Using Comics to Communicate About Health: An Introduction to the Symposium on Visual Narratives and Graphic Medicine

Health communication practitioners and researchers benefit from investigating novel methods for conveying information to a variety of relevant audiences (i.e., the public, health care professionals). Research has demonstrated the utility of using narratives to communicate about health (see, e.g., Green, 2006; Hinyard & Kreuter, 2007) and that using visual messaging elements (i.e., photos, illustrations, graphical displays) can be beneficial in communicating complex information (see, e.g., Houts, Doak, Doak, & Loscalzo, 2006). Allied fields, like medical education and public health, have started to pursue more systematic investigation of the intersection of narratives and visualization to communicate about health. The term “graphic medicine” (see Czerwiec et al., 2015; Green, 2010; Williams, 2012) has been coined by a collective of interested researchers, clinicians, and artists to capture this new subfield of research and practice.

The visual narratives most relevant to the study of graphic medicine are comics in their many forms. While explaining how people process comics or differentiating exactly what constitutes a visual narrative, comic, or graphic novel is beyond the scope of this symposium introduction,¹ graphic medicine examines the use of sequential (but not always narratively linear) visual storytelling to share health-related experiences and information.² Czerwiec and colleagues (2015) define graphic medicine as “the intersection of the medium of comics and the discourse of health … [combining] the principles of narrative medicine with an exploration of the visual systems of comic art, interrogating the representation of physical and emotional signs and symptoms within the medium” (p. 1).

While the practice and study of graphic medicine has been occurring for well over a decade—considerably longer if one retroactively categorizes comics and illustrations about health, wellness, and medicine as “graphic medicine”—research supporting its utility and effectiveness as a communicative tool or as a creative intervention itself is still developing. This symposium aims to add to that growing scholarly literature surrounding graphic medicine by providing a starting point for health communication researchers and scholars to consider the utility of such visual narratives within existing frameworks and paradigms. The symposium features four articles that offer an overview and a starting point for sorting out ways for health communication to contribute to the broad area of work called graphic medicine.

Research on Graphic Medicine and Health-Related Comics and Visual Narratives

Public health educators have used comics to communicate information to people for many years, to convey information about skin cancer (Putnam & Yanagisako, 1982), HIV/AIDS (Gillies, Stork, & Bretman, 1990), mental health (New York State Department of Mental Hygiene, 1950), the dangers of smoking (American Cancer Society, 1965; Marvel Comics & American Cancer Society, 1982), and other public health topics or matters of the public good (see, e.g., Graham, 2011). Additionally, popular comics occasionally feature storylines where some type of health concern (i.e., cancer) is central to a storyline and the stories often communicate the complexities of chronic illness (see Rhode & Conner, 2012 for a review). Overall, relevant public health and medical research typically examines the utility of comics to communicate (a) specific information to audiences (Farthing & Priego, 2016; Grootens-Wiegers, De Vries, Van Beusekom, van Dijck, & van den Broek, 2015; Leung, Tripicchio, Agarnonov, & Hou, 2014; Muzumdar & Nania, 2015) and (b) experiences of individuals relevant to specific health contexts (Lo-Fo-Wong, Beijaerts, de Haes, & Sprangers, 2014). Additional research examines how the creation of comics and visual narratives helps to make sense of and communicate about health-related experiences as a patient, caretaker, or medical professional (i.e., Czerwiec & Huang, 2014; Green, 2013, 2015; Kennedy, Rogers, Blickem, Daker-White, & Bowen, 2014).

Readers interested in more comprehensive reviews of relevant research can seek out additional resources (i.e., Czerwiec et al., 2015; Dobbins, 2016; Jee & Anggoro, 2012; Williams, 2012). For some examples of graphic medicine content appearing in academic journals, I would suggest readers consider reading “Annals of Graphic Medicine” found within Annals of Internal Medicine (see http://www.annals.org/GraphicMedicine). The four articles featured in this symposium offer contributions to the burgeoning research on graphic medicine just noted, with a particular interest in also contributing to the health communication literature.

Symposium Overview

The first article, by Melinda Krakow, offers a historical perspective on a comic created by the American Cancer Society to provide information to women in the 1960s about the Pap test for cervical cancer prevention and detection. Krakow proves a theory-driven analysis of the comic titled “Ladies … Wouldn’t It Be Better to Know?” that considers the visual narrative strategies used, as well as key behavioral constructs of interest within the pamphlet.

The second article, written by Aaron Hanson, Amy Drendel, Gary Ashwal, and Alex Thomas, reports on the feasibility of using a comic to communicate information about at-home pain experiences to children and their caregivers in an emergency medicine setting. Results support the utility of the comic in such settings, findings that offer additional evidence to support past work on the use of illustrations for communicating after-care information (e.g., Delp & Jones, 1996).

The third article, by May May Leung, Melanie Green, Deborah Tate, Jianwen Cai, Katarzyna Wyka, and Alice Ammerman, reports on a study of a manga comic promoting health eating choices among middle-school students. This work complements previous work by Leung and her colleagues (Leung et al., 2014) on the utility of manga comics for communicating health information to children. The study found that the comic used influenced outcome expectations and transportation in ways that could inform the future design and dissemination of similar health messages in the future.

The fourth and final article, written by Laurel Hourani, Shari Lambert, Russ Peeler, Becky Lane, and Carrie Borst, describes formative research for graphic novels created to mitigate stress among members of the military. More specifically, the article describes how the researchers worked with various stakeholders to create two well-known graphic novels: The Docs and Forward.

Acknowledgments

In closing, I want to thank Teri Thompson for her support of this symposium to appear in Health Communication. Similarly, thank you to those that reviewed for the symposium and to all the researchers, practitioners, and artists who submitted ideas and articles for consideration. The articles included in this symposium offer an entry point for health communicators to consider how visual narratives and sequential graphic storytelling could be useful to present health information to diverse audiences in novel ways.

Notes

¹ Interested readers, see Chute (2008), Cohn (2013), Eisner (2008), McCloud (1993), and Wolk (2007) for an overview of processing, criticism, and definitions of visual narratives, sequential stories, comics, and so on.

² Most research on comics and visual narratives focuses on static visual images in print or online form, but some visually oriented narrative work uses dynamic comics-type approaches (e.g., a motion comic produced by the Centers for Disease Control and Prevention about communicating sexually transmitted disease information to young people between the ages of 15 and 24 years: see Willis et al., 2013).