Center for Systematic Review for Health Policy and Systems Research, American University of Beirut, Beirut, Lebanon.
Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
Health Res Policy Syst. 2019 Mar 5;17(1):26. doi: 10.1186/s12961-019-0423-4.
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.
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.
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.
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.
The review protocol is registered in PROSPERO International prospective register of systematic reviews (ID = CRD42018085011 ).
人们对使用叙事或讲故事来影响卫生政策越来越感兴趣。本研究旨在系统综述使用叙事来影响卫生政策制定过程的证据。
合格的研究设计包括随机研究、非随机研究、过程评估研究、经济研究、定性研究、利益相关者分析、政策分析和案例研究。检索了 MEDLINE、PsycINFO、Cochrane 图书馆、护理学及相关健康专业文献累积索引（CINAHL）、世界卫生组织全球卫生图书馆、传播与大众媒体完整数据库和谷歌学术数据库。我们按照标准系统综述方法进行研究选择、数据提取和偏倚风险评估。我们对发现进行了叙述性综合，并根据政策周期的以下阶段进行了结果分层：（1）确定议程，（2）政策制定，（3）政策采纳，（4）政策实施和（5）政策评价。此外，我们还提出了与使用叙事来影响卫生政策制定相关的知识空白。
有 18 项研究符合入选标准，包括案例研究（n=15）、参与性行动研究（n=1）、文献分析（n=1）和传记方法（n=1）。大多数研究的方法学质量非常低。此外，没有一项研究正式评估了基于叙事的干预措施的有效性。研究结果表明，叙事可以作为激发政策探究的灵感和赋权工具、作为发起政策讨论和获得公众支持的教育和意识工具、作为制定、采纳或实施政策的宣传和游说工具，具有积极的影响。也有证据表明使用叙事会产生不良影响。在一项案例研究中，叙事的使用导致了对一种乳腺癌治疗方法的广泛保险报销，而后来证明该方法是无效的。另一项案例研究描述了叙事的不恰当使用如何夸大了一种手术的感知风险，从而导致其使用受限，使大量患者无法从中受益。第三项案例研究描述了如何有选择地使用患有癌症的儿童的乐观“治愈”或“希望”的故事来为癌症研究筹集资金，而忽视了负面现实。大多数纳入的研究没有提供关于叙事的定义或内容、叙事干预背后的理论框架或叙事干预成功的可能预测因素的信息。
现有证据基础不允许对叙事干预对卫生政策制定的影响做出任何稳健的推断。我们讨论了这些发现对研究和政策的意义。
本研究方案已在 PROSPERO 国际前瞻性系统评价注册库（ID=CRD42018085011）注册。
