title: Developing cartoons for long-term condition self-management information.
abstract: BACKGROUND
  Advocating the need to adopt more self-management policies has brought with it an increasing demand for information about living with and making decisions about long-term conditions, with a significant potential for using cartoons. However, the purposeful use of cartoons is notably absent in many areas of health care as is evidence of their acceptability to patients and lay others. This paper outlines the process used to develop and evaluate cartoons and their acceptability for a series of self-management guidebooks for people with inflammatory bowel disease, irritable bowel syndrome, diabetes, chronic obstructive pulmonary disease and chronic kidney disease (CKD).
  
  
  METHODS
  Principles for a process to develop information and cartoons were developed. Cartoon topics were created using qualitative research methods to obtain lay views and experiences. The CKD guidebook was used to provide a detailed exemplar of the process. Focus group and trial participants were recruited from primary care CKD registers. The book was part of a trial intervention; selected participants evaluated the cartoons during in-depth interviews which incorporated think-aloud methods.
  
  
  RESULTS
  In general, the cartoons developed by this process depict patient experiences, common situations, daily management dilemmas, making decisions and choices and the uncertainties associated with conditions. CKD cartoons were developed following two focus groups around the themes of getting a diagnosis; understanding the problem; feeling that facts were being withheld; and setting priorities. Think-aloud interviews with 27 trial participants found the CKD cartoons invoked amusement, recognition and reflection but were sometimes difficult to interpret.
  
  
  CONCLUSIONS
  Humour is frequently utilised by people with long-term conditions to help adjustment and coping. Cartoons can help provide clarity and understanding and could address concerns related to health literacy. Using cartoons to engage and motivate people is a consideration untapped by conventional theories with the potential to improve information to support self-management.
authors: Faculty of Health Sciences, NIHR CLAHRC Wessex, University of Southampton, Southampton, UK. a.kennedy@soton.ac.uk.
authors: Anne
authors: A
authors: Kennedy
authors: Anne
authors: A
authors: Rogers
authors: Christian
authors: C
authors: Blickem
authors: Gavin
authors: G
authors: Daker-White
authors: Robert
authors: R
authors: Bowen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002359:Cartoons as Topic; D002908:Chronic Disease / Q000628:therapy*; D003920:Diabetes Mellitus / Q000628:therapy; D005260:Female; D017144:Focus Groups; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000628:therapy; D007407:Interviews as Topic; D043183:Irritable Bowel Syndrome / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy; D051436:Renal Insufficiency, Chronic / Q000628:therapy; D012648:Self Care / Q000379:methods*; D014925:Wit and Humor as Topic