https://orcid.org/0000-0002-1172-4018
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Mireia Alemany-Pagès, Rui Tavares, Anabela Marisa Azul, João Ramalho-Santos, A healthy liver will always deliver: development of a NAFLD awareness comic, Health Promotion International, Volume 37, Issue 6, December 2022, daac165, https://doi.org/10.1093/heapro/daac165
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INTRODUCTION
The medium of comics constitutes a potentially engaging and informative communication tool, profiting from the synergistic potential of visual design and narrative storytelling, through the interplay between words and imagery (McCloud, 1993; Pratt, 2009; Jee and Anggoro, 2012; Farinella, 2018). Comics have the potential to convey factual knowledge and influence beliefs, attitudes and behaviors through narrative engagement (Hinyard and Kreuter, 2007; Schneider, 2014; Dobbins, 2016). With the same knowledge transfer capacity but creating higher engagement and motivation in the readers than text-based materials, graphic narratives can potentially be a useful tool in captivating the attention of new and hard-to reach audiences (Hosler and Boomer, 2011; Spiegel et al., 2013; Muzumdar and Pantaleo, 2017; Collver and Weitkamp, 2018).
For the past 50 years, science comics have capitalized on the visual storytelling capacity of comics to effectively communicate abstract biomedical phenomena beyond human perception by articulating them through metaphoric and anthropomorphic resources (Jee and Anggoro, 2012; Branscum et al., 2013; Waite, 2019). On the other hand, and preceding these efforts, public health comics have long been used for health communication and disease prevention throughout the world (Vigano, 1983; Convisser, 1992; WHO, 2013; Ngowi et al., 2017). Responding to public health threats the development of these graphic narratives has been progressively optimized, first by involving their target audiences and most recently by actively using principles of behavior change models in building plots (Cain, 1986; Herasme et al., 1992; Cash, 1993; Cash et al., 1994; Everett and Schaay, 1994). Since the 1970s, comics have been successful in raising awareness about diseases and their symptoms, assist patients and their families to better understand their illness, promote the self-management of chronic conditions and support informed decision-making both in children and adults (Tjiam et al., 2012, 2013; Iio et al., 2020). In so doing, public health comics have demonstrated to be a suitable format to potentially influence disease beliefs, attitudes, intentions and behaviors (Putnam and Yanagisako, 1985; Garbarino, 1987; Torrecilla García et al., 2004; Leung et al., 2014; Imamura et al., 2015; Alam et al., 2016; King, 2017; Massone et al., 2017; Mendelson et al., 2017; Shirotsuki et al., 2017). In these cases, patient’s histories may inspire well-designed characters and narratives that contextualize factual information about a disease to the emotional and social aspects of illness experience, turning real-life struggles visible (Dobbins, 2016; Leung et al., 2015; Leung et al., 2018; Willis et al., 2018; Willis et al., 2018). The latter are particularly poignant in graphic narrative comics or graphic pathographies, autobiographical recounts of illness experience (Williams, 2012; Czerwiec, 2018; Myers and Goldenberg, 2018).
