title: Using picture narratives to support equitable and informed participation in lung cancer screening
Creators: name: Gatting, Lauren Paige
Publisher: name: University of Glasgow
Year: 2022

description: Background: The use of pictures and narratives in print health communication has been successful in improving engagement, comprehension, and behavioural enactment. However, the use of these two modalities in an integrated way for health communication has been less extensively researched. Through the thesis, the term ‘picture narratives’ is used to refer to the portrayal of a narrative through a sequence of static visual images. Lung cancer is the third most common cause of death in Scotland – with some of the highest rates of lung cancer being in the most socioeconomically deprived areas of Glasgow. Lung cancer screening (LCS) is currently being trialled in the UK and, if expanded to a national screening programme, could greatly reduce the burden of lung cancer for individuals and for society. To be able to build understanding into the application of picture narratives in health communication, I developed and tested example picture narrative information in the context of LCS. Methodology: A multidisciplinary approach was taken while developing the picture narratives to ensure they were well designed before evaluating their effectiveness. The first stage of the design process (Study 1) was content analysis of picture narrative use in current practice, looking at official information materials produced for invitees to cancer screening in the UK. The second design stage (Study 2) involved an analysis of the ways in which LCS related topics have been portrayed in comics. This study was used to identify culturally prevalent images, symbols and conventions used for picture narrative portrayals of cancer which could be adopted in the designs to increase recognisability and appropriateness. The third design stage (Study 3) was a community-based design workshop with twelve people aged between 50 and 75 who smoke and were living in a low-resource area of Glasgow. This workshop was used to explore LCS information design preferences and perceptions surrounding LCS within the target audience to make the picture narrative designs more engaging, acceptable, and supportive. Picture narrative LCS information was then created based on the findings of these studies alongside an expert review, the support of a professional artist and usability testing with eight members of the target audience (Study 4). The picture narrative LCS information was then tested (Study 5) in a questionnaire study of randomised controlled trial design, with 311 people living in Glasgow aged between 50 and 75, to determine their effectiveness in supporting informed decision-making in an equitable way in comparison to the same lung screening information provided as text with pictures and as text alone. Support of informed decision-making was measured via LCS knowledge acquisition, LCS eligibility self-assessment accuracy and LCS related beliefs. Main findings: The picture narrative format was not found to support informed decision making when compared to the picture condition, producing lower knowledge scores and lower eligibility self-assessment accuracy. The LCS information provided as text with pictures was found to be most equitable, with the gap in knowledge scores between people with higher and lower levels of social economic deprivation being significantly smaller than when provided in text-only format. This thesis reaffirms the importance of using pictures that have been developed in a culturally sensitive way when producing health information materials that aim to both engage and inform. Other avenues and opportunities for making use of picture narratives for supporting informed and equitable participation in lung cancer screening are considered.