Diabetes Forecast

Comic Books and Cartoons for Better Health

By Lindsey Wahowiak , , ,
comic book covers

Maybe you’re a die-hard DC or Marvel fan or maybe you just glance over the funnies on your way to the crossword puzzle. Chances are, you’ve read a comic book or comic strip in your day. They’re quick, they’re often humorous, and they tell compelling stories. But what if comics and cartoons could help you with your diabetes management?

That’s the question Sarah Dobbins, MPH, CPH, asked herself. Dobbins, who was working in epidemiological research in 2012, knew that almost 50 percent of the people living in Fall River, Massachusetts, spoke Portuguese. And they also had a higher rate of diabetes than the state or national average, at 11.3 percent in 2012 (at the time, 7.1 percent of the total population statewide and 9.3 percent nationally had diabetes).

“Getting educational materials in their language was a big problem,” says Dobbins, who now lives in San Francisco. “We needed to get the tips out there—in their language, in an interesting way—and get them to the community.”

So Dobbins paired her public health know-how with her other passion: art. She and Hannah McLane, MD, MA, MPH, worked together to develop a one-panel comic strip—“Dica de Diabetes”—explaining different aspects of diabetes to the Portuguese community. And instead of posting the comics at doctors’ offices—where patients might miss them (or might not even visit)—they decided to reach people through the local Portuguese-language weekly paper, O’Jornal.

The results, Dobbins says, were countable: The paper’s staff reported getting good feedback from readers, and local clinics saw new patients, who cited the comic as the reason they came in.

Using comic strips and books to reach patients may sound novel, but it’s not a new idea. It’s the whole basis around Graphic Medicine, an organization that brings health and comics together. Health care professionals can use comics to communicate with patients, and patients can use them to share their stories.

Kim Vlasnik is an example of the latter. The 35-year-old Nebraska blogger’s website, textingmypancreas.com, has plenty of first-person accounts of what it’s like to live with type 1 diabetes. But in addition to her blog entries, Vlasnik often draws cartoons to share her literal and metaphorical highs and lows.

Art has been a part of Vlasnik’s life almost as long as diabetes. She was diagnosed with type 1 at 6 years old. She started taking art classes in elementary school. Diabetes comics as an adult? That’s just the natural progression for Vlasnik.

“I draw them for me,” she says. “I wanted to offer some levity and kind of balance out the scary stuff. That seems to really resonate with people. If you can bring people joy, I think that’s one of the most rewarding things you can do.”

But joy alone won’t regulate someone’s blood glucose. Fun is important, but so is information. And that’s where Mel Baron, PharmD, MPA, associate professor of clinical pharmacy and pharmaceutical economics and policy at the University of Southern California, comes in. Baron’s research projects include a series of health-centered fotonovelas, or photo-driven comics, directed toward the Hispanic and Latino communities. The series focused on diabetes in the issue titled “Sweet Temptations.”

Fotonovelas have a soap opera feel, and the images tell the bulk of the story, good for people who struggle with reading. Baron says the comics are distributed where they’ll do the most good: at “safety net clinics” and health centers for people who are uninsured, have low incomes, or struggle with literacy or English as a second language. Since starting the fotonovela project, Baron and his team have created eight books, distributing nearly half a million copies around Southern California.

The response, Baron says, has been great. Because fotonovelas are popular with the Hispanic and Latino communities, there’s already a desire for the stories. And because they’re easy to read and understand, people learn new things about chronic conditions they may have had for years.

Understanding your health and how to manage it is called health literacy, and Baron says the way information is delivered can have a huge impact on how health-literate a person becomes. “[At pharmacies, when you get your prescription, a computer] spits out one or two pages on your prescription. It’s really dense, over the head of most of the readers,” he says. “Most people just toss it! But the information there, it’s relevant. How do you develop a health message, how do you help them understand their disease and their medication?”

You reach them by giving them something they already want. Even in a high-tech world, where most people are just a few clicks away from the entire Internet, people still like comics. There’s something to be said for the tactile experience a fotonovela provides. And that’s not just for one person, Baron adds.

“People don’t throw these away; they pass them on,” he says. “Studies show … four people look at each one. People relate to it and understand it. This is still a popular medium.”

And it’s memorable. Baron says that because of the exciting and sometimes risqué nature of fotonovelas, the images make the booklet something you want to pick up and read.

That’s exactly what health care providers at the University of Chicago hope. The university’s teaching clinics, particularly on the South Side of Chicago, provide health services for people whose social determinants of health (factors such as income, race, education, and more) make them more likely to face disease. In fact, about half of the patients in these clinics have type 2 diabetes. And they were getting lost in the shuffle as their doctors graduated from medical school and new doctors came into the clinics.

Patients were given packets of information about their transition to a new doctor. But many didn’t remember getting the packet—if they showed up at all for their appointment with a new doctor. Amber Pincavage, MD, an assistant professor of medicine, and Laura Ruth Venable, project manager, wanted the information to stand out to patients. That’s when they turned to MK Czerwiec, RN, MA, the “Comic Nurse.”

Czerwiec is artist-in-residence at Northwestern University’s Feinberg School of Medicine and teaches graphic memoir at Columbia College. Together, the women created a one-page cartoon panel to explain doctor turnover to patients. They sent “Ms. B Changes Doctors” to nearly 8,000 patients during physician turnover time during med school graduation in 2013 and 2014. The comic was light on text, brightly colored, and came with a matching sticker on the outside of its envelope to attract patients’ attention.

The sticker was unexpected on a health mailing, Czerwiec says, the better to encourage the patient to notice the mailing. “It didn’t matter whether they remembered what happened in the comic; it was just getting them to remember they had the packet and the appointment.”

Venable and Pincavage are still analyzing the data but say more patients remembered they had a new doctor and kept their appointments. A full study will be published later this year.

For these health professionals and comic artists, the goal is to reach patients who are harder to connect with. And that’s Dobbins’ next project, as well. She hopes to make a comic that will reach homeless people who live with diabetes. Right now, she’s talking to providers who work with the homeless population, as well as current and former homeless individuals, to discuss their wants and needs in a health comic.

Dobbins says comics could be one of the best ways to connect with hard-to-reach patients. “I realized how much of a need there really is,” she says. “We need to re-contextualize the way that we’re talking to people, so that they understand it, retain it, and care [about the message].”

Funnies for Health

Just a few comic books and cartoons about diabetes

“Nomi Kane’s Quick Guide to Type One Diabetes” ($2 plus shipping) by Nomi Kane at brewforbreakfast.com. Artist Kane tells first-person stories about living with type 1 diabetes.

“Diabetes and Me: An Essential Guide for Kids and Parents” (2013, Hill and Wang, $15 paperback, $9.99 e-book) by Kim Chaloner and Nick Bertozzi. Science teacher Chaloner walks kids and adults through both type 1 and type 2 diabetes.

The Furdmont Chronicles: Main Street Mayhem” ($19.99) This app for Apple and Android devices is a cartoon adventure education game by physician and cartoonist Justin Grady Matrisciano, MD, FACE, at cartoonmd.com.



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