Health workers, artists partner to deliver messages via comics: Tools can influence health behavior
Public health advocates are banking on an old form of communication to get health information to patients in new ways. Health providers are using comics to educate patients on everything from asthma and diabetes to sexually transmitted infections.
Public health and comics have long worked together — World War II posters and pamphlets used illustrations to warn soldiers about venereal disease — but in the modern age, health professionals and artists are working to bring new life to the medium on two fronts: comics as educational tools for public health, and first-person narratives sharing the patient experience. Sometimes, those aspects overlap in a single comic.
“Comics is a rather anarchic medical medium,” said Ian Williams, MD, MA, a Brighton, United Kingdom-based physician and comics artist and writer who founded Graphic Medicine, a website and annual conference celebrating health and art.
A panel from “The Adventures of Iggy and the Inhalers,” an asthma comic from Booster Shot Comics. Public health workers are using comics to educate on a range of health issues.
Image courtesy Booster Shot Comics
“There’s been a huge democratization of health knowledge,” he told The Nation’s Health. “It’s the whole spreading of knowledge among non-experts. That side of it is much more exciting than the traditional side of, ‘I’m a doctor; I’m telling you what to do.’ I see that as a major function of the arts: It distills personal experience.”
Rather than giving patients pages of technical information about their health issues, comics, which can convey information with images and minimal wording, make information both easier to understand and more accessible, especially for people with low literacy levels. That includes people with low socioeconomic status and children — people at high risk for health disparities.
Alex Thomas, MD, a pediatrician and allergist at the University of Wisconsin, and Gary Ashwal, MA, an APHA member and creative strategist for health organizations, are the founders of Booster Shot Comics, a comic company that aims to educate and entertain health audiences. They said that comics have the potential to save lives. They created a comic book, “The Adventures of Iggy and the Inhalers,” to help teach children with asthma the differences between their inhalers, the triggers of asthma and what happens during an asthma attack.
The difference between a controller and a bronchodilator, or rescue inhaler, might seem too complex for an 8-year-old to grasp, but Thomas and Ashwal said that is not true. Kids can handle tough ideas: Adults just need to make ideas something kids will care about. For example, a person who asks a child about Pokémon will probably get a long lecture. So Thomas and Ashwal created anthropomorphized inhaler characters that kids can understand.
Broncho, a cowboy bronchodilator, embodies the rescue inhaler: He is fast and can lasso muscle bands to release them during an asthma attack, but he can only work for a short time. Coltron, a robot controller, is very strong and can keep airways open, but needs a long time to do so.
“Comics, I think, are very good at breaking down complex information, not just for kids but for adults as well,” Ashwal told The Nation’s Health. “It’s fun, relative to other health information that they’re getting, but it doesn’t need to be dumbed down the way we sometimes see it being dumbed down.”
Thomas and Ashwal have seen the results of their comic, which also comes with a short animated video and trading cards. When the Iggy and the Inhalers program was presented to children in June at the University of Wisconsin Hospital, Madison, Asthma Camp, attendees were quizzed about asthma before and after the one-day camp, and their scores improved markedly after reading the comics. Only 18 percent of attendees knew that a controller inhaler was not a rescue medication. After reading the comics, 68 percent got the correct answer.
A CDC motion comic educates young adults on HIV and other sexually transmitted infections. Testing shows the comic reduces stigma and increases protective behaviors, such as condom use.
Image courtesy CDC
Thomas and Ashwal will continue to evaluate their program this year. It will be tested in both inpatient and outpatient settings this fall.
Comics are not just kids’ stuff, however. The Centers for Disease Control and Prevention has created a motion comic that educates young adults on HIV and other sexually transmitted infections. The comics are aimed at people ages 15 to 24 to increase their health literacy and were created by a team of CDC researchers and Terminus Media artists.
In the most recent data — collected in 2011 — nearly half of all new STI diagnoses were among people between 15 and 24 years old. More than a quarter of all new HIV infections occurred among people ages 13 and 24 years old, as well.
“Lack of knowledge, low levels of health literacy, attitudes and incorrect beliefs all contribute to the high rates of STDs and HIV among youth,” the comics’ creators wrote in their description of the project for the Department of Health and Human Services Idea Lab, a contest that encourages innovation in health. “Our testing showed that among viewers, the motion comic decreased HIV stigma and increased intentions to engage in HIV/STD protective behaviors, e.g., condom use, abstinence and HIV/STD knowledge.”
The CDC comics are not limited to a three-panel strip: Motion comics include animation, sound effects, voiceovers and a musical score. They use technology to meet their audience where it is. In a pilot study, viewers who watched the motion comic showed increased knowledge about HIV, STIs and protective behaviors such as abstinence and condom use. The study also indicated a reduction in HIV stigma. The comic, called “There is Something I Need To Tell You,” has not yet made its public debut, but APHA member Leigh Willis, PhD, MPH, a behavioral scientist with CDC’s Epidemiology Branch, Division of HIV/AIDS Prevention, will be presenting on it at APHA’s 142nd Annual Meeting and Exposition, at session 5074 on Wednesday, Nov. 19.
Children enjoy health comics at a June asthma camp in Madison, Wisconsin, in June. Also pictured is Alex Thomas, a founder of Booster Shot Comics. An evaluation found that awareness of inhalers increased after children read the comic.
Photo courtesy Booster Shot Comics
“We chose this medium because comics are now a very popular and mainstream form of entertainment, particularly for young people,” said Willis, who headed up the team that created the motion comics. “Comics are part of the tradition of using the serial narrative format to deliver health messages — a format that allows for repeated exposure to these messages in (a) way that is also entertaining.”
Willis also told The Nation’s Health that using an entertainment medium to reach and engage young people with health messages makes sense, because young people are already so connected to technology and digital media.
Community health centers and hospitals are catching on to the trend and using comics to reach their patients. Connecticut Children’s Medical Center is using Super Safe Comics to promote public safety, and Graphic Medicine will publish a series through Penn State University Press.
Comics are effective in not only teaching health messages, but making them stick. A study by the Society for Nutrition Education and Behavior, published this year in the Journal of Nutrition Education and Behavior, showed that children who read manga, a Japanese style of comics, about healthy food were more likely to make better snack choices. Educational comics even go beyond the clinical setting.
“There are a lot of comic textbooks for microbiology, calculus,” Ashwal said. “Google put out a comic book explaining the backend workings of the Chrome browser.”
For more information, visit www.boostershotcomics.com andwww.graphicmedicine.org.
From maternal health to parasites, comics using illustrations to deliver messages
Health comics cover a range of topics. Among the offerings:
“It Takes A Village,” by Zoe Hopkins and Amancay Nahuelpan. The short story covers maternal child health in an aboriginal community.
“Parasites!” by Jamie Hall, Edward Ross and Rachel Morris. An eight-page comic, the creators cover both parasitic diseases in developing nations and the economics of researching and treating the diseases.
“Blue Pills: A Positive Love Story,” by Frederik Peeters. The graphic novel charts a relationship in which one person is HIV-positive.
“Monsters,” by Ken Dahl. Graphic Medicine called the book “the funniest book you’ll read about herpes this year.”
“Signature Wound: Rocking TBI,” by Gary Trudeau. The “Doonesbury” creator explores how a young veteran lives with traumatic brain injury after war.
“Walking the Dog,” by David Hughes. The protagonist in this graphic novel commits to being healthier as he takes care of a new pet.