A Building Block of Empathy: Establishing a Graphic Medicine Collection in an Academic Health Sciences Library.

To help address the well-being of the campus and contribute to empathy building amongst students pursuing careers as healthcare providers, an academic health sciences library built a graphic novel collection focused on comics that discuss medical conditions and health-related topics. The collection contains the experiences of patients, providers, and caregivers. The reader-friendly format of graphic novels provides an easy entry point for discussing empathy with health professions faculty and students. The collection has been used in the classroom during library instruction sessions, with the idea of integrating it within the curriculum.

Comics in the Time of a Pan(dem)ic: COVID-19, Graphic Medicine, and Metaphors.

Comics have always responded to pandemics/catastrophes, documenting the way we deal with such crises. Recently, graphic medicine, an interdisciplinary field of comics and medicine, has been curating comics, editorial cartoons, autobiographical cartoons, and social media posts under the heading "COVID-19 Comics" on their websites. These collected comics express what we propose to call covidity, a neologism that captures both individual and collective philosophical, material, and wide-ranging emotional responses to the COVID-19 pandemic. Treating such comics as the source material and drawing insights from theorists Ian Williams, Alan Bleakley, Susan Sontag, and others, this article examines graphic medicine's representation of the COVID-19 pandemic. The conceptual metaphors of war, anthropomorphism, and superheroism are used to represent and illustrate the lived experience of the pandemic, and the article investigates metaphor types, their utility, and motivational triggers for such representations. In doing so, the essay situates graphic medicine as a productive site that presents the pandemic's multifarious impact.

Comic book-based educational program on epilepsy for high-school students: Results from a pilot study in the Gran Chaco region, Bolivia.

INTRODUCTION: In low- and middle-income countries (LMIC), epilepsy still represents a significant health challenge. In the Bolivian Chaco, we have previously found high levels of stigma towards people with epilepsy (PWE) especially expressed by high school students. In order to increase the knowledge about epilepsy, we have tested a comic book-based intervention on a sample of high school students. METHODS: The study has been conducted in the Bolivian Chaco region where two urban and two rural classrooms have been randomly selected. Students have been administered a knowledge, attitudes, and practices (KAP) questionnaire, and then they underwent a comic book-based educational program where they were randomly assigned either to an autonomous reading or a character interpretation methodology. The same KAP questionnaire has been administered after the teaching session and at a three months follow-up. Mean KAP scores at the baseline were compared with the after teaching and the three-month assessment. RESULTS: Eighty-three students with a mean age of 15.5 ±â€¯0.9 years, of whom 38 (45.8%) males, were recruited. After the comic book session, students improved in the global score (p < 0.001) and in the knowledge (p < 0.001), attitudes (p = 0.004), and practices (p < 0.001) subscores. Both the autonomous reading and the character interpretation groups significantly improved in the global score, but only the latter improved in all the subscores. At the three months follow-up, there were no differences in the global, knowledge, and attitudes subscores, compared with scores immediately after the intervention. CONCLUSION: Using a comic book to teach about epilepsy led to a significant improvement in the knowledge, attitudes, and practices about the disease in high school students of LMIC. This teaching strategy can be easily implemented in LMIC.

Graphic illustration of impairment: science fiction, Transmetropolitan and the social model of disability.

The following paper examines the cyberpunk transhumanist graphic novel Transmetropolitan through the theoretical lens of disability studies to demonstrate how science fiction, and in particular this series, illustrate and can influence how we think about disability, impairment and difference. While Transmetropolitan is most often read as a scathing political and social satire about abuse of power and the danger of political apathy, the comic series also provides readers with representations of impairment and the source of disability as understood by the Social Model of Disability (SMD). Focusing on the setting and fictional world in which Transmetropolitan takes place, as well as key events and illustration styling, this paper demonstrates that the narrative in this work encompasses many of the same theoretical underpinnings and criticisms of society's ignorance of the cause of disability as the SMD does. This paper aims, by demonstrating how Transmetropolitan can be read as an allegory for the disabling potential of society as experienced by individuals with impairments, to prompt readers into thinking more creatively about how narratives, seemingly unconcerned with disability, are informed and can be understood via disability theory.

'To donate or not to donate? that is the question!': an organ and body donation comic.

Conversations surrounding end of life and death can be difficult or taboo for some, meaning that matters of organ and body donation are not widely discussed. To Donate or Not to Donate? That is the Question! is a comic developed to raise awareness and challenge common misconceptions about donation by encouraging the publics to engage in informed discussions about the different options available. This case study proposes graphic medicine as an alternative method of presenting donation information to a public audience, and illustrates how the comic medium can communicate body donation information in an accessible and engaging way.

The role of comics in public health communication during the COVID-19 pandemic.

As the COVID-19 pandemic sweeps the globe, evolving containment measures have created an unprecedented need for rapid and effective science communication that is able to engage the public in behavioural change on a mass scale. Public health bodies, governments, and media outlets have turned to comics in this time of need and found a natural and capable medium for responding to the challenge. Comics have been used as a vehicle to present science in graphic narratives, harnessing the power of visuals, text, and storytelling in an engaging format. This perspective paper explores the emerging role and research supporting comics as a public health tool during the COVID-19 pandemic.

Re-negotiating agency - patients using comics to reflect upon acting in situations of abuse in health care.

BACKGROUND: There is a growing body of international research that displays the prevalence and character of abuse in health care. Even though most of these studies are conducted from a patient perspective little is known about how patients conceptualize their agency in relation to such situations. This study aimed to explore how patients reason about their potential to act in abusive situations. METHODS: Qualitative interviews were conducted with thirteen patients in Sweden. Central in the interviews were three comics, inspired by Boal's Forum Theatre and part of an earlier online intervention study in which the informants had participated. Each comic showed a situation in which a patient feels abused, and on the opposite side were suggestions for how the patient could act in response. Informants were asked to reflect about situations of abuse and in specific upon the comics. We used the methodology of constructivist grounded theory throughout the study, including the analysis. RESULTS: It appeared that the informants constantly re-negotiated their and other patients' agency in relation to the specifics of the event, patients' and staff's responsibilities, and the patients' needs and values. This process questions views of agency as fixed and self-evident, and can be understood as part of changing discourses about patients' social role and possibilities to organize their care. Using a feminist theory of power we expected the informants to elicit instances of resistance to domination, which is central to the comics. While doing that, the informants also hinted at parallel stories of empowerment and less visible forms of agency in spite of domination. CONCLUSION: The current analysis showed different ways in which the informants constantly re-negotiated their agency in potentially abusive situations. Not only did the informants engage in reflections about immediate responses to these untoward situations, they also engaged in thoughts about strategies that could protect them and counteract abuse in health care over the long-term. This opens up for future research into ways patients organize their care and identify threats and barriers to the care they need, which could be valuable knowledge for care quality improvement.

Depictions of Tobacco and Alcohol Use in Contemporary Japanese Shonen Manga: A Content Analysis.

Japanese manga, which present dramatic and imaginative stories in comic book form, have a growing readership in Asia, Europe, and North America. We investigated depictions of tobacco and alcohol use in a sample of contemporary shonen manga, which have a primary readership of males ages 8-18, but also appeal to young females and adults. Large number of characters were shown smoking cigarettes and drinking alcohol, especially males, adults, and those categorized as "good" characters. Compared to the shonens' early chapters (initiated in 1990-2003, depending on the series), more recently published chapters (2011-2016) portrayed fewer characters overall using a tobacco product and fewer minors using an alcohol product. The later chapters also presented significantly fewer depictions of tobacco-related behavior, consumption of both beer and other/unknown alcoholic beverages, and alcohol-related paraphernalia. Antitobacco and antialcohol behaviors or dialogue were rare. These findings raise legitimate concerns about the influence of these depictions on young readers' beliefs, attitudes, and behavioral choices. Future research should explore whether those concerns are warranted, but in the interim, government agencies and watchdog groups in Japan should consider applying increased public pressure on manga artists and producers to curtail these depictions and to offer positive role models in their place.

Developing a Web-Based Comic for Newly Diagnosed Women With Breast Cancer: An Action Research Approach.

BACKGROUND: Personal narratives have been seen as a useful way of communicating about cancer treatment options and providing recovery information. Many printed versions of such material are available, including comics that explore the individual memories of patients who have gone through cancer treatment. These studies have been used to orientate patients, patients' relatives, and physicians. However, only a few Web-based comics have been specifically designed for patients with breast cancer and used as aids to decision making. OBJECTIVE: We aimed to describe the developmental process of creating an animated comic as a Web-based surgery decision-making tool; the comic was aimed at illustrating the feelings, thoughts, and meanings when a patient suffers from breast cancer. This was done by recounting the symptoms, diagnostic process, treatments, and treatment effects of such women from the diagnosis stage onward. METHODS: Using cycles of planning, action, evaluation, and reflection, which involved collaborative work, action research was conducted to develop a Web-based animated comic. The stages of action research consisted of (1) semistructured and in-depth interviews to collect experiences of women with breast cancer; (2) construction of an animated comic by editors, graphics designers, dubbers, and information technology engineers; (3) redrawing of pictures of the comic after gathering feedback from a breast surgeon; and (4) evaluation of the Web-based animated comic using 6 patient focus groups. RESULTS: The comic was produced and showcased on the website "The Network of Making-decision Aids for Breast Cancer Surgery"; the comic was accompanied by soft music and audio explanations. The comic functions as a personal statement that describes experiencing breast cancer. The animated comic consists of 8 chapters, based on the 8 themes deducted from the findings obtained during the analysis of relevant interviews. The 8 chapters include (1) the appearance of a lump; (2) confirmation by medical diagnosis; (3) the uncertainty of waiting (4) fear of life-threatening disease; (5) choosing life over despair; (6) being brave and deciding to undergo treatment; (7) choosing the type of surgery; and (8) being reborn. CONCLUSIONS: Using action research, this study illustrated that the comic that sheds light on issues of feelings, emotions, and thoughts that are present when a woman is diagnosed with breast cancer and provides a communication medium to explain the steps in the process. Meanwhile, it implies that hope will be able to overcome the challenges that will be faced. Within the Web-based decision aid for patients with breast cancer, the animated comic acts as an information resource and is aimed at patients' understanding of impacts of emotions arising when suffering from breast cancer. It is potentially applicable as a therapeutic tool that facilitates self-reflection and self-healing among newly diagnosed patients with breast cancer.

HIV/AIDS information promotion at the library: creative campaigns for young adults.

BACKGROUND: While rates of new HIV diagnoses have gone down nationally, Florida's HIV-positive population is growing and remains one of the largest in the country. Given this landscape, it is clear that diverse, creative, and collaborative efforts are needed to better inform the public about HIV risks, prevention, and treatment and to encourage healthy behaviors. CASE PRESENTATION: Building on previous work, librarians at the University of Florida engaged in a yearlong project to raise awareness about HIV/AIDS risks, prevention, and treatment among university students and to improve their information-seeking behaviors related to this disease. The "Creative Campaigns" project included 3 distinct elements of activity and engagement, designed to complement one another: a graphic novel contest, a social media campaign, and training for campus health care providers. The contest yielded 4 high-quality submissions, and the month long social media campaign garnered over 50,000 views and utilized Facebook ads to extend beyond the library's typical audience. The instruction proved useful to campus counseling and wellness staff. CONCLUSIONS: Overall, the team considered the project a success in terms of reaching new audiences in new ways, and several of its components have been integrated into subsequent projects and regular operations. Exploring new methods of outreach through social media and creative formats required careful planning and the development of new skill sets amongst project team members but proved to be a rewarding way to generate engagement in the local community.

Comics as an Educational Tool on a Clinical Clerkship.

OBJECTIVES: The authors investigated student satisfaction with the use of comics as an educational tool in clinical medical education. METHODS: Students on a Psychiatry clinical clerkship reviewed educational comics at the time of orientation. End of clerkship surveys were utilized to assess students' perceptions about the usefulness of comics for their learning during the clerkship. Students' responses were qualitatively and quantitatively analyzed. RESULTS: Eighty-four percent of students indicated that comics helped improve their understanding of clinical concepts, while approximately 80% felt that reviewing comics prior to each clerkship rotation helped ease transition into their assigned clinical service. Almost three quarters of all responders (74%) indicated that they were more likely to review preparatory material in comic form, as compared to other formats. Students found the comics easy to read, fun, and appreciated the concise presentation of information within them. Students also highlighted the limited amount of information presented as a relative weakness of the program. CONCLUSIONS: Comics may be utilized as an acceptable educational tool in clinical medical education.

Exploring gendered leadership stereotypes in a shared leadership model in healthcare: a case study.

The existing literature on leadership often describes it within fairly rigid gender roles. Entire models of leadership have been ascribed gendered labels. Shared leadership is, in traditional leadership theory, a feminine model. After observing a National Health Service (NHS) department enacting a shared leadership model, and using ethnography, grounded theory and comics-based research, we decided to explore the relationship between shared leadership and gender stereotypes. We realised our hope was to see a subversion of traditional stereotypes. Our data showed shared leadership overall as a feminine model, with its focus on distribution and compassion. Within the group, a range of gender roles were performed, meaning that the group could represent itself to the outside world as either more masculine or more feminine as required. This was beneficial, as conflict with outsiders was minimised and hence anxiety reduced. However, we noted that within the group, traditional gender roles were not subverted and were probably reinforced. Despite our view that shared leadership has not been an opportunity to resist gender stereotyping within this department, the success of this feminine model may represent a challenge to the prevailing masculine model of leadership within the NHS.

The Influence of Presentation Format of Story on Narrative Production in Chinese Children Learning English-as-a-Second-Language: A Comparison Between Graphic Novel, Illustration Book and Text.

Past studies have shown that multimodal presentation of story can improve story-retelling performance in the first language. The purpose of the present study was to investigate whether similar multimedia effects can be observed in second language learning and graphic novel reading. A total of 51 Chinese elementary school children, aged 7-8, who were learning English as a second language were recruited. They were randomly assigned to one of the three experimental conditions that differed in the format of story presentation: English text, English text with pictorial illustrations or graphic novel. After reading the same story, the children retold the story in English. The narratives produced were then rated by two independent raters. The results of group comparison showed that children from the three experimental groups had similar performance, indicating that multimedia presentation may not always facilitate narrative production in English as a second language. Within-subject comparison further showed that the children were relatively strong in language skills and capturing the main ideas of the story, while showing weakness in story structure awareness, elaboration, as well as local and global cohesion. Suggestions for the application of multimodal presentation of narrative texts are discussed.

Comics, Corn, and the Queer Phenomenology of Depression.

Grounded in analyses of two graphic memoirs, Ellen Forney's Marbles: Mania, Depression, Michelangelo and Me and Allie Brosh's "Depression (Parts One & Two)," this article draws from Sara Ahmed's 2006 book, Queer Phenomenology: Objects, Orientations, Others, in order to theorize the "queer phenomenology" of what gets called depression within many Western psychiatric, medical, and cultural discourses. Arguing that queer desires orient the subject away from (hetero)normative objects (or "happy objects," as Ahmed calls them, because they promise a life of happiness), Queer Phenomenology suggests that the subsequent turn toward queer objects produces feelings of dis-orientation in the subject. Noting the similarities between Ahmed's idea of queer disorientations and my own disorienting experiences of depression, this essay posits that depression similarly constitutes a turn away from"happy objects" andtoward objects which, through their newfound prominence in the depressed person's life, may appear as strange or even queer.

Divide and conquer: improving parental understanding of health-related instructions using sequential pictorial instructions.

Patient misunderstandings of healthcare-related instructions result in significant health, social and economic consequences. Pushing the boundaries of traditional academic methods may offer strategies that promote new ways to improve communication and understanding between healthcare providers, caregivers and patients. Comics can be an educational tool, offering an innovative strategy to communicate health-related information. Our study objective was to compare parents' understanding of health-related instructions (i.e. prescription labels, medical instructions and emergency situation scenarios) that were presented using two different formats-sequential pictorial instructions (SPIs) versus written text instructions (WRIs).This was a cross-sectional study to compare parents' understanding of health-related instructions for pediatric patients using structured SPIs versus WRIs. Parents (n = 359, 18-82 years old) of pediatric patients were given a card with instructions that were presented as SPIs (n = 195, 54.3%) or WRIs (n = 164, 45.7%), and then they completed a questionnaire. Total (14 questions) and grouped scores (10 questions) for parental comprehension of prescription and medical emergency instructions were significantly higher among participants viewing the SPIs than those viewing the WRIs in both English and Spanish. The mean understanding of instructions significantly increased from 6% to 12.2% when comparing the WRI versus the SPI.Our initial findings indicate that parents and caregivers of pediatric patients had significantly better understanding and recall of instructions delivered using SPIs than using WRIs.

Developing a Motion Comic for HIV/STD Prevention for Young People Ages 15-24, Part 2: Evaluation of a Pilot Intervention.

In the United States, young people (ages 15-24 years) are disproportionately affected by human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs), due at least in part to inadequate or incorrect HIV/STD-related knowledge, attitudes, beliefs, and behavioral intentions (KABI). Comic book narratives are a proven method of HIV/STD prevention communication to strengthen KABI for HIV/STD prevention. Motion comics, a new type of comic media, are an engaging and low-cost means of narrative storytelling. The objective of this study was to quantitatively evaluate the effectiveness of a pilot six-episode HIV/STD-focused motion comic series to improve HIV/STD-related KABI among young people. We assessed change in HIV/STD knowledge, HIV stigma, condom attitudes, HIV/STD testing attitudes, and behavioral intentions among 138 participants in 15 focus groups immediately before and after viewing the motion comic series. We used paired t-tests and indicators of overall improvement to assess differences between surveys. We found a significant decrease in HIV stigma (p < .001) and increases in both HIV knowledge (p = .002) and behavioral intentions to engage in safe sex (p < .001). In summary, this motion comic intervention improved HIV/STD-related KABI of young adult viewers by reducing HIV stigma and increasing behavioral intentions to engage in safer sex. Our results demonstrate the promise of this novel intervention and support its use to deliver health messages to young people.

Developing a Motion Comic for HIV/STD Prevention for Young People Ages 15-24, Part 1: Listening to Your Target Audience.

Young people (15-24 years) in the United States are disproportionately affected by infection with human immunodeficiency virus (HIV) and sexually transmitted diseases (STD). Shortfalls in HIV/STD-related knowledge, attitudes, beliefs, and behavioral intentions (KABI) likely contribute to this discrepancy. In this report we describe our experience developing a novel means of health communication combining entertainment-education theory and recent technological advances to create a HIV/STD-focused "motion comic." We also report the audience satisfaction and acceptance of the intervention. We used the Health Belief Model (HBM), entertainment-education (EE) principles, and the Sabido Method (SM) and conducted three rounds of focus groups to develop a 38-minute HIV/STD focused motion comic for young people between the ages 15 and 24 years. Participants indicated that motion comics were an acceptable method of delivering HIV/STD prevention messages. They also expressed satisfaction with motion comics plot, story settings, the tone of humor, and drama. Our results suggest that motion comics are a viable new method of delivering health communication messages about HIV/STD and other public health issues, and warrant further development and broader evaluation.

Best of Graphic Medicine-The 2023 Graphic Medicine International Collective Awards.

This Arts and Medicine feature reviews 4 health-related graphic medicine (comic) projects judged as the best of 2022 by the Graphic Medicine International Collective.

Using Comics to Promote Colorectal Cancer Screening in the Asian American and Pacific Islander Communities.

There are unaesthetic aspects in teaching people about the early detection of colorectal cancer using the fecal immunochemical test. Comics were seen as a way to overcome those unaesthetic aspects. This study used the Asian grocery store-based cancer education venue to pilot-test the clarity, cultural acceptability, and alignment of five colorectal cancer education comics intended for publication in Asian American and Pacific Islander (API) community newspapers. After developing the colorectal cancer education comics, API students asked shoppers to review a comic from their collection and provide feedback on how to make the comic clearer and more culturally pertinent to API readers. To evaluate viewers' responses, the students gathered such unobtrusive data as: (1) how many of the predetermined salient information points were discussed as the student educators interacted with shoppers and (2) how many comics the shoppers were willing to review. Shoppers were also asked to evaluate how effective the comics would be at motivating colorectal cancer screening among APIs. The students were able to cover all of the salient information points with the first comic. As evidence of the comics' capacity to engage shoppers' interest, shoppers willingly evaluated all five comics. Using multiple comics enabled the educators to repeatedly address the four salient colorectal cancer information points. Thus, the comics helped student educators to overcome the unesthetic elements of colorectal cancer discussions, while enabling them to engage shoppers in animated discussions, for far more time than with their conventional didactic educational methods.