health narrative essay

Narrative Medicine: Every Patient Has a Story

Learning to empathize

Rita Charon, MD, PhD, executive director of Columbia’s Program in Narrative Medicine, is widely recognized as the originator of the field. “The effective practice of medicine requires narrative competence, that is, the ability to acknowledge, absorb, interpret, and act on the stories and plights of others,” Charon wrote in a 2001 article in JAMA .

“It’s not a stretch to say we need help to look at our own processes or to see and appreciate what patients are telling us. For me, it became a way for patients to feel heard and noticed,” Charon said of her early experiences integrating narrative skills into her clinical practice. “It’s a commitment to understanding patients’ lives, caring for the caregivers, and giving voice to the suffering.”

A core component of narrative medicine education is “close reading,” or learning how to thoughtfully and critically analyze a text. This approach helps students develop empathetic listening skills to better understand and connect with patients. Today, all Columbia medical students are exposed to narrative medicine in their first years, when they’re required to take one of 14 seminars on topics ranging from memoir writing to visual arts to medical journalism. The medical school also offers a fourth-year elective for medical students, as well as a scholarly track in Narrative and Social Medicine that Charon also directs.

While Columbia University is the only school with a graduate degree in narrative medicine, many medical schools have followed its lead, offering a variety of courses and seminars.

At the University of Nevada, Reno (UNR) School of Medicine, medical students can take narrative medicine as a scholarly concentration or as a fourth-year elective. Assignments include 10,000 words of reflective writing on clinical encounters that students must submit to a medical humanities publication. Susan Palwick, PhD, who teaches narrative medicine at UNR, said most students are drawn to write personal essays, though many try their hand at fiction and poetry as well.

“It’s easy for patients to get reduced to a specific illness. Narrative medicine is a way of integrating everything back together; it’s a way of staying curious about people.” Susan Palwick, PhD University of Nevada, Reno School of Medicine

“It’s easy for patients to get reduced to a specific illness,” said Palwick, an associate professor of English and adjunct professor in UNR’s Office of Medical Education. “Narrative medicine is a way of integrating everything back together; it’s a way of staying curious about people. Ultimately, it’s a form of love.”

She said the experience can help students unpack their biases, too. For instance, Palwick said a student who was feeling particularly judgmental of patients undergoing bariatric surgery decided to write a series of vignettes imagining why such patients struggle with their weight and why they can’t lose it without the help of surgery. The process, Palwick discovered, “helps you stay empathetic and sympathetic."

Reflective writing also provides a “safe space” for students to discuss the stresses of medical school and their professional fears, she added.

Jake Measom, a fourth-year medical student at UNR, said that participating in the narrative medicine scholarly concentration has pushed him to be more creative in his approach to patient care. He also sees narrative medicine as a “remedy to burnout,” noting that while the practice of medicine can sometimes feel monotonous, narrative medicine reminds him that “there’s a story to be had everywhere.”

“It not only makes me a better physician in the sense of being able to listen better and be more compassionate,” he said, “it also helps you gain a better understanding of who you are as a person.”

Storytelling as a means of coping

“ First you get your coat. I don’t care if you don’t remember where you left it, you find it. If there was a lot of blood, you ask someone to go quickly to the basement to get you a new set of scrubs. You put on your coat and you go into the bathroom. You look in the mirror and you say it. You use the mother’s name and you use her child’s name. You may not adjust this part in any way.”

That’s an excerpt from “How to Tell a Mother Her Child Is Dead,” which was published last September in the New York Times in the Sunday Review Opinion section. Authored by Naomi Rosenberg, MD, a physician at Temple University Hospital, the piece is a heart-wrenching example of how narrative medicine can serve as an outlet for coping with the harrowing experiences that providers regularly encounter.

Pulitzer Prize-winning journalist Michael Vitez encouraged Rosenberg to submit the piece in his new role as director of narrative medicine at Temple University Lewis Katz School of Medicine. After retiring from a 30-year career as a reporter at the Philadelphia Inquirer , Vitez approached the school’s dean about using his skills to help students, faculty, and patients translate their experiences into words. The idea morphed into Temple’s new Narrative Medicine Program, which launched in 2016.

Currently, the Temple program is fairly unstructured, with students and faculty working one-on-one with Vitez on their narrative pieces. For example, Vitez said a third-year medical student recently sent him a poem she wrote after an especially difficult day in her psychiatric rotation: “It helped her process her emotions and turn a really bad day into something really valuable,” he noted. Eventually, Temple hopes to offer a certificate and master’s degree in narrative medicine.

“I believe that stories have an incredible power,” said Vitez. “Understanding what a good story is and learning how to interview and ask questions will help you connect with your patients, understand them, and build relationships with them.”

Jay Baruch, MD, associate professor of emergency medicine at Brown’s Warren Alpert Medical School and faculty advisor to the narrative medicine course there, likewise maintains that the type of creative thinking often associated with the arts and humanities—and that narrative medicine often promotes—deserves a more central role in medical education.

“[Students and physicians] need to know the anatomy of a patient’s story just as much as the anatomy of the human body,” he said.

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Medical journals that accept stories and essays from physicians

Health and health care are hot topics lately, and not just for journalists and bloggers debating Obamacare. Suddenly – or so it seems; in fact the trend has been building for years – people from all walks of life want to read about medicine.

Within medicine, a majority of journals now have essay, viewpoint, or perspectives sections. Not only are such sections frequently the most widely read portions of the journal (i.e.  JAMA’s A Piece of My Mind ), but for some, including the New England Journal of Medicine , if you have the table of contents delivered to your inbox as I do, all you see are the essays; if you want the science, you need to scroll down. And that’s just the traditional medical press. Increasing numbers of health professionals write for and read blogs to learn about, reflect upon, and engage with others about issues in medicine from the results of a new study to coping with burnout and inspiring tales from the front lines of research and practice.

But the trend isn’t just among health professionals. The blogosphere is replete with sites focus on wellness, illness, aging, and the patient experience. Many of the writers for these sites are themselves patients or caregivers, but others write about these topics because they matter not just today with the ACA debates, but always, since birth, death, disease, and caring are the touchstones of most lives. This reality was recognized in the 2012 edition of  Best American Essays  in which eight, or fully one third, of the essays were about medicine. The topics ranged from menopause as a vehicle to the true self and how an aging doctor wants to die to a writing class for children at a cancer hospital and the benefits of gaining weight to treat depression. Only two were written by physicians. All combined great writing and storytelling with novel insights and important information or thoughts about life, illness, caregiving, and death. And, no, the editor of the 2012 edition was not a doctor.

So whether you’re a health profession who writes or wants to write or a writer working on a piece that deals in some way with medicine, health, or illness, there is clearly interest in this sort of work, and possibly even growing interest.  Professional society annual meetings now feature workshops on narrative, advocacy writing, and social media, and many universities and medical schools now have courses in this sort of  Public Medical Communication (PMC)  writing, sponsor PMC-related annual conferences, and publish journals of essays, short stories, poetry, and art. Annual conferences around the nation invite anyone, professional or not, to come write about health and illness.

So what do all these essays and stories and blogs have in common? Each uses literary and journalistic techniques to explore topics related to health and health care in ways that are compelling, entertaining, and accessible to all. Mostly, it’s about communicating clearly, often using a story and characters to illustrate a point, and always about striving to understand and represent real lived experience.

Below is a partial list, in alphabetical order, of medical journals that publish this sort of work.

Academic Medicine

Medicine and the Arts (MATA): Two facing pages: left-hand page features an excerpt from literature, a poem, a photograph, etc. of no more than 700 words; right-hand page is a commentary of about 900 words that explores the relevance of the artwork to the teaching and/or practice of medicine.

Teaching and Learning Moments (TLM): Pieces vary in style and subject, but most are first-person, informal narratives from 250-600 words written from the perspective of instructor, student, or patient.

American Journal of Kidney Disease

In a Few Words: A nonfiction narrative essay up to 1,600 words which gives voice to the personal experiences and stories that define kidney disease. Submissions from physicians, allied health professionals, patients, or family members are welcome.

Annals of Internal Medicine

Perspective : Unstructured essays up to 1500 words representing opinions, presenting hypotheses, or considering controversial issues.

On Being a Doctor: Short essays or fiction up to 1500 words on illuminating experiences in practice.

On Being a Patient : Short essays up to 1500 words by physicians on their own experiences of illness and accounts written by patients or their families.

Personal Views: Highly readable, opinion based essays of about 850 words that make a single strong, novel, and well-argued point and are also often topical, significant, insightful, and attention grabbing.

Fillers : A articles of up to 600 words on topics such as: A patient who changed my practice; A memorable patient; A paper that changed my practice; The person who has most influenced me; My most informative mistake; Any other story conveying instruction, pathos, or humor.

Humanities: Unsolicited poetry, fiction and creative nonfiction limited to 1000 words or 75 lines (poems) that convey personal and professional experiences with a sense of immediacy and realism.

Salon: 700 word op-ed style articles of novel, lively, thoughtful and sometimes quirky ideas designed to ignite sparks of insight and stimulate thought and online discussion using our e-letters function.

Family Medicine

Narrative Essays : Stories from clinical practice or from the educational setting limited to 1000 words by teachers, learners, patients, or professionals practicing in the primary care disciplines that present a creative perspective both in their content and in their story-telling style. Narrative essays should illuminate the unique complexity and genuine personal dimensions of patient care and education in family medicine, primary care, or community medicine.

Health Affairs

Narrative Matters: Narrative essays of 2,500 words based on firsthand encounters with the health care system that explore the personal, ethical, and moral issues of delivering or receiving health care today.

A Piece of My Mind: Personal vignettes of up to 1800 words (eg, exploring the dynamics of the patient-physician relationship) taken from wide-ranging experiences in medicine; occasional views and opinions.

Poetry and Medicine: Poems no longer than 50 lines related to the medical experience, whether from the point of view of a health care worker or patient, or simply an observer.

Journal of the American Geriatrics Society

Old Lives Tales: Stories, experiences, or incidences of which have instructed, saddened or gladdened us and, above all, taught us something about the care of the older adult. 750 words.

Journal of General Internal Medicine

Materia Medica: Well-crafted, highly readable and engaging personal narratives, essays or short stories of up to 1500 words and poetry of up to 100 lines.

Text and Context: Excerpts from literature (novels, short stories, poetry, plays or creative non-fiction) of 200-800 words followed by an accompanying essay of up to 1000 words discussing the significance of the work for clinical practice or medical education.

Perspective: Articles limited to 1000 to 1200 words cover a wide variety of topics of current interest in health care, medicine, and the intersection between medicine and society.

Reflections: Poetry or prose, fiction or non-fiction, up to 2000 words that illustrate facets of the profession of neurology, particularly if written from a new perspective, are preferred. The quality of the writing style will be as important as the content.

Louise Aronson is a geriatrician and the author of A History of the Present Illness . She blogs at her self-titled site, Louse Aronson , and can be found on Twitter @LouiseAronson .

Image credit:  Shutterstock.com

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The Ultimate Narrative Essay Guide for Beginners

A narrative essay tells a story in chronological order, with an introduction that introduces the characters and sets the scene. Then a series of events leads to a climax or turning point, and finally a resolution or reflection on the experience.

Speaking of which, are you in sixes and sevens about narrative essays? Don’t worry this ultimate expert guide will wipe out all your doubts. So let’s get started.

Table of Contents

Everything You Need to Know About Narrative Essay

What is a narrative essay.

When you go through a narrative essay definition, you would know that a narrative essay purpose is to tell a story. It’s all about sharing an experience or event and is different from other types of essays because it’s more focused on how the event made you feel or what you learned from it, rather than just presenting facts or an argument. Let’s explore more details on this interesting write-up and get to know how to write a narrative essay.

Elements of a Narrative Essay

Here’s a breakdown of the key elements of a narrative essay:

A narrative essay has a beginning, middle, and end. It builds up tension and excitement and then wraps things up in a neat package.

Real people, including the writer, often feature in personal narratives. Details of the characters and their thoughts, feelings, and actions can help readers to relate to the tale.

It’s really important to know when and where something happened so we can get a good idea of the context. Going into detail about what it looks like helps the reader to really feel like they’re part of the story.

Conflict or Challenge 

A story in a narrative essay usually involves some kind of conflict or challenge that moves the plot along. It could be something inside the character, like a personal battle, or something from outside, like an issue they have to face in the world.

Theme or Message

A narrative essay isn’t just about recounting an event – it’s about showing the impact it had on you and what you took away from it. It’s an opportunity to share your thoughts and feelings about the experience, and how it changed your outlook.

Emotional Impact

The author is trying to make the story they’re telling relatable, engaging, and memorable by using language and storytelling to evoke feelings in whoever’s reading it.

Narrative essays let writers have a blast telling stories about their own lives. It’s an opportunity to share insights and impart wisdom, or just have some fun with the reader. Descriptive language, sensory details, dialogue, and a great narrative voice are all essentials for making the story come alive.

The Purpose of a Narrative Essay

A narrative essay is more than just a story – it’s a way to share a meaningful, engaging, and relatable experience with the reader. Includes:

Sharing Personal Experience

Narrative essays are a great way for writers to share their personal experiences, feelings, thoughts, and reflections. It’s an opportunity to connect with readers and make them feel something.

Entertainment and Engagement

The essay attempts to keep the reader interested by using descriptive language, storytelling elements, and a powerful voice. It attempts to pull them in and make them feel involved by creating suspense, mystery, or an emotional connection.

Conveying a Message or Insight

Narrative essays are more than just a story – they aim to teach you something. They usually have a moral lesson, a new understanding, or a realization about life that the author gained from the experience.

Building Empathy and Understanding

By telling their stories, people can give others insight into different perspectives, feelings, and situations. Sharing these tales can create compassion in the reader and help broaden their knowledge of different life experiences.

Inspiration and Motivation

Stories about personal struggles, successes, and transformations can be really encouraging to people who are going through similar situations. It can provide them with hope and guidance, and let them know that they’re not alone.

Reflecting on Life’s Significance

These essays usually make you think about the importance of certain moments in life or the impact of certain experiences. They make you look deep within yourself and ponder on the things you learned or how you changed because of those events.

Demonstrating Writing Skills

Coming up with a gripping narrative essay takes serious writing chops, like vivid descriptions, powerful language, timing, and organization. It’s an opportunity for writers to show off their story-telling abilities.

Preserving Personal History

Sometimes narrative essays are used to record experiences and special moments that have an emotional resonance. They can be used to preserve individual memories or for future generations to look back on.

Cultural and Societal Exploration

Personal stories can look at cultural or social aspects, giving us an insight into customs, opinions, or social interactions seen through someone’s own experience.

Format of a Narrative Essay

Narrative essays are quite flexible in terms of format, which allows the writer to tell a story in a creative and compelling way. Here’s a quick breakdown of the narrative essay format, along with some examples:

Introduction

Set the scene and introduce the story.

Engage the reader and establish the tone of the narrative.

Hook: Start with a captivating opening line to grab the reader’s attention. For instance:

Example:  “The scorching sun beat down on us as we trekked through the desert, our water supply dwindling.”

Background Information: Provide necessary context or background without giving away the entire story.

Example:  “It was the summer of 2015 when I embarked on a life-changing journey to…”

Thesis Statement or Narrative Purpose

Present the main idea or the central message of the essay.

Offer a glimpse of what the reader can expect from the narrative.

Thesis Statement: This isn’t as rigid as in other essays but can be a sentence summarizing the essence of the story.

Example:  “Little did I know, that seemingly ordinary hike would teach me invaluable lessons about resilience and friendship.”

Body Paragraphs

Present the sequence of events in chronological order.

Develop characters, setting, conflict, and resolution.

Story Progression : Describe events in the order they occurred, focusing on details that evoke emotions and create vivid imagery.

Example : Detail the trek through the desert, the challenges faced, interactions with fellow hikers, and the pivotal moments.

Character Development : Introduce characters and their roles in the story. Show their emotions, thoughts, and actions.

Example : Describe how each character reacted to the dwindling water supply and supported each other through adversity.

Dialogue and Interactions : Use dialogue to bring the story to life and reveal character personalities.

Example : “Sarah handed me her last bottle of water, saying, ‘We’re in this together.'”

Reach the peak of the story, the moment of highest tension or significance.

Turning Point: Highlight the most crucial moment or realization in the narrative.

Example:  “As the sun dipped below the horizon and hope seemed lost, a distant sound caught our attention—the rescue team’s helicopters.”

Provide closure to the story.

Reflect on the significance of the experience and its impact.

Reflection : Summarize the key lessons learned or insights gained from the experience.

Example : “That hike taught me the true meaning of resilience and the invaluable support of friendship in challenging times.”

Closing Thought : End with a memorable line that reinforces the narrative’s message or leaves a lasting impression.

Example : “As we boarded the helicopters, I knew this adventure would forever be etched in my heart.”

Example Summary:

Imagine a narrative about surviving a challenging hike through the desert, emphasizing the bonds formed and lessons learned. The narrative essay structure might look like starting with an engaging scene, narrating the hardships faced, showcasing the characters’ resilience, and culminating in a powerful realization about friendship and endurance.

Different Types of Narrative Essays

There are a bunch of different types of narrative essays – each one focuses on different elements of storytelling and has its own purpose. Here’s a breakdown of the narrative essay types and what they mean.

Personal Narrative

Description : Tells a personal story or experience from the writer’s life.

Purpose: Reflects on personal growth, lessons learned, or significant moments.

Example of Narrative Essay Types:

Topic : “The Day I Conquered My Fear of Public Speaking”

Focus: Details the experience, emotions, and eventual triumph over a fear of public speaking during a pivotal event.

Descriptive Narrative

Description : Emphasizes vivid details and sensory imagery.

Purpose : Creates a sensory experience, painting a vivid picture for the reader.

Topic : “A Walk Through the Enchanted Forest”

Focus : Paints a detailed picture of the sights, sounds, smells, and feelings experienced during a walk through a mystical forest.

Autobiographical Narrative

Description: Chronicles significant events or moments from the writer’s life.

Purpose: Provides insights into the writer’s life, experiences, and growth.

Topic: “Lessons from My Childhood: How My Grandmother Shaped Who I Am”

Focus: Explores pivotal moments and lessons learned from interactions with a significant family member.

Experiential Narrative

Description: Relays experiences beyond the writer’s personal life.

Purpose: Shares experiences, travels, or events from a broader perspective.

Topic: “Volunteering in a Remote Village: A Journey of Empathy”

Focus: Chronicles the writer’s volunteering experience, highlighting interactions with a community and personal growth.

Literary Narrative

Description: Incorporates literary elements like symbolism, allegory, or thematic explorations.

Purpose: Uses storytelling for deeper explorations of themes or concepts.

Topic: “The Symbolism of the Red Door: A Journey Through Change”

Focus: Uses a red door as a symbol, exploring its significance in the narrator’s life and the theme of transition.

Historical Narrative

Description: Recounts historical events or periods through a personal lens.

Purpose: Presents history through personal experiences or perspectives.

Topic: “A Grandfather’s Tales: Living Through the Great Depression”

Focus: Shares personal stories from a family member who lived through a historical era, offering insights into that period.

Digital or Multimedia Narrative

Description: Incorporates multimedia elements like images, videos, or audio to tell a story.

Purpose: Explores storytelling through various digital platforms or formats.

Topic: “A Travel Diary: Exploring Europe Through Vlogs”

Focus: Combines video clips, photos, and personal narration to document a travel experience.

How to Choose a Topic for Your Narrative Essay?

Selecting a compelling topic for your narrative essay is crucial as it sets the stage for your storytelling. Choosing a boring topic is one of the narrative essay mistakes to avoid . Here’s a detailed guide on how to choose the right topic:

Reflect on Personal Experiences

• Significant Moments:

Moments that had a profound impact on your life or shaped your perspective.

Example: A moment of triumph, overcoming a fear, a life-changing decision, or an unforgettable experience.

• Emotional Resonance:

Events that evoke strong emotions or feelings.

Example: Joy, fear, sadness, excitement, or moments of realization.

• Lessons Learned:

Experiences that taught you valuable lessons or brought about personal growth.

Example: Challenges that led to personal development, shifts in mindset, or newfound insights.

Explore Unique Perspectives

• Uncommon Experiences:

Unique or unconventional experiences that might captivate the reader’s interest.

Example: Unusual travels, interactions with different cultures, or uncommon hobbies.

• Different Points of View:

Stories from others’ perspectives that impacted you deeply.

Example: A family member’s story, a friend’s experience, or a historical event from a personal lens.

Focus on Specific Themes or Concepts

• Themes or Concepts of Interest:

Themes or ideas you want to explore through storytelling.

Example: Friendship, resilience, identity, cultural diversity, or personal transformation.

• Symbolism or Metaphor:

Using symbols or metaphors as the core of your narrative.

Example: Exploring the symbolism of an object or a place in relation to a broader theme.

Consider Your Audience and Purpose

• Relevance to Your Audience:

Topics that resonate with your audience’s interests or experiences.

Example: Choose a relatable theme or experience that your readers might connect with emotionally.

• Impact or Message:

What message or insight do you want to convey through your story?

Example: Choose a topic that aligns with the message or lesson you aim to impart to your readers.

Brainstorm and Evaluate Ideas

• Free Writing or Mind Mapping:

Process: Write down all potential ideas without filtering. Mind maps or free-writing exercises can help generate diverse ideas.

• Evaluate Feasibility:

The depth of the story, the availability of vivid details, and your personal connection to the topic.

Imagine you’re considering topics for a narrative essay. You reflect on your experiences and decide to explore the topic of “Overcoming Stage Fright: How a School Play Changed My Perspective.” This topic resonates because it involves a significant challenge you faced and the personal growth it brought about.

Narrative Essay Topics

50 easy narrative essay topics.

• Learning to Ride a Bike
• My First Day of School
• A Surprise Birthday Party
• The Day I Got Lost
• Visiting a Haunted House
• An Encounter with a Wild Animal
• My Favorite Childhood Toy
• The Best Vacation I Ever Had
• An Unforgettable Family Gathering
• Conquering a Fear of Heights
• A Special Gift I Received
• Moving to a New City
• The Most Memorable Meal
• Getting Caught in a Rainstorm
• An Act of Kindness I Witnessed
• The First Time I Cooked a Meal
• My Experience with a New Hobby
• The Day I Met My Best Friend
• A Hike in the Mountains
• Learning a New Language
• An Embarrassing Moment
• Dealing with a Bully
• My First Job Interview
• A Sporting Event I Attended
• The Scariest Dream I Had
• Helping a Stranger
• The Joy of Achieving a Goal
• A Road Trip Adventure
• Overcoming a Personal Challenge
• The Significance of a Family Tradition
• An Unusual Pet I Owned
• A Misunderstanding with a Friend
• Exploring an Abandoned Building
• My Favorite Book and Why
• The Impact of a Role Model
• A Cultural Celebration I Participated In
• A Valuable Lesson from a Teacher
• A Trip to the Zoo
• An Unplanned Adventure
• Volunteering Experience
• A Moment of Forgiveness
• A Decision I Regretted
• A Special Talent I Have
• The Importance of Family Traditions
• The Thrill of Performing on Stage
• A Moment of Sudden Inspiration
• The Meaning of Home
• Learning to Play a Musical Instrument
• A Childhood Memory at the Park
• Witnessing a Beautiful Sunset

Narrative Essay Topics for College Students

• Discovering a New Passion
• Overcoming Academic Challenges
• Navigating Cultural Differences
• Embracing Independence: Moving Away from Home
• Exploring Career Aspirations
• Coping with Stress in College
• The Impact of a Mentor in My Life
• Balancing Work and Studies
• Facing a Fear of Public Speaking
• Exploring a Semester Abroad
• The Evolution of My Study Habits
• Volunteering Experience That Changed My Perspective
• The Role of Technology in Education
• Finding Balance: Social Life vs. Academics
• Learning a New Skill Outside the Classroom
• Reflecting on Freshman Year Challenges
• The Joys and Struggles of Group Projects
• My Experience with Internship or Work Placement
• Challenges of Time Management in College
• Redefining Success Beyond Grades
• The Influence of Literature on My Thinking
• The Impact of Social Media on College Life
• Overcoming Procrastination
• Lessons from a Leadership Role
• Exploring Diversity on Campus
• Exploring Passion for Environmental Conservation
• An Eye-Opening Course That Changed My Perspective
• Living with Roommates: Challenges and Lessons
• The Significance of Extracurricular Activities
• The Influence of a Professor on My Academic Journey
• Discussing Mental Health in College
• The Evolution of My Career Goals
• Confronting Personal Biases Through Education
• The Experience of Attending a Conference or Symposium
• Challenges Faced by Non-Native English Speakers in College
• The Impact of Traveling During Breaks
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• The Impact of Music or Art on My Life
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• Overcoming Impostor Syndrome in College
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• The Influence of Family Expectations on Education
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Narrative Essay Comparison

Narrative essay vs. descriptive essay.

Here’s our first narrative essay comparison! While both narrative and descriptive essays focus on vividly portraying a subject or an event, they differ in their primary objectives and approaches. Now, let’s delve into the nuances of comparison on narrative essays.

Narrative Essay:

Storytelling: Focuses on narrating a personal experience or event.

Chronological Order: Follows a structured timeline of events to tell a story.

Message or Lesson: Often includes a central message, moral, or lesson learned from the experience.

Engagement: Aims to captivate the reader through a compelling storyline and character development.

First-Person Perspective: Typically narrated from the writer’s point of view, using “I” and expressing personal emotions and thoughts.

Plot Development: Emphasizes a plot with a beginning, middle, climax, and resolution.

Character Development: Focuses on describing characters, their interactions, emotions, and growth.

Conflict or Challenge: Usually involves a central conflict or challenge that drives the narrative forward.

Dialogue: Incorporates conversations to bring characters and their interactions to life.

Reflection: Concludes with reflection or insight gained from the experience.

Descriptive Essay:

Vivid Description: Aims to vividly depict a person, place, object, or event.

Imagery and Details: Focuses on sensory details to create a vivid image in the reader’s mind.

Emotion through Description: Uses descriptive language to evoke emotions and engage the reader’s senses.

Painting a Picture: Creates a sensory-rich description allowing the reader to visualize the subject.

Imagery and Sensory Details: Focuses on providing rich sensory descriptions, using vivid language and adjectives.

Point of Focus: Concentrates on describing a specific subject or scene in detail.

Spatial Organization: Often employs spatial organization to describe from one area or aspect to another.

Objective Observations: Typically avoids the use of personal opinions or emotions; instead, the focus remains on providing a detailed and objective description.

Comparison:

Focus: Narrative essays emphasize storytelling, while descriptive essays focus on vividly describing a subject or scene.

Perspective: Narrative essays are often written from a first-person perspective, while descriptive essays may use a more objective viewpoint.

Purpose: Narrative essays aim to convey a message or lesson through a story, while descriptive essays aim to paint a detailed picture for the reader without necessarily conveying a specific message.

Narrative Essay vs. Argumentative Essay

The narrative essay and the argumentative essay serve distinct purposes and employ different approaches:

Engagement and Emotion: Aims to captivate the reader through a compelling story.

Reflective: Often includes reflection on the significance of the experience or lessons learned.

First-Person Perspective: Typically narrated from the writer’s point of view, sharing personal emotions and thoughts.

Plot Development: Emphasizes a storyline with a beginning, middle, climax, and resolution.

Message or Lesson: Conveys a central message, moral, or insight derived from the experience.

Argumentative Essay:

Persuasion and Argumentation: Aims to persuade the reader to adopt the writer’s viewpoint on a specific topic.

Logical Reasoning: Presents evidence, facts, and reasoning to support a particular argument or stance.

Debate and Counterarguments: Acknowledge opposing views and counter them with evidence and reasoning.

Thesis Statement: Includes a clear thesis statement that outlines the writer’s position on the topic.

Thesis and Evidence: Starts with a strong thesis statement and supports it with factual evidence, statistics, expert opinions, or logical reasoning.

Counterarguments: Addresses opposing viewpoints and provides rebuttals with evidence.

Logical Structure: Follows a logical structure with an introduction, body paragraphs presenting arguments and evidence, and a conclusion reaffirming the thesis.

Formal Language: Uses formal language and avoids personal anecdotes or emotional appeals.

Objective: Argumentative essays focus on presenting a logical argument supported by evidence, while narrative essays prioritize storytelling and personal reflection.

Purpose: Argumentative essays aim to persuade and convince the reader of a particular viewpoint, while narrative essays aim to engage, entertain, and share personal experiences.

Structure: Narrative essays follow a storytelling structure with character development and plot, while argumentative essays follow a more formal, structured approach with logical arguments and evidence.

In essence, while both essays involve writing and presenting information, the narrative essay focuses on sharing a personal experience, whereas the argumentative essay aims to persuade the audience by presenting a well-supported argument.

Narrative Essay vs. Personal Essay

While there can be an overlap between narrative and personal essays, they have distinctive characteristics:

Storytelling: Emphasizes recounting a specific experience or event in a structured narrative form.

Engagement through Story: Aims to engage the reader through a compelling story with characters, plot, and a central theme or message.

Reflective: Often includes reflection on the significance of the experience and the lessons learned.

First-Person Perspective: Typically narrated from the writer’s viewpoint, expressing personal emotions and thoughts.

Plot Development: Focuses on developing a storyline with a clear beginning, middle, climax, and resolution.

Character Development: Includes descriptions of characters, their interactions, emotions, and growth.

Central Message: Conveys a central message, moral, or insight derived from the experience.

Personal Essay:

Exploration of Ideas or Themes: Explores personal ideas, opinions, or reflections on a particular topic or subject.

Expression of Thoughts and Opinions: Expresses the writer’s thoughts, feelings, and perspectives on a specific subject matter.

Reflection and Introspection: Often involves self-reflection and introspection on personal experiences, beliefs, or values.

Varied Structure and Content: Can encompass various forms, including memoirs, personal anecdotes, or reflections on life experiences.

Flexibility in Structure: Allows for diverse structures and forms based on the writer’s intent, which could be narrative-like or more reflective.

Theme-Centric Writing: Focuses on exploring a central theme or idea, with personal anecdotes or experiences supporting and illustrating the theme.

Expressive Language: Utilizes descriptive and expressive language to convey personal perspectives, emotions, and opinions.

Focus: Narrative essays primarily focus on storytelling through a structured narrative, while personal essays encompass a broader range of personal expression, which can include storytelling but isn’t limited to it.

Structure: Narrative essays have a more structured plot development with characters and a clear sequence of events, while personal essays might adopt various structures, focusing more on personal reflection, ideas, or themes.

Intent: While both involve personal experiences, narrative essays emphasize telling a story with a message or lesson learned, while personal essays aim to explore personal thoughts, feelings, or opinions on a broader range of topics or themes.

A narrative essay is more than just telling a story. It’s also meant to engage the reader, get them thinking, and leave a lasting impact. Whether it’s to amuse, motivate, teach, or reflect, these essays are a great way to communicate with your audience. This interesting narrative essay guide was all about letting you understand the narrative essay, its importance, and how can you write one.

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Narrative Essay Overview

Narration is a rhetorical style that basically just tells a story. Being able to convey events in a clear, descriptive, chronological order is important in many fields. Many times, in college, your professors will ask you to write paragraphs or entire essays using a narrative style.

A narration (or narrative) essay is structured around the goal of recounting a story. Most of the time, in introductory writing classes, students write narration essays that discuss personal stories; however, in different disciplines, you may be asked to tell a story about another person’s experience or an event.

NOTE:  Remember, if you’re writing a narrative essay, even though you’re telling a story, you’ll often be required to include a strong introduction, thesis statement, and conclusion.

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Excelsior Online Writing Lab (OWL). Located at:  https://owl.excelsior.edu/  . This site is licensed under a  https://creativecommons.org/licenses/by/4.0/  .

ENG102 Contextualized for Health Sciences - OpenSkill Fellowship Copyright © 2022 by Compiled by Lori Walk. All Rights Reserved.

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16 Personal Essays About Mental Health Worth Reading

Here are some of the most moving and illuminating essays published on BuzzFeed about mental illness, wellness, and the way our minds work.

BuzzFeed Staff

1. My Best Friend Saved Me When I Attempted Suicide, But I Didn’t Save Her — Drusilla Moorhouse

"I was serious about killing myself. My best friend wasn’t — but she’s the one who’s dead."

2. Life Is What Happens While You’re Googling Symptoms Of Cancer — Ramona Emerson

"After a lifetime of hypochondria, I was finally diagnosed with my very own medical condition. And maybe, in a weird way, it’s made me less afraid to die."

3. How I Learned To Be OK With Feeling Sad — Mac McClelland

"It wasn’t easy, or cheap."

4. Who Gets To Be The “Good Schizophrenic”? — Esmé Weijun Wang

"When you’re labeled as crazy, the “right” kind of diagnosis could mean the difference between a productive life and a life sentence."

5. Why Do I Miss Being Bipolar? — Sasha Chapin

"The medication I take to treat my bipolar disorder works perfectly. Sometimes I wish it didn’t."

6. What My Best Friend And I Didn’t Learn About Loss — Zan Romanoff

"When my closest friend’s first baby was stillborn, we navigated through depression and grief together."

7. I Can’t Live Without Fear, But I Can Learn To Be OK With It — Arianna Rebolini

"I’ve become obsessively afraid that the people I love will die. Now I have to teach myself how to be OK with that."

8. What It’s Like Having PPD As A Black Woman — Tyrese Coleman

"It took me two years to even acknowledge I’d been depressed after the birth of my twin sons. I wonder how much it had to do with the way I had been taught to be strong."

9. Notes On An Eating Disorder — Larissa Pham

"I still tell my friends I am in recovery so they will hold me accountable."

10. What Comedy Taught Me About My Mental Illness — Kate Lindstedt

"I didn’t expect it, but stand-up comedy has given me the freedom to talk about depression and anxiety on my own terms."

11. The Night I Spoke Up About My #BlackSuicide — Terrell J. Starr

"My entire life was shaped by violence, so I wanted to end it violently. But I didn’t — thanks to overcoming the stigma surrounding African-Americans and depression, and to building a community on Twitter."

12. Knitting Myself Back Together — Alanna Okun

"The best way I’ve found to fight my anxiety is with a pair of knitting needles."

13. I Started Therapy So I Could Take Better Care Of Myself — Matt Ortile

"I’d known for a while that I needed to see a therapist. It wasn’t until I felt like I could do without help that I finally sought it."

14. I’m Mending My Broken Relationship With Food — Anita Badejo

"After a lifetime struggling with disordered eating, I’m still figuring out how to have a healthy relationship with my body and what I feed it."

15. I Found Love In A Hopeless Mess — Kate Conger

"Dehoarding my partner’s childhood home gave me a way to understand his mother, but I’m still not sure how to live with the habit he’s inherited."

16. When Taking Anxiety Medication Is A Revolutionary Act — Tracy Clayton

"I had to learn how to love myself enough to take care of myself. It wasn’t easy."

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• How To Write a Narrative Essay: Guide With Examples
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• Updated December 12, 2023

Welcome to the creative world of narrative essays where you get to become the storyteller and craft your own narrative. In this article, we’ll break down how to write a narrative essay, covering the essential elements and techniques that you need to know.

Table of Contents

What is a Narrative Essay?

A narrative essay is a form of writing where the author recounts a personal experience or story. Unlike other types of essays, a narrative essay allows you to share a real-life event or sequence of events, often drawing from personal insights and emotions.

In a narrative essay, you take on the role of a storyteller, employing vivid details and descriptive language to transport the reader into the world of your story. The narrative often unfolds in chronological order, guiding the audience through a journey of experiences, reflections, and sometimes, a lesson learned.

The success of a narrative essay lies in your ability to create a compelling narrative arc. This means establishing a clear beginning, middle, and end. This structure helps build suspense, maintain the reader’s interest, and deliver a cohesive and impactful story. Ultimately, a well-crafted narrative essay not only narrates an event but also communicates the deeper meaning or significance behind the experience, making it a powerful and memorable piece of writing and leaving a lasting impression on the reader.

Types of Narrative Essays

Narrative essays come in various forms, each with unique characteristics. The most common type of narrative essay are personal narrative essays where you write about a personal experience. This can cover a whole range of topics as these examples of personal narrative essays illustrate. As a student in school or college, you’ll often be asked to write these types of essays. You may also need to write them later in life when applying for jobs and describing your past experiences.

However, this isn’t the only type of narrative essay. There are also fictional narrative essays that you can write using your imagination, and various subject specific narrative essays that you might have come across without even realizing it.

So, it’s worth knowing about the different types of narrative essays and what they each focus on before we move on to how to write them.

Here are some common types of narrative essays:

• Focus on a personal experience or event from the author’s life.
• Use the first-person perspective to convey the writer’s emotions and reflections.
• Can take many forms, from science fiction and fantasy to adventure and romance.
• Spark the imagination to create captivating stories.
• Provide a detailed account of the author’s life, often covering a significant timespan.
• Explore key life events, achievements, challenges, and personal growth.
• Reflect on the writer’s experiences with language, reading, or writing.
• Explore how these experiences have shaped the writer’s identity and skills
• Document the author’s experiences and insights gained from a journey or travel.
• Describe places visited, people encountered, and the lessons learned during the trip.
• Explore historical events or periods through a personal lens.
• Combine factual information with the writer’s perspective and experiences.

The narrative essay type you’ll work with often depends on the purpose, audience, and nature of the story being told. So, how should you write narrative essays?

How To Write Narrative Essays

From selecting the right topic to building a captivating storyline, we explore the basics to guide you in creating engaging narratives. So, grab your pen, and let’s delve into the fundamentals of writing a standout narrative essay.

Before we start, it’s worth pointing out that most narrative essays are written in the first-person. Through the use of first-person perspective, you get to connect with the reader, offering a glimpse into your thoughts, reactions, and the significance of the story being shared.

Let’s get into how to create these stories:

Write your plot

If you want to tell a compelling story you need a good plot. Your plot will give your story a structure. Every good story includes some kind of conflict. You should start with setting the scene for readers. After this, you introduce a challenge or obstacle. Readers will keep reading until the end to find out how you managed to overcome it.

Your story should reach a climax where tension is highest. This will be the turning point that leads to a resolution. For example, moving outside of your comfort zone was difficult and scary. It wasn’t easy at first but eventually, you grew braver and more confident. Readers should discover more about who you are as a person through what they read.

A seasoned writer knows how to craft a story that connects with an audience and creates an impact.

Hook readers with your introduction

In your introduction, you will introduce the main idea of your essay and set the context. Ways to make it more engaging are to:

• Use sensory images to describe the setting in which your story takes place.
• Use a quote that illustrates your main idea.
• Pose an intriguing question.
• Introduce an unexpected fact or a statement that grabs attention.

Develop your characters

You need to make readers feel they know any characters you introduce in your narrative essay. You can do this by revealing their personalities and quirks through the actions they take. It is always better to show the actions of characters rather than giving facts about them. Describing a character’s body language and features can also reveal a great deal about the person. You can check out these adjectives to describe a person to get some inspiration.

Use dialogue

Dialogue can bring your narrative essay to life. Most fiction books use dialogue extensively . It helps to move the story along in a subtle way. When you allow characters to talk, what they have to say seems more realistic. You can use similes , metaphors, and other parts of speech to make your story more compelling. Just make sure the dialogue is written clearly with the right punctuation so readers understand exactly who is talking.

Work on the pace of the story

Your story must flow along at a steady pace. If there’s too much action, readers may get confused. If you use descriptive writing, try not to overdo it. The clear, concise language throughout will appeal to readers more than lengthy descriptions.

Build up towards a climax

This is the point at which the tension in your story is the highest. A compelling climax takes readers by surprise. They may not have seen it coming. This doesn’t mean your climax should come out of left field. You need to carefully lead up to it step by step and guide readers along. When you reveal it they should be able to look back and realize it’s logical.

Cut out what you don’t need

Your story will suffer if you include too much detail that doesn’t move your story along. It may flow better once you cut out some unnecessary details. Most narrative essays are about five paragraphs but this will depend on the topic and requirements.

In a narrative essay, you share your experiences and insights. The journey you take your readers on should leave them feeling moved or inspired. It takes practice to learn how to write in a way that causes this reaction. With a good plot as your guide, it’s easier to write a compelling story that flows toward a satisfying resolution.

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The Benefits and Challenges of Socialized Medicine

This essay about socialized medicine examines its role in providing universal healthcare access, transcending wealth and privilege to ensure equitable health services for all. It highlights the benefits of health equity and cost control while addressing challenges such as funding, political opposition, and bureaucratic inefficiencies. The narrative explores both the promise and obstacles of socialized medicine, emphasizing its potential to transform the healthcare landscape despite the hurdles it faces.

How it works

In the complex framework of healthcare systems, socialized medicine stands out as a bold initiative, infusing the narrative of access with vibrant inclusivity while navigating the stormy seas of controversy. This intricate narrative intertwines numerous benefits and challenges, crafting a story of healthcare evolution marked by both admiration and apprehension.

At its essence, socialized medicine epitomizes the noble aspiration of universal healthcare, transcending the confines of wealth and privilege. By eliminating financial barriers, it heralds an era where medical facilities open their doors to all, embracing every individual with healthcare services.

In this egalitarian vision, the threat of financial catastrophe fades, replaced by the comforting assurance that one’s socioeconomic status will not determine the quality of care they receive.

In the grand orchestration of health equity, socialized medicine serves as a steadfast conductor, harmonizing a melody of accessibility for all. Marginalized communities are no longer relegated to the fringes of healthcare access, as the beacon of universal coverage shines brightly, guiding the way toward a more just and equitable healthcare landscape. In this radiant vision, the vast gap between privilege and poverty narrows, fostering a society where the right to health is upheld as an unalienable birthright.

Yet, amidst the chorus of praise, discordant notes of dissent resonate through the discourse. The call for fiscal responsibility echoes, its tone tinged with concern over the immense challenge of funding such a monumental endeavor. The shadow of taxation looms large, casting doubt on the feasibility of sustaining this lofty vision without straining the state’s finances.

Furthermore, the political arena becomes a battleground, where entrenched interests vie for dominance. Private insurers, pharmaceutical giants, and vested stakeholders act as defenders of the status quo, wary of the transformative potential that socialized medicine represents. Armed with the tools of lobbying and misinformation, they wage an unrelenting campaign to erode public support and maintain the existing order.

Yet, perhaps the most formidable challenge lies within the labyrinthine corridors of bureaucracy. Here, the machinery of governance grinds slowly, entangled in a web of red tape and administrative obstacles. Long wait times and bureaucratic inefficiencies threaten to undermine the very foundation of socialized medicine, casting doubt on its capacity to provide timely and effective care.

In the arena of innovation, socialized medicine faces another test. The swift advance of technological progress heralds a new era of healthcare delivery, where precision medicine and digital therapeutics promise to revolutionize patient care. Yet, amidst the excitement of progress, the risk of stagnation looms, threatening to stifle innovation and consign patients to outdated treatments and practices.

In conclusion, the narrative of socialized medicine is one of victory and challenge, a story of hope and difficulty woven into the fabric of healthcare discourse. Its benefits are numerous, offering the promise of universal access, health equity, and cost control. Yet, its journey is fraught with obstacles, from the bureaucratic maze to political opposition and the imperative of fiscal responsibility. Ultimately, the future of socialized medicine hangs in the balance, uncertain yet filled with the potential to transform the healthcare landscape for generations to come.

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Narrative Matters: The Power of the Personal Essay in Health Policy

Book and Media Reviews Section Editor: John L. Zeller, MD, PhD, Fishbein Fellow.

Narrative Matters is a compilation of accounts depicting health and disease and their context in the 21st century. It includes tales written by clinicians, policy makers, parents, children, and patients. Although stories about the human struggle with illness have been written since the dawn of humanity, this compilation is unique not only because of its strong relevance to today's health policy but also because it was first published in Health Affairs , a formal health policy journal. Thus, the reader is surrounded by a comfortable realization that these narratives indeed matter.

Sacajiu GM. Narrative Matters: The Power of the Personal Essay in Health Policy. JAMA. 2007;297(22):2529–2533. doi:10.1001/jama.297.22.2531

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Writing Can Change Health Care

For more than 20 years, the “ Narrative Matters ” section of the health policy journal Health Affairs has showcased some of the most compelling personal stories in health care. I have edited the section since the fall of 2012, following in the footsteps of Ellen Ficklen, Kyna Rubin, and the section’s founding editor, the late Fitzhugh Mullan. When Mullan launched the section in 1999 with the encouragement of John Iglehart, the founding editor of Health Affairs , he and the rest of the Health Affairs team envisioned it as an opportunity to leverage the power of storytelling – with all its depth, drama, and emotion – to bring a human, and humane, perspective to research data and to policy debates. As a happy by-product, we’ve also nurtured this form of writing (what we call the “policy narrative,” but also the genre of medical and health narratives more broadly) by creating a regular space for it, and providing peer review and editorial guidance to authors. In 2006, Mullan, Ficklen, and Rubin gathered some of the most popular Narrative Matters essays in a collection called Narrative Matters: The Power of the Personal Essay in Health Policy (Johns Hopkins University Press, 2006). In the time since that edition was published, the genre of medical and health narratives, often called “narrative medicine” a la Rita Charon’s groundbreaking program at Columbia University, has exploded. To date, Health Affairs has published more than 250 essays in the Narrative Matters section – along with some poetry. Time flies, and it has now been nearly a decade-and-a-half since that first edition came out. We felt it was time for an updated collection featuring some of our favorite recent essays.

The subtitle of the new edition of Narrative Matters might sound ambitious – “writing to change the health care system” – but we do believe writing is that powerful. These essays will stay with you, long after you’ve put the book down and gone about your day. We know anecdotally that they’ve been used in health advocacy and decision-making. And we know that they enrich, rather than replace, important health care research findings, while also giving voice to subtle issues within health care that research can’t tackle. Sharing intimate details of sometimes-painful health care experiences takes extreme courage, and we’re grateful to our authors for going on this journey with us. Mullan himself chronicled his deeply personal experiences as a physician and cancer survivor in his writing, including in his books Vital Signs: A Young Doctor’s Struggle With Cancer (Dell Publishing Company, 1984) and White Coat, Clenched Fist: The Political Education of an American Physician (Macmillan, 1976). Mullan, who was very supportive of and excited about this new edition, died from complications of cancer on November 29, 2019. This book is dedicated to him.

The topics covered in this new volume touch on familiar health care challenges such as appropriate end-of-life care, as well as new issues of the day, including opioid use disorders, transgender health care, and the impact of national immigration policies on the practice of medicine. Contributors include Pulitzer Prize–winner Siddhartha Mukherjee, MacArthur fellow Diane Meier, former Planned Parenthood president Leana S. Wen, former secretary of health and human services Louis W. Sullivan, and National Humanities Medal recipient Abraham Verghese, who also authored a new foreword for this edition.

Importantly, the growing field of medical and health narratives is not just about documenting complaints with the health care system and highlighting its failures. To be sure, that’s an important function of the genre, and many of the essays in this volume do shed light on systemic problems in health care, and offer potential solutions. For instance, in “‘Go Back To California: When Providers Fail Transgender Patients,” transgender doctor Laura Arrowsmith writes that doctors in training learn about obscure medical diseases that they may never encounter in medical practice, yet are not taught how to care for transgender patients – a population they will almost certainly encounter in practice. Still, health care offers lessons beyond the “horror stories,” and there’s a place in the genre to document where health care gets it right, too. I’m glad we were able to highlight that in several essays in the volume, such as in Maureen Mavrinac’s “Rethinking the Traditional Doctor’s Visit,” which shows how shared medical appointments can create new paths to healing in health care, and in “‘I Don’t Want Jenny to Think I’m Abandoning Her’: Views on Overtreatment” by Diane Meier, in which the author, a palliative care physician, teaches an oncologist that sometimes the most compassionate way to care for a patient is to know when to give up treatment.

This new edition of Narrative Matters would make an excellent teaching tool in a variety of courses. Beyond that, it’s just good reading, for anyone who has or will encounter the US health system as a patient (and, of course, that’s everyone). Chances are you’ll shed a few tears as you make your way through the powerful pieces in this book, and you’ll learn something along the way.

Order  Narrative Matters: Writing to Change the Health Care System   – published on March 3, 2020 – at the following link:  https://jhupbooks.press.jhu.edu/title/narrative-matters

Jessica Bylander is a senior editor at Health Affairs and the editor of Narrative Matters: Writing to Change the Health Care System .

Witches, devils, ghouls...and books! This Halloween, explore hauntingly good books from Hopkins Press, including The Secret History of the Jersey Devil and Dead Women Talking and uncover the mysteries and legends of the spookiest time of the year.

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Volume 11 — June 05, 2014

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TOOLS AND TECHNIQUES

Using written narratives in public health practice: a creative writing perspective, navigate this article, using stories, acknowledgments, author information, tess thompson, mph, mphil; matthew w. kreuter, phd.

Suggested citation for this article: Thompson T, Kreuter MW. Using Written Narratives in Public Health Practice: A Creative Writing Perspective. Prev Chronic Dis 2014;11:130402. DOI: http://dx.doi.org/10.5888/pcd11.130402 .

PEER REVIEWED

Narratives have become an increasingly common health communication tool in recent years. Vivid, engaging writing can help audiences identify with storytellers and understand health messages, but few public health practitioners are trained to create such stories. A transdisciplinary perspective, informed by both creative writing advice and evidence-based public health practices, can help public health professionals use stories more effectively in their work. This article provides techniques for creating written narratives that communicate health information for chronic disease prevention. We guide public health professionals through the process of soliciting, writing, and revising such stories, and we discuss challenges and potential solutions.

People attend, remember, and are transformed by stories. — Mary Pipher, Writing to Change the World (1)

Top of Page

Narratives have become an increasingly common health communication tool, but few public health practitioners are trained to create them (2). The writing style suitable for technical reports, program summaries, and grant proposals is very different from the simple, vivid writing that helps audiences connect with storytellers and understand health messages. We believe that a transdisciplinary perspective that creates new approaches to problem-solving can give public health professionals insights from creative writing and narrative communication that will help them use stories effectively (3). This article draws from one author’s experience teaching creative writing and from the other author’s expertise in narrative health communication to provide techniques for creating written narratives that communicate health information for chronic disease prevention.

Narratives are a natural, engaging means of communication. For public health purposes, a narrative is “any cohesive and coherent story with an identifiable beginning, middle, and end that provides information about scene, characters, and conflict; raises unanswered questions or unresolved conflict; and provides resolution” (4). Public health interventions may use fictional stories, authentic stories, or composite stories, which are realistic stories based on multiple narratives (5). Narrative interventions in various media have been used to promote health behaviors such as controlling hypertension (6), quitting smoking (7,8), receiving mammograms (9), and preventing skin cancer (10). One study, for example, found that reading narrative information about skin cancer increased the chance of engaging in preventive behaviors compared with reading an informational text (10). In another study, tailored success stories delivered through the Internet effectively promoted smoking cessation (8). Narratives may hold potential for targeting hard-to-reach populations and reducing health disparities (11). Narratives can also be used to disseminate information about chronic disease to policy makers (12) and to share stories about effective programs (2,13).

One strength of narratives is their ability to engage audiences. Writer and psychologist Mary Pipher contends, “Stories are particularly effective in places where logical statements would inspire argument. If a story is well conceived and well told, listeners are likely to experience emotions that soften their positions and enable them to consider the speaker’s point of view” (1). Research has found that, compared with predominantly informational methods of presentation, narratives can lead to stronger emotional reactions, greater identification with the person sharing the messages, and increased engagement (14).

These effects are consistent with theories of narrative and health behavior. Green and Brock’s Transportation-Imagery Model contends that stories are effective because they “transport” the audience through use of vivid imagery and identification with characters (15). Social Cognitive Theory (16) holds that behavioral modeling, including firsthand experiential narratives, can provide an audience with role models who demonstrate a new behavior. Zillmann’s Exemplification Theory holds that using exemplars — or characters whose stories serve as concrete, vivid examples — can increase emotional engagement with health-related stories and lead to enhanced memory of messages over time (17). Busselle and Bilandzic examined dimensions of audience engagement, including narrative understanding, attentional focus, emotional engagement, and narrative presence, and they concluded that engagement and enjoyment affect story-related beliefs and attitudes (18). Moyer-Gusé’s Entertainment Overcoming Resistance Model asserts that involvement with story characters may lead people to be less resistant to messages (19).

Written narratives in particular, whether shared in printed materials or over the Internet, can be used to communicate health information to a diverse audience. One objective of Healthy People 2020 is to employ health communication strategies for improving population health outcomes (20). The Guide to Community Preventive Services identified a range of evidence-based communication strategies, including small media, client reminders, educational materials, and social marketing (21). Although none of these strategies specifies the use of stories, stories can be embedded in or delivered through them.

Shaping stories

Successful use of narrative to communicate health information requires a transdisciplinary approach that incorporates a mix of practical tools and techniques from creative writing and public health practice. In the spirit of Fix et al (22), who used insights from theater arts to enhance storytelling for patient education, we draw insights from creative writing to help public health practitioners use written narratives to influence health behavior.

These tools and techniques are designed for public health professionals working independently, but they may be even more effective when used in partnership with professional writers or editors. When funding is limited, English departments at colleges and universities may be able to suggest talented students who would like to volunteer or work on a limited budget to gain experience.

Deciding to use stories

Public health practitioners must first determine whether written narratives are an appropriate communication strategy, given their goals and intended audience. Stories in general may be appropriate for helping an audience overcome resistance to health messages or reluctance to change health-related behaviors. Stories may help readers process complex or highly emotional material (eg, information about cancer treatment) or overcome high levels of medical mistrust (23). Written stories in particular may be appropriate when using small media and other evidence-based methods for promoting health (21). For some audiences, however, such as audiences with low literacy levels or highly motivated audiences that prefer statistical information, formats other than written stories may be more appropriate.

After deciding to use stories, consider their purpose, the intended audience, and the type of stories to use. Stories can, for example, lead into an informational article, provide supplemental information in a brochure, or stand alone on a Web page. Having a clear purpose for a story will guide other aspects of the story, such as length and amount of detail.

Defining the audience is important because stories often derive their power from audience members’ identification with characters (14). It is often helpful if key characters are similar to the audience in a way relevant to the story’s purpose (eg, characters are age-eligible for breast cancer screening, if mammography is the goal).

Writers must also decide whether to use authentic stories, fictional stories, or composite stories. Authentic stories may have the benefit of being perceived as realistic, especially if they are labeled “real stories,” but research indicates that using fictional instead of authentic stories may not affect the story’s persuasiveness (15,24). Stories that are not written by professional writers will almost certainly need extensive editing (2). Creating fictional stories based on observations and experiences requires writers to 1) know their subject matter and audience well so they can provide realistic details and 2) use a voice that will be easily understood by the intended readers. Composite stories created from narratives gathered through formative research provide an opportunity to use realistic details that can be fictionalized and shaped into unified, factually accurate stories.

Collecting stories

Authentic or composite stories should be collected systematically. Although there is no universally accepted protocol for developing health-related narratives, researchers have documented various formative processes that many public health practitioners find helpful. Wengraf provides a 3-step interview process to elicit narratives: first, ask the participant a general question about a topic (eg, “Tell me the story of your breast cancer”); next, ask them to elaborate on parts of their story (eg, “How did you tell your children about your diagnosis?”); and finally, probe with additional questions about topics of interest that did not arise naturally (25). Horner et al describe their process of using qualitative analysis of semistructured interviews with African American teenagers to learn about culturally sensitive narratives about HIV prevention behaviors (26). Fix et al provide a storytelling protocol that uses insights from theater arts to find appropriate storytellers, elicit compelling stories, and select the most effective stories for use in patient education (22).

Two protocols developed for generating print-specific narratives are especially helpful to public health practitioners. To share success stories about a cardiovascular screening program, Lewis et al developed a 10-step process to collect information used to create written narratives (13). The steps include specifying audience and purpose, soliciting story ideas from staff members, creating a standardized data collection form, conducting follow-up interviews to obtain additional details, and revising stories. The process described by Zwald et al (2) includes similar steps and extends those ideas by providing examples of tools used for story development, including a Web-based form with questions to collect specific details about programs and a follow-up interview script to solicit additional information.

It is important to use authentic and composite stories ethically (23). When collecting authentic stories, obtain consent from storytellers and tell them exactly how their stories will be used. Obtain explicit written permission to use identifiable images or personal health information. Storytellers should be told whether their stories will be used in their entirety or combined to form composite narratives. If using fictional stories, be sure to create stories that are nonstigmatizing and culturally appropriate; it is important to be sensitive to the difference between using cultural information to inform stories and using stereotypes that may be offensive or overly simplistic (5). It is also important to avoid using stories — however compelling — that include inaccurate or misleading information (23).

Creating stories

Once formative research has been conducted, techniques from writing manuals and creative writing workshops can help public health professionals use the information to create vivid stories that connect with readers. The following principles of good storytelling provide a starting point for public health professionals who would like to incorporate stories in their work. Although many recommendations come from books and workshops about writing fiction, they also apply to composite and authentic narratives. (See Appendix for a sample story.)

Choose a point of view. In Writing Fiction , Burroway says that the concept of point of view can be summed up by the following questions: “Who speaks? To whom? In what form? At what distance from the action?” (27). Most health narratives use either a first-person perspective (“I’ll never forget my first mammogram”) or third-person perspective (“Rita Evans will never forget her first mammogram”). First-person narration can lend intimacy and promote engagement (28), but third-person can be used to weave together multiple stories or multiple people’s points of view (29). It can be helpful to try both first-person and third-person point of view and see which is most effective for a particular story or intended audience (29). Consider also “distance from the action”: are cancer patients talking about current treatment or diagnoses that happened years ago? Will the story focus on experiences of a patient, or is the narrator a parent or family member watching someone else face a health issue? It is often best to align the point of view in the story with that of the target audience; for example, a story designed to provide information to partners of cancer patients is probably best told from the perspective of a patient’s partner.

Establish the conflict. Conflict is “the fundamental element in fiction” (27). In fictional narratives, conflict is a crucial part of plot: characters must face their conflicts and reach a resolution. Not all health narratives have the complex and dramatic conflicts of a bestselling novel or a blockbuster movie, but the most effective stories will involve a character facing a conflict that is eventually resolved. A conflict may be internal (eg, dealing with the fear of getting a mammogram) or external (eg, dealing with an uncommunicative doctor). The stakes in a conflict may be relatively low (“Anne Johnson was afraid getting a mammogram would hurt”) or very high (“Anne Johnson was afraid she would die of breast cancer”).

Health-related narratives allow readers to see how a person like them has resolved a health-related conflict. In the story in the Appendix, the narrator describes a conflict between enjoying her family’s traditional recipes and wanting to eat more healthfully. She resolves the conflict by learning to prepare healthier versions of traditional dishes. Portraying resolution of the conflict as a process of incremental steps rather than an immediate change allows readers to see how behavior change might unfold in their own lives.

Shape the story . In The Story Template, Deardon writes, “Without good structure, the story tends to meander without a point” (30). Knowing the central conflict is a helpful starting point, but people constructing stories must still decide how to best present a series of events. Stories can start in the middle of the action, for example, with a dramatic event such as a diagnosis. This technique can be an effective way to draw readers in; background information and past events can be shared after readers are emotionally invested in the story. Stories can also be presented chronologically, with events recounted in order (29). This form may be especially effective if the purpose of a story is to describe a series of actions in sequence, such as a treatment protocol that takes place in a particular order.

If more than 1 narrative is used, writers must decide how to weave stories together. In some cases, it is effective to include narratives sequentially (eg, include 3 complete stories from breast cancer survivors). This technique is effective if 1 purpose of the stories is to have readers identify with people who had similar experiences. In other cases, it is effective to alternate perspectives (eg, give each woman’s perspective on diagnosis, followed by each woman’s perspective on treatment, followed by each woman’s perspective on survivorship). This technique is especially effective if the primary purpose is to focus on stages of a health condition or to compare a range of experiences, such as patient and caregiver perspectives on the same stage of the disease process. If uncertain about the best structure, story creators can try different structural choices during revision to see which the target audience finds most effective.

Incorporate details . In the writing manual Writing Down the Bones , Goldberg says simply, “Our details are important” (31). Informational texts usually focus only on the health topic at hand, despite evidence that contextual details in narratives can provoke strong emotional reactions (32). Vivid imagery is one method for “transporting” readers into a story (15). Show, don’t tell is a mantra from creative writing that also applies to health narratives. Showing details in a story allows a reader to feel and experience what the character feels and experiences. (28). In a story, a narrator may tell by simply summarizing: “It was hard sharing my cancer diagnosis with my son.” This flat statement is far less engaging than showing details of the scene: “When I told my 8-year-old I had cancer, he didn’t say anything for a minute. I could see there were tears in his big brown eyes, but he brushed them away with the back of his hand. Then he threw his arms around me and squeezed me hard.”

Evoke emotion. In Bird by Bird: Some Instructions on Writing and Life, Lamott advises, “[Y]ou must risk placing real emotion at the center of your work” (33). Emotional content is rarely included in academic or technical writing, but one advantage of narrative over informational text is the opportunity to elicit emotional responses from readers. Doing so enhances the recall of information and the vividness of the memory (34). Using appropriate details conveys emotion and allows readers to empathize with characters. As the authors of Self-Editing for Fiction Writers explain, when it comes to conveying emotion, “You don’t want to give your readers information. You want to give them experiences” (28). It is important to use emotion carefully in health-related narratives, however. Emotion should be related to the key health messages in a story; otherwise, it may distract readers from the messages (34).

Use a natural voice. Stories can be a bridge between readers and difficult medical concepts. It is important to use a voice that sounds natural to the target audience, which means using lay language and a conversational tone. Once a story is complete, read it aloud (1,28) to see if it flows and sounds natural. Use active rather than passive voice when choosing verbs (for example, “We cooked a lot of healthy dishes” instead of “A lot of healthy dishes were cooked ”). In his book On Writing , novelist Stephen King admonishes writers to avoid using passive voice: “Two pages of the passive voice — just about any business document ever written, in other words, not to mention reams of bad fiction — make me want to scream” (35). King encourages writers to use direct sentences with active, vigorous verbs. Mary Pipher laments the “blandness and caution endemic to [the writing of] many academics” and tells writers, “Be bold. Be honest” (1). In the story in the Appendix, for example, the narrator does not say, “An unhealthy diet may contribute to obesity and other health conditions.” Instead, she talks about her family and says bluntly, “The high amounts of fat, salt, and sugar they ate hurt them.” Such language is direct and effective.

Solicit feedback and revise. Supreme Court Justice Louis Brandeis said, “There is no great writing, only great rewriting” (36). Creative writers often share their work-in-progress with other writers and receive feedback about which story elements are working well and which need revision. It is important to share health narratives with colleagues who can offer professional feedback and with members of the intended audience. Pilot testing stories can assess realism, literacy demands, and ease of understanding, as well as the extent to which readers identify with characters and see the stories as credible sources of health information. If multiple stories are developed, pilot testing helps practitioners select which are most effective.

Narratives are useful for health communication, but incorporating them into public health practice requires skills that may be new to public health professionals. The transdisciplinary approach of using techniques from creative writing helps practitioners use stories effectively to prevent chronic disease.

We thank Marissa Zwald and Thomas Rodebaugh for their feedback on a draft of this manuscript.

Corresponding Author: Tess Thompson, MPH, MPhil, Washington University in St Louis, One Brookings Dr, Brown School of Social Work, Campus Box 1196, St Louis, MO 63130. Telephone: 314-935-6605. E-mail: [email protected] .

Author Affiliation: Matthew W. Kreuter, Washington University in St Louis, Health Communication Research Laboratory, St Louis, Missouri.

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Appendix  

This story was developed by the Health Communication Research Laboratory at Washington University in St Louis for use in Healthy Body, Healthy Soul, a newsletter aimed at African American women.

My Family’s Traditions

Collard greens with ham hocks, mustard potato salad, candied sweet potatoes, and fried corn. Do those foods make you think about Sunday dinners? What about the neighborhood picnics you enjoy? Just the thought of the smell of a pot of greens on the stove or the sweet smell of spices from brown sugar-glazed sweet potatoes baking in the oven makes me hungry.

All of these foods are part of the African American tradition of using food to hold on to tradition, as a source of comfort and to bring families together. Fruits and vegetables are a traditional part of the African American culture. But many of the fruit and vegetables dishes I grew up eating were also high in fat, salt, and sugar.

As an adult, I saw family members struggle with their weight, and the heart disease, diabetes, high blood pressure, and cancer that can come with it. The high amounts of fat, salt, and sugar they ate hurt them. At first I quit eating my favorite dishes to avoid the fat. That meant I didn’t eat as many fruits and vegetables. Then I realized that I could just make a few changes, like using skinless turkey leg or wing instead of fatback to season my greens, using a little margarine instead of butter to flavor my vegetables, adding herbs and spices to foods instead of salt, and enjoying the natural sweetness of fresh fruit desserts.

I know that my kids and grandkids will have sweet memories of traditional foods just like I did, but the foods they remember will be a lot healthier. Tradition is important, but nothing compares to my family’s health. Our new tradition will be our old foods with a healthier way of cooking them.

This is a simple story designed to connect with a female audience about healthy food choices. The style and structure work together to tell a brief story about how the narrator came to change her eating habits.

Writing Style: The story is told from the first-person point of view of an unnamed narrator (in the newsletter, the story was accompanied by a photograph of an African American woman who was presumably the narrator). The overall style is informal; the narrator uses simple words such as “kids,” for example, and the first sentence is actually a sentence fragment. After the opening sentence, the narrator engages the reader with two rhetorical questions that build on supposed common ground between narrator and reader. Verbs are active (eg, “I quit,” “I realized,” “I saw,” “I know”). Sensory details, such as the smell of spices, draw the reader in and help both establish the conflict and resolve it (as when the narrator learns to enjoy “the natural sweetness of fresh fruit desserts”).

Structure: This story follows a simple structure: context, conflict, and resolution. In the first paragraph, the foods and the pleasant memories they evoke establish the context and create a connection with the audience. The conflict arises at the end of the second paragraph: Many of these favorite foods are unhealthy. The third paragraph develops the conflict by showing the impact of the unhealthy foods on the narrator’s family members. Finally, the narrator resolves the conflict in the third and fourth paragraphs by learning how to make healthier versions of traditional foods.

Encouraging action: In the newsletter, this story was accompanied by a recipe for mixed greens casserole. Readers who were drawn into the story and motivated to change their food behavior were given a simple next step they could try.

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Storybridging: Four steps for constructing effective health narratives

Anniek boeijinga.

a Centre for Language Studies, Radboud University Nijmegen, Nijmegen, The Netherlands

Hans Hoeken

b Utrecht Institute of Linguistics OTS, Utrecht University, Utrecht, The Netherlands

José Sanders

To develop a practical step-by-step approach to constructing narrative health interventions in response to the mixed results and wide diversity of narratives used in health-related narrative persuasion research.

Development work was guided by essential narrative characteristics as well as principles enshrined in the Health Action Process Approach.

The ‘storybridging’ method for constructing health narratives is described as consisting of four concrete steps: (a) identifying the stage of change, (b) identifying the key elements, (c) building the story, and (d) pre-testing the story. These steps are illustrated by means of a case study in which an effective narrative health intervention was developed for Dutch truck drivers: a high-risk, underprivileged occupational group.

Conclusion:

Although time and labour intensive, the Storybridging approach suggests integrating the target audience as an important stakeholder throughout the development process. Implications and recommendations are provided for health promotion targeting truck drivers specifically and for constructing narrative health interventions in general.

Introduction

Public health communication generally attempts to motivate people to engage in (e.g. the use of sun care products) or refrain from a certain behaviour (e.g. cease smoking), typically by means of providing arguments. Processing these persuasive messages requires considerable cognitive skill ( Boeijinga et al., 2017 ; Schellens and De Jong, 2004 ) and may be too demanding for target audiences of low socioeconomic status (SES) and health literacy. As a result, this approach is likely to increase health inequities between high and low SES groups. In addition, this approach rests on the assumption that changes in motivation, or intention, will automatically lead to changes in behaviour. However, there is ample evidence for the existence of an intention-behaviour gap ( Sheeran, 2002 ; Webb and Sheeran, 2006 ): despite being successful in changing intentions, the subsequent change in behaviour often remains modest or absent. Sheeran (2002) reports that people are only half of the time successful in acting upon their health intentions. Motivation to change may thus be a prerequisite for subsequent behaviour change, but it appears to be far from sufficient.

Narratives as bridge builders

Narrative health interventions appear promising for bridging the intention-behaviour gap as well as health inequities between high and low SES groups. Narrative presents a sequence of chronological events, which comprises specific characters ( Jahn, 2005 ) and ‘a plot that intentionally relates events in the story’ ( Clough, 2011 : 704), encompassing a variety of forms (e.g. novels, plays, films, comic strips) and offering ‘meaning through evocation, image, the mystery of the unsaid’ ( Mattingly, 1998 : 8). Across time and cultures, narratives have been used to disseminate behavioural information. From infancy onwards, human beings are capable of producing and processing narratives – contrary to expository texts that are only mastered in adolescence ( Berman and Nir-Sagiv, 2007 ). In other words, humans are highly capable of comprehending information provided in a narrative format ( Graesser et al., 2002 ; Mar, 2004 ), without explicit education. This makes narratives accessible for a large audience, including target audiences with lower SES and health literacy skills ( Murphy et al., 2013 ).

Narratives may also solve the intention-behaviour gap. The Health Action Process Approach ( Schwarzer, 2008 ) posits that people may not perform the desired behaviour for different reasons: non-intenders are not (yet) motivated to perform the desired behaviour, whereas intenders may be motivated to do so but fail to put this intention into action. According to the Health Action Process Approach, planning strategies are essential in helping intenders to overcome this intention-behaviour gap. Such strategies involve specifying the when, where and how of the intended behaviour (action planning), and anticipating potential barriers and preparing successful strategies to overcome them (coping planning). Narratives are especially suited for supporting such planning strategies; they focus on specific characters, their actions and motivations, and express the unfolding events in a temporal and causal framework ( Berman and Nir-Sagiv, 2007 ). Hence, characters can function as role models showing how to put an intention into action, what obstacles to expect, and how to successfully navigate them ( Bandura, 2004 ; Green, 2006 ).

Overall, narrative health interventions have proved effective in creating positive health beliefs, increasing health attitudes and intentions, and stimulating healthy behaviours –though not for each and every narrative intervention (see for reviews, De Graaf et al., 2016 ; Shen et al., 2015 ). This variation can be explained by the diversity of narratives used in these studies ( De Graaf et al., 2016 ) and raises the question of how to develop effective health narratives. Whereas previous studies have extensively examined the mechanisms and processes involved in narrative persuasion (e.g. Murphy et al., 2013 , 2011 ), relatively little attention has been focused on the construction of health narratives.

Some researchers have provided concrete strategies and writing techniques for constructing narratives ( Gesser-Edelsburg and Singhal, 2013 ; Thompson and Kreuter, 2014 ). Several studies have described the development of their narrative health materials, including a HIV prevention video for company workers in Ecuador ( Del Carmen Cabezas et al., 2015 ), a depression fotonovela for Latinos with limited English proficiency ( Cabassa et al., 2012 ), photo stories for older adults with limited health literacy ( Koops Van ‘t Jagt et al., 2016 ), stories on obesity prevention ( Zwald et al., 2013 ), and narratives for the African American community on breast cancer screening ( Kreuter et al., 2008 ), HIV prevention ( Berkley-Patton et al., 2009 ), smoking cessation ( Houston et al., 2011 ), and hypertension management ( Fix et al., 2012 ). The majority of these studies focused on minority groups and, either implicitly or explicitly, addressed the health disparities gap. However, none of the previous studies has addressed the issue of the target group’s current stage(s) of behaviour change (non-intenders and intenders) in the narrative construction process.

This article introduces the concept of ‘storybridging’ as a method for constructing effective and well-tailored narrative health interventions, identifying meaningful steps in the construction process with regard to content and form characteristics. The method will be illustrated by examples of health narratives for Dutch truck drivers, which proved effective in increasing health intentions ( Boeijinga et al., in press ).

Storybridging: constructing effective narratives

Storybridging refers to the use of stories as a tool for bridging the gap between health inequities as well as the intention-behaviour gap. Below, the characteristics composing effective narrative health interventions are specified and converted into specific steps for narrative development.

With regard to content characteristics, a distinction is made between health narratives targeting non-intenders and intenders, as these groups require different approaches ( Schwarzer, 2008 ).

Narratives for non-intenders

According to the Health Action Process Approach, the motivation to change one’s behaviour depends on a person’s risk perception, outcome expectancies, and self-efficacy ( Schwarzer, 2008 ). Narratives can portray the negative consequences of risky behaviours, thereby increasing the audience’s risk perceptions ( De Wit et al., 2008 ; So and Nabi, 2013 ). Health narratives focusing on risk perception encompass (a) the present situation/behaviour and (b) the consequences of continuing the present behaviour. The negative consequences of the current behaviour should be presented as both severe and realistic, since ‘too severe of a threat and too low of a threat are equally as ineffective’ ( Averbeck et al., 2011 : 40).

Outcome expectancies refer to the audience’s perceptions of the expected consequences of a new behaviour. Observing a narrative character’s behaviour being rewarded can lead to positive intentions to perform this behaviour as well. Health narratives focusing on outcome expectancies thus entail (a) the desired situation/behaviour and (b) the consequences of performing the desired behaviour. The consequences should be presented as both realistic and positive for them to work as a motivator. In addition, conveying the story of a character who was able to successfully perform the behaviour may also increase the audience’s self-efficacy perception.

Narratives for intenders

According to the Health Action Process Approach, intenders will benefit from a focus on action and coping planning strategies ( Schwarzer, 2008 ). A universal narrative pattern of action and coping is ‘the hero’s journey’ ( Campbell, 2008 ): the main character – the hero – is called for an adventure into the unknown and faces the beginning of change. During the journey, the hero is tested; dragons have to be slain and barriers passed. Once the goal is achieved, the hero returns in an essentially changed, and improved, state of being. Put in more generic terms, ‘ someone is confronted with some problem which he/she/it overcomes (or succumbs to) in some way ’ ( Gordon, 1978 : 7). The way in which a recognisable character resolves recognisable problems can provide an example for the target audience on how to deal with similar problems ( Bandura, 2004 ).

Health narratives focusing on planning strategies include (a) the present situation/behaviour, (b) the desired situation/behaviour, and (c) the connecting strategy between the present and desired situation/behaviour. An important part of the present situation/behaviour consists of the barriers experienced when trying to perform the desired situation/behaviour. According to Gordon (1978) , a prerequisite for effective narratives is that the presented connecting planning strategies are well-formed , in that they lie within the target audience’s reach and control.

Again, seeing others successfully perform the desired behaviour may not only enhance the audience’s planning strategies, but also their self-efficacy perception ( if they can do it, so can I ) ( Falzon et al., 2015 ). Within the Health Action Process Approach, perceived self-efficacy is considered an important determinant at both stages of the health behaviour change process. For non-intenders, self-efficacy refers to beliefs about one’s ability to initiate healthier lifestyle behaviours ( action self-efficacy ), whereas for intenders, it refers to beliefs about one’s ability to deal with barriers that arise while performing these behaviours ( maintenance self-efficacy ).

Character similarity

A vital element for narrative characters to serve as role models is that the target audience perceives the character as similar to itself. This perceived similarity may be based on various characteristics of the character such as ‘socioeconomic status, group membership, place of residence, life experience, or attitudes, beliefs and values’ ( Kreuter et al., 2007 : 229). In depicting characters, language is essential, since the use of authentic, culturally resonant language reflects a target group’s culture, including its beliefs, norms and values ( Larkey and Hecht, 2010 ).

Perceived similarity in language and other details (social class and context, gender and profession, etc.) has been suggested as a driver for identification ( Brown, 2015 ; Cohen, 2006 ; Hoeken et al., 2016 ), which is recognised as an important mechanism for narrative persuasion. For example, identification with narrative characters has been found to influence attitudes ( De Graaf et al., 2012 ; Hoeken and Sinkeldam, 2014 ; Igartua and Barrios, 2012 ), as well as intentions and actual behaviour ( Moyer-et al., 2011 ). Not only character similarity but also setting familiarity seems a promising characteristic to make narratives more persuasive ( De Graaf et al., 2016 ). Familiarity with a character’s (living) situation was found to encourage transportation ( Green, 2004 ) and effective in increasing risk perceptions ( De Graaf, 2014 ).

Perspective

Another driver for identification is the perspective presenting the narrative ( De Graaf et al., 2012 ; Hoeken and Fikkers, 2014 ; Hoeken et al., 2016 ). First-person health narratives tend to be more effective compared to third-person health narratives ( see for a review, De Graaf et al., 2016 ). A first-person story perspective, in which the ‘I’-character is the deictic here-and-now-centre of the narrative, requires readers to take the position of the protagonist ( Graesser et al., 2002 ), thus inviting them to process the presented information from their own spatial body perspective ( Brunyé et al., 2009 ); readers appear to use ‘self’ as an anchor in organising information ( D’Ailly et al., 1995 ). In other words, the strategic use of language can guide people to identify with certain characters ( Hoeken et al., 2016 ).

Finally, the medium through which the narrative is presented may be relevant. Although Braddock and Dillard’s (2016) meta-analyses did not find clear effects for a superior effect of one medium over the other, this factor should not be underestimated regarding target audiences with lower SES and health literacy. For example, print messages may require higher cognitive demands than audio messages ( Wilson and Wolf, 2009 ).

A four-step method

These essential characteristics provide guidance for narrative development and can be translated into concrete steps. As non-intenders require a different intervention approach to intenders, the first step is identifying the target audience’s present stage of behaviour change, which determines the focus, and thus the content, of the narrative. For non-intenders, the narrative should focus on risk perception, outcome expectancies and/or self-efficacy, whereas a narrative for intenders should focus on planning strategies.

Step 2 involves identifying and selecting the content elements of the narrative, based on the audience’s stage of change. This implies foremost gaining an understanding of (a) the nature of the present situation/behaviour, including significant persons and events. In addition, the following elements need to be identified: (b) the experienced negative consequences of the present behaviour, (c) the desired situation/behaviour, (d) the positive consequences of the desired behaviour and/or (e) corresponding connecting strategies.

The third step involves constructing the story that basically is built on the selected key elements. Regardless of the target audience, stories should be isomorphic in order to be effective: that is, the story should cover the situations/behaviours as perceived by the audience, including relevant characters, events and barriers ( Gordon, 1978 ). The target audience’s characteristics and experiences gathered in Steps 1 and 2 thus function as important building blocks in constructing the health narrative, materialised in optimal character similarity, linguistic perspective and medium choice.

The final step involves pre-testing the health narrative with members of the target audience, assessing its authenticity and comprehensibility. Important aspects to test include perceived similarity (To what extent does the target audience relate to/identify with the character?), isomorphism (To what extent are the narrative’s key elements perceived as realistic and authentic?) and well-formedness (To what extent are the desired behaviour and connecting strategy in reach or control of the target audience?). On the basis of the results from the pre-test, the narrative is repeatedly edited and retested, until it is considered authentic and appealing by the target group. The final version of the health narrative thus results from iterative construction and pre-testing.

For all steps, it is important to integrate the target audience ( Miller et al., 2015 ). In Steps 1 and 2, their personal stories are used as input, and in Steps 3 and 4, they provide valuable feedback on the output (the developed story). In other words, effective narrative health interventions are co-created with the target audience.

Application

The above-presented Storybridging steps are illustrated with a successful case study of narrative health communication for Dutch truck drivers ( Boeijinga et al., in press ): a large, high-risk, low SES group with relatively unhealthy lifestyles that is hard to reach ( Sectorinstituut Transport en Logistiek [STL], 2016 ) and was underserved in attention of health intervention researchers so far ( Ng et al., 2015 ).

Step 1: identifying the stage of change

To identify the current stage of behaviour change, semi-structured, in-depth interviews were conducted with members of the target audience ( n  = 20) ( Boeijinga et al., 2016 ). Participating truck drivers were asked general inquiries about their daily life and routines (‘What is it like to be a truck driver?’) as well as more specific questions about current eating and exercise behaviours, satisfaction with one’s physical condition and previous attempts to improve one’s condition (e.g. ‘Have you ever tried to lose weight or keep from gaining weight?’, ‘Can you tell me more about these attempts?’). To avoid socially desirable answers, questions on health-related themes were posed using indirect probing questions or postponed towards the end of the interview. Each participant was debriefed afterwards about the actual nature and purpose of the research.

Step 2: identifying the key elements

The content elements were incorporated in the interview design by questions like ‘What does a typical day look like?’ ‘Who are involved?’ (present situation/behaviour); ‘What advantages and disadvantages do you experience from …?’ ‘What are your expectations on the long-term?’ (consequences of continuing present behaviour); ‘What would you like to be changed?’ ‘What changes would you like to make?’ (desired situation/behaviour); ‘What advantages do you expect or experience from …?’ ‘Why would you recommend to …’ (consequences of adopting desired behaviour); ‘What stops you from …?’ ‘How will you be able to …?’ and ‘What advice would you give other truck drivers?’ (connecting strategy).

Step 3: building the story

The story was built around the identified key elements. To enhance isomorphism and perceived similarity, key quotes and comments were extracted from the truck drivers’ personal stories and used as building blocks for the health narrative. Similarity of language was ensured to incorporate the target group’s culture. In line with previous research, the story was written from a first-person perspective. In addition, the social perspective from which the interviewed truck drivers related their personal experiences – for example, as a truck driver, husband, father and so forth – was taken into account. Health care aspects of the content were checked for accuracy with health scientists. Also, potential media formats were checked with interview data regarding media usage as well as with literature data from other studies.

Step 4: pre-testing the story

The pre-test was conducted in collaboration with a Dutch trucking company. The participating truck drivers ( n  = 7) read the story aloud, providing immediate feedback followed up by further questioning and evaluation (e.g. ‘What do you think of the story?’ ‘How does the story make you feel?’ ‘To what extent can you relate to the story?’). In addition, the story was proofread for authenticity and accuracy by important stakeholders in the transport sector, such as the Dutch National Institute for Transport and Logistics and the editors of a trucking magazine. Based on the pre-test’s results, the narrative health intervention was edited and refined.

Stage of change: non-intenders and intenders

The interviews revealed that Dutch truck drivers regard health as important and that they manage to warrant a sense of good health by comparing their own health to that of colleagues who are worse off (e.g. who suffered from heart attack or knee malfunction). This kind of downward social comparison enables truck drivers to maintain a relatively benign image of their own health status. As a result, some truck drivers feel little motivation to change their lifestyle, which qualifies them as non-intenders.

More truck drivers, however, indicated that they actually would like to live a healthier life and had repeatedly tried to do so – qualifying them as intenders. Their attempts were, in most cases, thwarted by barriers within their work environment (e.g. irregular working hours and lack of exercise facilities) and personal environment (e.g. social expectations or obligations). There are thus both non-intenders and intenders among the target audience.

Key elements: a risk narrative and planning narrative

Two health narratives were developed: a risk narrative in response to the non-intending truck drivers’ tendency to downplay their health risks, and a planning narrative to facilitate intenders to put their intention into action. Accordingly, relevant content elements for both narratives were identified.

Present situation/behaviour

The interviewed truck drivers generally described their current work situation as strenuous: ‘What is it like to be a truck driver? Working at impossible hours, unsightly hours, stressful, […] just bad for your health, just a bad job’. Their current health situation was typically related to their work; health-related issues such as overweight, obesity, worn vertebrae, stress and (chronic) fatigue were considered ‘part of the job’. The less truck drivers managed to downplay their health threats by downward social comparison, the more they regarded their present health situation as problematic.

With regard to relevant others, the partner’s role appeared to be particularly decisive. The partner (if there was one) usually prepared the trucker’s lunchbox and was in charge of the groceries and meals at home, thus playing an important role in controlling dietary patterns. At the same time, the partner’s expectations (or demands) regarding quality/family time sometimes prevented truckers from exercising during leisure time and, thus, hindered their healthy exercise habits. Crucial appeared the shift from work to home (and the balance between them). Once home, truck drivers experienced more control over their behaviours, but their lack of energy after work prevented them from exercising.

Thus, both the work and personal environment were associated with barriers; irregular working hours and a lack of exercise facilities were indicated as most decisive barriers to healthy lifestyles. The interviewed truck drivers reported unfavourable behaviours regarding both diet (irregular and unhealthy meals) and exercise (a lack of physical activity). In consultation with health scientists, a focus on exercise behaviours was chosen as most promising. Truckers’ perceived barrier of ‘lack of exercise facilities in the work environment’ resulted from their framing ‘exercise’ as ‘going to the gym’, which was generally considered too demanding or even outrageous (cf. Caddick et al., 2016 ). Reframing exercise as ‘being physically active’ may offer an alternative frame and, thereby, provide more ecological opportunities for truck drivers to act upon. Thus, truck drivers’ exercise behaviours appeared to provide a window of opportunity for improvement.

Negative consequences

Stories about other truckers being worse off provided the content for depicting negative consequences of continuing the present behaviour. For example, truck drivers described heart attacks, involving either themselves or their colleagues. Other important downsides experienced by the target audience were being unfit to engage in physical activities with their (grand)children or being afraid of not witnessing them grow up.

Desired situation/behaviour

The intending truck drivers indicated that they would like to adopt healthier lifestyle behaviours in order to feel better and fitter. Specifically, they would like to improve their physical shape so that they would have more energy during/after work. In addition, intenders indicated that they strive to lose weight, not wanting to look like ‘typical truck drivers’, who are often stigmatised and portrayed as obese, ‘meatball-eating’ men.

Connecting strategy

Stories of truck drivers who already managed to improve their health and lifestyle provided strategies for bridging the gap between the present and desired situation/behaviour. These strategies involved (a) battling the irregularity by structuring the day, (b) exercising without typical sports equipment, and (c) tackling temptations (e.g. exercising instead of watching television) by willpower. In general, the truck drivers considered themselves in control of their own health; ‘your health is in your own hands’.

Building the story: from quotes to narratives

The identified key elements served as basic elements for the stories. For both narratives, a storyline was developed around the fictitious, but representative, character with the (in Dutch) neutral name René Louwisse, a 41-year-old trucker, the father of Tim (14 years) and the husband of Anja (38 years). These features were based on the characteristics of the interviewed truck drivers; the majority was ethnically Dutch, aged between 40 and 50 years and had a partner and children. As the age of 50 was described as a turning point at which physical pains and reduced fitness could no longer be ignored or downplayed, an age of early 40s was chosen; truckers around this age generally feel no need (yet) to engage in preventive health behaviours. Given the importance and influence of the partner and children, who were frequently mentioned as drivers of motivation, both the spouse and child were elaborated upon as characters in the narrative.

Risk narrative

The risk perception narrative described René during a typical day at work (present situation/behaviour). While unloading his truck, he experiences chest pains. At first, he tries to ignore the pain since he is already behind schedule. During his general practitioner (GP) visit the next day, he is immediately referred to the hospital for examination. It turns out that an artery near his heart is clogged and requires immediate surgery (negative consequences); the subsequent operation is successful. René realises he has been lucky and that he needs to change his current lifestyle, including lack of physical activity and overweight.

The next story fragment is taken from the risk narrative with elements derived from the interviews in italics:

I was on my way to a delivery address in Germany and suddenly felt unwell . […] Once arrived, I stepped out the truck to unload. I pulled open the side of the trailer and suddenly felt real cold, very uncommon . I called Anja and said: ‘ There’s such a cramp in my chest and guts, damn ’. Usually she would comfort me and make jokes about men and their aches and pains. But not this time. ‘ I’d rather see you go to the ER ’, she said. I said: ‘Yes, will do’, but thought: no way. I’m not going to a hospital abroad, right ?

Planning narrative

The narrative focusing on planning strategies depicted René, reflecting on the road he travelled to a healthier lifestyle. Seeing his son’s embarrassment of his poor physical shape (present situation/behaviour), René decides to improve his lifestyle (desired situation/behaviour) – which proves easier said than done. His first bike ride to work is not much of a success; he arrives at his truck sweaty and red faced. The rain is not helping his resolution to cycle either, and the couch is tempting after a long day on the truck. Nevertheless, he finds his ways (connecting strategies) to navigate past these challenges and establishes a healthier life by setting fixed biking days (battling irregularity by structuring the day/week), going for walks (exercising without sport equipment) and resisting temptations (willpower) – including a specification of the when, where and how.

All three connecting strategies were incorporated in the storyline. In this way, audience members can decide for themselves which (combination of) strategy is applicable to their personal situation. In addition, an example was given on how to spend family time while getting some exercise – that is, René playing soccer with his son – in response to the experienced social expectations and obligations and the limited ‘exercise-frame’.

A story fragment illustrates how these elements were incorporated into the narrative:

On days I don’t bike, I go for a walk. That’s easy enough to organise . Anything from a walk around the block to a couple of miles, all depends on my time available . Sometimes together with Anja or the dog. […] Although it’s true, there are still days I don’t feel like doing anything. Such days, the couch is very tempting indeed. The other day, for example, it started raining just when I wanted to go out for a walk. So, I went for walk with my umbrella. […] Well, there’re always excuses for not going, but it’s a matter of focusing on the reasons for going. It’s your own choice; it’s in your own hands.

Based on the truck drivers’ preferences and on previous research findings, the health narratives were presented in a written and audio format; a survey revealed that nine out of 10 truck drivers read trucking magazines, and that they consistently listen to the radio during work ( TON Magazine, 2013 : 12–17), which was confirmed by the interview data ( Boeijinga et al., 2016 ).

Pre-testing the story: isomorphic and well-formed

The pre-test confirmed the health narratives’ isomorphism and perceived similarity. After reading the risk narrative, one truck driver remained quiet for a while and then said, ‘This story is about me, there is more to heaven and earth …’ It turned out that his name was René as well and that he had also suffered from heart failure. Generally, the desired situation/behaviour and connecting strategy as part of the planning narrative were considered well-formed. Some truckers pointed out that the home-to-work bike distance (10 km) was quite ambitious, and it was therefore altered to 6 km. The selected male voices ( n  = 3) for the audio version were all recognised as authentic. The one identified as most representative was used for the final version of the audio versions. The potential of both media formats was confirmed by the stakeholders; that is, by truck drivers themselves as well as by the Dutch National Institute for Transport and Logistics and cooperating trucking companies.

Based on the pre-test, minor changes were made. The final versions of the health narratives consisted of approximately 840 words (risk narrative: 852 words, planning narrative: 825 words). The readability was also similar for both narratives (Gunning Fog Indices: risk perception-focused narrative: 7.49, planning strategies-focused narrative: 7.13). The recorded narratives were each below 5 minutes (risk perception-focused narrative: 04: 50 minutes, planning strategies-focused narrative: 04:37 minutes). Thus, in this case study, the Storybridging approach resulted in four health narratives: (a) a written risk narrative and (b) an auditory risk narrative for non-intending truck drivers; and (c) a written planning narrative and (d) an auditory planning narrative for intending truck drivers.

Using the Storybridging method, health narratives were developed for both non-intending and intending Dutch truck drivers. A quantitative study testing the effectiveness of these narratives showed that both narratives were, via different routes and regardless of their medium, effective in increasing truck drivers’ exercise intentions ( Boeijinga et al., in press ). These findings endorse the effectiveness of the applied Storybridging method, in which the target audience served as an important stakeholder throughout the development process; their personal stories (input) formed the basis of the health narratives (output). On the basis of this case study, the article aims to offer a practical step-by-step method for constructing effective narrative health interventions.

Although time-consuming and labour intensive, the Storybridging method suggests that it pays off to first gain a thorough understanding of the problem behaviour at stake and the stage(s) of behaviour change the target audience is at (Step 1). Based on this knowledge, the health narrative’s key elements can then be determined (Step 2) and used as building blocks while constructing the story (Step 3). According to the Health Action Process Approach, non-intenders benefit from a focus on risk perception, outcome expectancies and/or self-efficacy, whereas intenders benefit from a focus and action and coping planning.

However, the theoretical concepts implicit in the Health Action Process Approach have a certain interrelatedness, which prevents a clear-cut distinction between them both in practice and while developing health narratives. The developed planning narrative, for example, depicts the story of a role model truck driver who (after a bumpy road) is currently living and enjoying a healthier life. By implying the beneficial aspects of his lifestyle change (e.g. ‘being happy with the lifestyle changes’; ‘feeling stronger and fitter’), the storyline unintentionally could lead to positive outcome expectancies as well. Planning strategies also operate in concert with perceived self-efficacy, both of which are enhanced by role model behaviour of narrative characters. With regard to persuasiveness, the story’s quality, accuracy and readability outweigh its strictness and limit in focus. The theoretical concepts should therefore serve as guide rather than fixed rules.

The final step involves pre-testing and refinement (Step 4). The developed health narratives were pre-tested in a research setting, which may differ from truck drivers’ real-life setting. The question is whether these narratives would also be read on a voluntary basis under less favourable, everyday conditions. A promising format in this regard is TON magazine , a free of charge, national trucking magazine that is widely distributed both in printed (home delivery) and digital format (available at http://www.tonmagazine.nl ), and well read by Dutch truck drivers ( Steijvers and Van der Valk, 2012 ). The importance and influence of both the work and private context give rise to another limitation. Rather than targeting the target group on its own, narrative health interventions may benefit from a multiple audience design, including significant others such as the partner. Printed home-delivered versions of professionally focused magazines such as TON may reach both the primary, professional target group members and their household members, specifically their partners. In collaboration with the National Institute for Transport and Logistics, for example, a special edition of TON magazine could be developed targeting truckers’ partners by sharing stories and tips (e.g. easy recipes and exercises) on how to facilitate healthier lifestyles. Previous research has indicated that such a holistic, multi-stakeholder health promotion approach – including individual, interpersonal and ecological levels – is an imperative need in the context of the trucking sector ( Apostolopoulos et al., 2012 , 2011 ).

To conclude, the Storybridging method offers a careful and practical step-by-step approach for co-creating narrative health interventions, in response to the mixed results and wide diversity of narratives used in health-related narrative persuasion research. The steps established are guided by the Health Action Process Approach as well as choices around narrative characteristics. An important implication of this method is that non-intenders and intenders each require a specific approach and, therefore, specific narrative content. Identifying the target group’s stage of behaviour is thus an essential first step in constructing effective health narratives. The developers of narrative health interventions are recommended to involve the target audience in each step of the development process. Narrative health interventions developed using the Storybridging method are promising in bridging health inequities as well as the intention-behaviour gap. Future narrative health interventions should be carried out following the Storybridging steps to further verify the utility and generalisability of the method.

Acknowledgments

The authors thank the truck drivers and sector partners for their time and participation.

Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the Netherlands Organisation for Scientific Research (NWO/ZonMW), Project BGRL-11-15.

Narrative Health: Using Story to Explore Definitions of Health and Address Bias in Health Care

Affiliation.

• 1 Community University Health Care Center, University of Minnesota, Minneapolis.
• PMID: 30939266
• PMCID: PMC6380479
• DOI: 10.7812/TPP/18-052

When defining health and illness, we often look to governing bodies such as the Centers for Disease Control and Prevention and the World Health Organization rather than our communities. With health disparities prominent throughout the US, it is important to look at the structures we have set forth in health care and find new ways to address health as well as new definitions. Storytelling is a valuable tool to help understand how our communities address health and the place of the hospital or clinic in their health. Narrative Health focuses not just on storytelling but also story listening. At the Community-University Health Care Center in Minneapolis, MN, we have implemented narrative health programs with patients and learners from various health professions. Using creative writing pedagogy and techniques to decentralize the practitioner-patient binary of illness, we learn about our patients' stories of health and experiences with health care. It is important to move past the definitions of health to the complexities of story that allow for the human aspects of illness to be absorbed and understood.

• Communication*
• Healthcare Disparities*
• Social Determinants of Health*

A Systematic Narrative Review of Recent Obesity Interventions with Black Women in the United States

• Published: 21 May 2024

Cite this article

• Melina Tidwell Torres 1   na1 ,
• Amelia Bailey 1 , 2   na1 ,
• Patricia Markham Riscia 1 , 3 , 4 &
• Augustine W. Kang   ORCID: orcid.org/0000-0002-4268-993X 2 , 5  

45 Accesses

Explore all metrics

This study is to comprehensively review recent obesity interventions for Black women in the United States.

We searched PubMed and EBSCOhost for articles published between 2013 and 2022 using a comprehensive search strategy. Two reviewers screened titles, abstracts, and full texts. Data from the included articles were extracted. Qualitative themes related to the intervention designs were identified across studies.

Fifty-two studies were included in the review. Interventions typically aimed to reduce weight by targeting diet and/or physical activity. Intervention activities were delivered virtually and in-person via several formats including didactic content and interactive sessions. Outcomes were assessed through a variety of research designs. Across papers, we identified six key themes of intervention design: integration of technology, centering community and culture, personalization of content, use of social support, skill-building through intervention activities, and addressing comorbid health conditions.

Conclusions

To address the obesity epidemic, future research can build upon key lessons learned from recent interventions tailored to Black women.

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“whole-of-community” obesity prevention: a review of challenges and opportunities in multilevel, multicomponent interventions, trends in evidence-based lifestyle interventions directed at obese and overweight adult latinos in the us: a systematic review of the literature, data availability.

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Melina Tidwell Torres and Amelia Bailey contributed equally.

Authors and Affiliations

Department of Behavioral and Social Science, Brown School of Public Health, Providence, RI, USA

Melina Tidwell Torres, Amelia Bailey & Patricia Markham Riscia

Center for Alcohol and Addiction Studies, Brown School of Public Health, Providence, RI, USA

Amelia Bailey & Augustine W. Kang

Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI, USA

Patricia Markham Riscia

Department of Epidemiology, Brown School of Public Health, Providence, RI, USA

Stanford University School of Medicine, Stanford, CA, USA

Augustine W. Kang

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All authors contributed to the review’s design, development, and editing process. The design of the paper and research question was determined by A.K. and M.T.T. A comprehensive literature search was conducting by M.T.T. A.B. and M.T.T. screened and selected studies and extracted data from the final selection of papers. The first draft of this manuscript was written by M.T.T. and A.B. A.K. and P.M.R. provided edits to the manuscript prior to submission. All authors read and approved the final version of the manuscript.

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Correspondence to Augustine W. Kang .

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Tidwell Torres, M., Bailey, A., Riscia, P.M. et al. A Systematic Narrative Review of Recent Obesity Interventions with Black Women in the United States. J. Racial and Ethnic Health Disparities (2024). https://doi.org/10.1007/s40615-024-02026-9

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Received : 04 February 2024

Revised : 06 April 2024

Accepted : 08 May 2024

Published : 21 May 2024

DOI : https://doi.org/10.1007/s40615-024-02026-9

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