayals alone (Afifi et al., 2006; Morgan, 2004; Morgan et al., 2005). It is important to note that we are not suggesting Caucasians display greater medical mistrust than African Americans, but our findings imply that Grey’s Anatomy programming appears to penetrate the belief systems of Caucasians more deeply than African Americans. On the other hand, Latinos were less influenced by Grey’s Anatomy content despite perceiving it to be realistic. Much like their African American counterparts, it is likely that information pertaining to organ donation is communicated and learned through social networks and news programs, among other sources.

Practical Implications

With respect to the implications of these findings, combating common myths about donation is critical considering their demonstrated negative impact on knowledge of and attitudes toward organ donation. As results from RQ2 and 3 as well as H6 demonstrate, African Americans and Latinos displayed higher scores on many of the barriers that prevent individuals from registering to be organ donors. With television reported as the number one source for organ donation information (Conesa et al., 2004), from a public health perspective, as the rate at which the number of people finding themselves on the waiting list continues to grow (UNOS, 2012), intervention may need to confront Hollywood producers in order to get them to stop telling blatant lies, regardless of their entertainment value (Morgan, Movius, et al., 2009). Certainly an argument can be made that shows such as Grey’s Anatomy are not obligated to serve as a public service announcement for organ donation. However, with this in mind, depicting images and storylines reifying common myths held by individuals about organ donation only exacerbates the organ shortage in the United States.

Second, more efforts should be made to address these myths with young adults as well as Grey’s Anatomy viewers. Compared to their more seasoned friends and relatives, on average, young adults’ experience with organ donation is limited, which according to Busselle and Shrum (2003) would amplify the perceived realism of television depictions of organ donation on shows such as Grey’s Anatomy. Thus, future efforts aimed at promoting organ donation to viewers, and younger viewers in particular, of medical dramas such as Grey’s Anatomy is strongly encouraged. One method for doing this is to partner with television producers and writers to arm them with the facts about organ donation as well as inform them of the aversive consequences of blatant misrepresentations about organ donation. Another possibility for practitioners is to identify and recruit an actor, ideally a doctor, from a medical drama to promote organ donation.

These findings should underscore the need for additional research and/or tailored promotional messages to address these particular barriers when reaching African Americans. The larger question at hand is how to effectively mitigate these barriers among African Americans as well as Latinos. What this study reveals is that organ donation barriers should be addressed in promotional materials. However, does acknowledging barriers such as medical mistrust, disgust, superstition, and bodily integrity reinforce their perpetuation? While there is a need to combat these beliefs, addressing them to others previously unaware of these barriers could backfire and cause some to not join the organ donation registry. The effectiveness of presenting and combating these barriers as well as debunking Grey’s Anatomy portrayals of organ donation by clearly communicating about the medical process used by healthcare professionals in organ allocation should be examined in future research to ascertain the relative effectiveness of various strategies.

Despite the advances made in understanding how Grey’s Anatomy viewing influences organ donation attitudes as mediated by way of perceived realism, knowledge, and barriers, future research should look to extend these findings in the following ways. First, Morgan and colleagues (2009) found that emotional involvement as well as perceived accuracy in medical drama storylines influenced both learning and motivation. Future research should look to understand the role of emotional involvement within the current model. Shows such as Grey’s Anatomy arouse any number of emotions among viewers from week-to-week. An examination of the various discrete emotions (e.g., fear, guilt, and happiness) aroused while viewing and their role in shaping beliefs and subsequent action tendencies warrants investigation. Second, future research should take into account real world experience with organ donation as it might moderate the media exposure and perceived realism association. Following Busselle and Shrum (2003), we assume that with limited experience with organ donation, portrayals of this phenomenon on Grey’s Anatomy will be perceived as more realistic than portrayals of less novel topics. However, this is an empirical question deserving attention in future studies. Third, the current study was limited to Grey’s Anatomy, albeit this was the only medical drama watched with any regularity among study participants as viewing frequency was inquired for a number of medical dramas. Future research should investigate the impact of alternative medical dramas to determine if similar patterns of influence emerge.

A limitation of the current study is that it assumes a linear path with media exposure preceding beliefs and subsequent organ donation attitudes. However, according to Slater’s (2007) reinforcing spirals perspective, media exposure is influenced by viewers’ beliefs, attitudes, and behaviors. Following his argument, exposure to Grey’s Anatomy could influence beliefs and subsequent attitudes but it is also likely that established attitudes and beliefs would influence the perceived realism of Grey’s Anatomy as well as the regularity with which viewers watch this particular program. Future research should use panel studies to tease out the directionality of these associations using longitudinal designs. Additionally, a fair amount of research utilizes social representation theory (Moscovici, 1984) to describe how media portrayals of organ donation and how these storylines shape cognitions and subsequently emerge in conversations about the topic with family and friends (Morgan, 2008; Morgan et al., 2008). Future research should examine the influence of programs perceived as realistic and how these portrayals and subsequent conversations shape social representations of organ donation.

Finally, future research should look to improve the measurement of medical mistrust. In the current study, the four-item measure resulted in low reliability (α < .60), which forced us to rely on a two-item measure. Challenges in measuring organ donation attitudes remain. In our study, much like previous efforts, participants’ attitudes toward organ donation were very high. Future research should consider measuring the importance of organ donation as well. Despite these limitations, this study provides additional evidence to the ability of realistic entertainment programming to shape viewers’ beliefs and attitudes toward registering to be an organ donor.

Conclusion

In all, we believe these findings add to our current understanding of how television depictions of organ donation influence various individuals’ decision to join organ donor registries. Together, these findings support calls to encourage Hollywood to communicate accurate storylines pertaining to organ donation (see Harrison et al., 2008; Morgan et al., 2010). After all, despite an increase in large-scale organ donation campaigns nationwide, television remains the featured source for information about organ donation among U.S. residents (Conesa et al., 2004; Feeley & Servoss, 2005). Thus, based on these results, we reiterate calls for television producers to end their counter campaign against organ donation (Harrison et al., 2008; Morgan et al., 2007; 2009; Quick, 2009). Potential donors should be equipped with facts, not myths, about organ donation when deciding to register as an organ donor.

Footnotes

Acknowledgements

The authors would like to thank the US Department of Health and Human Services Administration, for funding this project.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

This study was supported by grant #R39OT15493-02 from the Health Resources and Services Administration’s Division of Transplantation (HRSA/DoT), U.S. Department of Health and Human Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the views of HRSA/DoT.

Author Biographies

Brian L. Quick (PhD, Texas A & M University, 2005) is an associate professor in the Department of Communication and in the College of Medicine at the University of Illinois at Urbana-Champaign. His primary research interests examine how individuals process persuasive messages in a variety of health contexts.

Susan E. Morgan (PhD, University of Arizona, 1997) is a professor in the Brian Lamb School of Communication at Purdue University. She designs and evaluates persuasive messages targeting health behavior change in multicultural populations.

Nicole R. LaVoie (MA, University of Illinois at Urbana-Champaign, 2010) is a doctoral student in the Department of Communication at the University of Illinois at Urbana-Champaign. Her research examines the unintended consequences of health portrayals communicated through entertainment programs and health campaigns.

Dave Bosch (MA, Illinois State University, 1993) is the Director of Communications and Legislative Affairs for Gift of Hope Organ & Tissue Donor Network. His research has examined public perceptions of organ donation as well as the effectiveness of various communication outlets at promoting organ and tissue donation.

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