In this systematic review, we will synthesize evidence about the use of digital storytelling in health research studies using established systematic review methods [27]. This review is unique in that it has a focus on a research method as opposed to a phenomenon or intervention [28] . Although qualitative, quantitative studies and mixed methods studies will be included, only narrative data related to our research questions will be extracted. The PRISMA-P checklist [29] guided the development of this protocol (see Additional file 1). This review protocol is registered with PROSPERO [30].
Inclusion and exclusion criteria
Study design
We will include quantitative, qualitative, and mixed method study designs. Qualitative studies can include, but will not be limited to, designs such as phenomenology, grounded theory, ethnography, action research, and feminist research. Quantitative studies can include, but will not be limited to, randomized controlled trials, non-randomized controlled trials, quasi-experimental studies, before and after studies, prospective and retrospective cohort studies, case control studies, descriptive cross-sectional studies, and analytical cross-sectional studies for inclusion. Mixed methods studies can include any combination of these qualitative and quantitative approaches. We will consider published and unpublished articles from January 1, 1990, to present to align with the emergent nature of digital storytelling [10]. We will include only English language articles due to the time and the cost of acquiring and translating articles. There remains controversy surrounding the benefit of expending significant resources for translation [31]. If a quantitative or mixed methods study does not report narrative data, it will be excluded from the review.
Participants and setting
Study participants will encompass pediatric or adult populations, their families, and/or health care professionals. The context of the studies will be health research, which includes research conducted in healthcare settings (e.g. clinics, hospitals, community outreach, home visits) or by medical, nursing, or allied healthcare professionals. The research can take place in any geographical location.
Intervention
The review will include any primary research studies that use digital storytelling as a method at any point in the research process (i.e. recruitment, data collection, data analysis, knowledge translation). Digital storytelling has been defined as a “creative arts process that is used to capture personal stories, using images and sound in a three to five-minute digital clip” [1], p. 183. The reviewers will exclude the article if digital storytelling is used solely as a therapeutic or pedagogical intervention, for example, within a therapeutic process, a therapeutic intervention, or a teaching strategy.
Outcomes
We will extract outcomes related to how digital storytelling impacts the research process (e.g. participants’ engagement and role in the research process, ethical considerations and procedures as described by the researchers in the article, researchers’ and participants’ narrative comments or evaluation of using digital storytelling, findings/conclusions of the study that are relevant to the digital storytelling method, and knowledge translation initiatives).
Literature search strategy
A specialized healthcare librarian will conduct a rigorous search of the literature for potentially eligible studies. Informed by a preliminary literature search for ‘digital storytelling’ and its variants, a MEDLINE database search strategy, reflecting the range of possible terminology to capture studies relevant to digital storytelling will be translated for each additional database to be searched (see Additional file 2). We will use search tools and strategies specific to each database, including truncation of keywords where appropriate, use of thesaurus terms and subject headings, and combining terms and search strings with the appropriate Boolean operators. We will search the following databases and resources: MEDLINE, PsycINFO, Academic Search Complete, CINAHL, Cochrane Central Register of Controlled Trials, Web of Science (incorporating Social Sciences Citation Index and Arts & Humanities Citation Index), Art Full Text, Art Bibliographies Modern, and Google Scholar. We will search the reference lists of identified articles for additional studies, and forward citations of identified articles will be retrieved using the tools available in resources such as Scopus and Google Scholar. We will search for ongoing or recently completed trials in ClinicalTrials.gov and the International Clinical Trials Registry Platform. We will also search for grey literature in the Dissertations & Theses database, in targeted websites, including StoryCenter [32], Patient Voices [33], and Community Story Collective [34], and by using a limited version of the search strategy in Google.
Study selection
We will export the search results from the databases to an EndNote library where we will identify and remove duplicate citations, and manage all records. We will use a two-step process for screening retrieved articles. Two independent reviewers will screen titles and abstracts against inclusion criteria following the removal of duplicates, and we will label each study as include, exclude, or unsure. The full text for all articles classified as include or unsure will be retrieved. These articles will be examined independently by two reviewers and evaluated as include or exclude using a screening form (see Additional file 3). We will resolve all disagreements through discussion, and if necessary, a third reviewer will adjudicate unresolved differences.
Prior to the title/abstract screening, we will ensure consistency and rigour during the screening process by randomly selecting 10 articles to assess interrater reliability. The articles will be independently reviewed by each team member against inclusion and exclusion criteria. A scorer sheet will be completed and a kappa’s co-efficient calculated to measure agreement and identify any issues with title/abstract screening procedures. We will consider an acceptable kappa co-efficient to be 0.80 or above based on a sample of ten articles. In the case of a lower kappa result, team discussion will occur on differences in scores. Inclusion/exclusion criteria will be clarified and testing of interrater reliability and discussion will be repeated until agreement reaches the substantial level.
Data extraction
Data extracted will include context, purpose, uses, benefits, challenges, ethical considerations, and procedures of digital storytelling when used in research, and its impact on research processes, products, and healthcare practices. We will pilot a standardized data extraction form created for this review (Additional file 4) with five included studies. We will then revise the data extraction form in consultation with review team members. One reviewer will extract the data, and a second reviewer will check the data extraction. The reviewers will extract the following data from included studies:
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1)
Title, authors, publication date, journal title
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Study purpose, design, and methods
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Context and participants’ characteristics (e.g. clinical or community setting, geographical location, socio-demographic variables, and diagnosis).
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Description of the digital storytelling purpose, framework, and processes
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Role and training of the researcher(s) regarding digital storytelling
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Participants’ engagement and role in the research process
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Ethical considerations and procedures as described by the researchers in the article
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Researchers’ and participants’ narrative comments or evaluation of using digital storytelling in health research (i.e. effectiveness, feasibility, usefulness, impact on research study/findings, issues)
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Findings of the study that are relevant to the digital storytelling method
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Study conclusions
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Knowledge translation initiatives (i.e. if and how they used the digital stories in their dissemination of the research findings)
Quality appraisals
Two independent reviewers will critically appraise included studies using the Quality Assessment Tool for Quantitative Studies [35] and the Joanna Briggs Institute Checklist for Qualitative Research [36] (Additional files 5 and 6). The Quality Assessment Tool for Quantitative Studies [35] assesses studies on the eight criteria: selection bias, study design, confounders, blinding, data collection methods, withdrawals/dropouts, intervention integrity, and data analysis. The Joanna Briggs Institute Checklist for Qualitative Research [36] assesses studies to see if there is congruity between the research methodology and the stated philosophical perspective, research question, methods used to collect data, representation and analysis of data, and interpretation of results, as well as other trustworthiness criteria. Reviewers will receive pre-training, which will include conducting quality appraisals with the tool on another set of articles (n = 5). The reviewers will compare results and discuss their differences, which will increase inter-rater reliability with the quality appraisal tools. Any disagreements will be resolved through discussion between the two reviewers, and if needed, through adjudication by a third reviewer.
Articles will not be excluded based on quality appraisal as the focus of this review is on the synthesis of data related to the digital storytelling method as opposed to primary study results. However, the quality appraisal assessments will provide understanding of how digital storytelling has been implemented as a method. For example, if there are 25 included studies in the review, and 15 of them are rated as having low methodological quality, this knowledge can identify issues and inform recommendations to improve the rigour of future studies. Thus, the quality appraisals will be reported and inform the interpretation and discussion of the review findings. This quality appraisal process will also allow us to identify and discuss exemplars of high-quality studies that have used digital storytelling.
Data analysis and synthesis
We will present the extracted narrative data in an evidence table organized by study design, clinical context, or research process/stage incorporating the digital story. We will synthesize extracted data through a narrative synthesis [27]. This analytical process will involve a preliminary synthesis and an exploration of the relationships that are evident in the data. The heterogeneity of the studies reviewed will be considered in the process of the narrative synthesis. A minimum of two reviewers will independently code the data and conduct a thematic analysis. The reviewers will describe the use, impact, and ethical considerations of digital storytelling in health research by developing descriptive themes to answer each review question. The review team will engage in ongoing, iterative discussions to deepen and extend the initial analysis produced. Given that this systematic review will address how digital storytelling has been employed across the research process, we will not primarily focus on synthesizing the research findings of the included studies, but will analyze the impact of digital storytelling on the research process. This critical analysis will provide insight into why, when, and how digital storytelling impacts research processes [37]. We will also highlight any methodological limitations of the studies that are identified in our quality appraisals of the work. Since we aim to develop methodological and ethical guidelines, it is critical for us to consider the quality of the studies that underpin these guidelines. This process will allow us to develop salient recommendations to improve future research studies using digital storytelling.
Integrated knowledge translation plan
We will base the dissemination of the systematic review findings on the Canadian Institutes of Health Research guide to knowledge translation [38]. We will use an adapted integrated knowledge translation plan that includes intensive end-of-project dissemination activities. Integrated knowledge translation incorporates knowledge end users throughout the systematic review to facilitate effective uptake of the research findings [38]. National and international researchers who have expertise in using digital storytelling in health research will be consulted during the analysis phase of the systematic review, as well as in the planning of dissemination activities (researchers based in Canada and Australia). The research team will also actively engage three research advisory groups, facilitating feedback from three Canadian research sites.
We will integrate arts-based approaches into the dissemination plan. Specifically, the research team will create three digital stories. The first digital story will focus on the systematic review findings, the second on ethical implications and guidelines for the use of digital storytelling as a research method, and the third will articulate its use as a health research method. This approach will facilitate a creative, active engagement with the research findings rather than relying solely on more passive, traditional knowledge translation approaches [22]. The research team will also share the findings at local/national/international academic conferences and publish a detailed systematic review manuscript of the findings, in addition to derivative methodological papers (i.e. ethical considerations/guidelines). Finally, we will develop a visual infographic that will be used to disseminate the findings widely using traditional and more innovative social media contexts such as Twitter, on blogs, Instagram, and on academic websites. A one-page executive summary outlining specific research recommendations, ethical guidelines and implications for future research will also be developed and shared extensively using social media, and other channels (i.e. Arts Health Network Canada, The Arts Health Early Career Research Network). These diverse avenues of dissemination will ensure the findings are shared broadly with researchers, practitioners, healthcare consumers, and the public.
