Abstract
Digital storytelling aims to illuminate complex narratives of health and illness when used as a method in health research. Digital stories are three to five minute videos that integrate written and narrated stories with multiple aesthetic components. There is increasing interest in digital storytelling as a research method, yet there is limited synthesized knowledge about its use. A systematic review to advance methodological understanding was warranted. Our systematic review purpose was to identify and synthesize evidence on the use, impact, and ethical considerations of digital storytelling as a method in health research. Key databases and online sources were searched for qualitative, quantitative, and mixed methods studies using digital storytelling. Articles with pediatric or adult populations, family members, or healthcare professionals were included. The focus was on digital storytelling in health research, where it was used as a method, at any point in the research process. Two independent reviewers screened abstracts and full texts to confirm eligibility. We conducted a narrative synthesis of the extracted narrative data. The searches yielded 7285 articles. Following the removal of duplicates and screening, 46 articles met the inclusion criteria, which predominantly used qualitative methodology. An analysis of the extracted data resulted in seven descriptive themes which provided insight into the purpose, definition, process, context, impact and ethical considerations of this method. Digital storytelling is an empowering and disruptive method that captures voice through a process-oriented, flexible approach. It is particularly effective at honouring local and cultural knowledge, and evoking change. Researchers have used consistent facilitation approaches, but theoretical inconsistency, diverse positioning in analysis, and ethical complexity remain significant challenges. These findings provide methodological insight for applying digital storytelling in future research. Systematic review protocol registration: CRD42017068002.
Keywords
Background
Digital storytelling is an arts-based research method that combines the art of storytelling with the power of technology (De Vecchi et al., 2016; Gubrium, 2009a; Rieger et al., 2018). Although digital storytelling is increasingly being used, its application as a specific method has not been fully articulated, leaving researchers with limited guidance about how to effectively integrate it within the research process. We conducted a systematic review on digital storytelling’s use, impact, and ethical considerations in health research. For this review, digital storytelling was defined as a facilitated process of capturing personal stories through the production of a three to five minute multimedia digital video (Lambert, 2013). Participants write and record a story and commonly add images and music to convey poignant moments of meaningful personal life experience (Gubrium, 2009a).
Digital storytelling came to prominence through the work of Lambert and colleagues at StoryCentre in Berkley, California. In establishing the Centre, they combined their skills in media production and the arts to create stories using digital technology (Lambert, 2009). Drawing heavily on cultural democracy and the power of stories to create change (Hartley & McWilliam, 2009), their approach primarily involves workshops which include story sharing and feedback, script work and image preparation, recording scripts, digital editing, and story screening. This method aligns with the visual revolution, where multimedia consumption, creation, and sharing have significantly influenced how people cognitively process and understand information.
The use of digital storytelling in community development is well established (de Jager et al., 2017), and there is an increasing body of literature exploring its potential as a research method. In healthcare, researchers have described digital storytelling as evocative, empowering, and impactful (De Vecchi et al., 2016). Internationally, there is also a growing emphasis on research impact and rapid translation of knowledge to policy and practice (Rieger & Schultz, 2014; Williams & Grant, 2018). Scholars have described the potential of digital storytelling as an innovative knowledge translation approach for impact beyond academic publications (de Jager et al., 2017; De Vecchi et al., 2016).
Digital storytelling has been used in diverse healthcare fields, including mental health (De Vecchi et al., 2016; De Vecchi et al., 2017), oncology (Akard et al., 2015; Cueva et al., 2016), sexual health promotion (Guse et al., 2013), and refugee health (Lenette & Boddy, 2013; Lenette et al., 2019; Vecchio et al., 2017). However, the complex methodological and ethical challenges associated with digital storytelling as a method in healthcare research have not been fully explored.
Previous Reviews of Digital Storytelling
We located several related reviews. A literature review by Wilson, Hutson and Wyatt (2015) focused on the reflective processes and therapeutic effects of digital storytelling in pediatric oncology. In mental health, De Vecchi and colleagues (2016) completed a scoping review where 15 digital storytelling studies were categorised across four broad areas: education, learning skills, learning about other people’s lived experience, and learning about personal lived experience. They noted that researchers have not utilised the full potential of the method in knowledge translation.
In a broad systematic review of digital storytelling in research, de Jager and colleagues (2017) identified 27 studies and outlined key aspects and uses of the method. Their review was not focused on health research, and they only included studies that closely resembled the process described by Lambert (2006, 2009, 2010, 2013). No validated quality appraisal tool was used in their review, and their discussion of ethical issues was limited (de Jager et al., 2017). In other reviews, the use of digital storytelling has been explored in sexual health and wellbeing amongst young people from migrant and refugee backgrounds (Botfield et al., 2018), in social work practice (Chan & Sage, 2021), and education (Wu & Chen, 2020).
Given the limited synthesized knowledge on digital storytelling in health research, the aim of this systematic review was to identify and synthesize evidence on the use, impact, and ethical considerations of digital storytelling as a method.
Methods
Our published protocol (Rieger et al., 2018) guided this review. The review questions were: (1) What is known about the purpose, definition, use (processes), and contexts of digital storytelling as part of the research process in health research? (2) What impact does digital storytelling have on the participants, research process, knowledge development, and healthcare practice? and (3) What are the key ethical considerations when using digital storytelling within qualitative, quantitative, and mixed-methods research studies? We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for reporting (Page et al., 2021). The review is unique as it focused on a research method rather than a study phenomenon (McCrae & Purssell, 2016).
Inclusion and Exclusion Criteria
Inclusion Criteria.
Search Strategy
An expert healthcare librarian designed and conducted database searches of MEDLINE (Ovid), CINAHL (EBSCOhost), PsycINFO (ProQuest, Ovid), EMBASE (Ovid), Academic Search Complete (EBSCOhost), Web of Science [Social Sciences Citation Index and Arts & Humanities Citation Index] (Clarivate Analytics), CENTRAL [Cochrane Central Register of Controlled Trials] (Wiley), Art Full Text (EBSCOhost), and ArtBibliographies Modern (ProQuest). The search strategy was initially developed for MEDLINE and translated for each additional database, according to the subject coverage and differing search functions. The search was first conducted in December, 2017 and then updated in November, 2019. A broad Google search was undertaken to identify any potential articles missed in the database search. Details of the search strategies can be found in the Supplementary File 1.
Study Selection, Data Extraction, and Synthesis
Retrieved articles were imported into Covidence (2022), and following duplicate removal, two reviewers independently screened titles/abstracts against inclusion criteria. Full texts were read to confirm eligibility, with all disagreements resolved through discussion. One researcher extracted data from included studies with a pre-designed standardized data extraction form (Supplementary File 2), and a second member of the team checked the extracted data. The form was pilot tested on five articles and revised in consultation with research team members. As this was a methodological review, the focus was on synthesizing elements of the study process to identify use, impact on the research process and participants, and ethical considerations. We conducted a narrative synthesis (Mays et al., 2005) of the extracted narrative data. Data was coded by two reviewers, and similar codes were clustered to form descriptive themes to answer our review questions. Throughout the analysis, we moved back and forth between the extracted data and the full texts of the included articles. Iterative discussion with research team members was ongoing to extend the initial analysis. The Joanna Briggs Institute Checklist for Qualitative Research (Joanna Briggs Institute, 2017), the Mixed Methods Appraisal Tool (Gagnon et al., 2018; Hong et al., 2018), or the EPHPP Quality Assessment Tool for Quantitative Studies (Thomas et al., 2004) were used for quality appraisal. If two or more articles were published from the same study, we only conducted a critical appraisal on the paper with the most richly described methods.
Results
Following duplicate removal, 5066 titles/abstracts were screened against the inclusion criteria, and 46 articles were included in the final data set (see Figure 1, PRISMA flow diagram). PRISMA 2020 flow diagram.
Study Characteristics
Description of Included Studies.
Quality Appraisal of Studies
We appraised the methodological quality of the qualitative studies with the JBI Checklist for Qualitative Research (Joanna Briggs Institute, 2017). Overall, no studies met all the appraisal criteria (Supplementary File 3), but 63.2% of the studies met eight or nine of the ten criteria. The majority of studies demonstrated congruity between the research methodology and the research question (81.6%; Q2) and methods used to collect data (84.2%; Q3). Most studies (84.2%) had conclusions that flowed from the analysis, or interpretation, of the data (Q10). Weaknesses identified in the quality appraisal included the following: only 63.2% of authors included a description of clear congruity between the stated philosophical perspective and research methodology (Q1), only 68.4% between the research methodology and interpretation of results (Q5), and the researchers influence on the research was only discussed by 39.5% of authors (Q7). We assessed one mixed-methods study [39] with the Mixed Methods Appraisal Tool (Gagnon et al., 2018; Hong et al., 2018). The study components were well integrated, interpretation was clear, and divergencies and inconsistencies between the different methods were noted and discussed. Adherence to the quality criteria for qualitative and quantitative studies was evident, but detail on data analysis was limited. Lastly, one study [27] was assessed with the EPHPP Quality Assessment Tool for Quantitative Studies (Thomas et al., 2004) and received a moderate score, as it was a one-group pre-test-post-test study. Although the authors considered confounding variables and used valid/reliable measurement tools, their participant selection and blinding processes were unclear.
Analytic Findings
An analysis of the extracted data resulted in seven descriptive themes which are described below.
Digital Storytelling: An Empowering and Disruptive Method
Consistent with our review criteria, most authors described digital storytelling as short videos combining images, voice, and music commonly produced in workshops. A few authors used terms such as first-person narratives [1], visual narratives [4], a tool for social connectedness [37], a culturally grounded qualitative research tool [38], a critical narrative intervention [15], or a ‘multisensory tool for realising narrative shock’ [24] (p. 425). Other descriptions included: a culturally sensitive method [2, 4, 7, 45] that assisted in the communication and disruption of intergenerational trauma [2], a democratic process that disrupted tension and opened new understanding [6], an empowerment method of engaging participants as partners with expertise [31] and a powerful arts-based inquiry method that amplified voice, facilitated aesthetic engagement/significance [6, 7] and supported identity and world-making processes [7]. In a study exploring the experiences of women who were refugees [28] digital storytelling was conceptualized as a visual ethnographic method, and in another study, as an empowerment research method with young women who had experienced dating violence [31].
Consistent Facilitation Approaches amongst Theoretical Inconsistency
The digital storytelling approach developed by StoryCenter (Lambert, 2006, 2009, 2010, 2013) [1, 2, 6-9, 12-16, 19, 31, 34, 35, 37-39, 44, 45] was described by most authors, however, in seven studies [11, 25, 26, 29, 33, 36, 43] no explicit description of the facilitation process was provided. The authors modified the StoryCenter approach in five studies by integrating Indigenous cultural protocols [2, 12, 33, 45] and/or ceremony [12]. The work of Gubrium and colleagues (Gubrium, 2009a, 2009b; Gubrium, Fiddian-Green, & Hill, 2016; Gubrium et al., 2014; Gubrium & Harper, 2013; Gubrium & Turner, 2011) was cited in fourteen of the included studies [3, 11, 17, 21, 24, 27, 28, 30, 32, 36, 41-43, 46] with other researchers adopting the work of Creative Narrations [4], or researcher developed digital storytelling protocols [5, 10]. (see Table 2).
Overall, the articles lacked detailed descriptions of underpinning theories, frameworks, and models for research using digital storytelling as a method. Where detail was provided, authors described a culture centred theoretical framework [9], a social support and health behaviours model [35], a model of health promotion and social determinants [10], social determinants of health with a capacity building lens [41], feminist theory [1], historical trauma and Indigenous epistemology [2], philosophical hermeneutics and narrative theory [25, 26], and transportation theory [4]. Missing, however, was detail on how these theories, frameworks, and models were enacted. Some authors [6, 7, 39] cited Freire (1996) to reinforce the potential of digital storytelling to challenge power, politics, social structures, and lives of the oppressed. Humanistic nursing theory was used in one study to support the notion of digital storytelling as a unique, reciprocal encounter [14].
Honouring Local and Cultural Knowledge
The importance of digital storytelling in “rendering…discounted local knowledge as relevant by working with marginalized communities to produce their own stories”, acting to recalibrate “damaging and disempowering conversations on social health and wellbeing” [15] (p. 291) was highlighted by Gubrium and colleagues. For example, with Indigenous communities (n = 14), digital storytelling reflected and honoured ancient Indigenous oral traditions [5, 12, 20, 33, 36]. The aim was to teach, educate, document history, and transmit cultural knowledge to future generations [10, 11, 20-22, 33]. Indigenous peoples [10, 11, 33] shared their health experiences [5, 19, 22, 41], elevated Indigenous knowledge and practices [10, 12], and reframed stigmatizing, colonialized narratives [11, 32, 40, 43, 44, 46] in a safe, engaging space [12].
Capturing Voice through a Process-Oriented, Flexible Method
The digital storytelling process occurred over a period of time, and often in a group format. The varied and unique temporal elements allowed for the processing of experiences over hours, days, or even weeks. Workshop duration varied from 6 hours [20], to 2 days [31], 3 days [6, 8, 13, 34, 35, 41, 45], 4 days [1, 2, 9, 15, 16, 27, 38] or 5 days [12, 39, 44], to a week-long workshop or retreat [11, 32, 33]. In some studies, digital stories were produced over a series of meetings instead of an intensive workshop [25, 36, 37, 42]. For example, some participants took part in two-hour meetings over 5 weeks [4] or three sessions [26]. In other studies, a series of after-school workshops were held [7, 43]. Participants in Fletcher and Mullet’s [10] three-day workshop reconvened after they had time to work on their stories in their communities.
In the studies reviewed, digital storytelling was facilitated by various people, including researcher(s) or research staff [1, 2, 26, 34, 35, 41-43], staff from a professional digital storytelling organization [1, 9, 30], or community members alongside research staff [10, 16, 17]. Several authors stated that the facilitator had received training through StoryCenter [14, 16, 34, 35]. In most articles, there was a lack of detail about facilitator training [2, 5, 12, 18, 24, 26, 29, 30, 39, 41, 42] or the facilitators were not described [8, 13, 32, 40, 46].
Some researchers asked participants to prepare beforehand to enhance the workshop or make the timeline more feasible [5, 11, 32]. For example, in one study, participants were provided with information and tools to collect images 4 months before the workshop and participated in regular teleconference calls to prepare [32]. Martin and colleagues [31] held two pre-workshop individual interviews with participants to provide a forum for sharing traumatic stories in a safe and supportive environment before the group workshop.
Before the digital storytelling workshop, some researchers used a photovoice or photo-elicitation phase [20, 28, 30]. For example, in one study, young people were given cameras to take photos of what represented strengths and challenges in their community. They chose 20 images, produced a 250-word narrative, and created a digital story [20].
Many facilitators offered prompts that guided the storytelling process [1, 4, 6, 13, 17-19, 21, 24, 26, 35]. To illustrate, Flicker and colleagues [11] asked: “Can you tell us a story about a time when HIV/AIDS impacted your life? (p. 328). Ward and colleagues [41] worked with youth to develop the following question prompt: “What does mental health/wellness mean to you?” (p. 21), and Morgan and colleagues [33] asked participants to tell a story that would demonstrate what they wanted the Maa-nulth Treaty to bring to their community.
Central to digital storytelling was shaping the story which involved selecting a story, refining it, writing a script, and recording it. The process often involved individual reflection, writing, group discussion, and feedback, highlighting the ordinary voice of participants [3] (p. 299) and for some, selecting and refining a story involved a story circle. Each participant shared story ideas with the group and received feedback from the facilitator(s) and other participants [4, 9, 24, 34, 37, 38]. Participants often wrote a short script (e.g., 250-350 words), edited it with the support of the facilitator, and, once satisfied, digitally recorded it [6, 14, 17, 26, 37, 38].
Selecting and layering multimedia materials (e.g., photos, video clips, music, sound effects, text) onto recorded stories allowed participants to muse about their experiences and metaphorically express nuanced, complex experiences [4-6, 14, 24, 26, 28]. Authors described using various video editing platforms, including iMovie [10, 25], Moviemaker [20], iPads [23], and WeVideo [37] to assemble stories. This process allowed for skill development in video editing [32], and several authors discussed the importance of providing tailored technical support according to the participant’s learning styles and technical abilities [4, 6, 12, 33]. Once completed, digital stories were often shared and celebrated with the group [4, 6, 9, 17, 21, 37].
In a few studies [14, 19, 25], researchers used one-on-one digital storytelling sessions instead of group workshops. In one study [10], mini-stories were created with only a few photos to facilitate work within a short timeframe.
Diverse Positioning in Analysis
The digital stories were analyzed in twenty-two studies [1, 3, 9, 11-16, 18-20, 24, 28, 31, 33-35, 38, 40, 41, 43]. Within this group of studies, 11 described a multimodal analysis process focused on the text of the created stories and additional aesthetic components, including audio and visual data [1, 9, 13, 15, 16, 24, 33-35, 38, 43]. Gubrium and colleagues were the only research team to describe a specific digital story analytical approach [1, 9, 15, 24, 34, 35, 43]: intertextual transcription method (Gubrium & Turner, 2011). In this method, still images from digital stories were combined with the transcription of voiceover recordings, “notes on affect, features of visual objects, text on screen, music, and special effects” to facilitate understanding and “meaning across different modalities of visual, chronological, aural and oral, emotional, gestural, and textual elements found in a digital story” (Gubrium & Turner, 2011, p. 473). There were two additional studies that used a specific multimodal analysis process: one was guided by narrative and thematic analysis of the stories [38], and the other a modified version of grounded theory that integrated semiotic (Rose, 2007) and audio discourse (Bauer & Gaskell, 2000) [33].
There were a group of articles where the analysis focused on the digital storytelling workshop experience [2, 4, 6, 7, 45]. In one study, a case study approach was informed by process evaluation [6], with the remainder using a culturally sensitive thematic analyses [2, 4, 45]. The primary source of data in these studies were post-workshop qualitative interviews [2, 4, 6], post-workshop questionnaires [45], researcher discussions about the workshop facilitation process [6], recruitment documents, and attendance records [6].
Evoking Change through the Creation of a Safe Space for Story Sharing
Incorporating digital storytelling in research resulted in wide-ranging impacts on participants, research processes, and knowledge development. Challenging dominant discourses and power were common across most studies. Beltrán and Begun [2] described the method as transformative, healing, and disruptive, allowing participants to articulate and understand traumatic experiences. The term ‘tool of identity’ (Hannerz, 1983) was discussed by Eglington and colleagues [7], suggesting that involvement in the digital storytelling process enabled youth to engage with personal, cultural artifacts that were important in mediating their lives. The impact of a safe space for story sharing resulted in community connectedness [4, 6, 46] and acted as a means of catharsis for participants [8]. Fiddian-Green and colleagues [9] described the learning of technical skills that could be applied to other contexts as an agentive process. One study described the burden related to the complexity of the method process [28] and another the intense emotional labor participants engaged in as they worked to shape their digital story [31]. Overall, participants were empowered as they experienced increased confidence with technology [4, 6, 8, 41].
The concept of change was explicit in some articles, such as Fiddian-Green and colleagues [9]. They discussed social change praxis in their study of sexuality and identity with Puerto Rican youth. Only a small number of authors examined the impact of digital stories on health professionals, including Laing et al. [26] in oncology, Limaye et al. [30] in maternal and child health in Peru, and Waycott et al. [42] in a community setting. Cordova et al. [5] posited that sharing stories with family members might increase knowledge, support, and responses from others. Flicker et al. [11] stated that digital storytelling could be a catalyst for community health promotion. The potential for digital stories to disrupt thinking amongst public and policy makers was identified by Goodman [14]. Digital stories as a lobbying tool were described in a study that challenged social security policy discourse in Northern Ireland [23].
Ethical Complexity
Ethical approval, the use of ethical procedures, and/or an informed consent process was reported in 32 of the 46 included articles [4-6, 10-13, 15, 16, 18-23, 25-31, 33-36, 38-42, 44]. Only a small group of researchers articulated consent processes specific to digital storytelling, which included: signing a release form unspecified in purpose [34]; or for the use of digital stories in education, community, or knowledge translation activities [4, 5, 25, 30, 39]; a photo release for the use of other people’s photos in the digital story [30, 35]; or consent/explicit permission to use participants’ names [11, 24]. Researchers in only two studies identified the use of a consent process for sharing digital stories online [12, 30].
Ensuring emotional safety when using digital storytelling was identified as an ethical priority. Emotional support and security for participants occurred through the following strategies: psychological pre-screening counselling support [31], an introductory session to explain ethical/consent processes [6], allowing adequate time for story creation [6], support from expert facilitators [6] or a professional counsellor during the digital storytelling workshop [31], as well as fostering a relationship with participants [2, 3, 31, 45]. Emotional support for participants outside the research process was only noted in three of the reviewed articles [13, 18, 31]. In Haffejee and Theron’s [18] study with adolescent girls, the researchers required participants to have a debriefing session with a mental health professional not involved in the research. In Martin et al.’s [31] study with young women who had experienced dating violence, support was provided from a hired professional counsellor during and after the digital storytelling workshop. Psychological pre-screening and follow-up counselling services were available for potential participants who were in psychological crisis [31].
The ethical importance of allowing participants to hold ownership and control over their digital story was identified in a small number of studies [1, 6, 10, 12, 28, 31, 39], with fewer addressing how and where the digital story was shared following its creation [1, 2, 12, 25]. The ethical practice of ownership and choice was exhibited in the studies through the digital story remaining the property of participants [1, 6, 10, 12], ensuring participants maintained control over the conceptual and methodological aspects of the research process [41, 45], control over whether the digital stories were shared with the public/larger audiences [1, 2, 25], or social media [2], as well as the use of participants’ real names rather than a pseudonym [11, 30].
Authors of articles with Indigenous peoples [2, 5, 7, 10-12, 20-22, 32, 33, 36, 41, 43-46] or other cultural groups [1, 4, 8, 9, 15-18, 24, 27, 29, 30, 38, 39] gave attention to culturally sensitive ethical considerations. These included the specific adaption of cultural protocols in the digital storytelling process [12, 33, 45], a heightened sensitivity to relationality [2, 45], the inclusion of Indigenous/cultural members in the research team [4, 10, 21], consultation with tribal members during the research process [4, 5, 7, 10, 11, 20-22, 33, 43, 45], consultation with cultural advisory groups [5, 11, 18, 33, 45], the integration of cultural ceremony [2, 12] and explicitly addressing colonialism within the inquiry process [33].
The use of a specific ethical framework was only described in one study. Gubrium, Lowe, and colleagues [17] analysed the ethical complexities they encountered using the work of Gubrium et al. (2014).
Discussion and Implications
Interest in digital storytelling as a method in health research has increased significantly. Previous digital storytelling reviews have focused on specific populations or disciplines (Botfield et al., 2018; Chan & Sage, 2021; De Vecchi et al., 2016; Wu & Chen, 2020), or have examined the use of digital storytelling more generally (de Jager et al., 2017). Our review extends previous reviews by being the first to focus on the quality of reviewed articles, and process, impact, and ethical considerations of digital storytelling in health research to meet our review aim. The conduct of our review aligned with our published protocol (Rieger et al., 2018).
The expressive components of digital storytelling were documented across most studies, with authors describing it as an aesthetically engaging arts-based method. While most authors drew on Lambert’s process (2006, 2009, 2010, 2013), which has been well described, precise detail on how researchers enacted this process was limited or absent. Most authors echoed Gubrium and colleagues (Gubrium, 2009a; Gubrium et al., 2019; Gubrium et al., 2018) in describing digital storytelling as a method for eliciting rich, affective, and nuanced data to chronicle healthcare experiences in the context of structural disadvantage. The creation of a safe space enabled participants to explore and challenge dominant, disempowering discourses. Terms such as transformation, healing, and disruption were commonly used, with authors describing how lives were mediated and communities connected. While authors have identified digital storytelling as a catalyst of change, only a paucity of literature has explored the full potential of digital storytelling in knowledge translation (de Jager et al., 2017; De Vecchi et al., 2016). Most authors articulated the impact on individuals, with limited consideration of the effect of knowledge translation beyond academic publications.
Many authors described digital storytelling as an impactful and culturally sensitive method applicable to various groups and populations. In the reviewed studies, diverse cultural groups were considered; however, Indigenous communities held a particular affinity with digital storytelling due to their connection with the ancient tradition of oral storytelling (Cordova et al., 2015; Fontaine et al., 2019; Holliday et al., 2018; Morgan et al., 2014; Schurer et al., 2015) and the centrality of Indigenous ways of knowing (Archibald, 2008; Archibald et al., 2019; Kovach, 2021; Rieger et al., 2020, 2021; Wilson, 2008).
A general reference to ethics approval, ethical procedures, and consent related to digital storytelling was found in 32 of the reviewed studies. A much smaller group documented ethical considerations specific to digital storytelling. Where ethics were considered, most authors only made cursory mention of strategies to ensure emotional safety, consent processes for images and story release, story ownership, and specific cultural protocols to inform sound practice. Gubrium et al. (2014) state that as innovative methods such as digital storytelling emerge, so too do new ethical issues. They provide a useful summary of ethical considerations and reinforce that ethical conduct extends far beyond institutional approval. While they have called for robust dialogue and appraisal of contextually focused ethical practice in digital storytelling, their calls have gone largely unheeded.
In the studies reviewed, rich data were collected in innovative ways. However, there was an overall lack of detailed descriptions of theories, conceptual frameworks, or models to underpin digital storytelling as a research method. Rice and Mündel (2018) argue that story is both method and methodology and situate their work in activist arts traditions and critical arts-based research. Similar to Rice and Mündel (2018), the authors of articles in our review provided insight into the intersecting and oppressive factors influencing participants’ health and access to healthcare. However, the authors of only one study explicitly identified the use of arts-based research methodology (Martin et al., 2019). We argue that philosophical positioning is essential for advancing digital storytelling as a rigorous method with a solid theoretical grounding. There remain differing views on whether digital storytelling is a method, a methodology, or both. Future critical analysis should focus on a distinction and careful articulation of the method of digital storytelling and specific methodologies in which to situate this emerging, arts-based method.
Arts-based research methodology, informed by expressive arts philosophy and theory, may be useful in further developing digital storytelling as a method, given its grounding in aesthetic ontology and epistemology (McNiff, 2018), polyaesthetic theory, and intermodal theory (Knill et al., 2003; Knill, 2005). McNiff (2018) argues that artistic inquiry (arts-based research) is a fundamental way of knowing and advocates “staying close to artistic ways of knowing” (p. 22) throughout the research process.
The role of the imagination and the creation of a space for the imagination is foundational to artistic inquiry (Knill, 2005; Levine, 2019; McNiff, 2004, 2018; West et al., 2022). In our review, capturing participants’ voices within a creative process enabled important knowledge sharing. Knill and colleages (2003) argued that imagination is ‘intermodal’, with the expressive arts simultaneously drawing on a diverse array of ancient artistic traditions rather than focusing on a singular creative form. Like the performance artist, an expressive arts researcher strives to understand the interplay or inter-relatedness of texts, sounds, images, and movements, rather than considering these aesthetic components in isolation (Knill, 2005).
While there were some descriptions of multimodal analysis processes employed with digital storytelling, detail was scant. Gubrium and Turner’s (2011) intertextual transcription analysis involves the purposeful consideration of the multiple aesthetic layers evident within digital storytelling, contributing to the meaning created. While Gubrium and Turner (2011) do not describe the congruency of intertextual transcription analysis with specific methodologies, consideration of the layered aesthetic contributions at play in digital storytelling would appear to align with arts-based research methodology.
Limitations
There are inherent limitations associated with a systematic review that can impact reproducibility (e.g., the subjectivity of study selection and quality appraisals). While subjectivity is an inherent risk in any systematic review, an international team of experienced reviewers, clear team communication, a two-person screening process, verification of data extraction by a second reviewer, and careful training and close supervision of reviewers and study staff have mitigated some of the risks. Although a healthcare librarian conducted the search, studies might have been missed due to the emergent nature of digital storytelling as a research method and resulting in lack of consistent MeSH and other controlled vocabulary. Due to feasibility, only articles in English were included. Finally, peer-reviewed journal word count restrictions may have limited the amount of detail presented about the digital storytelling process in the included articles, thus impacting our analysis and findings.
Future Research
There is a need for future studies to provide in-depth descriptions and reporting of the digital storytelling process, moving beyond simple definitions or statements that a particular process was followed. Examining the meaningfulness and effectiveness of different approaches with diverse groups is needed. While digital storytelling has been used with specific cultural groups, there is a need for more detailed description of method adaptions and congruency with specific qualitative methodologies. For example, when working collaboratively with Indigenous communities, the integration of cultural protocols, ceremony, analytical approaches, and dissemination needs to be further understood.
There is a paucity of literature on the impact of digital storytelling as an arts-based knowledge translation strategy. Rigorous studies are needed to evaluate the effect on education, policy, and practice, and robust methods to assess change, particularly long term. When designing future research studies, greater attention should be given to the study methodology. Arts-based research methodology, informed by expressive arts philosophy and theory (Knill, 2005; Levine, 2019; McNiff, 2018; West et al., 2022), has potential, but its applicability to digital storytelling must be further studied and articulated. Multimodal analysis (e.g., intertextual transcription) appear to be congruent with the purposes of digital storytelling, but this needs examination in different contexts and with diverse populations. There is a need for further conceptual development of analytical methods that align with different methodologies. As digital storytelling techniques develop, well designed studies focused on all aspects of ethical conduct should be a priority. There is a need to develop robust frameworks to guide safe, ethical research practice.
Conclusion
Key Recommendations for Digital Storytelling as a Method.
Supplemental Material
sj-pdf-1-ijq-10.1177_16094069221111118 – Supplemental Material for Digital Storytelling as a Method in Health Research: A Systematic Review
Supplemental Material sj-pdf-1-ijq-10.1177_16094069221111118 for Digital Storytelling as a Method in Health Research: A Systematic Review by Christina H. West, Kendra L. Rieger, Amanda Kenny, Rishma Chooniedass, Kimberley Mitchell, Andrea Winther Klippenstein, Amie Zaborniak, Lisa Demczuk and Shannon D. Scott in International Journal of Qualitative Methods
Supplemental Material
sj-pdf-2-ijq-10.1177_16094069221111118 – Supplemental Material for Digital Storytelling as a Method in Health Research: A Systematic Review
Supplemental Material sj-pdf-2-ijq-10.1177_16094069221111118 for Digital Storytelling as a Method in Health Research: A Systematic Review by Christina H. West, Kendra L. Rieger, Amanda Kenny, Rishma Chooniedass, Kimberley Mitchell, Andrea Winther Klippenstein, Amie Zaborniak, Lisa Demczuk and Shannon D. Scott in International Journal of Qualitative Methods
Supplemental Material
sj-pdf-3-ijq-10.1177_16094069221111118 – Supplemental Material for Digital Storytelling as a Method in Health Research: A Systematic Review
Supplemental Material sj-pdf-3-ijq-10.1177_16094069221111118 for Digital Storytelling as a Method in Health Research: A Systematic Review by Christina H. West, Kendra L. Rieger, Amanda Kenny, Rishma Chooniedass, Kimberley Mitchell, Andrea Winther Klippenstein, Amie Zaborniak, Lisa Demczuk and Shannon D. Scott in International Journal of Qualitative Methods
Footnotes
Acknowledgments
Dr. Kendra Rieger holds funding from a Michael Smith Health Research BC Scholar Award. We thank Naomi Armah, PhD Candidate, College of Nursing, University of Manitoba for referencing support of this manuscript.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: We are grateful for funding support from a Manitoba Centre for Nursing and Health Research Grant (College of Nursing, University of Manitoba). We also acknowledge funding support for open access publication from the College of Nursing Endowment Fund, University of Manitoba.
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References
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