For more than half of the sample in the study, the level of general knowledge about Hepatitis C infection was medium to high, with only 9% of the sample providing less than 10 out of 19 correct answers to the questionnaire administered. This result is similar to what was found in the study by Daniali et al. (2015), although in that case the sample was made up of students from the medical-health area, where a greater average knowledge and awareness of the risks related to such infections was likely to be expected (6). A common result between our study and the one mentioned above was the absence of positive correlation between the level of knowledge and the behavioral intention of prevention. The level of knowledge was not associated with the socio-cultural level of belonging, suggesting that there are other sources of information (presumably school, friends, direct and indirect contact with infected people). 30% of the sample had already undergone a hepatitis C test and 20.2% had direct knowledge of people with hepatitis C. The importance attached to personal diagnostic testing was not directly associated with the level of specific knowledge about the infection, but was rather proportionate to the estimated spread of Hepatitis C throughout the country. Those who tended to underestimate the spread of infection consequently attached less value to medical monitoring (35, 36). However, there was an association between the importance attributed to diagnostic control and the level of risk attributed to the category of university students (to which the participants belonged). These results appear congruent with Kasperson, et al. (1988) (37).
With regard to the effect of the use of narrative scenarios on the propensity for diagnostic control, it was found that the group to which the negative scenario was presented reported significantly higher levels of propensity for control, especially compared to the group with the positive scenario. It was likely that the positive scenario had a reassuring effect that limited the participants' propensity for control: the early diagnosis was followed by an adequate course of treatment that allowed the protagonist to lead a substantially normal life; while the negative scenario increased the levels of fear: the late diagnosis was followed by a progressive worsening of health conditions, by a heavy impact of drugs and their side effects on the protagonist's quality of life. In the ambivalent scenario it was probably possible to activate a simultaneous activation of different emotional states, such as fear, anger and resignation; here it could be hypothesized that the response to the medical check could have depended on the prevailing emotion aroused by the scenario and that in any case the presence of more than one emotion does not make it possible to know which and how this prevailed in the participant. The placement of the level of propensity for control in an intermediate position with respect to the groups with positive and negative scenarios suggests that the activating effect of fear could have received a moderation from any feelings of anger and resignation induced by the representation of such a scenario.
The administration of the supplementary information sheet after the completion of the initial questionnaire had a substantial reassuring effect, especially in the group that had only received the initial questionnaire delivery and not the narrative scenario; the effect is also partly detectable on the group with a positive scenario.
In order to explain this result, we can hypothesize that the reassuring effect of the form was induced in particular by the points in which the participant was informed that in any case the greatest risk of contagion was through blood. This may have reassured all those who felt they were leading a lifestyle far from such a risk condition.
It is worth noting that the initial questionnaire consisted of 19 questions addressed to the participant in the second person on the knowledge they had about hepatitis C ( i.e. “How many people do you know who are affected ...”; “Have you ever undergone a check ...”; “How many people are infected with hepatitis C ...”). These probably activated, in association with mental images related to the situations, a personal self-referential response (with internal control locus), during which the participant did not know if he was responding correctly, but certainly in a manner consistent with his imagination. The recurrence among the questions of locutions that alluded directly to risk, damage, danger and diffusion favoured the attention to a personal scenario of reference and risk assessment. Even where the person considers a situation to be at risk, and in reality it is not, he will still be afraid of that situation and will try to implement strategies of self-protection (38). The next information sheet, associated with an authoritative source, therefore becomes reassuring and reduces one's fears by correcting distorted or erroneous knowledge.
This effect was definitely evident in the experimental situation in the absence of a scenario, where the propensity for diagnostic control was greater only in the absence of supplementary scientific information from an authoritative source and without any reference to a possible course of treatment. Therefore, we can hypothesize that in such a condition the person is alone with the idea of the disease and has only himself as the reference point of information (personal level).
The reassuring effect of the information was less marked in the scenarios, but still present, although not statistically significant, in the positive and ambivalent scenarios. In the negative scenario it was irrelevant and fear probably prevailed, not only related to Hepatitis C, but also to the prognosis and the treatment process. This would explain why the propensity for control was statistically significant in the worst case scenario. The positive and ambivalent scenarios, however, suggested that there is a cure and probably lower the fear of the disease; on the ambivalent scenario we can hypothesize the stimulation of anger or resignation as the last emotion with which the person came into contact, when the information that passed was that the cure existed but was not available for economic reasons.
Compared to the research hypothesis, we would have expected that the scenarios would have played a greater role in stimulating the idea of undergoing diagnostic investigation to facilitate early diagnosis. In this case we hypothesize that the third person scenario had a reassuring or defensive role for the participant, since a change of perspective probably occurs by moving from a subjective self-referencing point of view to an external hetero referent point of view. In this interpretative framework the scenario would have activated a shift from a personal level of “me and the disease” to an impersonal level of “the Other and the disease” (39).
When the Other is of the same sex the effect of identification produces a greater propensity for statistically significant diagnostic screening in the negative scenario condition. We can therefore hypothesize that in this case, with the prevalence of the activation of fear, when the Other is perceived as “similar to me”, the danger however concerns me (it can be associated to my gender) and for this reason a greater propensity to the diagnostic test is activated.
The results of the study showed that, at least in the juvenile population, even if the level of awareness of the disease is medium-high, the propensity for diagnostic control is positively associated with the use of a negative scenario, which leverages fear as a motivating emotion (40).
The low propensity for screening can, however, be read positively as the effectiveness of both information campaigns and security protocols implemented over the past decades. Considering that the sample was sufficiently well informed (91% with medium-high knowledge) and a third had already undergone a test for Hepatitis C, providing correct scientific information, despite resulting in a lower propensity for screening, this can be interpreted not as an irresponsible gesture, but as a conscious identification of risk situations, choosing to undergo screening only in the necessary situations.