Digital storytelling in healthcare

Digital Storytelling in Healthcare

Rieger et al. (2018) refer to digital storytelling as an arts based method. They suggest it has the potential for greater user engagement from a wider variety of audience due to the ability to elicit nuanced meaning (Boydell et al., 2012). They draw on Groff’s (2013) research of cognitive processing with three distinct phases: visual-object, like static images; visual-spatial, like moving images; and verbal/language based processing. Groff argues that non-verbal processing has become more dominant than verbal due to the advent of social media and other digital forms of communication, meaning that teaching and learning must make better use of these visual forms of processing. According to Rieger et al. (2018) digital storytelling combines all three of these processing skills. They cite uses of it in mental health (De Vecchi et al., 2016), public health (Lenette and Boddy, 2016) and oncology (Cueva et al., 2016; Akard et al., 2015), as well as in the training of nurses (Christiansen, 2011) and medical doctors (Sandars and Murray, 2009).

Rieger et al. (2018) highlight the benefits of digital storytelling in qualitative health research that fits in well with the drive for holistic, person centred care models of care in health these days, compared to the old biomedical model of disease. Lambart (2013) discusses the “mediation of a profound symbolic exploration of the affective and embodied aspects of healthcare experiences” in a book on digital storytelling that focusses on the creation of community. Gubrium (2009), Cunsolo-Wilcox, Harper and Edge (2013), and Wexler, Eglinton and Gubrium (2014) all describe the potential of digital storytelling to foster greater community cohesion and discussion. It has also been used in medical education to improve critical reflection of medical students (Rieger and Schutlz, 2014).

Drawbacks of digital storytelling can be a challenge for confidentiality and ethics, for example the sharing of photographs, personal stories and other personal information may cross safeguarding boundaries or cause offence/upset to some people. Devechhi et al. (2017) explored this and found a lack of framework for institutional ethics boards to use in assessing digital storytelling content for potential negative consequences. Storycenter (2016) have proposed ethical guidelines, but Rieger et al. (2018) point out these are not based on systematic review evidence. Based on Beauchamp and Childress’s (Holm, 2001) principle of autonomy, if a participant chooses/wants their story to be told, who has the right to withdraw their story? This has to weighed against the benefits or that person and others in telling/hearing that story, opposed to the consequences (possible maleficence) of that story for some people viewing it.

Evaluating Digital Storytelling

Moreau et al. (2018) conducted a review of the pedagogy of digital storytelling in health education, using the New World Kirkpatrick Model (Kirkpatrick Partners, 2021) to evaluate success. The Kirkpatrick Model focusses on four levels of evaluation: Level 1 is the “Reaction” of the students to the learning and applicability to their jobs; Level 2 is the “learning”, how much knowledge and skills did the students gain; Level 3 is the “behaviour”, how much do students apply their new training in the real world; Level 4 is the “Results”, how much can the outcomes of the learning be measured and what was the achievement level of these outcomes. Moreau et al. (2018) found 153 eligible articles and 42 that were relevant to healthcare education, however only 16 of these were suitable for data extraction based on the Kirkpatrick Model. They found that when patients and health professionals co-created digital storytelling the learning of health professionals was enhanced. When patient’s digital storytelling on its own was used, there was minimal impact on health professional learning. Only three of these studies looked at the context of continuing professional development (CPD), most were used with undergraduate medical education. It seems that digital storytelling was superior to hypothetical case studies in at least one study (Price et al., 2015), a similar benefit (although no comparator used) was found by Cueva et al. (2016) when looking at healthcare professionals combining traditional learning with personal digital storytelling about cancer.

Stacey and Hardy (2011) showed an improved transition to practice for newly qualified nurses with the use of digital storytelling, they suggest that the creation process itself enhanced the nurses’ reflective practice and emotional awareness, it also allowed them to see the stories of others and realise that their experiences/struggles were shared by their peers, making them easier to deal with. The use of co-creation of stories helped with inter-generational interactions between new medical students and caring for older adults, also reducing the signs of ageism (Hewson, Danbrook and Sieppert, 2015).

Our Context

Just over 30% of the studies in Moreau et al. (2018) focused on health professionals learning from listening to authentic patient digital stories. Whilst none of these looked at it from the perspective of dealing with prisoners, the wide variety of contexts used may suggest this method could work with digital storytelling from prisoners as well. However, only 1 (Fenton, 2014) of the 5 studies found a significant improvement in medical and nursing students’ knowledge of or empathy for the topic they were looking at, so maybe the effects of digital storytelling will not improve healthcare professionals empathy for prisoners. Bruno et al. (2012) was one of the four studies that found no significant improvement, they looked at underserved medical populations in the USA (which may include some former prisoners), over 85% of the medical students already had sympathetic views on healthcare for the underserved before the study, the authors point out this high baseline may have limited the ability of the study to detect an improvement. The students did report an improved desire to care for underserved populations in the future.

Considerations in course creation

Snelgrove, Tait and Tait (2016) found nurses valued the digital storytelling authenticity, but several students were unable to link the stories content to the psychological course outcomes. This may serve as a learning tool for educators to make the links between digital storytelling and learning outcomes more explicit. Three studies looked at training course for digital storytelling creation, these courses ranged from 3-5 days in length. Moreau et al. (2018) suggest that reflection activities, peer support and additional guided learning are key add ons to digital storytelling to improve learning outcome attainment.

References

Akard T, Dietrich M, Friedman D, Hinds P, Given B, Wray S, Gilmer M. (2015) Digital storytelling: an innovative legacy-making intervention for children with cancer. Pediatr Blood Cancer. 2015;62:658–665. doi: 10.1002/pbc.25337.

Boydell KM, Gladstone BM, Volpe T, Allemang B, Stasiulis E. (2012) The production and dissemination of knowledge: a scoping review of arts-based health research. Forum Qualitative Sozialforschung/Forum: Qualitative Social Research; 2012; 13. . http://www.qualitative-research.net/index.php/fqs/article/download/1711/3329. (Accessed 26 May 2021).

Bruno R, Andrews A, Garvey B, Huntoon K, Mazumder R, Olson J, et al. Videotaped patient stories: impact on medical students' attitudes regarding healthcare for the uninsured and underinsured. PLoS One. 2012;7:e51827.

Christiansen A. (2011) Storytelling and professional learning: a phenomenographic study of students’ experience of patient digital stories in nurse education. Nurse Educ Today. 2011;31:289–293. doi: 10.1016/j.nedt.2010.10.006.

Cueva M, Kuhnley R, Revels L, Schoenberg N, Lanier E, Dignan A. (2016) Engaging elements of cancer-related digital stories in Alaska. J Cancer Educ. 2016;31:500–505. doi: 10.1007/s13187-015-0826-z.

Cunsolo Willox A, Harper SL, Edge VL, (2013) Storytelling in a digital age: digital storytelling as an emerging narrative method for preserving and promoting indigenous oral wisdom. Qual Res. 2013;13:127–147. doi: 10.1177/1468794112446105.

De Vecchi N, Kenny A, Dickson-Swift V, Kidd S, (2016) How digital storytelling is used in mental health: A scoping review. Int J Ment Health Nurs. 2016 Jun; 25(3):183-93.

DeVecchi, N., Kenny, A., Kidd, S. Dickson- Swift, V, (2017) Exploring the process of digital storytelling in mental health research: a process evaluation of consumer and clinician experiences. International Journal of Qualitative Methods. 2017;16:1–13.

Groff JS. (2013) Expanding our “frames” of mind for education and the arts. Harv Educ Rev. 2013;83:15–39. doi: 10.17763/haer.83.1.kk34802147665819.

Gomez-Sanchez E, Bote-Lorenzo ML, Abellan IMJ, Vega-gorgojo G, (2009) Conceptual framework for design, technological support and evaluation of collaborative learning. Accessed online at: (PDF) Conceptual framework for design, technological support and evaluation of collaborative learning (researchgate.net) (Accessed 17/5/2021).

Gubrium A, (2009) Digital storytelling: an emergent method for health promotion research and practice. Health Promot Pract. 2009;10:186–191. doi: 10.1177/1524839909332600.

Hewson J, Danbrook C, Sieppert J. Engaging post-secondary students and older adults in an intergenerational digital storytelling course. Comtemp Issues Educ Res. 2015;8:135–42.

Holm S, (2001) Principles of Biomedical Ethics 5^th Edition. Journal of Biomedical Ethics, Volume 28, Issue 5.

Kay, J., Maisonneuve, N., Yacef, K. and Reimann, P. (2006) ‘The big five and visualisations of team work activity’ in Intelligent Tutoring Systems, Berlin/Heidelberg, Springer, pp. 197–206.

Kirkpatrick Partners, (2021) The New World Kirkpatrick Model. Accessed online at: The New World Kirkpatrick Model (kirkpatrickpartners.com) (Accessed 26 May 2021).

Klopfer E, Perry J, Squire K, Jan MF, (2005) Collaborative learning through augmented reality role playing. Accessed online at: (PDF) Collaborative learning through augmented reality role playing (researchgate.net) (Accessed 17/5/2021).

Lambart J, (2013) Digital storytelling: Capturing lives, creating community 4th ed. New York: Routledge Taylor & Francis Group; 2013.

Lenette C, Boddy J. (2013) Visual ethnography and refugee women: nuanced understandings of lived experiences. Qual Res J. 2013;13:72–89. doi: 10.1108/14439881311314621.

Moreau KA, Eady K, Horsley T, Pound C, Sampson M, (2016)The impact of digital storytelling on patients and health professionals: a systematic review. PROSPERO 2016:CRD42016050271. http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016050271. (Accessed 26 May 2021).

Moreau KA, Eady K, Sikora L, Horsley T, (2018) Digital storytelling in health professions education: A systematic review, BMC Medical Education 18; 208.

Price DM, Strodtman L, Brough E, Lonn S, Luo A, (2015) Digital storytelling: an innovative technological approach to nursing education. Nurse Educ. 2015;40:66–70.

Rieger KL, Schultz AH. (2014) Exploring arts-based knowledge translation: sharing research findings through performing the patterns, rehearsing the results, staging the synthesis. Worldviews Evid-Based Nurs. 2014;11(2):133–139. doi: 10.1111/wvn.12031.

Rieger KL, West CH, Kenny A, Chooniedass R, Demczuk L, Mitchell KM, Chateau J, Scott SD, (2018) Digital storytelling as a method in health research: a systematic review protocol. Systematic Reviews 2018; 7:41.

Salas, E., Sims, D. and Burke, C. (2005) ‘Is there a “Big Five” in teamwork?’, Small Group Research, vol. 36, no. 5, pp. 555–99.

Sandars J, Murray C. (2009) Digital storytelling for reflection in undergraduate medical education: a pilot study. Education for Primary Care. 2009;20:441–444. doi: 10.1080/14739879.2009.11493832.

Snelgrove S, Tait DJR, Tait M. Teaching psychology to student nurses: the use of ‘talking head’ videos. Res Learn Tech. 2016;24:30891.

Stacey G, Hardy P. Challenging the shock of reality through digital storytelling. Nurse Educ Pract. 2011;11:159–64.

Storycenter, (2016) Ethical practice. Berkeley, CA 2016. https://static1.squarespace.com/static/55368c08e4b0d419e1c011f7/t/579134a05016e13dde264720/1469133984611/Ethics.pdf. (Accessed 26 May 2021).

Wexler L, Eglinton K, Gubrium A, (2014) Using digital stories to understand the lives of Alaska Native young people. Youth & Society. 2014;46:478–504. doi: 10.1177/0044118X12441613.