Injury narratives in occupational safety and health prevention in Italy

BACKGROUND

Storytelling is an effective information source when coupled with technical-scientific evidence. It can promote a structured relationship between evidence-based knowledge and field experience of workplace safety and prevention services (WSPS) inspectors. This is key to identifying the causes of workplace injuries and to set priorities for prevention strategies.

AIMS

The main aim was to describe and report how story collection can be used for deriving validated indications for injury prevention. The specific objectives were to report the results of the creation and dissemination on the web of the story collection and the experience of setting up a community of practice (CoP) to develop preventive recommendations.

METHODS

WSPS inspectors from local health boards in Piedmont (northwest Italy) were asked to write injury stories. They identified the key elements of their stories and developed a narrative of witness accounts to explore the critical issues identified during the investigation. In sessions with the CoP, the inspectors validated the indications for prevention elaborated in each story to reduce bias and standardize recommendations.

RESULTS

Between 2012 and 2017, 60 WSPS inspectors wrote 53 injury stories which were collected and published on the institutional website. Twenty-two stories were selected for discussion during peer review sessions in the CoP and the indications for prevention were transformed as preventive solutions.

CONCLUSIONS

Occupational safety and health prevention can benefit from a narrative-based approach that provides a more comprehensive look at health and safety by facilitating knowledge improvement and sharing.

Storytelling as a research tool and intervention around public health perceptions and behaviour: a protocol for a systematic narrative review

INTRODUCTION

There is a growing trend to use storytelling as a research tool to extract information and/or as an intervention to effect change in the public knowledge, attitudes and behaviour (KAB) in relation to public health issues, primarily those with a strong element of disease prevention. However, evidence of its use in either or both capacities is limited. This protocol proposes a systematic narrative review of peer-reviewed, published literature on the use of storytelling as a research tool within the public health arena.

METHODS AND ANALYSIS

Medline, EMBASE, PsycINFO, ERIC (Educational Resources Information Center), Web of Science, Art and Humanities database (ProQuest), Scopus and Google Scholar will be searched for studies that look at the use of storytelling in the research of pressing current public health issues, for example, vaccinations, antimicrobial resistance, climate change and cancer screening. The review will synthesise evidence of how storytelling is used as a research tool to (a) gain insights into KAB and (b) to effect change in KAB when used as an intervention. Included studies will be selected according to carefully defined criteria relevant to public health issues of interest, and data from qualitative, quantitative and mixed-methods studies will be extracted with a customised data extraction form. A narrative synthesis will be performed according to Economic and Social Research Council guidance from Popay, J, 2006.The study protocol follows the recommendations by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P).

ETHICS AND DISSEMINATION

Formal ethical approval is not required for this study, as no primary data will be collected. Dissemination will involve publishing results of this study in relevant peer-reviewed journal(s). Where possible, the study results will also be presented as posters or talks at relevant medical conferences and meetings.

PROSPERO REGISTRATION NUMBER

CRD42019124704.

The use of personal narratives in hospital-based palliative care interventions: An integrative literature review

BACKGROUND

People living with life-threatening illness experience unmet existential needs despite the growing research and clinical field of palliative care. Narrative interventions show promise in managing these problems, but more knowledge is needed on the characteristics of narrative interventions and the feasibility of using personal narratives in a hospital.

AIM

To review the literature on personal narratives in hospital-based palliative care interventions and to strengthen palliative care practices.

DESIGN

We conducted a systematic integrative review with qualitative analysis and narrative synthesis in accordance with PRISMA where applicable (PROSPERO#:CRD42018089202).

DATA SOURCES

We conducted a systematic search in PubMed, Embase, Scopus, Cinahl, SocINDEX and PsychInfo for primary research articles published until June 2018. We assessed full-text articles against the eligibility criteria followed by a discussion of quality using the Critical Appraisal Skills Programme.

RESULTS

Of 480 articles, we found 24 eligible for this review: 8 qualitative, 14 quantitative and 2 mixed methods. The articles reported on dignity therapy, legacy building, outlook, short-term life review and life review. Data analysis resulted in five themes: core principles, theoretical framework, content of narrative, outcome and, finally, acceptability and feasibility.

CONCLUSION

Various types of systematic palliative care interventions use personal narratives. Common to these is a shared psychotherapeutic theoretical understanding and aim. Clinical application in a hospital setting is both feasible and acceptable but requires flexibility regarding the practices of the setting and the needs of the patient.

Leveraging Micro-Stories to Build Engagement, Inclusion, and Neural Networking in Immunology Education

Storytelling is a highly effective strategy for delivering course content. It can provide real-world contexts and the relevance students desire. Through personal connections to the narrative details, anecdotes facilitate the incorporation of content into pre-existing knowledge and neural networks that enhances retention. In addition, stories can honor students' diverse backgrounds, which builds a sense of belonging and community. In turn, these aspects can drive intrinsic motivation to learn and increase students' alertness in class and overall engagement in the course. Despite the educational power of stories, there often is not enough time to integrate them into curricula. To address this dilemma, faculty can condense stories into micro-stories that require relatively minimal class time. Many aspects of stories that enhance learning can be leveraged in just a few sentences by focusing on narrative details that engage a variety of cognitive and emotional processes. In particular, the inclusion of multiple sensory descriptions and small details, like locations and names, can provide sufficient context to maintain the value stories provide. Micro-stories can function independently or extend a single theme throughout a course. Presented in this Perspective are examples of micro-stories for concepts in immunology and strategies for developing them. Proposals are made for leveraging micro-stories to enhance student engagement and course community, content retention and retrieval, and satisfaction with immunology courses of all sizes and levels.

The fundamental role of storytelling and practical wisdom in facilitating the ethics education of junior doctors

Practical wisdom is a key concept in the field of virtue ethics, and it has played a significant role in the thinking of those who make use of virtue when theorising medical practice and ethics. In this article, we examine how storytelling and practical wisdom play integral roles in the medical ethics education of junior doctors. Using a qualitative approach, we conducted 46 interviews with a cohort of junior doctors to explore the role doctors feel phronesis has in their medical ethics practice and how they acquire practical wisdom through storytelling as an essential part of their medical ethics education. Through thematic analysis of the interviews, we discuss the key role storytelling about moral exemplars and role models plays in developing medical ethics education, and how telling stories about role models is considered to be one of the most useful ways to learn medical ethics. We finish by developing an argument for why practical wisdom should be an important part of medical ethics training, focusing on the important role that phronesis narratives should have in teaching medical ethics.

Redesign Me: Virtual Reality Experience of the Line of Life and Its Connection to a Healthier Self

Virtual Reality is used in various ways for creating a storytelling experience. It gives us the opportunity to imagine one’s life events as a story, and in settings that are intended to aid the self, such as treatment of trauma, anxiety, phobia, etc. This paper discusses the ways that challenging experiences change the way people perceive their life narratives and form their memories. This paper suggests that virtual reality (VR) can be used for the exploration of alternative scenarios in order to see one’s overall line of life in a new and healthier way. Considering the theoretical background of the narrative self, this research proposes a novel view of VR immersion as a medium for constructing a new storyline and attitude to the past. The approach would also influence attitudes regarding the present and future, and thus better shape the narrative of the self, which can lead to healthier life experiences.

A Qualitative Study on the Impact of First Steps-A Peer-led Educational Intervention for People Newly Diagnosed with Parkinson's Disease

Aim: The dual aim of this research was to consider the impact of providing the First Steps program on the stories of people with Parkinson's Disease (PD) and to investigate the psychosocial and emotional mechanisms which may explain this impact. Methods: A qualitative study using a subtle realist paradigm and hermeneutic phenomenological methodology was undertaken. A single semi-structured interview was used to consider the impact and experiences of people with PD who completed either the intervention (2-day peer-led behavior intervention using storytelling 6-8 weeks apart) or received telephone support calls as part of the active control group. Descriptive statistics and a narrative analysis were undertaken on the results. Results: Forty-two participants were invited to participate, forty of whom completed the interview. This included 18 from the intervention group and 22 from the active control group. The intervention group identified the value of the program as worth-while, demonstrating improved exercise behavior and coping mechanisms following the intervention. Three major stories (the affirmed, the validated and the transformed story) identified the impact of the intervention. Three internal mechanisms (perceived control, hope and action, and the individual's mind set) alongside three social mechanisms (social comparison, social control and the first opportunity to share with peers) appeared to explain this impact. Conclusion: This study provides exciting and novel evidence of the impact of a peer-led psycho-educational intervention for people newly diagnosed with PD. Further research is needed to consider the impact of stories-based approaches on participants and consider a critical evaluation of the mechanisms which may explain changes in stories and self-reported behaviour.

Adventures in Evolution: The Narrative of Tardigrada, Trundlers in Time

A lesson plan on the phylum Tardigrada is presented in a storytelling workbook that introduces the evolutionary concepts of adaptive radiation, speciation, divergence, and "tree-thinking" through narrative, transitional art, contemplative coloring, and data searches, which can be enhanced with microscopy wet labs. Students gain insight into the invertebrate world of the highly adaptable, ubiquitous microorganisms known colloquially as "water bears," generating a microevolutionary and macroevolutionary perspective through a narrative that includes an introduction to the TimeTree database.

Narrative Interventions in the Palliative Care Setting: A Scoping Review

CONTEXT

This scoping review maps the existing literature on narrative interventions within a palliative care and end-of-life context.

OBJECTIVES

A scoping review was performed to address the following research question: What observational or randomized controlled trials have been performed to evaluate narrative interventions in the palliative care setting?

METHODS

A search across multiple electronic databases was performed. The search results were screened. Relevant articles were reviewed for the identification of common themes and challenges.

RESULTS

After reviewing 495 citations from electronic searches, and 44 articles from author archives or from manual review of article reference lists, we identified 34 articles for inclusion. Narrative interventions have focused on reflection or communication, and have been studied among providers, students, patients, and caregivers. Only patient/caregiver studies used randomized controlled design. Most studies were small and at the level of evaluating feasibility. Challenges include a high degree of heterogeneity among interventions and heterogeneity among parameters for evaluating those interventions.

CONCLUSION

Narrative interventions are actively being evaluated with the intention of improving communication and well-being among all parties within the palliative care and end-of-life experience. The field would benefit from selecting a subset of outcomes that are comparable across studies, and a common framework for describing narrative interventions. Scant literature exists regarding narrative interventions to assist providers in communication.

A Long-Term Study of Young Children's Rapport, Social Emulation, and Language Learning With a Peer-Like Robot Playmate in Preschool

Prior research has demonstrated the importance of children's peers for their learning and development. In particular, peer interaction, especially with more advanced peers, can enhance preschool children's language growth. In this paper, we explore one factor that may modulate children's language learning with a peer-like social robot: rapport. We explore connections between preschool children's learning, rapport, and emulation of the robot's language during a storytelling intervention. We performed a long-term field study in a preschool with 17 children aged 4-6 years. Children played a storytelling game with a social robot for 8 sessions over two months. For some children, the robot matched the level of its stories to the children's language ability, acting as a slightly more advanced peer (Matched condition); for the others, the robot did not match the story level (Unmatched condition). We examined children's use of target vocabulary words and key phrases used by the robot, children's emulation of the robot's stories during their own storytelling, and children's language style matching (LSM-a measure of overlap in function word use and speaking style associated with rapport and relationship) to see whether they mirrored the robot more over time. We found that not only did children emulate the robot more over time, but also, children who emulated more of the robot's phrases during storytelling scored higher on the vocabulary posttest. Children with higher LSM scores were more likely to emulate the robot's content words in their stories. Furthermore, the robot's personalization in the Matched condition led to increases in both children's emulation and their LSM scores. Together, these results suggest first, that interacting with a more advanced peer is beneficial for children, and second, that children's emulation of the robot's language may be related to their rapport and their learning. This is the first study to empirically support that rapport may be a modulating factor in children's peer learning, and furthermore, that a social robot can serve as an effective intervention for language development by leveraging this insight.

Interactive Elaborative Storytelling: Engaging Children as Storytellers to Foster Vocabulary

Positive effects of shared reading for children’s language development are boosted by including instruction of word meanings and by increasing interactivity. The effects of engaging children as storytellers on vocabulary development have been less well studied. We developed an approach termed Interactive Elaborative Storytelling (IES), which employs both word-learning techniques and children’s storytelling in a shared-reading setting. To systematically investigate potential benefits of children as storytellers, we contrasted this approach to two experimental groups, an Elaborative Storytelling group employing word-learning techniques but no storytelling by children and a Read-Aloud group, excluding any additional techniques. The study was a 3 × 2 pre-posttest randomized design with 126 preschoolers spanning 1 week. Measured outcomes were receptive and expressive target vocabulary, story memory, and children’s behavior during story sessions. All three experimental groups made comparable gains on target words from pre- to posttest and there was no difference between groups in story memory. However, in the Elaborative Storytelling group, children were the least restless. Findings are discussed in terms of their contribution to optimizing shared reading as a method of fostering language.

The effect of storytelling on anxiety and behavioral disorders in children undergoing surgery: a randomized controlled trial

Background

One of the most frightening procedures for children is surgery. This study aimed to assess the effect of animated illustrated stories on anxiety and behavioral disorders in children after surgery.

Methods

In this randomized controlled clinical trial (RCT), 60 children between 4 and 8 years who went through adenotonsillectomy were divided into two groups based on random numbers. In the intervention group, animated illustrated books were read for the children by the researcher, for 30 mins, on the night before surgery. Child’s anxiety was measured using the Revised Children’s Manifest Anxiety Scale (RCMAS) and Behavioral Disorder questionnaire (a researcher-made tool) before and 10 days after the book reading. Data were analyzed using descriptive statistics and the non-parametric Mann–Whitney U test and Wilcoxon signed-rank test.

Results

The results showed that mean scores of physiological anxiety (P-value<0.001), social concerns/concentration (P-value=0.012), and total anxiety (P-value<0.001), except worry/oversensitivity (P-value=0.140), statistically significantly decreased in the intervention group after book reading, but mean total anxiety and its three dimensions did not show statistically significant differences before and after treatment in the control group (P-value>0.05). Mean scores of the Behavioral Disorder questionnaire significantly decreased in the intervention group after book reading (P-value=0.001), but significantly increased in the control group (P-value<0.001).

Conclusion

The results showed that reading animated illustrated books could be effective in reducing anxiety and behavioral disorders in children after surgery. It seems that these books could be a new and creative way to distract children and can be used as supportive care.

Exploring the Effects of a Social Robot's Speech Entrainment and Backstory on Young Children's Emotion, Rapport, Relationship, and Learning

In positive human-human relationships, people frequently mirror or mimic each other's behavior. This mimicry, also called entrainment, is associated with rapport and smoother social interaction. Because rapport in learning scenarios has been shown to lead to improved learning outcomes, we examined whether enabling a social robotic learning companion to perform rapport-building behaviors could improve children's learning and engagement during a storytelling activity. We enabled the social robot to perform two specific rapport and relationship-building behaviors: speech entrainment and self-disclosure (shared personal information in the form of a backstory about the robot's poor speech and hearing abilities). We recruited 86 children aged 3–8 years to interact with the robot in a 2 × 2 between-subjects experimental study testing the effects of robot entrainment Entrainment vs. No entrainment and backstory about abilities Backstory vs. No Backstory. The robot engaged the children one-on-one in conversation, told a story embedded with key vocabulary words, and asked children to retell the story. We measured children's recall of the key words and their emotions during the interaction, examined their story retellings, and asked children questions about their relationship with the robot. We found that the robot's entrainment led children to show more positive emotions and fewer negative emotions. Children who heard the robot's backstory were more likely to accept the robot's poor hearing abilities. Entrainment paired with backstory led children to use more of the key words and match more of the robot's phrases in their story retells. Furthermore, these children were more likely to consider the robot more human-like and were more likely to comply with one of the robot's requests. These results suggest that the robot's speech entrainment and backstory increased children's engagement and enjoyment in the interaction, improved their perception of the relationship, and contributed to children's success at retelling the story.

'This is our liver patient…': use of narratives during resident and nurse handoff conversations

OBJECTIVE

Handoffs are often framed as the co-construction of a shared understanding relying on narrative storytelling. We investigated how narratives are constructed and used during resident and nurse handoff conversations.

METHOD

We audio-recorded resident (n=149) and nurse (n=126) handoffs in an inpatient medicine unit. Qualitative analysis using grounded theory was conducted to identify and characterise the structure of resident and nursing handoff narratives.

RESULTS

Handoff conversations among both residents and nurses used three types of narratives: narratives on creating clinical imagery, narratives on coordinating care continuity and narratives on integrating contextual aspects of care. Clinical imagery narratives were common during patient introductions: residents used a top-down approach relying on overarching patient clinical situations (eg, 'a liver patient'), whereas nurses used a bottom-up approach using patient-specific identifying information. Narratives on the coordination of care continuity for residents focused on managing internal and external coordination activities, whereas nurse narratives focused on internal coordination, emphasising their role as an interface between patients and their physicians. Both resident and nurse narratives on the contextual aspects of care had considerable focus on highlighting 'heads up' anticipatory information and personal patient information; such information was often not present in patient charts, but was important for ensuring effective care management.

DISCUSSION

The presence of narrative structures highlights the need for new perspectives for the design of handoff tools that allow for both informational and cognitive support and shared awareness among conversational partners during handoff conversations. We discuss the implications of the use of narratives for patient safety and describe specific design considerations for supporting narrative interactions during handoffs.

Judging Domestic Violence From the Bench: A Narrative Analysis of Judicial Anecdotes About Domestic Violence Protective Order Cases

Interview participants sometimes share anecdotes (stories about past events), to illustrate a point or discuss their perspectives. When sharing these stories, participants may imbue the events with their own personal meaning-making, selective memory, and biases. We conducted a narrative analysis of anecdotes shared by judges ( n = 20) who preside over Domestic Violence Protective Order (DVPO) hearings to examine how biases and misperceptions shape decisions in DVPO cases. We found that judges rely on biases to sort cases as "true domestic violence" compared with "frivolous cases." In the anecdotes they shared, judges often used gendered stereotypes to depict litigants, and many judges felt that DVPOs had limited efficacy in preventing violence. We argue that important cognitive insights are revealed by interview participants during the spontaneous act of storytelling. In the case of judges, their biases could lead to DVPOs being denied in situations when they are warranted.

Rewriting stories of trauma through peer-to-peer mentoring for and by at-risk young people

Adverse childhood experiences are strongly associated with the development of mental health disorders during the life span. When mental health issues are not effectively dealt with during the adolescent period, young people can become long-term consumers in the mental health system. A widely accepted method of intervention is the provision of mentoring. More recently, young people have been fulfilling the role of mentor to their peers and mentoring has played a large role in supporting young people who are considered at-risk of not achieving the expected psychosocial, educational, and/or developmental goals. What is not known is why young people, previously identified as being at-risk, are motivated to mentor their at-risk peers. The study aim was to examine what motivates previously recognized at-risk young people to provide mentoring to their at-risk peers. Participants were twelve previously recognized at-risk young people recruited through a formal peer-to-peer mentoring programme. Semi-structured interviews were conducted, and the data analysed through narrative inquiry and reported in accordance with the consolidated criteria for reporting qualitative research guidelines (COREQ). Results indicate that young people are motivated by their own lived experiences of trauma(s) to provide at-risk peer mentoring. The experience of mentoring afforded opportunities to rewrite individual personal journeys of trauma through mentoring their at-risk peers, thus constructing a more positive self-identity. Outcomes of developing positive peer relationships and prosocial behaviours could significantly assist mental health clinicians in providing more acceptable care to clients in an age group known to be reluctant to accept traditional mental health intervention.

How narratives influence colorectal cancer screening decision making and uptake: A realist review

BACKGROUND

Although narratives have been found to affect decisions about preventive behaviours, including participation in cancer screening, the underlying mechanisms of narratives remain unclear.

OBJECTIVE

The purpose of this study was to summarize and synthesize existing literature on narrative interventions in the context of colorectal cancer screening. Our main research question was as follows: How, when and for whom do narratives work context of decision making about colorectal cancer screening participation?

METHODS

We undertook a realist review to collect evidence on narratives in the context of colorectal cancer screening. A search of the literature was performed in Embase, MEDLINE/PubMed, Cinahl and PsycINFO. We included empirical evaluations (qualitative or quantitative) of narrative interventions. In total, 15 studies met the inclusion criteria. A content-based taxonomy of patient narrative types in decision aids formed the basis for our initial programme theory.

MAIN RESULT

We identified four mechanisms: (a) process narratives that address perceived barriers towards screening lead to improved affective forecasting, (b) experience narratives that demonstrate the screening procedure lead to increased self-efficacy, (c) experience narratives that depict experiences from similar others lead to more engagement and (d) outcome narratives that focus on outcomes of colorectal cancer (CRC) screening decision decrease or increase fear of colorectal cancer. The evidence was limited on which narrative type may facilitate or bias informed decision making in colorectal cancer screening.

DISCUSSION AND CONCLUSION

The findings indicate the importance of more detailed descriptions of narrative interventions in order to understand how mechanisms may facilitate or bias informed decision making in colorectal cancer screening.

Attuning to laboratory animals and telling stories: Learning animal geography research skills from animal technologists

Posthumanism has challenged the social sciences and humanities to rethink anthopocentricism within the cultures and societies they study and to take account of more-than-human agencies and perspectives. This poses key methodological challenges, including a tendency for animal geographies to focus very much on the human side of human-animal relations and to fail to acknowledge animals as embodied, lively, articulate political subjects. In this paper, we draw on recent ethnographic work, observing and participating in the care of research animals and interviewing the animal technologists, to contribute to the understandings of life within the animal house. In so doing, the paper makes three key arguments. Firstly, that studying how animal technologists perform everyday care and make sense of their relationships with animals offers useful insights into the specific skills, expertise and relationships required in order to study human-animal relations. Secondly, that animal technologists are keenly aware of the contested moralities which emerge in animal research environments and can offer an important position from which to understand this. Thirdly, that storytelling (exemplified by the stories told by animal technologists) is a useful resource for animal geographers to engage with complexity in human-animal relations.

Syntax of Testimony: Indexical Objects, Syntax, and Language or How to Tell a Story Without Words

Language-often said to set human beings apart from other animals-has resisted explanation in terms of evolution. Language has-among others-two fundamental and distinctive features: syntax and the ability to express non-present actions and events. We suggest that the relation between this representation (of non-present action) and syntax can be analyzed as a relation between a function and a structure to fulfill this function. The strategy of the paper is to ask if there is any evidence of pre-linguistic communication that fulfills the function of communicating an absent action. We identify a structural similarity between understanding indexes of past actions of conspecifics (who did what to whom) and one of the simplest and most paradigmatic linguistic syntactic patterns - that of the simple transitive sentence. When a human being infers past events from an index (i.e., a trace, the conditions of a conspecifics or an animal, a constellation or an object) the interpreters' comprehension must rely on concepts similar in structure and function to the 'thematic roles' believed to underpin the comprehension of linguistic syntax: in his or her mind the idea of a past action or event emerges along with thematic role-like concepts; in the case of the presentation of, e.g., a hunting trophy, the presenter could be understood to be an agent (subject) and the trophy a patient (direct object), while the past action killed is implied by the condition of the object and its possession by the presenter. We discuss whether both the presentation of a trophy and linguistic syntax might have emerged independently while having the same function (to represent a past action) or whether the presentation of an index of a deed could constitute a precursor of language. Both possibilities shed new light on early, and maybe first, language use.

« Imaginaire et sensibilités » : la mise en récit de la déshospitalisation psychiatrique en Ontario

This paper proposes a historiographical discussion based on the article « Les contrecoups de la déshospitalisation psychiatrique. L'exemple du parcours transinstitutionel de Françoise ». Françoise's transinstitutional journey presented in the collective publication La fin de l'asile ? Histoire de la déshospitalisation psychiatrique dans l'espace francophone au XX^e siècle, gives me the opportunity to reveal the subtext of this article, and to describe the method and the historical reasoning that gave life to the psychiatric journey of an anonymous person named Françoise. This process is organized around three main points: my positioning as a researcher, the issues related to my narrative approach, and a statement on my historical reasoning in an interdisciplinary perspective. Influenced and inspired by the work of Alain Corbin, George Duby, Roy Porter, Natalie Zemon Davis and Arlette Farge, my approach focusses on the feelings and emotions hidden in historical sources. I remain connected to a subjective intuition, and stay away from positivist reflexes. Based on my research experience with psychiatric records, my conclusion explores the renewal of historical writing , in which I suggest that it is possible to write the history of ordinary people while telling stories with sensitivity.

Using narratives to impact health policy-making: a systematic review

BACKGROUND

There is increased interest in using narratives or storytelling to influence health policies. We aimed to systematically review the evidence on the use of narratives to impact the health policy-making process.

METHODS

Eligible study designs included randomised studies, non-randomised studies, process evaluation studies, economic studies, qualitative studies, stakeholder analyses, policy analyses, and case studies. The MEDLINE, PsycINFO, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), WHO Global Health Library, Communication and Mass Media Complete, and Google Scholar databases were searched. We followed standard systematic review methodology for study selection, data abstraction and risk of bias assessment. We synthesised the findings narratively and presented the results stratified according to the following stages of the policy cycle: (1) agenda-setting, (2) policy formulation, (3) policy adoption, (4) policy implementation and (5) policy evaluation. Additionally, we presented the knowledge gaps relevant to using narrative to impact health policy-making.

RESULTS

Eighteen studies met the eligibility criteria, and included case studies (n = 15), participatory action research (n = 1), documentary analysis (n = 1) and biographical method (n = 1). The majority were of very low methodological quality. In addition, none of the studies formally evaluated the effectiveness of the narrative-based interventions. Findings suggest that narratives may have a positive influence when used as inspiration and empowerment tools to stimulate policy inquiries, as educational and awareness tools to initiate policy discussions and gain public support, and as advocacy and lobbying tools to formulate, adopt or implement policy. There is also evidence of undesirable effects of using narratives. In one case study, narrative use led to widespread insurance reimbursement of a therapy for breast cancer that was later proven to be ineffective. Another case study described how the use of narrative inappropriately exaggerated the perceived risk of a procedure, which led to limiting its use and preventing a large number of patients from its benefits. A third case study described how optimistic 'cure' or 'hope' stories of children with cancer were selectively used to raise money for cancer research that ignored the negative realities. The majority of included studies did not provide information on the definition or content of narratives, the theoretical framework underlying the narrative intervention or the possible predictors of the success of narrative interventions.

CONCLUSION

The existing evidence base precludes any robust inferences about the impact of narrative interventions on health policy-making. We discuss the implications of the findings for research and policy.

TRIAL REGISTRATION

The review protocol is registered in PROSPERO International prospective register of systematic reviews (ID =  CRD42018085011 ).

Storytelling: How We Learn

The best conference presentations tell a story with an interesting introduction, details in the middle, and a conclusion that leads to new research, questions or answers about practice, and perhaps further research on the topic. So, too, do journal articles, and this publication is dependent on the rigors of quality research to tell stories about our patients and their experiences and make suggestions on how we can effect change.

Stories of Identity from High Performance Male Boxers in Their Training and Competition Environments

The current submission was conceived to broaden the discussion around male athletic identities by exploring the stories told by four members of the Canadian National Boxing Team. The athletes' stories were elicited through an arts-based method followed by a conversational interview. Stories were then analyzed using an interpretive thematic analysis. Three salient themes were found-fluid masculinity, ethnicity brings an edge to boxing, and expressing identity through language. These themes present accounts that highlight how socially, culturally, and historically dominant narratives can allow athletes to feel comfortable in presenting the identities they might reveal or feel constrained from doing so due to factors outside of their control. The need to develop training and competition contexts that allow for the empowerment of athletes' individually distinct identities is highlighted as a method to ensuring the positive mental health of elite level athletes.

Digital Storytelling in Early Childhood: Student Illustrations Shaping Social Interactions

This study tests an instructional model designed to empower students in an early childhood classroom as emerging digital storytellers. Educators can use digital storytelling to support students' learning by encouraging them to organize and express their ideas and knowledge in an individual and meaningful way while developing voice and facility in child-computer interactions. This work also helps develop traditional communication skills, fosters collaboration, and strengthens emergent literacy practices. Students develop enhanced communication skills by learning to organize their ideas, ask questions, express opinions, and construct narratives as they interact with others and computers in the creation of digital stories. The "Emerging Digital Storytellers" instructional model focuses on social-emotional development and finding student voice through writing and digital content construction in the early childhood educational context.

Narrative Assessment: A new approach to evaluation of advocacy for development

This article proposes an approach to monitoring and evaluating advocacy that integrates theory of change and storytelling. This approach, called Narrative Assessment, addresses the feasibility of objectivity and evidence in the complex context of advocacy and proposes an evaluation methodology rooted in alternative conceptualizations of rigour and of evaluator roles. The approach centres on practical judgment and the construction and examination of stories through interaction between advocates and monitoring and evaluation specialists. The article discusses how Narrative Assessment can be useful in the evaluation of advocacy in terms of (1) monitoring and evaluation specialists' orientation toward programmes; (2) the interpretation of outcomes; (3) the assessment of outcome relevance; (4) reflection and learning and (5) the communication of programme results. The approach builds on lessons drawn from evaluation of eight advocacy programmes in international development.