The Use of Narrative in Science and Health Communication: A Scoping Review

Design for Dissemination: Leaders Suggest Local Strategies for Implementing a Health Communications Campaign

PurposeUsing evidence-based health communication campaigns (EBHCC) is critical for addressing disparities in tobacco-related health outcomes among LGBTQ+ populations; therefore, this study aimed to examine processes and supports for community-based organizations (CBOs) to integrate evidence-based solutions into practice using a design-for-dissemination framework.ApproachQualitative interviews were conducted.SettingCBOs serving LGBTQ+ populations.Participants22 staff from U.S.-based CBOs participated in video interviews.MethodWe used reflexive thematic analysis to generate themes.Results3 key themes included: (1) leaders perceived storytelling as a desirable and effective way to operationalize hyperlocal adaptation of content, particularly when in-group stories came from the community and included video content (which was perceived to maximize reach); (2) researcher participation in content production/delivery was seen as a compelling implementation strategy; and (3) these requested components were seen as adding value rather than as substitutions for text- and image-based EBHCC content.Adaptations envisioned by participants are associated with increased demand for limited resources (ie, requiring more time or financial resources), on the part of CBOs, the research team, or both. Researcher strategies were identified to support meeting CBOs' needs given these contextual constraints.ConclusionThis research explores supports and processes requested by CBOs serving LGBTQ+ populations as part of the adaptations envisioned in implementing EBHCCs and highlights possible avenues to better meet CBOs' needs in effectively utilizing interventions.

Insights Into the Efficiency and Health Impacts of Emerging Microplastic Bioremediation Approaches

The pollution caused by microplastics (MPs) is a global environmental and health concern. These plastic particles disrupt food chains and pose health risks to organisms, including humans. From a total of 827 studies, synthetic textiles (35%) and tires (28%) are the primary sources of MPs, with fibers being the most common shape (60%). MPs were detected in feces (44% of studies), lungs (35%), and blood (17%), indicating widespread contamination and potential health impacts. Bioremediation is a promising and sustainable method for mitigating MP pollution, as it uses microorganisms and plants to break down or convert MPs into less hazardous substances. However, it is important to understand and address the potential unintended consequences of bioremediation methods on the environment and human health. This scoping literature review examines the efficiency of currently emerging approaches for microplastic bioremediation, their strengths and weaknesses, and their potential impacts on the environment and human health. Highly effective methods such as mycoremediation, soil microbes for enhanced biodegradation, and phytoextraction were identified, but they pose high toxicity risks. Moderately effective methods include plant-assisted remediation, rhizosphere degradation, phytodegradation, and biodegradation, with effectiveness rates between 50% and 65% and moderate toxicity risks.

Strategies to correct vaccine misinformation on social media for pregnant women and the impact of vaccine skepticism

Health-related misinformation on social media may affect vaccination behavior, particularly among (soon-to-be) mothers. Research suggested different strategies to correct misinformation, but it is unclear which strategies work best for what group and in what situation. Addressing the call for more emotion-based debunking strategies, this study examined how text genre (narrative vs. expository) and harm presence (with vs. without harm-stressing messages) interact to affect emotional responses, and debunking efficacy in corrective texts about vaccination and reproductive health, specifically targeting pregnant or planning-to-be pregnant women (N = 432) with varying levels of vaccine skepticism. We further assessed social media engagement, and information-seeking intentions. In particular, harm presence was tested as a moderator in the relationship between text genre and emotional responses, which in turn, mediate outcomes such as engagement with corrective texts and further information-seeking intentions on social media. Results from an online experimental survey showed that, in general, corrective texts about COVID-19 vaccine misinformation were more effective in reducing misconceptions compared to control texts. For women not skeptical towards vaccination, narratives with harm-stressing messages (vs. no harm) induced most negative emotions, reducing debunking efficacy, social media engagement, and information-seeking intention. For women skeptical towards vaccination, narratives (vs. expository) elicited stronger negative emotions, irrespective of harm-stressing messages, leading to decreased debunking efficacy, social media engagement, and the intention to seek information. This study illuminates the importance of tailoring vaccination corrective texts for different vaccine skepticism groups, avoiding one-size-fits-all strategies and being mindful of strong negative emotions and their counter-persuasive impact.

Findings from a qualitative analysis: Social media influencers of color as trusted messengers of HPV vaccination messages

BACKGROUND

Despite HPV vaccination reducing the prevalence of cervical cancer by 90%, vaccination rates remain lower among communities of color due to vaccine hesitancy and mistrust in traditional public health messengers. The emergence of social media influencers, a newer kind of messenger, presents a unique opportunity to share immunization messages in new ways with a variety of communities. This paper reviews the qualitative findings from a study aimed at assessing influencers' perceptions of and approaches to sharing messaging about the HPV vaccine.

METHODS

Guided by several theories (Theory of Planned Behavior, Narrative Theory, and Opinion Leader Theory), the study team designed an intervention-based study consisting of qualitative interviews and social media influencer-designed and disseminated messaging. We worked closely with an influencer marketing firm to recruit 10 influencers of color who had children aged 9-14 - to write about the vaccine with their followers. Influencers used a provided factsheet to draft social media posts about vaccinating their children against HPV. Influencers were interviewed about their post and posts and interview transcripts were analyzed for key themes.

RESULTS

Most influencers were hesitant to talk about vaccinations for fear of backlash. Most committed to writing, however, because they were compelled to support important health topics. All used the power of storytelling to convey the messages and highlighted their personal journeys of vaccine decision making. Influencers also highlighted the struggles of parenting and talked emotionally about how making decisions about this vaccine prompted feelings about their child growing up. Influencers also believed that they could help people make the decision to vaccinate.

CONCLUSIONS

The findings from this study elucidates the emotional context within which parents are being asked to vaccinate their children and thus, how personal the decision to vaccinate is. Most influencers noted that they had received a doctor's recommendation but were taking the time to do their own research. Insights from this study can help inform current and future public health communication programs aimed at supporting immunization efforts. It also can provide lessons for other health topics.

What does it mean? Translating anatomical language to engage public audiences

The language of anatomy, with its roots in Ancient Greek and Roman languages, is complex and unfamiliar to many. Its complexity creates a significant barrier to public knowledge and understanding of anatomy-many members of the public find themselves asking "what does it mean?", and this can manifest as poor health literacy and outcomes. To address this, anatomists who interact with the public should be able to translate anatomical language and support the development of individuals' foundational understanding of why structures are named the way they are. In this review, language is categorized by themes that inform the naming of anatomical structures, such as function, location, and appearance, and paired with pedagogical approaches informed by education and public engagement research to underpin effective communication that demystifies the language of anatomy for public audiences. Drawing on pre-existing sometimes unrelated knowledge, gamification and quizzes can make language more accessible and recognizable. Humorous etymological insights into the origins of anatomical terms can build rapport between anatomist and public audience and normalize discussions about sensitive topics, such as genitalia, in an inclusive manner. Finally, eponyms, while contentious due to their lack of diversity and ethical concerns, can serve as narrative subjects to start discussions that address anatomy's relevance to wider socio-political and bioethical discourse. Ultimately, by deploying established science communication tools when translating anatomical language, anatomists can deliver effective public engagement that cultivates ongoing curiosity in anatomy, its language, and more broadly health.

Systematic optimization and evaluation of a Dutch sexual health intervention: Role model stories for chlamydia prevention, testing, and treatment

Background

The rapidly evolving nature of eHealth necessitates regular optimization and subsequent evaluation. Within the Dutch sexual health intervention Sense.info, we utilized a mixed-methods cyclic evaluation process to assess and optimize the potential impact of the chlamydia page. This paper reports on the page's optimization through the development of role model stories for chlamydia prevention and the subsequent evaluation of these stories.

Method

The experiences of 10 young individuals served as the basis of role model stories using the behavior change principle modeling based on social cognitive theory. These stories aimed to motivate young individuals to undergo sexually transmitted infection testing, use condoms, and notify sexual partners. Once the stories were posted online, we tracked use data between July and September 2022 and investigated end-user perspectives through a think-aloud study combined with semistructured interviews (N = 20, M age = 19.7, SDage = 2.65). Template analyses were used for the analysis of the think-aloud study.

Results

Use data revealed that all stories were accessed by website visitors, yet other page elements on the chlamydia page interacted with more. The exploration of end-user perspectives indicated a positive impact of the personal stories on normalization, self-efficacy, and skills related to chlamydia preventive behaviors. Mixed results were found regarding some conditions for the effectiveness of the behavior change principle modeling.

Discussion and conclusion

This study provided valuable insights into the cyclic evaluation process for evaluating and optimizing web-based public health interventions, as well as the potential impact of role model stories on sexual health prevention. Also, aspects of the stories that could be optimized in future optimization rounds were identified. Overall, this research contributes to enhancing the impact of eHealth interventions through iterative evaluation and optimization processes.

Effect of an integrated narrative program (INP) on quality of life among patients with non-small cell lung cancer (NSCLC): An experimental trial

PURPOSE

To investigate the effectiveness of an integrated narrative program (INP) in enhancing the resilience, self-efficacy and quality of life of postoperative NSCLC patients.

METHODS

135 patients participated in this trial. 45 participants were recruited into the integrated narrative program group and received both the digital storytelling intervention and narrative therapy after a randomized controlled trial, while the control group (n = 45) received routine care and the intervention group (n = 45) underwent the digital storytelling intervention (DST). Questionnaires were administered to assess resilience, self-efficacy and quality of life at baseline (T0) (within 3 days before surgery), immediately after intervention (T1), one month post-intervention (T2), and three months post-intervention (T3). A linear mixed effects model was conducted via the intention-to-treat analysis.

RESULTS

During follow-up assessments, the INP group exhibited significantly greater increase in resilience, self-efficacy, and quality of life (all P < 0.001) compared to both DST group and control group, which were consistent with the sensitivity analysis results (all P < 0.001).

CONCLUSION

The INP was more effective than DST in improving the resilience, self-efficacy, and quality of life of postoperative NSCLC patients, and these benefits could persist for at least three months post-intervention. Due to the fact that the INP process is relatively complicated, so we recommend the use of web-based platforms for INP interventions in future clinical work.

The Impact of Health Communication Research on Medical and Health Professional Education and Training

In this essay, we review how health communication scholarship has been translated into various communication skills trainings (CSTs), we present four case studies of how health communication research informed the development and implementation of specific CSTs, and we reflect on how we can productively define "impact" in looking back as well as looking forward within this line of research.

Substance use as subtext to health narratives: Identifying opportunities for improving care from community member perspectives

OBJECTIVE

To analyze patient and caregiver narratives addressing experiences related to substance use and substance use disorder (SUD).

METHODS

Thirty audio-narratives from the MyPaTH Story Booth archive addressed substance use between 5/20/2016 and 2/24/21. Two coders established an average Cohen's kappa statistics of 0.81 over 16 stories. The primary coder coded and summarized additional narratives and conducted content and thematic analyses. The final analytic sample addressed perspectives of individuals with SUD, caregivers for individuals with SUD and individuals who have used opioids to manage pain.

RESULTS

Storytellers' average age was 51, 55 % were female and 85 % were white. Participants with SUD and caregivers described frustration with the current treatment system, reported limited treatment of SUD in medical settings, and noted relying on community-based groups for ongoing care. Individuals with chronic pain felt stigmatized and resented perceived restrictions on pain treatment due to the opioid epidemic.

CONCLUSIONS

Unstructured narratives provide insights into the lived experiences of people impacted by SUD. Participants reported struggling with the effects of SUD and failing to find adequate treatment from the medical system. Stories highlight SUD-related stigma.

PRACTICE IMPLICATIONS

Understanding patient and caregiver perspectives related to SUD can be a critical step towards developing effective interventions.

A mobile telehealth program for behavioral treatment of urinary incontinence in women Veterans: Qualitative evaluation of MyHealtheBladder

Women Veterans constitute a distinctive cohort whose exposure to military service can contribute to development of bladder conditions, such as urinary incontinence (UI), as they age. Behavioral therapies are recommended as first-line treatment for incontinence, yet many VA Medical Centers do not have staff trained to administer them. The purpose of this research study was to conduct a qualitative program evaluation of MyHealtheBladder, a mobile telehealth version of an evidence-based eight-week behavioral treatment program designed for women Veterans with incontinence. MyHealtheBladder uses mobile telehealth technology to teach pelvic floor muscle exercises, bladder control strategies, fluid management, risk factor reduction, and self-monitoring. Eighteen women Veterans who completed a pilot study of MyHealtheBladder participated in semi-structured telephone interviews exploring their experience with the program. A directed content analysis was conducted of the transcribed interview data. Participants described ease of accessing MyHealtheBladder using smart phones and other mobile devices, emphasizing the flexibility of using the program at home, work, or while traveling. Most participants described program content as understandable, relevant, and easy to follow. They discussed how the program increased knowledge of UI, promoted consistency in practicing behavioral therapy, strengthened pelvic floor muscles, reduced urine leakage, and improved psychosocial wellbeing. Suggestions for improvement included more interaction with staff, more individualized tailoring of content to UI type, incorporating in-person clinic visits, and including supplementary material. Participants uniformly endorsed the program and recommended it for other women Veterans, as well as for those in active duty to prevent or treat UI earlier in the life course.

Navigating chronic uncertainty: a theory synthesis for nursing communication in life-limiting illness

BACKGROUND

Despite the proven benefits of early palliative care, patient communication regarding these services remains elusive. Therefore, this paper aims to (a) provide a focused literature review on nurse palliative care communication addressing chronic uncertainty in life-limiting illness (LLI), (b) define the Reconceptualization of Uncertainty in illness Theory and Problematic Integration Theory within a nursing Unitary Caring Science philosophical worldview and, (c) synthesize these theories and literature review into a unique theoretical framework for early palliative care communication in acute care nursing.

METHOD

Turner's theory synthesis methodology was combined with a PRISMA-style literature review. The literature search was conducted in July 2023 and updated in May 2024 using EBSCOhost, Pubmed, and PsychINFO databases. A second literature search was undertaken to identify applicable uncertainty theories in chronic or LLIs.

RESULTS

This theory synthesis highlights the interconnectedness of all facets of uncertainty for those living with severe LLI (personal factors, types of uncertainty, and the nursing communicatory process) and conceptualizes uncertainty communication as a series of events happening simultaneously, not simply a cause-and-effect process.

DISCUSSION

The framework resulting from this synthesis encourages nurses' holistic understanding of the complex nature of uncertainty in LLI, highlights the integral communicatory role nurses have in their patients' health and wellness, and promotes further nursing-specific communication research. Future research on enabling nurse-initiated early palliative care communication and narrative communication techniques will support patients' values and dignity throughout more than a single hospital stay but their entire disease trajectory.

Knowledge, attitudes, and intentions regarding COVID-19 vaccination in the general population and the effect of different framing messages for a brief video on intentions to get vaccinated among unvaccinated individuals in the United States during July 2021

OBJECTIVE

To identify knowledge, attitudes, and beliefs (KABs) associated with COVID-19 vaccination intentions and assess the impact of vaccine-promoting messages on vaccination intentions.

METHODS

Our nationally representative survey measured KABs of COVID-19 vaccination and incorporated a randomized experiment to assess the impact of different framing messages for a video encouraging vaccination intentions among unvaccinated adults in the US. Multivariable multinomial logistic regression models were fitted to investigate the relationships of KABs, trust in public health authorities (PHAs), and vaccine confidence with vaccination intentions. Difference-in-difference estimation was conducted to assess the impact of framing messages for a video on unvaccinated individuals' vaccination intentions.

RESULTS

We observed that people with increasingly favorable vaccine KABs, trust in PHAs, and vaccine confidence were more likely to be vaccinated or intend to get vaccinated against COVID-19. Difference-in-difference estimates indicated a positive impact of exposure to the video on vaccination intentions while framing messages in some cases appeared to lower vaccination intentions. Associations between the video and vaccination intentions were more pronounced among Black/African American and Hispanic/Latinx populations and Democrats; however, associations did not vary by trust in PHAs or vaccine confidence.

CONCLUSION

Videos that encourage people to get vaccinated may provide an efficient approach to nudge vaccine-hesitant individuals towards getting vaccinated. However, framing messages may negatively impact vaccination intentions and need to be developed carefully.

PRACTICE IMPLICATIONS

This study provides solid experimental evidence for the importance of tailoring message framing to the characteristics and experience of the audience, while cautioning potential negative impacts of framing that does not match its intended audience. Our findings are applicable to health communication strategies on the population level, such as mass media campaigns, and the use of framing for messages to encourage vaccination but may also be informative for healthcare professionals consulting hesitant individuals about COVID-19 vaccinations.

Interactive Narrative-Based Digital Health Interventions for Vaccine Communication: Protocol for a Scoping Review

BACKGROUND

Interactive narrative-based digital health interventions hold promise for effectively addressing the complex determinants of vaccine hesitancy and promoting effective communication across a wide range of settings and vaccine types. Synthesizing evidence related to the implementation and evaluation of these interventions could offer valuable perspectives for shaping future strategies in vaccine communication. Prior systematic and scoping reviews have examined narrative-based vaccine communication interventions but not the inclusion of interactivity in such interventions.

OBJECTIVE

The overall objective of the scoping review is to summarize the evidence on the use of interactive narrative-based digital health interventions for vaccine communication. Specific research questions focus on describing the use of interactive narrative-based digital health interventions (RQ1), describing evaluations of the impact of interactive narrative-based digital health interventions on promoting vaccine uptake (RQ2), and factors associated with their implementation (RQ3).

METHODS

A detailed search string will be used to search the following databases for records that are relevant to the review questions: PubMed, Embase, Scopus, Web of Science, CINAHL, and PsycINFO. Two reviewers will independently screen the titles and abstracts of identified records against the predefined eligibility criteria. Subsequently, eligible records will undergo comprehensive full-text screening by 2 independent reviewers to assess their relevance to review questions. A data charting tool will be developed and used to extract relevant information from the included articles. The extracted information will be analyzed following the review questions and presented as a narrative summary. Tabular or graphical representations will be used to display review findings, as relevant.

RESULTS

Public health informationists were consulted to develop the detailed search strategy. The final search string comprised terms related to narrative communication, digital health, and vaccines. The search string was customized to each proposed publication database and implemented on April 18, 2023. A total of 4474 unique records were identified using the search strategy and imported into the Covidence (Veritas Health Innovation Ltd) review management software for title and abstract screening. Title and abstract screening of identified records are ongoing as of December 29, 2023.

CONCLUSIONS

To our knowledge, this will be the first scoping review to investigate the features of interactive narrative-based digital health interventions and their role in vaccine communication. The goal of this study is to provide a comprehensive overview of the current research landscape and identify prevailing gaps in knowledge. The findings will provide insights for future research and development of novel applications of interactive narrative-based digital health vaccine communication interventions.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51137.

Parents' Use of Social Media for Health Information Before and After a Consultation With Health Care Professionals: Australian Cross-Sectional Study

Background

Social media is a crucial source of health information for many parents due to its integration into modern life, raising critical concerns for public health. Parents use various social media platforms to find health information for their children, with most information created and shared by parents with no medical or health training. The extent to which parents seek health information from social media before and after a consultation and their motivations for doing so remain underresearched.

Objective

This study aimed to investigate Australian parents' use of social media for health information for their children, aged between 6 months and 5 years, before and after consulting with health care professionals.

Methods

A representative cross-sectional survey of 1000 Australian parents with children aged 6 months to 5 years was conducted between November and December 2021. Data were cleaned and analyzed using IBM SPSS software. The primary outcomes were (1) parental motivation and prevalence of social media use for health information and (2) parental motivation for using social media before and after a consultation with their child's health care professional.

Results

Of the 1000 parents surveyed, 82.2% (n=822) reported using social media for health information for their child. Parents were more likely to consult social media before and after a health consultation if they were aged 30-39 or ≥50 years and born in Australia. Parents with higher levels of education were less likely to consult social media. Parents were motivated to seek health information before a consultation for a variety of reasons, including exchanging opinions and experiences (639/767, 83.3%), having information that is available 24/7 (622/767, 81.1%), receiving emotional support (599/767, 78.1%), having previous positive experiences (597/767, 77.8%), and having friends and family that use social media for health information (577/767, 75.2%). Parents sought information after a consultation to connect with parents with similar experiences (546/794, 68.8%), seek a second opinion (505/794, 63.6%), fact-check information provided by their health care professional (483/794, 60.8%), and look for other treatment options (353/794, 44.5%).

Conclusions

Using social media for child health information is part of the modern parenting experience. It can be challenging to discern the quality of health information on social media, leaving parents open to incorrect information and misinformation. Although access to immediate social support is a welcomed feature of social media, receiving incorrect health information can have unwanted consequences for the child, family, health provider, and wider community. The upskilling of parental health literacy to navigate the unique health literacy challenges that social media brings, alongside the creation and delivery of accessible, evidence-based information in varying formats, is urgently required. The provision of this information is the responsibility of every level of the health system, not just the treating health care professional.

Evaluation of online videos to engage viewers and support decision-making for COVID-19 vaccination: how narratives and race/ethnicity enhance viewer experiences

Background

Vaccine hesitancy has hampered the control of COVID-19 and other vaccine-preventable diseases.

Methods

We conducted a national internet-based, quasi-experimental study to evaluate COVID-19 vaccine informational videos. Participants received an informational animated video paired with the randomized assignment of (1) a credible source (differing race/ethnicity) and (2) sequencing of a personal narrative before or after the video addressing their primary vaccine concern. We examined viewing time and asked video evaluation questions to those who viewed the full video.

Results

Among 14,235 participants, 2,422 (17.0%) viewed the full video. Those who viewed a personal story first (concern video second) were 10 times more likely to view the full video (p < 0.01). Respondent-provider race/ethnicity congruence was associated with increased odds of viewing the full video (aOR: 1.89, p < 0.01). Most viewers rated the informational video(s) to be helpful, easy to understand, trustworthy, and likely to impact others' vaccine decisions, with differences by demographics and also vaccine intentions and concerns.

Conclusion

Using peer-delivered, personal narrative, and/or racially congruent credible sources to introduce and deliver vaccine safety information may improve the openness of vaccine message recipients to messages and engagement.

Framing harm reduction as part of an integrated approach to reduce drug overdose: A randomized message testing experiment in a nationally representative sample of U.S. adults, 2022

OBJECTIVES

Low public support impedes widespread adoption of harm reduction services in the U.S. There are growing efforts to implement integrated programs offering harm reduction services alongside other services for people who use drugs. We tested how messages depicting integrated programs influence audience attitudes about harm reduction.

METHODS

A nine-group randomized experiment (N=3,181) embedded in a national survey of U.S. adults tested how factual and narrative messages describing programs integrating harm reduction, addiction treatment, and/or other services to reduce overdose influenced respondents' attitudes about harm reduction, relative to a comparison message defining harm reduction. The survey was fielded from September 16^th to September28th, 2022 using the NORC Amerispeak probability-based online survey panel. The survey response rate was 74%. Measures included perceived effectiveness of standalone and integrated harm reduction programs, willingness to have a harm reduction program in the neighborhood or person using harm reduction services as a neighbor, and support for increasing government spending on harm reduction services.

RESULTS

54.4% of respondents viewing the comparison message defining harm reduction reported that an integrated approach including harm reduction, addiction treatment, and other services is effective at reducing overdose, compared to 63.6%-69.1% of respondents viewing messages describing integrated programs (p<0.05). Messages depicting either standalone harm reduction or integrated programs lowered respondents' willingness to have a harm reduction program in their neighborhood, particularly when the messages depicted a Black person, versus a White person, benefiting from harm reduction.

CONCLUSIONS

Messages depicting programs offering integrated services including but not limited to harm reduction may heighten audience endorsement of the effectiveness of such an approach but lower willingness to have a harm reduction program in the neighborhood.