The Power of Digital Storytelling to Influence Human Behaviour

Abstract The aim of this multi-disciplinary research was to explore the power of digital, interactive or participatory storytelling to influence human behaviour in the context of public health. It addressed three related questions: RQ1: Does digital storytelling have the power to influence human behaviour? RQ2: If digital storytelling can influence human behaviour then how might it do so? RQ3: Is a ‘digital storytelling framework’ feasible as an approach to behaviour change? Four linked qualitative studies were conducted: a scoping review, in-depth interviews with 11 international ‘digital storytellers’, two case studies of ‘digital storytelling designed to influence human behaviour’ and six focus groups with 35 adolescent ‘digital story participants’. The research found that: RA1: Digital storytelling appears to influence human behaviour. RA2: Digital storytelling appears to influence by engaging at ever deepening emotional and non-conscious levels. Commerce appears to understand and embrace this power: But public health appears to rely on traditional uni-directional, non-participatory message led approaches and appeals to cognition. This presents threats and opportunities to public health. RA3: The proposed ‘digital storytelling framework’ is feasible and desirable as a behaviour change paradigm. The thesis concludes that Digital Storytelling appears to influence human behaviour. It appears to derive its power to influence by facilitating unprecedented depths of emotional engagement potentially en route to behaviour change. The current imbalance in how commerce and public health corral the power of digital storytelling suggests that the latter might embrace its potential; and tougher regulation might constrain how the former uses it to market harmful products. The proposed digital storytelling framework makes a valuable creative, analytical and critical contribution to both of these ends. Its core principles have informed the design of numerous story-led digital health interventions; and they now sit at the core of a counter-marketing campaign to reduce harmful effects of marketing on children’s health

Head-mounted virtual reality and mental health: critical review of current research

Background: eHealth interventions are becoming increasingly used in public health, with virtual reality (VR) being one of the most exciting recent developments. VR consists of a three-dimensional, computer-generated environment viewed through a head-mounted display. This medium has provided new possibilities to adapt problematic behaviors that affect mental health. VR is no longer unaffordable for individuals, and with mobile phone technology being able to track movements and project images through mobile head-mounted devices, VR is now a mobile tool that can be used at work, home, or on the move. Objective: In line with recent advances in technology, in this review, we aimed to critically assess the current state of research surrounding mental health. Methods: We compiled a table of 82 studies that made use of head-mounted devices in their interventions. Results: Our review demonstrated that VR is effective in provoking realistic reactions to feared stimuli, particularly for anxiety; moreover, it proved that the immersive nature of VR is an ideal fit for the management of pain. However, the lack of studies surrounding depression and stress highlight the literature gaps that still exist. Conclusions: Virtual environments that promote positive stimuli combined with health knowledge could prove to be a valuable tool for public health and mental health. The current state of research highlights the importance of the nature and content of VR interventions for improved mental health. While future research should look to incorporate more mobile forms of VR, a more rigorous reporting of VR and computer hardware and software may help us understand the relationship (if any) between increased specifications and the efficacy of treatment

Assessment of Muscle Activation of Caregivers Performing Dependent Transfers With a Novel Robotic-Assisted Transfer Device Compared With the Hoyer Advance

OBJECTIVE: The purpose of this study was to compare muscle activity in caregivers while using a novel robotic assistive transfer device (Strong Arm) to a clinical standard of care (Hoyer Advance). DESIGN: A Quasi-Experimental design was used in which twenty caregivers (33±15 years old) performed transfers with three surfaces (toilet, bench and shower chair) with the Strong Arm and Hoyer Advance. Transfer completion time (sec), peak percentage surface electromyography (EMG) and integrated EMG of the bilateral erector spinae, latissimus dorsi, pectoralis major and anterior deltoid were measured. RESULTS: Caregivers required less transfer time when transferring from wheelchair to surface using the Hoyer Advance (p=.011, f=.39). Lower back: significantly lower pEMG were found using Strong Arm in 50% and for the iEMG in 25% of the cases, with the remaining cases showing no significant differences. Shoulder: significantly lower pEMG were found using Strong Arm in 19% of transfers and lower iEMG was found in 25% of transfers when using the Hoyer Advance, with the remaining cases showing no significant differences. CONCLUSION: While back muscle activation during Strong Arm transfers is statistically, but not clinically, lower, additional features that couple with significantly lower muscle activation make it an alternative to the clinical standard for further research and possible clinical applicability

Game of Stones:feasibility randomised controlled trial of how to engage men with obesity in text message and incentive interventions for weight loss

Objectives To examine the acceptability and feasibility of narrative text messages with or without financial incentives to support weight loss for men. Design Individually randomised three-arm feasibility trial with 12 months’ follow-up. Setting Two sites in Scotland with high levels of disadvantage according to Scottish Index for Multiple Deprivation (SIMD). Participants Men with obesity (n=105) recruited through community outreach and general practitioner registers. Interventions Participants randomised to: (A) narrative text messages plus financial incentive for 12 months (short message service (SMS)+I), (B) narrative text messages for 12 months (SMS only), or (C) waiting list control. Outcomes Acceptability and feasibility of recruitment, retention, intervention components and trial procedures assessed by analysing quantitative and qualitative data at 3, 6 and 12 months. Results 105 men were recruited, 60% from more disadvantaged areas (SIMD quintiles 1 or 2). Retention at 12 months was 74%. Fewer SMS+I participants (64%) completed 12-month assessments compared with SMS only (79%) and control (83%). Narrative texts were acceptable to many men, but some reported negative reactions. No evidence emerged that level of disadvantage was related to acceptability of narrative texts. Eleven SMS+I participants (31%) successfully met or partially met weight loss targets. The cost of the incentive per participant was £81.94 (95% CI £34.59 to £129.30). Incentives were acceptable, but improving health was reported as the key motivator for weight loss. All groups lost weight (SMS+I: −2.51 kg (SD=4.94); SMS only: −1.29 kg (SD=5.03); control: −0.86 kg (SD=5.64) at 12 months). Conclusions This three-arm weight management feasibility trial recruited and retained men from across the socioeconomic spectrum, with the majority from areas of disadvantage, was broadly acceptable to most participants and feasible to deliver

Promoting smoking cessation during pregnancy: A feasibility and pilot trial of a digital storytelling intervention delivered via text?messaging

ObjectiveSmoking during pregnancy causes risks to mother and infant health. We investigated the feasibility and likely success of SKIP-IT, a narrative and picture-based smoking cessation intervention delivered via text messages.MethodsA feasibility and pilot trial. We aimed to recruit 70 pregnant women who smoked, randomised to usual care alone, or usual care and the SKIP-IT intervention, between 12 weeks of pregnancy and 6 weeks post due-date. Outcomes assessed were recruitment, retention, acceptability of, and engagement with the intervention, smoking behaviour, intentions, perceived risk, and self-efficacy.ResultsOf 312 women initially approached by smoking cessation services only 54 (17%) agreed to be contacted by the research team. Twenty were then either ineligible or uncontactable and 28 (82%) participated. Most women reported texts to be entertaining and helpful. The proportion of women not smoking at follow-up was lower in the intervention group, but numbers were too small to draw conclusions about effectiveness.ConclusionThe intervention was acceptable, but difficulty in making initial and follow-up contacts meant our methods were unfeasible for a larger trial.Practice implicationsDigital Storytelling interventions could help women quit smoking, but further research is required to identify alternative methods for studies with pregnant women who smoke

Reducing patient delay in Acute Coronary Syndrome (RAPiD): research protocol for a web-based randomized controlled trial examining the effect of a behaviour change intervention

AimsTo evaluate the efficacy of a behaviour change technique-based intervention and compare two possible modes of delivery (text+visual and text-only) with usual care.BackgroundPatient delay prevents many people from achieving optimal benefit of time-dependent treatments for Acute Coronary Syndrome. Reducing delay would reduce mortality and morbidity, but interventions to change behaviour have had mixed results. Systematic inclusion of behaviour change techniques or a visual mode of delivery might improve the efficacy of interventions.DesignA 3-arm web-based, parallel randomised controlled trial of a theory-based intervention.MethodsThe intervention comprises 12 behaviour change techniques systematically identified following systematic review and a consensus exercise undertaken with behaviour change experts. We aim to recruit n=177 participants who have experienced Acute Coronary Syndrome in the previous 6 months from a National Health Service Hospital. Consenting participants will be randomly allocated in equal numbers to one of three study groups: i) usual care ii) usual care plus text-only behaviour change technique-based intervention or iii) usual care plus text+visual behaviour change technique-based intervention. The primary outcome will be the change in intention to phone an ambulance immediately with symptoms of Acute Coronary Syndrome ?15 minutes duration, assessed using two randomised series of 8 scenarios representing varied symptoms before and after delivery of the interventions or control condition (usual care). Funding granted January 2014

Reducing patient delay in acute coronary syndrome: Randomized controlled trial testing effect of behaviour change intervention on intentions to seek help

ObjectivesThe aim of this study was to evaluate the efficacy of a behaviour change intervention to reduce patient delay with symptoms of acute coronary syndrome.DesignA 3-arm web-based, parallel randomized controlled trial.MethodsThe intervention comprised 12 behaviour change techniques (BCTs) embedded in a text-only or text+visual narrative (the techniques were systematically identified through systematic review and a consensus exercise). Between February and November 2017, n = 145 people who had recently experienced acute coronary syndrome were randomly allocated to intervention (‘text+visual’ or ‘text-only’) or control. Intentions to phone an ambulance immediately for acute coronary syndrome symptoms were assessed before and after the intervention using symptom scenarios, and the change in intention was compared across the three groups.ResultsSignificant increases in intention to phone an ambulance immediately for ACS symptoms were seen following the ‘text+visual’ intervention but not following ‘text-only’ or control. However, the study was underpowered to detect any significant changes in intention between the 3 groups. There were no unintended effects on intentions for non-urgent symptoms.ConclusionsA ‘text+visual’ BCT-based intervention may significantly increase intention to phone an ambulance with symptoms of ACS. Further testing of the effect of the intervention on actual behaviour is required

The READ-IT study protocol for a feasibility randomised controlled trial of using a support worker/family carer mediated online reading programme to teach early reading skills to adults with intellectual disabilities

Background: Many individuals with intellectual disability (ID) have not learnt basic reading skills by the time that they reach adulthood, potentially limiting their access to critical information. READ-IT is an online reading programme developed from the Headsprout® Early Reading (HER®) intervention and supplemented by support strategies tailored for adults with ID. HER® has been successfully used to teach adults with ID to read in a forensic setting by trained staff. The aim of this study is to assess the feasibility of delivering READ-IT to adults with ID by family carers/support workers and will assess whether it would be feasible to conduct a later definitive randomised controlled trial (RCT) of the effectiveness of the programme. The study will aim to contribute to the evidence base on improving outcomes for adults with ID and their caregivers. Methods: This study is a feasibility RCT, with embedded process evaluation. Forty-eight adults with ID will be recruited and allocated to intervention: control on a 1:1 basis. Intervention families will be offered the READ-IT programme immediately, continuing to receive usual practice and control participants will be offered the opportunity to receive READ-IT at the end of the trial follow-up period and will continue to receive usual practice. Data will be collected at baseline and 6 months post-randomisation. Discussion: The results of this study will inform a potential future definitive trial, to evaluate the effectiveness of READ-IT to improve reading skills. Such a trial would have significant scientific impact internationally in the intellectual disability field. Trial registration: ISRCTN1140909

Text messaging and financial incentives to encourage weight loss in men with obesity: the Game of Stones feasibility RCT

Funding: This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 11. See the NIHR Journals Library website for further project information.Peer reviewedPublisher PD