Telling Stories of Vaccine-Preventable Diseases: Why It Works

"A powerful story allows a parent to step into the shoes of another parent and provides visual imagery that can trigger a positive health behavior. Evidence demonstrates that storytelling can improve health behaviors and knowledge."

This paper explores the benefits of storytelling in health communication and, in particular, immunisation education. As the authors explain, during the mid-20th century polio epidemic in the United States (US), both personal stories and scientific information abounded in the media. "The campaign to battle the polio epidemic was successful in uniting a nation against a disease. Every day the media was filed with personal stories of children affected by polio. We even had a president who shared his own battle with polio in the media and served as the face of the campaign. At the same time, science had never been so visible to the public. The country held its breath as a vaccine was developed and underwent clinical trials. Hundreds of thousands flocked to receive the first polio vaccine, and the creators of the vaccines, Jonas Salk and Albert Sabin, became national celebrities. During this time, both personal narratives and scientific information about polio abounded in the media."

However, as the authors note, as rates of vaccine-preventable diseases declined due to the ongoing development of new vaccines, narratives about the dangers of such diseases faded so that only a generation or two after the eradication of polio in the US, "the public fear of such diseases also seems to have disappeared. As both the narratives about vaccine-preventable diseases and the diseases themselves disappeared, a new phenomenon began to occur. The scientific community acquired overwhelming amounts of robust data demonstrating the safety, efficacy and necessity of vaccines, yet lost the personal message of why immunizations are important."

They assert that medical experts often counter anti-vaccine concerns with scientific information, which can fail to persuade parents. Furthermore, evidence suggests that many people misunderstand quantitative information, resulting in a misinterpretation of risk. "Compared to scientific information, stories relate life lessons and values. They are effective because they are memorable and relatable." One lesson shared here - backed up by research - is that stories that are made culturally relevant, particularly to cultures with strong oral traditions, such as African-American and Native American cultures might be more effective in health communication than simply providing information.

Cited in the paper are several studies that have examined the effect of storytelling on health behaviour change. Although evidence regarding effectiveness of stories in immunisation interventions, specifically, is limited, De Wit et al. compared the effects of narratives to statistical information among men who have sex with men and are at increased risk for hepatitis B. The narratives were found to be more effective at increasing both risk perception and intention to vaccinate.

The authors assert that "storytelling in health communication can be combined with powerful visual imagery to create an even more profound effect." They cite these examples:

• In Harm's Way - True Stories of Uninsured Texas Children, by the Children's Defense Fund, which is a booklet for policymakers and elected officials that shares the personal stories of 16 uninsured Texans who were "impacted by the confusing and oftentimes impractical eligibility process of the Texas Children’s Health Insurance Program (CHIP) and Medicaid system."
• Faces of Influenza by the American Lung Association, which is a multi-media campaign that shares photos and stories of people, some of whom have been affected by influenza and others who are advocates for influenza vaccination, such as police officers, physicians, celebrities, school teachers, pregnant women, and families living with chronic illnesses. The campaign aims to remind all Americans that anyone can be affected by influenza and reinforces the recommendation that all persons 6 months of age and older receive an annual influenza vaccine.
• Vaccine-Preventable Disease: The Forgotten Story, by the authors of this paper, which is a collection of photographs and personal stories of families affected by vaccine-preventable diseases. In a survey to physicians using the book, the authors found that most use the book in conjunction with other immunisation materials, including handouts, vaccine information statements (VISs), and other vaccine books, as well as personal conversations with the parent.

It is noted here that, "[b]ecause storytelling in health risk communication often involves tragic or painful experiences, the potential storyteller should be approached carefully and respectfully....It is also important for the person and/or family sharing their story to be advocates with a clear message. The story and underlying message should be able to stand on its own, be easily understandable and be free from complicated medical details. Lastly, consent should be collected from each storyteller if personally identifiable information is to be used."

The authors conclude that, with increased emphasis on evidence-based practices, stories can be used to personalise medical information and motivate patients - including parents deciding whether or not to immunise their children - into taking the best steps to protect their health. "Given the many benefits of storytelling, providers should reflect on their personal and professional backgrounds and strive to include stories along with medical facts in their daily practice."