LETTERS STORYTELLING TO ENHANCE THE VALUE OF RESEARCH The article by Neta et al.1 introduces a muchneeded structure for advancing discussions about how researchers might build a bridge between practice, policy, and research. Each phase is outlined with important factors to consider. I appreciate reading a conclusion that emphasizes the importance of recognizing (1) the interrelatedness of all issues described in the framework and (2) the risk of “guideline fatigue” when researchers face an expanding number of recommendations that could hinder the use of reporting guidelines. Without diminishing the contributions of this article, the authors may have overlooked a critical need for researchers to step back as scholars in writing reports with a narrative voice that is both informative and compelling or engaging. Reports designed to influence public policy may need to be written with great attention to communicating a human story that offers a solution. The art of storytelling may be more than the sum of tasks involved in reporting relevant information to stakeholders or bringing together multiple stakeholders to the planning table. It is about writing reports in a way that
Letters to the editor referring to a recent Journal article are encouraged up to 3 months after the article's appearance. By submitting a letter to the editor, the author gives permission for its publication in the Journal. Letters should not duplicate material being published or submitted elsewhere. The editors reserve the right to edit and abridge letters and to publish responses. Text is limited to 400 words and 10 references. Submit online at www. editorialmanager.com/ajph for immediate Web posting, or at ajph.edmgr.com for later print publication. Online responses are automatically considered for print publication. Queries should be addressed to the Editor-in-Chief, Mary E. Northridge, PhD, MPH, at [email protected].
inspires readers to care enough to move forward. It is about showing readers rather than telling readers what it is like to be in a given situation. It is about opening a window for readers to enter a world experienced by research participants, such as the dilemmas faced by parents who encounter any number of access-to-care problems when caring for their children with disabilities. This may also include the need to uncover systemic struggles faced by organizations that serve families of children with disabilities, including the challenges that might come with interagency or intra-agency collaborations.2,3 Aside from the merits of research methodology and the politics of political timing, one of the greatest challenges in disseminating research for public policy use may ultimately rest in how the story is packaged for presentation. j Brason Lee, MSW, MS
About the Author Brason Lee is a research consultant with the Center for Health and Education, Sacramento, California. Correspondence should be sent to Brason Lee, Center for Health and Education, 3108 Guadalajara Way, Sacramento, California (e-mail: [email protected]). Reprints can be ordered by visiting http://www.ajph.org and clicking on the “Reprints” link. This letter was accepted December 31, 2014. doi:10.2105/AJPH.2014.302548
References 1. Neta G, Glasgow RE, Carpenter CR, et al. A framework for enhancing the value of research for dissemination and implementation. Am J Public Health. 2015;105(1):49---57. 2. Cikara M, Paluck EL. When going along gets you nowhere and the upside of conflict behaviors. Soc Personality Psychol Compass. 2013;7(8):559---571. 3. Rieley JB. Overcoming the barriers to effective collaboration. Global Business and Organizational Excellence. 2014;33(3):37---45.
CARPENTER ET AL. RESPOND We wish to thank Brason Lee for a thoughtful suggestion on one component of scientific
April 2015, Vol 105, No. 4 | American Journal of Public Health
dissemination, which we had not fully contemplated: communication and the potential for personal narrative. In the past decade, exemplar stories have been used to convey individual experiences in trying to achieve optimal, research-based outcomes, and these narratives often extend beyond societal divisions of medicine, social science, and public services.1 Personal narratives provide a glimpse into the complexity inherent in putting formal, precision-focused research reports into the real world. Evidence-based medicine leaders suggest that the next evolution of research-based practice will combine traditional critical appraisal with pertinent stories that tie researchers to clinicians and their patients.2 Narrative methods have also been used to nurture scientific manuscript penetration into medical practice as an evolving paradigm of translational medicine.3 Educators are using personal illness storytelling to help medical students incorporate empathy into routine practice early in their careers.4 Training health care professionals using humanistic storytelling to convey the individual impact of key medical decisions cultivates relationship-centered care delivery.5 Similarly, at the population health level narratives have been used to successfully address social disparities in the primary and secondary prevention of illness.6 For policyrelated audiences, the preference of narrative versus a data-based presentation my vary according to gender, age, and political ideology.7 Finally, personal narratives can also be used for sharing lessons learned among researchers (see the Narrative Library Web site at http://www.makeresearchmatter.org/narrativelibrary/about-the-narrative-library.aspx). However, a narrative approach to communicating research findings is not without limitations. Excessive focus on the story rather than the data risks tokenism and undue attention to the entertaining raconteur at the expense of the pioneering scientist. In addition, some stories cannot or should not be told in public forums.8 Contemplating a more inclusive dissemination and implementation research reporting
Letters | e1
LETTERS
framework within the context of narrative communication also suggests challenging barriers. Manuscripts pass through a rigorous peer-review process, often including unpaid and over-tasked volunteer editorial board members or reviewers with tangential understanding of the topic or methods. Reviewers’ understanding of the potential for narrative to enhance the impact, distribution, and uptake of research is likely to be limited and will require time to penetrate the psyche of editorial boards and peer referees across specialties. Advocates for a narrative approach to convey the positive, negative, or equivocal impact of research into the lives of real persons will need to educate reviewers of these benefits within the context of contemporary rigorous scientific reporting. j Christopher R. Carpenter, MD, MSc Gila Neta, PhD Russell E. Glasgow, PhD Borsika A. Rabin, PhD Ross C. Brownson, PhD
2. Silva SA, Charon R, Wyer PC. The marriage of evidence and narrative: scientific nurturance within clinical practice. J Eval Clin Pract. 2011;17(4):585---593. 3. Goyal RK, Charon R, Lekas HM, et al. “A local habitation and a name”: how narrative evidence-based medicine transforms the translational research paradigm. J Eval Clin Pract. 2008;14(5):732---741. 4. DasGupta S, Charon R. Personal illness narratives: using reflective writing to teach empathy. Acad Med. 2004;79(4):351---356. 5. Sierpina VS, Kreitzer MJ, Mackenzie E, Sierpina M. Regaining our humanity through story. Explore (NY). 2007;3(6):626---632. 6. Kreuter MW, Green MC, Cappella JN, et al. Narrative communication in cancer prevention and control: a framework to guide research and application. Ann Behav Med. 2007;33(3):221---235. 7. Brownson RC, Dodson EA, Stamatakis KA, et al. Communicating evidence-based information on cancer prevention to state-level policy makers. J Natl Cancer Inst. 2011;103(4):306---316. 8. Bradby H, Hargreaves J, Robson M. Story in health and social care. Health Care Anal. 2009;17(4):331---344.
About the Authors Christopher R. Carpenter is with Washington University School of Medicine, Division of Emergency Medicine, St Louis, MO. Gila Neta is with Implementation Science, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD. Russell E. Glasgow is with Department of Family Medicine and Colorado Health Outcomes Research Program, University of Colorado, Denver. Borsika A. Rabin is with Department of Family Medicine, School of Medicine, University of Colorado, Denver, and CRN Cancer Communication Research Center, Institute for Health Research, Kaiser Permanente Colorado, Denver. Ross C. Brownson is with Prevention Research Center in St Louis, MO, and Brown School Washington University in St Louis, MO, and Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis. Correspondence should be sent to Christopher R. Carpenter, Washington University in St. Louis School of Medicine, Campus Box 8072, 660 S. Euclid Avenue, St Louis, MO 63110 (e-mail: [email protected]). This letter was accepted January 28, 2015. doi:10.2105/AJPH.2015.302606
Contributors C. R. Carpenter led the writing and production of the letter. R. C. Brownson, G. Neta, R. E. Glasgow, and B. A. Rabin provided substantial feedback on the initial draft of the letter. All authors contributed to the final version of the letter.
References 1. Dahlstrom MF. Using narratives and storytelling to communicate science with nonexpert audiences. Proc Natl Acad Sci U S A. 2014;111(Suppl 4):13614---13620.
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American Journal of Public Health | April 2015, Vol 105, No. 4
Letters to the editor referring to a recent Journal article are encouraged up to 3 months after the article's appearance. By submitting a letter to the editor, the author gives permission for its publication in the Journal. Letters should not duplicate material being published or submitted elsewhere. The editors reserve the right to edit and abridge letters and to publish responses. Text is limited to 400 words and 10 references. Submit online at www. editorialmanager.com/ajph for immediate Web posting, or at ajph.edmgr.com for later print publication. Online responses are automatically considered for print publication. Queries should be addressed to the Editor-in-Chief, Mary E. Northridge, PhD, MPH, at [email protected].
inspires readers to care enough to move forward. It is about showing readers rather than telling readers what it is like to be in a given situation. It is about opening a window for readers to enter a world experienced by research participants, such as the dilemmas faced by parents who encounter any number of access-to-care problems when caring for their children with disabilities. This may also include the need to uncover systemic struggles faced by organizations that serve families of children with disabilities, including the challenges that might come with interagency or intra-agency collaborations.2,3 Aside from the merits of research methodology and the politics of political timing, one of the greatest challenges in disseminating research for public policy use may ultimately rest in how the story is packaged for presentation. j Brason Lee, MSW, MS
About the Author Brason Lee is a research consultant with the Center for Health and Education, Sacramento, California. Correspondence should be sent to Brason Lee, Center for Health and Education, 3108 Guadalajara Way, Sacramento, California (e-mail: [email protected]). Reprints can be ordered by visiting http://www.ajph.org and clicking on the “Reprints” link. This letter was accepted December 31, 2014. doi:10.2105/AJPH.2014.302548
References 1. Neta G, Glasgow RE, Carpenter CR, et al. A framework for enhancing the value of research for dissemination and implementation. Am J Public Health. 2015;105(1):49---57. 2. Cikara M, Paluck EL. When going along gets you nowhere and the upside of conflict behaviors. Soc Personality Psychol Compass. 2013;7(8):559---571. 3. Rieley JB. Overcoming the barriers to effective collaboration. Global Business and Organizational Excellence. 2014;33(3):37---45.
CARPENTER ET AL. RESPOND We wish to thank Brason Lee for a thoughtful suggestion on one component of scientific
April 2015, Vol 105, No. 4 | American Journal of Public Health
dissemination, which we had not fully contemplated: communication and the potential for personal narrative. In the past decade, exemplar stories have been used to convey individual experiences in trying to achieve optimal, research-based outcomes, and these narratives often extend beyond societal divisions of medicine, social science, and public services.1 Personal narratives provide a glimpse into the complexity inherent in putting formal, precision-focused research reports into the real world. Evidence-based medicine leaders suggest that the next evolution of research-based practice will combine traditional critical appraisal with pertinent stories that tie researchers to clinicians and their patients.2 Narrative methods have also been used to nurture scientific manuscript penetration into medical practice as an evolving paradigm of translational medicine.3 Educators are using personal illness storytelling to help medical students incorporate empathy into routine practice early in their careers.4 Training health care professionals using humanistic storytelling to convey the individual impact of key medical decisions cultivates relationship-centered care delivery.5 Similarly, at the population health level narratives have been used to successfully address social disparities in the primary and secondary prevention of illness.6 For policyrelated audiences, the preference of narrative versus a data-based presentation my vary according to gender, age, and political ideology.7 Finally, personal narratives can also be used for sharing lessons learned among researchers (see the Narrative Library Web site at http://www.makeresearchmatter.org/narrativelibrary/about-the-narrative-library.aspx). However, a narrative approach to communicating research findings is not without limitations. Excessive focus on the story rather than the data risks tokenism and undue attention to the entertaining raconteur at the expense of the pioneering scientist. In addition, some stories cannot or should not be told in public forums.8 Contemplating a more inclusive dissemination and implementation research reporting
Letters | e1
LETTERS
framework within the context of narrative communication also suggests challenging barriers. Manuscripts pass through a rigorous peer-review process, often including unpaid and over-tasked volunteer editorial board members or reviewers with tangential understanding of the topic or methods. Reviewers’ understanding of the potential for narrative to enhance the impact, distribution, and uptake of research is likely to be limited and will require time to penetrate the psyche of editorial boards and peer referees across specialties. Advocates for a narrative approach to convey the positive, negative, or equivocal impact of research into the lives of real persons will need to educate reviewers of these benefits within the context of contemporary rigorous scientific reporting. j Christopher R. Carpenter, MD, MSc Gila Neta, PhD Russell E. Glasgow, PhD Borsika A. Rabin, PhD Ross C. Brownson, PhD
2. Silva SA, Charon R, Wyer PC. The marriage of evidence and narrative: scientific nurturance within clinical practice. J Eval Clin Pract. 2011;17(4):585---593. 3. Goyal RK, Charon R, Lekas HM, et al. “A local habitation and a name”: how narrative evidence-based medicine transforms the translational research paradigm. J Eval Clin Pract. 2008;14(5):732---741. 4. DasGupta S, Charon R. Personal illness narratives: using reflective writing to teach empathy. Acad Med. 2004;79(4):351---356. 5. Sierpina VS, Kreitzer MJ, Mackenzie E, Sierpina M. Regaining our humanity through story. Explore (NY). 2007;3(6):626---632. 6. Kreuter MW, Green MC, Cappella JN, et al. Narrative communication in cancer prevention and control: a framework to guide research and application. Ann Behav Med. 2007;33(3):221---235. 7. Brownson RC, Dodson EA, Stamatakis KA, et al. Communicating evidence-based information on cancer prevention to state-level policy makers. J Natl Cancer Inst. 2011;103(4):306---316. 8. Bradby H, Hargreaves J, Robson M. Story in health and social care. Health Care Anal. 2009;17(4):331---344.
About the Authors Christopher R. Carpenter is with Washington University School of Medicine, Division of Emergency Medicine, St Louis, MO. Gila Neta is with Implementation Science, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD. Russell E. Glasgow is with Department of Family Medicine and Colorado Health Outcomes Research Program, University of Colorado, Denver. Borsika A. Rabin is with Department of Family Medicine, School of Medicine, University of Colorado, Denver, and CRN Cancer Communication Research Center, Institute for Health Research, Kaiser Permanente Colorado, Denver. Ross C. Brownson is with Prevention Research Center in St Louis, MO, and Brown School Washington University in St Louis, MO, and Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis. Correspondence should be sent to Christopher R. Carpenter, Washington University in St. Louis School of Medicine, Campus Box 8072, 660 S. Euclid Avenue, St Louis, MO 63110 (e-mail: [email protected]). This letter was accepted January 28, 2015. doi:10.2105/AJPH.2015.302606
Contributors C. R. Carpenter led the writing and production of the letter. R. C. Brownson, G. Neta, R. E. Glasgow, and B. A. Rabin provided substantial feedback on the initial draft of the letter. All authors contributed to the final version of the letter.
References 1. Dahlstrom MF. Using narratives and storytelling to communicate science with nonexpert audiences. Proc Natl Acad Sci U S A. 2014;111(Suppl 4):13614---13620.
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American Journal of Public Health | April 2015, Vol 105, No. 4
