12 Tips for Centering Patient Voices through "Lived Experience Panels" in Preclinical Undergraduate Medical Education

Background: Integrating patient narratives into medical education enhances understanding of person-centered care, empathy, and the human experience of illness. This paper explores the implementation of lived experience panels (LEPs) in preclinical medical education. Aims & Description: Twelve strategies for effective LEP integration are presented, emphasizing thoughtful curation of panelists, timing considerations, vulnerability cultivation, and empowerment of marginalized voices. The paper outlines leveraging virtual platforms, skillful facilitation, student and patient preparation, post-session support, and debriefing mechanisms. Experiences from the University of Texas Branch at Galveston are showcased. Conclusion: The incorporation of LEPs into medical education holds immense potential for benefiting both learners and patients. Ensuring intentional and sensitive inclusion of these panels is paramount for the development of impactful curricula. By incorporating patient voices into medical education, we can nurture empathy, reinforce person-centered care principles, and cultivate authentic connections among learners, ultimately facilitating a transformative shift in the dynamics of the physician-patient relationship.

Whakawhanaungatanga-Building trust and connections: A qualitative study indigenous Māori patients and whānau (extended family network) hospital experiences

AIMS

Investigated the experiences of Māori (the Indigenous peoples of Aotearoa, New Zealand) patients and whānau (extended family network) engaging with acute hospital inpatient services and their priorities for a Māori-centred model of relational care.

DESIGN

A qualitative Māori-centred research design using a Thought Space Wānanga (learning through in-depth group discussion, deliberation and consideration) approach.

METHODS

Two wānanga were conducted between May 2022 and June 2022, with 13 Māori patients who had been acutely hospitalized within the past 12 months and their whānau members. The first wānanga utilized storytelling and journey mapping to collect data. The second wānanga refined the initial themes. Wānanga were audio-recorded and then inductively coded and developed into themes.

RESULTS

Thirteen patients and whānau attended the first wānanga, while 10 patients and whānau participated in the second wānanga). Four themes were developed: (1) Whakawhanaungatanga (establishing connections and relationships), (2) Whakamana (uplifting the status and esteem of Māori), (3) Whakawhitiwhiti kōrero (the importance of communicating, discussing and deliberating) and (4) Kotahitanga (working together with purpose) all provide insights into the importance of effectively engaging and connecting with Māori patients and whānau when acutely hospitalized.

CONCLUSIONS

The experiences and priorities of Māori patients and whānau affirm the international literature, suggesting that Indigenous relational concepts are critical to building relationships, connections and trust. Despite existing healthcare models for working with Indigenous peoples, their poor application contributes to sub-optimal healthcare experiences at all points of their healthcare journey. A relational mode of practice focused on engagement and forming connections better meets the needs of Indigenous peoples engaging with inpatient health services.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Despite the existence of Indigenous models of care, Indigenous peoples consistently report a lack of engagement and connection when accessing inpatient health services. Without establishing relationships, applying models of care is challenging.

IMPACT (ADDRESSING)

What problem did the study address? Internationally, healthcare systems are consistently ill-equipped to deliver culturally safe care for Indigenous and marginalized peoples, evident in ongoing health inequities. Like other reports of Indigenous experiences of health services, Māori express dissatisfaction with care delivery in an acute inpatient setting. This study investigated Māori patients and whānau experiences engaging with acute hospital inpatient services and their priorities for a Māori-centred model of relational care. What were the main findings? Māori patients and whānau recounted negative experiences with healthcare professionals lacking effective relationships and trust. Satisfaction occurred when engagement with health care professionals resembled Indigenous cultural rituals of encounter that considered their holistic, collective and dynamic worldviews. Previous models of relational care, while helpful, are not Indigenous and so do not address their needs, such as engagement as a mode of practice (how) to achieve this. Where and on whom will the research have an impact? This research impacts Indigenous peoples' health outcomes, particularly Māori, and nurses and clinicians working and interacting within acute inpatient and other hospital settings. Indigenous research methods support co-constructing knowledge for translation into practical outcomes through transformational practices, policies and theory development.

REPORTING METHOD

We used the Consolidated Criteria for Strengthening the Reporting of Health Research Involving Indigenous Peoples (CONSIDER) statement (see File S2-CONSIDER Checklist) and the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines (see File S3-COREQ Checklist).

PATIENT OR PUBLIC CONTRIBUTION

Māori patients and their whānau interviewed about their experiences were involved in data interpretation.

Risking at the Rocks

This article uses storytelling and poetry to emphasize the core concepts of taking a risk while highlighting the mystique of the Grand Canyon in Arizona.

Perspectives From Adolescent and Young Adult Cancer Survivors for a Planned Nurse-Patient Dyadic Storytelling Intervention

Purpose: This qualitative study aimed to explore the perspectives of adolescents and young adults (AYA) on a planned nurse-patient dyadic storytelling intervention. Background: Cancer is a highly distressful event for AYA. AYA with cancer experience multidimensional suffering while dealing with their developmental transition from adolescence to young adulthood. Their unique needs require appropriate, well-tailored psychosocial support. Nurses can provide such support through storytelling approaches.

METHOD

AYA cancer survivors participated in cross-sectional qualitative interviews to provide feedback on the nurse-patient storytelling intervention model.

ANALYSIS

Qualitative content analysis was used to interpret and categorize the data.

FINDINGS

Barriers and facilitators of the intervention emerged. Themes related to barriers included (a) the disadvantages of an online program, (b) the limitations of the in-person program, (c) interacting with nurses, (d) sharing personal stories with others, and (e) the timing of the program. Themes regarding facilitators included (a) benefits to AYA with cancer, (b) benefits to nurses, (c) benefits of online/in-person programs, and (d) willingness to participate. Conclusions: AYA with cancer may benefit from the nurse-patient dyadic storytelling intervention. Developing innovative methods to optimize and customize interventions based on preferences is essential. Future research should involve nurse feedback and tailored approaches for AYA with cancer.

Honoring our teachings: children's storybooks as indigenous public health practice

Introduction

American Indian and Alaska Native (AIAN) communities continue to flourish and innovate in the face of the COVID-19 pandemic. Storytelling is an important tradition for AIAN communities that can function as an intervention modality. To support the needs of AIAN children and caregivers, we (a collaborative workgroup of Indigenous health researchers) developed a culturally grounded storybook that provides pandemic-related public health guidance and mental health coping strategies woven with Inter-Tribal values and teachings.

Methods

A collaborative workgroup, representing diverse tribal affiliations, met via four virtual meetings in early 2021 to discuss evolving COVID-19 pandemic public health guidance, community experiences and responses to emerging challenges, and how to ground the story in shared AIAN cultural strengths. We developed and distributed a brief survey for caregivers to evaluate the resulting book.

Results

The workgroup iteratively reviewed versions of the storyline until reaching a consensus on the final text. An AI artist from the workgroup created illustrations to accompany the text. The resulting book, titled Our Smallest Warriors, Our Strongest Medicine: Honoring Our Teachings during COVID-19 contains 46 pages of text and full-color illustrations. An online toolkit including coloring pages, traditional language activities, and caregiver resources accompanies the book. We printed and distributed 50,024 physical copies of the book and a free online version remains available. An online survey completed by N = 34 caregivers who read the book with their child(ren) showed strong satisfaction with the book and interest in future books.

Discussion

The development of this storybook provides insights for creative dissemination of future public health initiatives, especially those geared toward AIAN communities. The positive reception and widespread interest in the storybook illustrate how braiding AIAN cultural teachings with public health guidance can be an effective way to disseminate health information. This storybook highlights the importance of storytelling as an immersive learning experience through which caregivers and children connect to family, community, culture, and public health guidance. Culturally grounded public health interventions can be effective and powerful in uplifting AIAN cultural values and promoting health and well-being for present and future generations.

Interactive Narrative-Based Digital Health Interventions for Vaccine Communication: Protocol for a Scoping Review

BACKGROUND

Interactive narrative-based digital health interventions hold promise for effectively addressing the complex determinants of vaccine hesitancy and promoting effective communication across a wide range of settings and vaccine types. Synthesizing evidence related to the implementation and evaluation of these interventions could offer valuable perspectives for shaping future strategies in vaccine communication. Prior systematic and scoping reviews have examined narrative-based vaccine communication interventions but not the inclusion of interactivity in such interventions.

OBJECTIVE

The overall objective of the scoping review is to summarize the evidence on the use of interactive narrative-based digital health interventions for vaccine communication. Specific research questions focus on describing the use of interactive narrative-based digital health interventions (RQ1), describing evaluations of the impact of interactive narrative-based digital health interventions on promoting vaccine uptake (RQ2), and factors associated with their implementation (RQ3).

METHODS

A detailed search string will be used to search the following databases for records that are relevant to the review questions: PubMed, Embase, Scopus, Web of Science, CINAHL, and PsycINFO. Two reviewers will independently screen the titles and abstracts of identified records against the predefined eligibility criteria. Subsequently, eligible records will undergo comprehensive full-text screening by 2 independent reviewers to assess their relevance to review questions. A data charting tool will be developed and used to extract relevant information from the included articles. The extracted information will be analyzed following the review questions and presented as a narrative summary. Tabular or graphical representations will be used to display review findings, as relevant.

RESULTS

Public health informationists were consulted to develop the detailed search strategy. The final search string comprised terms related to narrative communication, digital health, and vaccines. The search string was customized to each proposed publication database and implemented on April 18, 2023. A total of 4474 unique records were identified using the search strategy and imported into the Covidence (Veritas Health Innovation Ltd) review management software for title and abstract screening. Title and abstract screening of identified records are ongoing as of December 29, 2023.

CONCLUSIONS

To our knowledge, this will be the first scoping review to investigate the features of interactive narrative-based digital health interventions and their role in vaccine communication. The goal of this study is to provide a comprehensive overview of the current research landscape and identify prevailing gaps in knowledge. The findings will provide insights for future research and development of novel applications of interactive narrative-based digital health vaccine communication interventions.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51137.

Erasing stigmas through storytelling: why interactive storytelling environments could reduce health-related stigmas

In this article we describe how designers can apply storytelling to reduce health-related stigmas. Stigma is a pervasive problem for people with illnesses, such as obesity, and it can persistently hinder coping, treatment, recovery, and prevention. Reducing health-related stigma is complex because it is multi-layered and self-perpetuating, leading to intertwined vicious circles. Interactive storytelling environments can break these vicious circles by delimiting the narrative freedom of stigma actors. We theoretically explain the potential of interactive storytelling environments to reduce stigma through the following seven functions: 1) expose participants to other perspectives, 2) provide a protective frame, 3) intervene in daily conversations, 4) persuade all stigma actors, 5) exchange alternative understandings, 6) elicit understanding and support for stigma victims, and 7) support stigma victims to cope with stigmatization. We elaborate on these functions through a demonstration of an interactive storytelling environment against weight stigma. In conclusion, this article is a call on designers for health and wellbeing, scientists, and practitioners from various disciplines to be sensitive to the pervasiveness of stigma and to collaboratively create destigmatizing storytelling environments.

Digital Storytelling for Bereaved Individuals in a Virtual Setting

An emerging body literature exists highlighting the use of Digital Storytelling as an educational, and/or therapeutic intervention. Authors of this manuscript have studied Digital Storytelling as a narrative bereavement intervention designed to help individuals make meaning of adverse life events, like the death of a family member. Until recently, Digital Storytelling is typically delivered in person. The purpose of this article is to describe the steps to implementing Digital Storytelling as a bereavement intervention in a completely virtual setting, using Zoom technology. Best practices and lessons learned for the virtual delivery of Digital Storytelling are provided.

Counter-Stories in the way of caste: towards an anti-casteist public health praxis in contemporary India

How can ethnographic methods track implicit & explicit forms of structural casteism in Indian public health policy and praxis? How can a critical attention to ordinary stories and subjectivities of casted lives reveal the underlying Brahmanical moralities, assumptions and imaginations of public health but equally also unravel anti-caste counter-framings/counter-theorizations of symptoms, afflictions, injuries and chronic wounds wrought by caste? How, in other words, can the horizons of anti-colonial theory-making be expanded to capaciously conceptualize casteism as a core determinant of community health outcomes and life-chances in India? By mobilizing 'counter-storytelling' as a concept and method for critical medical anthropology from the Global South, and case studies from longitudinal ethnography in northern India, this paper provides a dual critique of: 1. Public health praxis in relation to questions of caste, addiction, respiratory debilitation, air pollution and TB. And, 2. Epistemologies of health policy making pertaining to wellness for 'the poor' and the gendered and casted labour of community care workers like ASHAs and non-institutionalized health actors.

A Two-Phase Qualitative Enquiry Into Storytelling's Potential to Support Palliative Care Patient-Led Change, Using a Systematic Review Approach

A terminal diagnosis can diminish an individual's sense of agency and identity. Leading change appears to restore a sense of agential self. The first phase of this literature review explores factors influencing patient-led change across the palliative care ecosystem. The second phase illuminates how storytelling can support palliative care patients in leading ecosystem-wide change. 35 studies were identified in Phase 1 and 36 in Phase 2. This research highlights the need to situate patient leadership activity within a palliative care ecosystem to understand factors likely to support or hinder patient leadership activity within it. The evidence indicates the potential use of storytelling to support patients with a life-limiting illness to lead change across the palliative care ecosystem. This challenges current conceptualisations of such patients and offers them instead as an additional source of palliative care support.

Medical Error: Using Storytelling and Reflection to Impact Error Response Factors in Family Medicine Residents

I am a healer, yet sometimes I do more harm than good…David Hilfiker, 1984.

Objectives

Medical error is common and significantly impacts patients, physicians, learners, and public perception of the medical system; however, residents receive little formal training on this topic. Research on error response in practicing physicians is limited, and even more so on medical education interventions to improve this. This study evaluates a curriculum developed to foster the sharing of faculty medical error stories, practice of constructive coping strategies, and growth in resident confidence in managing error.

Methods

Researchers identified factors related to effective physician error management and recovery to develop a targeted intervention for family medicine residents. The intervention consisted of three one hour didactic sessions in a medium-sized midwestern, urban family medicine residency program over the course of 6 months. Instructional methods included guided reflection after mentor storytelling, small group discussion, role play, and self-reflection.

Results

Of the 30 residents, 22 (73%) completed the preintervention survey, and 15 (50%) completed the postintervention survey. While most residents reported having experienced error (55%), fewer than half of the residents reported they knew what to do when faced with medical errors (46%). This increased to 93% after intervention. Personal error stories from mentors were the most desired type of training reported by residents preintervention, but this was surpassed by legal and malpractice concerns in the postintervention survey. Rates of reported error story sharing increased after the intervention. Residents reported self-efficacy (I can be honest about errors) and self-awareness (I acknowledge when I am at increased risk for error) also increased with intervention. However, these changes did not reach statistical significance.

Conclusions

Family medicine residents are receptive to learning from peers and mentors about error management and recovery. A brief intervention can impact the culture around disclosure and support. Future research should focus on the impact of targeted interventions on patient-oriented outcomes related to medical error.

Dental students' perceptions of instructor storytelling for clinical learning: A qualitative description study

OBJECTIVE

Storytelling has been infrequently used in dental education to link clinical knowledge and practice. Our study aimed to explore dental students' views of instructor storytelling with an emphasis on clinical reasoning within a case-based oral pathology seminar.

METHODS

Qualitative description guided the study design. Participants were third- and fourth-year undergraduate dental students who participated in the seminar. Data were collected through semi-structured, one-on-one interviews. Data analysis was approached using inductive, manifest thematic analysis. Verification strategies were employed to ensure methodological rigor throughout the analysis.

RESULTS

In total, 21 students participated in the study ranging in age from 22 to 29 years. Three interrelated themes were identified, which were related to storytelling authenticity, benefits, and recommendations for improvement. Specifically, students reported that instructor stories effectively conveyed genuine cases and clinical reasoning; were beneficial in terms of engagement, awareness, knowledge acquisition, and skill development; and needed to be educationally and clinically relevant to bridge the knowledge-practice gap.

CONCLUSIONS

Instructor storytelling was regarded by dental students as both positive and beneficial. Research is needed to further demonstrate the effectiveness of instructor storytelling in fostering clinical learning and reasoning using indirect and direct outcome measures.

Adding online storytelling-based acceptance and commitment therapy to antidepressant treatment for primary care patients: a randomized clinical trial

Depression is most often treated in primary care, where the prevailing treatment is antidepressant medication. Primary care patients with depression are less likely to be exposed to psychosocial interventions, despite evidence suggesting many of these treatments are effective. An example is acceptance and commitment therapy (ACT), a behavioral treatment for depression with a growing evidence base. A self-guided ACT intervention with a peer narrative (i.e. storytelling) format was developed with the intention of creating a treatment option for primary care patients that was more accessible than traditional psychotherapy. Titled LifeStories, the online program features videos of real individuals sharing coping skills for depression based on lived experiences and key ACT principles. A total of 93 primary care patients taking antidepressants were randomized to either continued antidepressant treatment alone or antidepressant treatment plus LifeStories for 4 weeks. There were no differences over time on depression severity and psychological inflexibility. However, LifeStories led to greater improvements in quality of life and increased patients' interest in additional treatment compared to antidepressant medication alone.Clinical trial pre-registration: ClinicalTrials.gov (NCT04757961).

Narrative Approach and Mentalization

The core focus of this research centered on the intricate relationship between mentalization, the fundamental mental process underlying social interactions, and the narrative approach proposed by Bruner. Mentalization, encompassing both implicit and explicit interpretations of one's and others' actions, plays a pivotal role in shaping the complexity of social interactions. Concurrently, the narrative approach, as elucidated by Bruner, serves as the primary interpretative and cognitive tool through which individuals derive meaning from their experiences. Narrative, in essence, empowers individuals to imbue their experiences with significance, constructing knowledge and enabling a reinterpretation of their lives by reconstructing the meanings attached to events. This intertwining of mentalization and the narrative approach is particularly salient, given their shared reliance on autobiographical narratives and the inference of mental states. In the context of this study, our primary objective was to explore how practical and theoretical activities, rooted in the re-elaboration of personal life information and events, could serve as a catalyst for enhancing mentalization skills. By engaging students in activities specifically designed to encourage the reinterpretation of their life experiences, we aimed to bolster their ability to infer mental states effectively. These enhanced mentalization skills, we hypothesized, form the foundational basis for executing complex educational tasks rooted in constructed teaching methodologies. In summary, this research serves as a pioneering exploration into the synergistic interrelation of mentalization and the narrative approach, offering valuable insights for educators and practitioners aiming to foster enhanced social cognition and enriched educational experiences.

Storytelling: Manifesting Integral Interconnectedness in Holistic Nursing Education

This paper presents a middle-range theory of storytelling in nursing education. Both explanatory and predictive, the theory further develops the existing conceptual work on the topic of storytelling. It places storytelling as a pedagogical technique within the realm of holistic nursing theory and philosophy. Storytelling is seen as a manifestation of the process of integral interconnectedness. The theory suggests a mechanism by which storytelling, as mediated by narrative transportation and neuroplasticity, can be effective in promoting desirable outcomes for holistic nursing students, including the achievement of affective and cognitive educational objectives. The theory describes the relationship of storytelling to narrative transportation and neuroplasticity. Within the concept of storytelling, the Temporal Bidirectionality of Story and Experience and the Story Creation-Interpretation-Recreation Cycle of telling and listening are explained. This theory was developed using deductive reasoning combining existing nursing and non-nursing theories. Recommendations for research and application are included.

Evaluation of a culturally adapted reminiscence therapy intervention: Improving mood, family and community connectedness in Spanish- and Vietnamese-speaking older adults

Reminiscence therapy (RT) is an evidence-based treatment for alleviating depression and improving life satisfaction among elders, yet less is known about its efficacy in diverse ethnic groups. We report on the evaluation of a cultural adaptation of the RT intervention that combines reminiscence with three innovative elements: including family members in RT; conducting community events for participants to present their artwork and life-story books created during the intervention; and using ethnically matched bilingual community workers. The 12-week intervention with pre- and post-test assessments was completed by 73 Hispanic and 92 Vietnamese elders (mean age  =  75 years; 62% female; mostly foreign-born, with limited English proficiency). Paired t-tests indicated statistically significant improvement in depression, loneliness, and life satisfaction. Sixty-two percent of participants noted improved relationships with family/friends through improved communication and shared understanding of the participant's life story. Fifty percent of respondents participated in a community event and the qualitative comments noted improved connection with their community through listening to others' life experiences and sharing their own. Participant perceptions of ethnically matched community workers were positive, but several indicated they could work with someone from a different ethnic background. Similar to general RT findings, the culturally adapted RT intervention demonstrated improvement in depression, loneliness, and life satisfaction among elders from two different ethnic backgrounds. Implications for future projects are discussed based on the findings and experience of conducting this intervention.

Tales of me: storytelling identity work, authenticity, and impression management during new CEOs' work role transitions

Introduction

This study aims to understand how new CEOs construct, revise, and maintain in their narrative, repertoire stories that represent their identity as it is associated with their new occupational role.

Methods

For this purpose, we conducted a qualitative study using the Grounded Theory method, involving 47 CEOs from different sectors residing in Brazil.

Results

Our results allowed for the construction of a central category called Storytelling Identity Work, which refers to stories that individuals tell about themselves, and enable them to propose and redefine who they are during major life transitions. This paper seeks to explain: (a) under what conditions this phenomenon tends to occur; (b) what characterizes the success of Storytelling Identity Work and; (c) what leads to the revision or retention of stories in the self. Our results show that storytelling identity work tends to be used by new CEOs during their transition period into the role, and when their new position involves higher levels of visibility and alteration of prestige levels in comparison to their previous position. They also suggest that storytelling identity work tends to be more successful when the stories are co-constructed and validated with other significant individuals and when they enable new CEOs to feel "sufficiently authentic" and "sufficiently impressive." Finally, we theorize that such feelings, along with a sense of coherence between the story being told and other narratives consciously or unconsciously being narrated by the interviewees throughout their lives, lead to the retention of the story within the individual's self.

Discussion

This article innovates by connecting the literature on personal storytelling with identity work and exploring processes that are not only useful during the process of transitioning into the role of new CEOs but also influence the constitution of the narrative repertoire and, consequently, the identity of these individuals.

Writing to Heal: The Arts as a Learning Methodology in Psychiatry

This piece explores how poetry and prose can be used as an adjunct to medical education and patient care, especially in the field of psychiatry. It details the author's personal experience with spoken word poetry as a medium of communication about their own story and how this may be harnessed to tell the stories of patients as well. The piece touches on how mental health can be explored through creative writing and how this may be a useful tool for working with patients.

Evaluating an intergenerational art and storytelling program with older adults and medical students

Older adults in residential communities face loneliness and isolation, challenges exacerbated by COVID-19, leading to adverse physical and mental health outcomes. Intergenerational arts and humanities programs have been successful in addressing these challenges while also enabling medical learners to better understand aging populations. Draw YOUR Story, a program at a Houston residential senior living community, connects premedical and medical student volunteers with older adults through an art and storytelling activity. To evaluate the program, we conducted a focus group with older adults and pre and post-volunteering student surveys with questions about attitudes towards older adults and an Interpersonal Reactivity Index. Student surveys (n = 18) showed increased comfort working with older adults after volunteering (p = 0.02). Students who spent less time volunteering reported a decline in their perceptions of older adult quality of life, when compared to more frequent volunteers (p = 0.02). Older adults shared that the program encouraged learning new skills, offered time for reflection, connected them to medicine, and furthered desire for community. Draw YOUR Story benefitted students and older adults, increasing student comfort with older adults, providing aging adults opportunities to learn new skills and reflect, and building intergenerational connections.

Using storytelling in undergraduate dental education: Students' experiences of emotional competence training

AIM

The aim of the study was to explore the use of storytelling as a teaching method for emotional competence interventions within undergraduate dental curriculum (dental and dental hygiene students).

MATERIALS AND METHODS

Students participated in five sessions related to emotional competence: one theoretical and four practical. During the latter, divided in small groups, students told individually two stories: a story about a clinical situation in which they had an emotional experience and a story concerning a patient's experience of the same emotion. Each session focused on a single emotion: happiness, fear, anger and shame. A questionnaire was used to collect perceptions about enjoyment, how stories were chosen, what was learned and if the sessions were stimulating in any way. A focus group was organised to collect reflections about the learning environment, process of learning and specific skill set developed during these sessions.

RESULTS

The majority of the students enjoyed listening, telling and preparing the stories. They reported to experience social support and feeling a sense of community during the sessions. The students believed that stories helped them to reflect on their clinical work and to regulate their emotional experiences more efficiently in clinical situations. Regarding the learning environment, the dental students pointed out the distinctiveness and dissimilarities between the dental and dental hygiene students, but also expressed that they had a desire to learn more about the other student group.

CONCLUSION

Storytelling used as part of an emotional competence course appears to have benefits for students' reflection about their role as dental health professionals. This teaching method was well-perceived by the students included in this study.

'A Story of Being Invisible': A Single Case Study on the Significance of Being Recognised When Needing Acute Healthcare in the Early COVID-19 Pandemic

Severe illness is often an existential threat that triggers emotions like fear, stress, and anxiousness. Such emotions can affect ill patients' encounters with healthcare personnel. We present a single case study of an older woman who contracted COVID-19 and her challenge to be recognised by healthcare personnel in the early pandemic. Storytelling is vital to understand how patients can create meaning in illness as it gives them the opportunity to reshape and restore their past and to project a future. We used Arthur Frank's dialogical narrative analysis to explore how one patient experienced her encounters with healthcare personnel. Although she felt very ill from COVID-19, she experienced being almost invisible and not being believed by healthcare personnel in a system marked by high stress levels and uncertainty. Despite rejections and illness, she managed to mobilise her resources, even though she depended on significant others. Her story brings forward altered self-understanding and growth. The importance of facilitating dialogical settings for healthcare professionals through patient storytelling also contributes to a broader societal understanding of illness beyond a biological perspective.

Food access narratives as told by consumers and retailers engaging in a COVID-19-stricken urban food system: A brief report

Small food retail ("corner") stores in many underserved urban settings face challenges to stocking healthy, affordable foods. The food supply chain is considered one of the most important sectors of the economy and has suffered recent negative impacts due to the Coronavirus disease 2019 (COVID-19) pandemic, from farm to consumer. As part of the larger Baltimore Urban food Distribution (BUD) Study, we examine corner store owner and consumer perceptions of the impact of COVID-19 on navigating an urban food environment using a brief, reflective, semi-structured oral interview framed as "storytelling." Open-ended responses are documented, transcribed, and analyzed for key themes. Presently, we discuss initial key findings in hopes of helping to ensure sufficient value added for corner store owners and consumers who will interact with the BUD mobile application as part of a full-scale trial being implemented in Baltimore, Maryland.

Play therapy and storytelling intervention on children's social skills with attention deficit-hyperactivity disorder

BACKGROUND

Attention deficit-hyperactivity disorder (ADHD) is a common neuro-behavioral disorder that negatively affects educational, relational, and occupational aspects of one's life. Although many children diagnosed with this disorder can benefit from taking medication, particularly for core symptoms, play therapy and storytelling can be seen as engaging, stimulating, and more compatible with children's developmental needs. The social skills of these children are as vital as other symptoms and can be better addressed with cognitive-based art therapy interventions. Because little research has been focused on the combination of play therapy and storytelling and the social interactions of children with ADHD are highly important in academic settings, this study aimed to determine the effects of this combination on children's social skills with ADHD.

MATERIALS AND METHODS

This survey was a quasi-experimental study with a pre-test-post-test design and a control group. Participants were 7-11-year-old girls and boys with ADHD based on DSM-V referred to child and adolescent psychiatrists' clinics. Selected children were randomly allocated into intervention and control groups. The intervention group received an individual combined intervention of play therapy and storytelling, whereas the control group did not receive any therapeutic intervention for social skills at that time and was on the waiting list. The research tool was the Social Skills Rating System (SSRS), and data were computer-analyzed using SPSS-20 and a couple of descriptive and analytic tests including ANCOVA.

RESULTS

In this study, 30 children with ADHD were included. The combined intervention of play therapy and storytelling has had a significant effect on post-test results of ADHD patients in terms of social skills as well as all test subscales (P < 0/05). There was a significant improvement in the subscales of self-expression, self-control, responsibility, and cooperation (P < 0.05).

CONCLUSIONS

Results show promise for combined play therapy and storytelling intervention to enhance the social skills of elementary school children diagnosed with ADHD.