Storytelling to Promote Stakeholder Engagement

Stakeholder engagement is defined as the process of meaningfully involving persons affected by research findings or programs in the research process. ^{Reference Bowen, Hyams, Goodman, West, Harris-Wai and Yu1} Recognized as a key process to improve the way research is prioritized, translated, and used in real-life settings, ^{Reference Brett, Staniszewska and Mockford2} stakeholder engagement can occur across all stages of research, spanning from topic identification and study design to interpretation and dissemination of findings. ^{Reference Forsythe, Ellis and Edmundson3} A national survey ^{Reference Skinner, Williams and Richmond4} revealed “research results disseminated to the community in a culturally relevant and appropriate manner” as one of the top indicators of successful community engagement.

The National Institutes of Health Clinical and Translational Science Award (CTSA) program emphasizes the importance of engaging nonacademic stakeholders in the research process. Therefore, many CTSAs have developed methods and infrastructure to support stakeholder engaged research. ^{Reference Joosten, Israel and Williams5–Reference Cunningham, Miller and Joosten7} The Community Engagement Program of the Johns Hopkins Institute for Clinical and Translational Research (ICTR, Hopkins CTSA), which includes members representing three academic institutions and nonacademic stakeholders, collectively developed a training program using storytelling as a strategy for dissemination of research information and findings.

Storytelling or narrative communication (referred to as storytelling hereafter) is increasingly recognized as an effective, human-centered technique used among various settings and populations, such as older adults to improve cognition, ^{Reference Whitty, Mansour and Aguirre8,Reference Fong, Tan, Mahendran, Kua and Chee9} patients with cancer, diabetes, and hypertension to improve their health behaviors, ^{Reference Lipsey, Waterman, Wood and Balliet10} healthcare workers to address psychosocial stress, ^{Reference Phillips and Becker11} and community-level stigma reduction and awareness related to suicide. ^{Reference Mohatt, Singer and Evans12} Recent systematic reviews highlight the positive impact of storytelling on health behaviors and outcomes among traditionally undervalued demographic groups, such as American Indian and Alaskan Native youth ^{Reference Andreo and Andrade13} and African American women. ^{Reference Ballard, Davis and Hoffner14} Additionally, some researchers used storytelling as a stakeholder engagement approach to identify research priorities impacting young African American breast cancer survivors. ^{Reference Yan, Millon-Underwood and Walker15}

Storytelling has a typical structure that includes the following: ^{Reference Dahlstrom16} (1) cause-and-effect relationships between events that take place (2) over a certain period (3) that impact certain character(s). Different from traditional scientific communication aimed at providing abstract truths that are valid and context-free, storytelling is context-dependent as it attempts to derive a depiction and meaning of individual experiences from the cause-and-effect structure of the events. Within a sociocultural framework, storytelling is considered as a central medium of knowledge sharing and communicating science across diverse audiences in ways that make sense to the communities where the research takes place. ^{Reference Louis17,Reference Christensen18}

Educational Gap

Storytelling is considered highly relevant to populations with health disparities such as African Americans, for whom there is a strong cultural connection as a form of social discourse. ^{Reference Ballard, Davis and Hoffner14} While literature is growing to discuss “what” happened as a result of storytelling, ^{Reference Whitty, Mansour and Aguirre8–Reference Ballard, Davis and Hoffner14,Reference Fakunle, Thomas David, Gonzales, Vidot and Johnson19} published evaluations of storytelling training (i.e., how it was done and how it was received) are rare. Given the increasing attention to storytelling as a potentially versatile stakeholder engagement approach, it is important to describe the ways in which storytelling training is provided so that it can be adopted by future research teams as a practical engagement method. Therefore, this paper’s purpose is to discuss the format, scope, and evaluation outcomes of the storytelling training program offered by the ICTR’s Community Engagement Program.

Target Audience

The target audience of the storytelling training program were faculty, research staff, community members, students, and fellows interested in utilizing storytelling approaches for disseminating research findings. The introductory seminar was advertised on Eventbrite, ICTR’s social media handles, through ICTR’s Community Engagement Program partners at the University of Maryland and Morgan State University, Hopkins’ School of Nursing network, emailing lists of existing community partner organizations, and to Hopkins’ Community Research Advisory Council members. The “how to” phase was a workshop designed to provide basic skills for creating individual stories and was primarily advertised to participants of the introductory storytelling seminar.

Description of the Storytelling Training Program

Table 1 details the format, structure, and scope of the two-session storytelling training program which was offered over Zoom, an online video conferencing platform. The introductory seminar (first session) and skills building workshop (second session) were both facilitated by the same expert (DF), who has over 20 years of experience in the art of Black storytelling, African drumming, singing, and theater. Serving as a faculty and professor at two universities in the USA, the expert integrates the artistic and cultural practice to strengthen health, social equity, and liberation. Both sessions were designed to fit the needs of scholarly and community members wishing to share stories about what matters to them.

Table 1. Curriculum of storytelling training program

The purpose of the 1-hour introductory seminar was to orient participants to what storytelling is and how it can empower stakeholders. The presentation discussed how to portray one’s own personal context in a story, why storytelling matters, making the audience find themselves in a story, and the general elements that make a story a “story.”

The objective of the second session was to equip participants with the specific storytelling skills needed to better collaborate as researchers and community members, thus promoting community engagement in research. Not all participants had attended the introductory seminar, but the second session presented and dived deep into many of the concepts introduced in the first seminar. The second session began with the facilitator and each participant introducing themselves and expressing anything they enjoyed doing and/or were thankful for. Following introductions, the workshop consisted of two main activities: The Hero’s Journey and the Movie Trailer. The Hero’s Journey was used as the most common and popular template of storytelling that our participants can easily relate to. ^{Reference Sander20} Through the Hero’s Journey, an individual’s evolving life story can be created to provide the person with meaning and purpose. ^{Reference Kerr, Deane and Crowe21} The Hero’s Journey activity involved participants identifying where they would place themselves on a narrative progression map, which ranges from limited awareness of a problem to the mastery of a problem. ^{Reference Williams22} This activity provided participants with a method for reflection on and framing of stories for prospective audiences. The movie trailer activity involved participants developing a short story analogous to a movie advertisement, applying the techniques introduced in the skills building workshop. The two main activities were structured as general introductions by the storytelling expert, followed by small group breakout sessions for hands-on practice and a full group debrief to discuss the experience. There were no specific story topics other than what interested the participants, and they were willing to share with their peers in the breakout rooms, and occasionally with the bigger group during debrief. Finally, participants convened to receive further elucidation on the “story” and “telling” components of storytelling and concluded with a question-and-answer period to address outstanding and critical points.

Evaluation Methods

At the end of each of the two sessions, we administered a short survey to evaluate participants’ experience. The survey included multiple-choice, 5-point Likert-type scale, and open-ended questions. Given that this was an early and innovative program, the evaluation goals were largely formative and sought to characterize participants’ reactions and content of the process of the program. Additionally, qualitative evaluation of the skills building workshop utilized field notes captured during breakout sessions. Four notetakers were staff with the ICTR Community Collaboration Core and one was from University of Maryland Baltimore—a partner University for Community Engagement. Notetakers were each assigned to a breakout group solely to observe and document group interactions. Prior to the skills building workshop, notetakers were informed about the main objectives and briefed on good practices of field (albeit virtual) observations. Notetakers were instructed to document factual data (e.g., date, time, how many participants) along with participants’ interactions and conversational points.

Descriptive analysis was used to examine participants’ characteristics, as well as their ratings to the evaluation surveys administered after the introductory seminar and skills building workshop. Content analysis was used to summarize the main themes identified from the open-ended survey questions, and field notes pooled from the skills building workshop breakout groups.

Lessons Learned and Moving Forward

Leveraging the growing emphasis and relevance of stakeholder engagement, the ICTR’s Community Engagement Program successfully developed and implemented a storytelling training workshop targeting researchers, research staff, community members, and students. According to evaluation data, using a two-phase approach (i.e., introduction to storytelling followed by a skills building workshop with interactive breakout activities) worked well for giving participants a general orientation about storytelling and followed by the opportunity to practice the art of storytelling. These findings are consistent with Urstad et al. ^{Reference Urstad, Ulfsby, Brandeggen, Bodsberg, Jensen and Tjoflåt23} who reported that storytelling generated strong emotional engagement while maintaining high levels of attention and interest from students in higher education. We observed that the learner-to-learner interaction increased communication and collaboration among participants. Such educational experiences have been shown to facilitate quality learning experience with significant positive outcomes for students. ^{Reference Al-Huneidi and Schreurs24}

Despite the positive impact of the training program, some of the participants noted uncertainty about what they were expected to do or how to frame the stories. For future iterations, we will need to consider spending more time to review the process of developing stories with clearer instructions and modeling to foster a better understanding of the activities’ purposes. As for modeling, audiovisual material such as slides and pre-recorded videos could be used as examples to better orient the learner to the process. Such orientation and training may help stimulate the learner’s creation of story while allowing the training team to teach storytelling skills on a larger scale and with consistency. Additionally, training activities could include diverse media avenues to accommodate varying learning styles. ^{Reference Rodríguez-Almagro, Prado-Laguna, Hernández-Martínez, Monzón-Ferrer, Muñoz-Camargo and Martín-Lopez25} The proportion of community members who attended the training was relatively small. Other training sessions should conduct targeted recruitment to ensure community representativeness. Finally, it would be important to assess the participants’ readiness to share and proceed with storytelling, and as the field is evolving, new tools are being developed to measure storytellers’ readiness. For example, questionnaires may serve as a self-reflective tool that prospective storytellers could use, ^{Reference Ashdown and Maniate26} and trainers can use quantitative ratings as a basis to gauge changes before and after the training workshop.

In conclusion, the ICTR’s storytelling training program was successfully implemented with consistently high satisfaction ratings and positive comments. The utility of storytelling as a culturally relevant experiential technique to potentially improve stakeholder engagement in the research process is to be determined. Future programs should address the impact of such training on actual engagement of participants’ storytelling abilities with stakeholders in the research process, from ideation of research questions to the dissemination of findings.