At the University of Southampton in Hampshire the research team has used patient feedback to create a series of cartoons that demonstrate common experiences, problems and anxieties.
The cartoons were incorporated into a guidebook given to chronic kidney disease patients, who were asked their opinion on the use of cartoons and humour in regular patient information and then asked to evaluate the cartoons drawn for the guidebook.
Results showed a range of feelings towards the cartoons including amusement, recognition, hostility and incentives to action.
Overall, patients found the cartoons useful in lightening the tone of information and giving them insight and understanding not gained before.
The findings were initially published in the Health Services Research journal and the study was carried out under the auspices of the National Institute for Health Research (NIHR).
Inspired by patients’ quotes
As the study leader, Associate Professor Dr Anne Kennedy, pointed out: ‘Humour is frequently and naturally used by people with chronic illnesses, to help them adjust and understand what is happening to them. Our study has shown that cartoons could provide clarity to patients and be a way to engage with them. It is an untapped resource and could be a potential approach to support self-management.’
Dr Kennedy’s team worked closely with cartoonist Fran Orford, who followed her brief, along with quotes and stories provided by patients. The cartoons cover a range of topics from ‘uncertainty about diagnosis because being called into GP practice for so many repeat tests’, a ‘GP judging that the time is not right to tell a patient about yet another condition’, ‘making family decisions about meals and shopping’ and ‘exercise motivation – how dog-walking introduces you to others’.
Anne Kennedy believes health professionals could use the cartoon approach to help their patients engage more in the management of their own conditions. ‘Cartoons can be challenging,’ she added, ‘and the difficult emotional responses some pictures evoke could be used to help people adjust to their situation, but they can also be used to dispel some of their misconceptions.
‘The word chronic is often misinterpreted as meaning terminal – reaction to the particular cartoon that demonstrated chronic did prove a bit shocking to some patients but it allowed the word to be talked through and it was a tipping point for patients to better understand what their condition was.’
Fran Orford believes his background (his 15-year experience in social work, working with vulnerable children) helped him set the right tone for the cartoons. ‘I’ve drawn for hundreds of clients and am well aware that cartoons can perform a number of different functions, from simply amusing to inspiring. They can add a valuable visual ‘tag’ to grab the viewers attention in a way that words sometimes don’t. They can also help to lend text a little emotion.
Visual emotional creatures
‘The messages were undoubtedly very serious, but people who suffer from a medical condition may have enough potential gloom in their lives without health messages being presented in a depressing way. The images weren’t meant to detract from the seriousness of the message, but just present it in a different way.’
With humans being visual, emotional creatures, the cartoonist said it was not unreasonable for health professionals to experiment with providing information in an attention-grabbing way and that cartoons can help as part of the ‘mix’. ‘I hope patients using the booklet would like the fact that effort has been put in to make it as attractive as possible for them. I believe the cartoons would make it more likely that people would pick it up and read it, even if they hate the cartoons, the messages will still have more impact than uninterrupted text.’
Professor Anne Rogers, from the NIHR, who also worked on the study, said: ‘Cartoons, drawn with patient input, have potential to help communicate important advice and to help patients self-manage their conditions while boosting moral.’
Dr Anne Kennedy is a Senior Research Fellow in the Department of Health Sciences at the University of Southampton. Her main academic interests concern the self-management of long-term conditions. To that end, she has developed a number of self-management support interventions and tested them in randomised controlled trials. Dr Kennedy has a long-standing belief in patient involvement in research.