What is storytelling, and why is it important for Medical Affairs?

The ever-increasing pressure on Medical Affairs organizations to demonstrate the impact of their activities has spawned unprecedented efforts to develop content and programs that are likely to be effective and to deliver a return on investment. This new era of evidence-based medical communications manifests most obviously in data-backed efforts to (1) address the knowledge needs of different audiences (with a reach goal of individual HCP-level personalization), (2) provide content in formats and via channels aligned to audience preferences, and (3) leverage principles of adult learning where possible. However, a major piece of the puzzle that’s often missing is storytelling—namely, the extent to which a narrative style is deployed and the effectiveness of the resulting narratives. “Not storytelling,” you may insist. “Isn’t that one of the most omnipresent buzzwords of our age?” We agree that storytelling has become something of a “bumper sticker.” But how often in the world of industry-developed medical communications is there anything of substance behind the bumper sticker? Like a bumper. Or even a fully intact car to transport you to another destination, as good storytelling should? In short, and to borrow from the most legendary of storytellers, Hans Christian Andersen, is it possible that the emperor has no…narratives?

A true evidence-based approach to medical communications must give more than lip service to storytelling because it’s associated with numerous benefits over more expository styles of communication for education and knowledge transfer.^1-3 A wealth of data indicates that we are neurologically predisposed to focus on content presented in a story format. ⁴ Given the immense volume of new data, the limited time that HCPs have to keep up with new information and the soaring complexity of medical science (novel therapeutic modalities, complex patient journeys, etc), isn’t it time to remind ourselves that HCPs are humans too and provide them—and their patients—with content crafted in a narrative style that resonates on a human level?

Which properties make a story effective?

Imagine a scenario in which we developed educational content for an HCP that aligned with her clinical interests, was packaged into an appealing format (eg, animated video), and was delivered via one of her preferred channels, but it contained a subpar story? It should be obvious that all the exciting technologies, striking visuals, or novel formats in the world won’t rescue a story that’s poorly constructed, ill conceived, lacking in credibility, or boring. So, how can we develop effective stories in Medical Affairs? Before answering that question, we must define what we mean by “effective”—essentially, what do we want our stories to achieve? An effective story is often considered to be one that is:

1. attention-grabbing: commanding (and retaining) the attentional focus of the audience^5,6
2. comprehensible: the ability to be easily understood³
3. engaging: in which the audience feels immersed in, almost experiencing the story—a property often referred to as “narrative transportation” ^7,8
4. persuasive: the power to shape, change, or reinforce the beliefs and possibly also the actions of the audience⁹
5. memorable: easy to recall, resulting in an enduring rather than an ephemeral impact³

Obviously, these goals are heavily interconnected and interdependent. If your story falls at the first hurdle (grabbing attention), it’s clearly game over for everything else. Importantly, research also indicates that narratives are stripped of their power to persuade and be remembered if the audience is not sufficiently engaged.⁷ To craft a story that achieves some or all these goals, we can tap into a large and growing body of research, with an evidence base that draws from diverse disciplines, including psychology, linguistics, philosophy, and cognitive science. As a proponent of evidence-based medical communications, our team of scientists and narrative experts has reviewed data from across those disciplines to create a simple framework for Medical Affairs storytelling excellence that encompasses seven key properties (see Figure 1).

• STRUCTURED. We can view the potential effectiveness of a story by examining how closely its structure resembles that of a typical narrative and the extent to which it contains key elements of stories, including a protagonist, a plot (the series of events in which the protagonist pursues a goal, encounters obstacles, and finds a solution to those obstacles), and a setting (eg, time or location).^10,11 These narrative elements and most Medical Affairs topics may seem, prima facie, to be strange bedfellows; for example, does the mechanism of action (MOA) narrative for a new therapy really have a protagonist? However, with a more expansive mindset, perhaps the protagonist could be the molecule itself or even the team of researchers taking the molecule from early-stage R&D to approval and beyond, surmounting numerous obstacles along the way. Another critical and differentiating element of stories is causality—ie, cause-and-effect relationships between events—because those give stories meaning.¹² Causality helps the audience to understand the plot and engage with the characters, and it creates momentum for the story.

• TAILORED. Obviously, effective stories are created with the needs of the audience in mind, and a deep understanding of the audience is essential to creating a story that has relevancy and that will resonate with them. In addition to understanding what audiences know, want to know, and need to know, we must appreciate how their existing attitudes and beliefs could shape their response to the story.¹³ For HCPs, this includes consideration of the nuances of their specialty, clinical practice setting, demographic and career characteristics (eg, geographical location, number of years in practice), and also their value, attitudes, ethics, and mindset with respect to the topic being communicated. For patient and caregiver stories, we need to be mindful that while some recipients may have a relatively low level of scientific literacy and a need for a simple story, others will prefer to receive quite detailed information on the disease area or therapy.¹⁴ Obtaining a detailed knowledge of our audiences also allows us to leverage a technique known as identification, in which the recipient of a story either believes they have something in common with the protagonist and feels a sense of connection with them (identification through sympathy) or believes they are unlike the protagonist (identification through antithesis).^15,16 Research has shown that stories that elicit identification in the audience are more likely to engage and persuade.^17,18 Finally, a benefit of stories in healthcare is their ability to reach culturally diverse and marginalized patient populations.¹⁹ However, these stories will fail to resonate with the target audience of they are lacking in cultural relevance and context.²⁰

• ORIGINALITY. As communicators, we need to recognize we’re in an arms race for the attention of our target audiences. And the battle for hearts and minds starts with a skirmish for attention. The simplest way to grab someone’s attention—and keep it—is to break a pattern; in other words, do something novel or original. This is necessary because we’ve all been exposed to countless narratives (everything from superhero movies to mattress commercials to disease unmet need narratives) over the course of our lives, and the memory of those narratives (stored in semantic knowledge structures known as schemas) sets up expectations for all future stories we encounter.²¹ Stories that depart from what’s expected (schema incongruent) are more likely to grab attention and are thought to trigger a deeper level of cognitive processing, thereby increasing the engagement of the audience (ie, narrative transportation).²² For ways to achieve schema incongruity in Medical Affairs narratives, we recommend exploring how to tell the story with a fresh perspective, structure the plot differently, include unexpected details, or use a less common narrative arc. When we design storytelling skills training sessions for our clients, we like to emphasize that even relatively minor alterations can make their stories more effective. A good example of this is in the abstracts of peer-reviewed journal articles. A quick PubMed search for review articles on therapies for Duchenne muscular dystrophy will uncover so many abstracts that begin in an almost identical way, with the first sentence being a simple definition of the disease and its burden (eg, “Duchenne muscular dystrophy (DMD) is a severe, progressive, muscle-wasting disease, characterized by progressive deterioration of skeletal muscle that causes rapid loss of mobility.”).²³ One abstract, however, begins very differently: “Despite the full cloning of the Dystrophin cDNA 35 years ago, no effective treatment exists for the Duchenne Muscular Dystrophy (DMD) patients who have a mutation in this gene.”²⁴ This grabs our attention because it is different and because it communicates urgency and a “call to action”—almost 4 decades and still no effective treatment!

• RATIONALITY. HCPs can detect irrelevant or inauthentic content from a mile away. For that reason, it is important that our stories meet the standards of what’s known as narrative rationality, which includes two concepts: coherence and fidelity.²⁵ Coherence is the degree to which the story “hangs together” and makes sense. We need to ask ourselves, “Does the story make sense?” or “How probable is it?” or “Are the characters consistent in their actions?” The second concept, fidelity, is the degree to which the story resonates with the beliefs and values of the audience. Does it “ring true” and match their beliefs and prior experiences? Deep research into the attitudes, experiences, and current knowledge of the target audience is one way to increase the likelihood that it will have fidelity, and stories should also be tested with members of the target audience. However, in our experience the best way to create an authentic, clinically relevant, and coherent story is to involve members of the target audience—HCP, patient, or patient advocacy group—from the very beginning and co-create the story with them.

• IMMEDIACY. Immediacy is the degree to which there is a psychological sense of closeness or distance between the protagonist and the recipient of a story. Perhaps the most effective way to increase the immediacy of a story is to use (where appropriate) a first-person narrative voice. First-person voices have been reported to increase the persuasive impact of some health promotion narratives (eg, smoking prevention) compared with narratives that use a third-person voice, an effect that may be due to the first-person voice being more likely to trigger identification with the protagonist.²⁶ In recent years, even scientific and medical journals have moved away from insisting that authors use a detached narrative voice, and now encourage first-person pronouns and active verbs to increase the clarity of writing and imply greater ownership of the results.²⁷ Another linguistic trick that can increase both the immediacy and the impact of narratives is to use present tense verbs over past tense ones, where appropriate.²⁸

• EMOTIONALITY. Research has shown that emotion plays a major role in decision-making.²⁹ For better or worse, emotions may be the main driver of most meaningful decisions in our lives. However, historically, there has been tension between the use of emotion vs rationality in the communication of science. Yet, research has shown that emotional content is effective at commanding attention, engaging and persuading audiences, and making stories more memorable.^7,30-33 It has also been suggested, by our own research and that of others, that the use of emotionally salient language may be associated with greater influence of journal articles.^34,35 Moreover, scientific discoveries reported using more emotional language and more positive language may be more likely to be shared by non-experts on social media.³⁶

• SIMPLICITY. An effective story is a simple story, but simple does not mean simplistic or “dumbed down.” It means identifying the core message we wish to convey and filtering out extraneous information, tangential elements, and unnecessary details. Also worth considering is the use of figurative language (eg, metaphors) to make abstract concepts easier to understand. A final consideration when creating a story that’s simple and easy to comprehend is selecting a format and medium (eg, print piece, video, audio, immersive technology) that’s most appropriate for the topic and most likely to resonate with the target audience.