The use of digital stories as a health promotion intervention: a scoping review.

BACKGROUND: It is challenging to develop health promotion interventions created in collaboration with communities affected by inequities that focus beyond individual behavior change. One potential solution is interventions that use digital stories (DS). Digital storytelling (DST) is an opportunity for reflection, connection with others, and the elevation of voices often absent from daily discourse. Consequently, public health researchers and practitioners frequently employ the DST workshop process to develop messaging that promotes health and highlights concerns in partnership with historically marginalized communities. With participants' permission, DS can reach beyond the storytellers through behavior or attitude change interventions for health promotion among communities who share the targeted health concern. Our goal was to synthesize the literature describing interventions that use DS for health promotion to identify gaps. METHODS: We conducted a scoping review. Our inclusion criteria were articles that: 1) described empirical research; 2) used DS that were developed using the StoryCenter DST method; 3) assessed an intervention that used DS to address the health promotion of viewers (individuals, families, community, and/or society) impacted by the targeted health issue 4) were written in English or Spanish. To synthesize the results of the included studies, we mapped them to the health determinants in the National Institute of Minority Health and Health Disparities (NIMHD) research framework. We assessed the number of occurrences of each determinant described in the results of each article. RESULTS: Ten articles met the eligibility criteria. All the included articles highlighted health equity issues. Our mapping of the articles with definitive results to the NIMHD research framework indicates that interventions that use DS addressed 17 out of 20 health determinants. All mapped interventions influenced intentions to change health behaviors (NIMHD level/domain: Individual/Behavioral), increased health literacy (Individual/Health Care System), and/or stimulated conversations that addressed community norms (Community/Sociocultural Environment). CONCLUSIONS: Interventions that use DS appear to positively affect the health promotion of participants across a range of health issues and determinants. Future research is needed in the Interpersonal, Community, and Societal levels and within the Biological, Physical/Built Environment, and Sociocultural Environment domains.

Critical Narrative Intervention for Health Equity Research and Practice: Editorial Commentary Introducing the Health Promotion Practice Critical Narrative Intervention Special Collection.

This special collection of Health Promotion Practice introduces critical narrative intervention (CNI) as a key theoretical framing for an asset-based, narrative, and participatory approach to promoting health and addressing social inequality. Innovative digital and visual methodologies highlighted in this special collection-comics and graphic novels, cellphilms and other participatory film, story booths, digital storytelling, and photovoice-are changing the way critical public health researchers and practitioners forge new knowledge, creating new possibilities for interdisciplinary and activist-based inquiry. Public health research and engagement efforts that critically contend with historically repressive structures and intervene through narrative and participatory processes to enact change with and for disenfranchised communities are long overdue. This special collection showcases six CNI projects that promote equity and justice in the context of LGBTQ, nonbinary, and other gender-diverse young people; people who inject drugs living with hepatitis C virus; young women who trade sex; undocumented and formerly undocumented immigrants; and people living with HIV/AIDS. It is our intent that this collection of exemplars can serve as a guidepost for practitioners and researchers interested in expanding the scope of critical public health praxis. Individually and collectively, the special collection illustrates how CNI can create space for the increased representation of historically silenced populations, redress stigma, and provoke important questions to guide a new era of health equity research.

Meth Mouth, White Trash, and the Pseudo-Racialization of Methamphetamine Use in the U.S.

Drug scares have historically been created for a range of purposes and with a variety of effects in the United States. Moral panics evoked by these drug scares either support or challenge dominant American ideas about race, economics, and society. In the present study, we examined newspaper accounts of methamphetamine use in the Inland Pacific Northwest of the United States in an effort to understand how the "reality" of the "meth epidemic" is socially constructed in a "meth hotspot," and reflect upon the ways that the discourse of Whiteness intersects with this construction. For our analysis, we are cognizant of the "slipperiness" of the logic of Whiteness as a concept, and the ways that an alternative logic is articulated - one that strategically embraces or distances White drug users to support notions of White dominance. We focus on the possibility that individual meth users could then be portrayed pseudo-racially as "White trash," and thus rendered outside the logic of White racial order. Our findings center on two main themes: (1) the use of fear in the construction of the meth drug scare through the sensationalization of meth, its anthropomorphization, and the depiction of the threat of the White drug user; and (2) how the logic of Whiteness is discursively reconciled within this construction. Given current mediated discourses about drug use and health in the United States that center on the emergence of the White drug user as the face of the opioid crisis, we are well served to carefully consider the recent historical precedence of the "meth epidemic" in which the public was faced with reconciling their views about drug use and the intersection of race, class, and mainstream American identity.

Restor(y)ing Health: A Conceptual Model of the Effects of Digital Storytelling.

We currently see an interdisciplinary shift toward a "participatory turn" in health research and promotion under which community engagement, shared decision making and planning, and the use of visual and digital methods have become paramount. Digital storytelling (DST) is one such innovative and engaging method increasingly used in applied health interventions, with a growing body of research identifying its value. Despite its increasing use, a standard approach to empirically assess the impacts on individuals participating in DST interventions does not currently exist. In this article, we define DST as a distinct narrative intervention, illustrate key elements that inform the methodology, and present a conceptual model to examine how DST may contribute to increased socioemotional well-being and bolster positive health outcomes. Our proposed model is informed by elements of narrative theory, Freirian conscientization, multimodality, and social cognitive theory and can serve as a guide for public health practitioners and researchers interested in assessing the potential benefits of DST as an applied health intervention. Recommendations for practice call for a rigorous methodological approach to apply and test this model across a range of health contexts and populations.

Moms Supporting Moms: Digital Storytelling With Peer Mentors in Recovery From Substance Use.

Substance use disorder (SUD) is a growing issue nationally, and SUD in pregnancy has significant consequences for mothers and their children. This article describes findings from a pilot project that used digital storytelling as a mechanism for understanding substance use and recovery from the perspective of women in recovery from SUD in pregnancy who worked as peer mentors with pregnant women currently experiencing SUD. Research on peer mentorship has primarily focused on outcomes for mentees but not the experience of the peer mentors themselves. In this qualitative study, a 3-day digital storytelling workshop was conducted with five women in recovery serving as peer mentors in their community. Each mentor also participated in an individual, in-depth interview. The digital storytelling workshop process helped peer mentors make linkages between their past substance use experiences to their present work of recovery, and fostered deep social connections between mentors through the shared experience. The workshop process also elicited a sense of hope among participants, which served as groundwork for developing advocacy-based efforts. Digital storytelling may be therapeutic for women in recovery and has the potential to be integrated into recovery programs to bolster hope and social support among participants.

Puerto Rican Latina Youth Coming Out to Talk About Sexuality and Identity.

Public health efforts focused on Latina youth sexuality are most commonly framed by the syndemic of teen pregnancy and sexually transmitted infections, a narrow and often heteronormative focus that perpetuates silences that contribute to health inequities and overlooks the growing need for increased education, awareness, and support for lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth. This article presents findings from the project Let's Talk About Sex: Digital Storytelling for Puerto Rican Latina Youth, which used a culturally centered, narrative-based approach for analyzing participants' own specifications of sexual values and practices. The strength of digital storytelling lies in its utility as an innovative tool for community-based and culturally situated research, as well as in its capacity to open up new spaces for health communication. Here we present two "coming out" case studies to illustrate the value of digital storytelling in supporting the development of meaningful and culturally relevant health promotion efforts for LGBTQ-identified Puerto Rican Latina youth across the life span.

Measuring Down: Evaluating Digital Storytelling as a Process for Narrative Health Promotion.

Digital storytelling (DST) engages participants in a group-based process to create and share narrative accounts of life events. We present key evaluation findings of a 2-year, mixed-methods study that focused on effects of participating in the DST process on young Puerto Rican Latina's self-esteem, social support, empowerment, and sexual attitudes and behaviors. Quantitative results did not show significant changes in the expected outcomes. However, in our qualitative findings we identified several ways in which the DST made positive, health-bearing effects. We argue for the importance of "measuring down" to reflect the locally grounded, felt experiences of participants who engage in the process, as current quantitative scales do not "measure up" to accurately capture these effects. We end by suggesting the need to develop mixed-methods, culturally relevant, and sensitive evaluation tools that prioritize process effects as they inform intervention and health promotion.

Digital Storytelling as a Narrative Health Promotion Process: Evaluation of a Pilot Study.

Digital storytelling (DST) engages participants in a group-based process to create and share narrative accounts of life events. The process of individuals telling their own stories has not been well assessed as a mechanism of health behavior change. This study looks at outcomes associated with engaging in the DST process for vulnerable youth. The project focused on the experiences of Puerto Rican Latinas between the ages of 15 to 21. A total of 30 participants enrolled in a 4-day DST workshops, with 29 completing a 1 to 3-minute digital story. Self-reported data on several scales (self-esteem, social support, empowerment, and sexual attitudes and behaviors) were collected and analyzed. Participants showed an increase in positive social interactions from baseline to 3-month post workshop. Participants also demonstrated increases in optimism and control over the future immediately after the workshop, but this change was not sustained at 3 months. Analysis of qualitative results and implications are discussed.

Protecting pregnant people & infants against influenza: A landscape review of influenza vaccine hesitancy during pregnancy and strategies for vaccine promotion.

Before COVID-19, influenza vaccines were the most widely recommended vaccine during pregnancy worldwide. In response to immunization during pregnancy, maternal antibodies offer protection against potentially life-threatening disease in both pregnant people and their infants up to six months of age. Despite this, influenza vaccine hesitancy is common, with few countries reporting immunization rates in pregnant people above 50%. In this review, we highlight individual, institutional, and social factors associated with influenza vaccine hesitancy during pregnancy. In addition, we present an overview of the evidence evaluating interventions to address influenza vaccine hesitancy during pregnancy. While some studies have indicated promising results, no single intervention has consistently effectively increased influenza vaccine uptake during pregnancy. Using a social-ecological model of health framework, future strategies addressing multiple levels of vaccine hesitancy will be needed to realize the potential health benefits of prenatal immunization programs.

Pregnant people are a high priority group for influenza vaccination annually. Although vaccination can protect both mother and infant, vaccination rates are suboptimal during pregnancy. Previous research has suggested reasons for suboptimal vaccination rates, including concerns about the safety of vaccination during pregnancy and limited access to, and awareness of, influenza vaccines during pregnancy. Studies that have attempted to increase influenza vaccination rates during pregnancy have mostly shown no effect ­ with some exceptions. Public health professionals need to reevaluate strategies for improving vaccination rates during pregnancy.

Women-Reported Barriers and Facilitators of Continued Engagement with Medications for Opioid Use Disorder.

Opioid-related fatalities increased exponentially during the COVID-19 pandemic and show little sign of abating. Despite decades of scientific evidence that sustained engagement with medications for opioid use disorders (MOUD) yields positive psychosocial outcomes, less than 30% of people with OUD engage in MOUD. Treatment rates are lowest for women. The aim of this project was to identify women-specific barriers and facilitators to treatment engagement, drawing from the lived experience of women in treatment. Data are provided from a parent study that used a community-partnered participatory research approach to adapt an evidence-based digital storytelling intervention for supporting continued MOUD treatment engagement. The parent study collected qualitative data between August and December 2018 from 20 women in Western Massachusetts who had received MOUD for at least 90 days. Using constructivist grounded theory, we identified major themes and selected illustrative quotations. Key barriers identified in this project include: (1) MOUD-specific discrimination encountered via social media, and in workplace and treatment/recovery settings; and (2) fear, perceptions, and experiences with MOUD, including mental health medication synergies, internalization of MOUD-related stigma, expectations of treatment duration, and opioid-specific mistrust of providers. Women identified two key facilitators to MOUD engagement: (1) feeling "safe" within treatment settings and (2) online communities as a source of positive reinforcement. We conclude with women-specific recommendations for research and interventions to improve MOUD engagement and provide human-centered care for this historically marginalized population.

Digital storytelling as critical narrative intervention with adolescent women of Puerto Rican descent.

This article focuses on findings of a two-year pilot research study focused on addressing sexual and reproductive health inequities faced by adolescent women of Puerto Rican descent living on the mainland United States. Working with three groups of young women, in the pilot study we gathered ethnographic data in and around a group-based digital storytelling process to inform the development of a larger intervention. Digital stories are short (1-3 minute), participant produced videos that synthesize still and moving image, a voiceover recording of the participant telling her story, and background music and text to document personal experiences. Based on narrative analysis of digital stories and field notes written in and around the digital storytelling workshop process, as well as follow-up individual interviews with workshop participants, our findings center on the ways that trauma has specifically shaped participants' sexual and reproductive health experiences. We argue that digital storytelling serves as a critical narrative intervention, whereby participants' engagement in the storytelling process enables them to collaboratively interrogate and potentially address prior trauma, bolster a sense of social support and solidarity, and potentially recalibrate stigmatizing conversations about them. We introduce our project methodology, and then present key findings on trauma as it informs sexual and reproductive health practices, with digital storytelling showcased as a modality for critical narrative intervention. We conclude by discussing implications for critical public health research and practice.

Bodies as evidence: Mapping new terrain for teen pregnancy and parenting.

Predominant approaches to teen pregnancy focus on decreasing numbers of teen mothers, babies born to them, and state dollars spent to support their families. This overshadows the structural violence interwoven into daily existence for these young parents. This paper argues for the increased use of participatory visual methods to compliment traditional research methods in shifting notions of what counts as evidence in response to teen pregnancy and parenting. We present the methods and results from a body mapping workshop as part of 'Hear Our Stories: Diasporic Youth for Sexual Rights and Justice', a project that examines structural barriers faced by young parenting Latinas and seeks to develop relevant messaging and programming to support and engage youth. Body mapping, as an engaging, innovative participatory visual methodology, involves young parenting women and other marginalised populations in drawing out a deeper understanding of sexual health inequities. Our findings highlight the ways body mapping elicits bodies as evidence to understand young motherhood and wellbeing.