Can narratives and Cochrane reviews work together?

Cochrane reviews and storytelling:Can they work together?

Tamara Rader

Cochrane Musculoskeletal Group

March 7, 2008

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Welcome!

Introductions

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What Are Narratives?

Stories which follow a certain format

Have a beginning a middle and an end and make a point

There is mounting evidence to suggest that making stories, listening to stories and responding to stories is an essential and transformational human process, that helps make meaning of life’s often deeply contradictory experiences.

It can promote acceptance and recovery, inspire hope and trigger insights that can lead to significant personal growth.

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Why Narratives?

Narratives or story telling is a natural part of the grieving process in many cultures

It is a form of communication which is suitable for many populations

Can be written, auditory or visual

Can be in real time or asynchronous

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Literature review

Narratives can be a therapeutic, knowledge translation or evaluation tool

Using narratives as a contextual tool to develop a program which meets the specific needs of a community or individual

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Best Practices from Literature Review

Adequate planning Defined criteria for participants Prolonged engagement Process of checking and confirming Participant checks Dissemination

Adapted from Kirkpatrick 2005

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Adequate planning

Comprehensive review of narrative methods

Develop a clear goal of the storytelling intervention

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Define Criteria

Choose a consistent story type which is appropriate to your purpose and audience

Ensure that participants are properly trained and supported

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Prolonged engagement

Careful data collection [interviews?, journals? Participant observation?]

Ideally involves a follow up of a year or more

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Process of checking and confirming

Validation, reflecting and checking

ongoing contact with story teller

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Participant checks

Share the narrative summary with participants to ensure it reflects their story.

Somewhat dependent on the kind of narratives and how they are being used (ie participants telling their story vs storytellers telling constructed stories)

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Dissemination

Use stories to promote understanding of the lives and stories of people’s experiences

Stories create relationships Told and retold

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Examples of narratives in action!

Adherence to antiretroviral therapy Bereavement project AfriAfya DIPEx

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Adherence to antiretrovirals

Using lay health workers to enhance adherence to antiretroviral therapy among homeless people

Homeless people communicate through stories

Authenticity is critical

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Current practice

Highly Active Antiretroviral Treatment (HAART) is prescribed at community health centres in Ottawa

Adequate adherence to HAART is less than 55% (Mills 2006)

Lack of follow-up and monitoring due to:– lack of family physician, – personal beliefs, – lack of social support, – daily schedule barriers (Mills 2006)

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Bereavement project

Ottawa End of Life network initiated working group on Bereavement

Desire to improve availability and effectiveness of bereavement care recognizing limits of funding and resources

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Current Practice

Little funding for bereavement services and no reasonable expectation of future funding from government sources

National standards include expectation of bereavement care

Pediatric standards are specific, adults not but, there is an obligation to provide services for all populations

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Traditional approach to bereavement services tends to concentrate on therapy/counseling, self help groups or volunteer contact

Recognition that certain populations (mental illness, dementia, oral cultures, literacy issues) are not being adequately served by current practice.

Interest in looking at sustainable initiatives which could be applied to many populations and setting

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AfriAfya

Kenya-Ottawa partnership Uses puppet shows and theatre, comic

books to convey messages to the community about best evidence on HIV/AIDS treatment and prevention.

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AfriAfya in Support of Narrative:

African culture is an oral culture. “We prefer to talk, rather than read. It therefore makes sense to harness the narrative aspects of our culture in information sharing and exchange”.

Low levels of literacy can be a barrier to information sharing and exchange

Limited communication infrastructure in most rural parts of the country, narrative becomes a cost effective and easily adaptable way of information sharing and exchange

- AnneRose Kaiya

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DIPEx

Database of Individual Patient experiences Stories of patients experiences with diseases

or treatments Compelling but may risk emphasizing

negative aspects of treatment

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8 Narrative Patterns

A Springboard story Communicating who you are Communicating who the company is

(Branding) Transmitting values Fostering collaboration Taming the grapevine Sharing knowledge Leading people into the future

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A springboard story

Story of one person carrying out some recent change that improved the organization.

explains what would have happened without the change.

has a happy ending, Inspires action in the audience.

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Communicating who you are

colourful, well-told story, usually based on an incident in your life

reveals some strength or vulnerability and helps others to understand you better.

it shows others what you value.

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Communicating who the company is

These are the stories told about the company (organization) and its products, to develop trust and establish a brand.

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Leading people into the future

Evocative story of the future, Example: Martin Luther King's "I Have A

Dream" speech. Requires a high degree of verbal skill

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Transmitting values

parables describe an incident that exemplifies the

values you want listeners to follow not explicit, but instead lets people reflect on

what the story means.

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Fostering collaboration

Groups sharing stories to build bonds It’s the act of sharing the story One story sparks another among participants

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Taming the grapevine

Using a story to diffuse negative rumours. Using gentle humour Make sure the bad news is true

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Sharing knowledge

Explains a problem and how it was solved. Detailed We learn from our mistakes, and we can

learn from other people’s mistakes through this type of story.