From health to the environment, how comics could drive behaviour change

When we hear the word “comic”, graphic novels oozing with superheroes, villains and other colourful characters are likely to come to mind.

It’s true that comics are, traditionally, fictional tales condensed into compelling visual narrative. But since their infancy in the 1920s, and evolution to superhero fiction in the 1960s, comics have been adapted to various fiction subgenres – and to non-fiction contexts too.

Today, comics are increasingly used to educate and influence attitudes and behaviour in various settings. Comics can support our understanding of health information – an area we call “graphic medicine”. They can also be used as an educational tool when it comes to environmental issues – these are sometimes called “eco-comics”.

Graphic medicine Comics which visually explain health treatments and complex medical procedures can improve physical and mental health literacy and help people to keep taking their medications. They can also help alleviate anxiety in patients before surgery.

By providing accessible health information and advice, comic novels can also encourage people to engage in health screening, helping prevent chronic conditions.

During the current pandemic, comics and images extracted from comics have been used to convey how COVID-19 is spread, and how our behaviour can affect its spread.

Health researchers believe that comics not only provide a more accessible medium for disseminating important public health information, but that readers can relate to and develop empathy for the comic characters. This can influence their perceptions of health risk. In turn, they may be inclined to imitate the behaviour of these characters (a concept called modelling) if the observed behaviour results in a favourable outcome.

There has also been a steady growth of comics used to convey patients’ lived experiences of chronic physical illness and mental health conditions. These comics provide a resource for others who are dealing with similar health challenges, by validating experiences such as fear, uncertainty, and isolation, and presenting advice and solutions through the narrative.

Comics depicting lived experience of illness may also help healthcare providers empathise with their patients, which can improve the quality of care they provide.

I recently developed a comic called “Diabetes Cyberspace” together with a comic artist and a group of young people living with type 1 diabetes from the UK, Ireland and Denmark. The narrative of the comic was informed by themes generated through interviews with these young people (our findings are published as a pre-print).

The comic tells the story of a young person with type 1 diabetes and the impact that diabetes-related social media content has on their mental wellbeing.

The comic is intended to be used as an educational resource to convey some of the challenges that young people with type 1 diabetes experience. It also provides advice and tips to help young people with the condition deal with unhelpful content online.

Research has demonstrated the potential benefits of comics as communication tools in the areas of physical and mental health. But most of the existing evidence on comics is speculative, based on theoretical studies (where researchers observe and analyse the contents of the comic) and small qualitative studies.

With a lack of empirical studies examining the effectiveness of comics to influence health-related outcomes such as knowledge and behaviour change, it’s difficult to understand the scale of their impact.

We hope the Diabetes Cyberspace comic can be evaluated to explore its effectiveness as an educational resource and communication tool for young people with type 1 diabetes and their caregivers, and in turn go some way to filling this knowledge gap.

Eco-comics Comics have also been used to enhance learning about environmental issues. As with graphic medicine, the body of evidence exploring the capacity for ecological comics to influence environmental attitudes and behaviour is sparse.

But recently the use of an eco-comic in primary schools in east Africa demonstrated positive results. Questionnaires indicated the children had enhanced conservation knowledge immediately after and, again, one year after they were exposed to the comic.

In other research, a comic which illustrated more sustainable ways of disposing of waste resulted in significant improvements in waste disposal habits among people in Nigeria.

By providing information in a more accessible way, these studies highlight the potential for eco-comics to increase environmental literacy and promote conservation.

We have also recently developed an ecological comic, called “Tales of Ecological Terror – A Plastic Nightmare.” We hosted face-to-face and online workshops with students and staff from diverse disciplines across Queen’s University Belfast to co-design the comic.

The comic aims to raise awareness of the harmful impact of plastic waste and the importance of waste reduction and recycling through a fun yet emotive narrative. We envisage that the comic will be piloted in different educational settings to measure its potential impact on ecological literacy, attitudes and behaviour.

(By Emma Berry, Lecturer in Health Psychology, Queen’s University Belfast Belfast, UK)